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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by schleprock on July 18, 2012, at 19:40:00
I realize that this is a rather amateur question, but I've been getting very concerned that after mostly 20 years of Nortriptyline monotherapy, the drug is finally starting to "poop-out". My current Pdoc seems opposed to this hypothesis. We've just went over the results of my first nortriptyline level blood test in the past couple of years and my levels are currently reading at a high 145. My Pdoc suggests that is is evidence that the drug has not failed.
So my question is: in the case of Nortriptyline, do the measured blood levels correspond to the drugs actual efficacy. I can certainly understand how lower levels would be supportive of a drug not having its intended effect, but could it ever be the case that a drug like Nortriptyline could just simply cease to do anything (having "pooped out") despite having an adequate blood levels. Or is the often reported "poop out" for antidepressents related to having a decreased presence in the bloodstream?
Posted by schleprock on July 18, 2012, at 19:42:26
In reply to Relation between nortriptyline levels and efficacy, posted by schleprock on July 18, 2012, at 19:40:00
I should have mentioned that my dosage is 150mg.
Posted by linkadge on July 18, 2012, at 20:46:00
In reply to Re: Relation between nortriptyline levels and efficacy, posted by schleprock on July 18, 2012, at 19:42:26
This is an adequate blood level......so what does your doctor propose?
Linkadge
Posted by papillon2 on July 25, 2012, at 11:59:16
In reply to Re: Relation between nortriptyline levels and efficacy, posted by linkadge on July 18, 2012, at 20:46:00
I don't understand. If your blood level is adequate but you have relapsed / have breakthrough depression for no good reason, then surely the med has indeed failed or just isn't up to scratch. It's not like it goes POOF! out of your system. It's still there, but it's no longer doing its thing.
Is your doc saying that your blood level used to be higher, so it may just be a dosage issue? Because that I understand. If that's what he's saying, that you still have room to move, then push the dose higher to see if it switches into gear again.
If that doesn't work, or you have indeed maxed out your dose, try augmenting it with a mood stabilizer such as Lithium. If that in turn doesn't work, it's time to switch your anti-depressant.
Obviously your current treatment isn't working well enough for you. We can argue about causes as much as we like, but if something's not working it's time to stop flogging the dead horse and move on. Stop the suffering. Change things up. It sucks having to take another ride on the med-go-round, but untreated depression sucks more.
Hang in there. I know it's tough. I went through this process last year when Effexor stopped being effective after 7 years. I thought that was a good innings, but 20 -- wow! I now take Nortriptyline amongst other things. Here's hoping it's as successful for me as it seems to have been for you.
This is the end of the thread.
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