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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by bulldog2 on August 9, 2009, at 15:11:45
In my opinion a vastly underused drug. Pharm reps are pushing newer drugs where the profit is. Most docs receive their med education thru these salespeople so the oldies are often not used or even have false knowedge of these drugs.
This med is not only good as a primary depression drug but can be used as a good adjunct.Also has many other uses.
One poster in this forum usually posts a bad experience from a single 10 mg pill. This experience has been posted in almost every thread about nortriptyline and may give some the impression that this drug has bad sides. Actually many have used this medication and found the sides quite tolerable.I used this med and found if you titrate 10 mg a week the sides were quite tolerable. Also helped my insomnia quite a bit.
Read this and make up your own mind. Personally I am med sensitive and often abandom meds because of sides. I've used this med on several occassions with good results.
http://www.modern-psychiatry.com/nortriptyline.htm
Posted by floatingbridge on August 9, 2009, at 15:36:42
In reply to Good Study On Nortriptyline, posted by bulldog2 on August 9, 2009, at 15:11:45
Bulldog,
I bookmarked the site you posted. Looks good, esp his attention to violence and media (I have a small boy).
Thanks!
fb
Posted by SLS on August 9, 2009, at 15:41:29
In reply to Good Study On Nortriptyline, posted by bulldog2 on August 9, 2009, at 15:11:45
Great piece.
I noticed that one study chose 150mg as the dosage of nortriptyline tested. If nortriptyline truly has a window of efficacy with an upper bound, I'm surprised that so many people did well. Perhaps even more people would have received benefit from nortriptyline treatment if the initial dosage were lower. It would have been interesting to get a blood level from these people.
From what I have gathered, most people need only 75mg. I am a rapid metabolizer of tricyclics as tested during treatment with imipramine, desipramine, and nortriptyline. It is not surprising that I would need 150mg, but what about for people who are not rapid metabolizers?
I am very happy to see the tricyclics revisited. Nortriptyline is probably the friendliest of all of them. Its side effects are the mildest, and its rate of efficacy is not much lower than imipramine.
With regard to combining a tricyclic with a MAOI, nortriptyline and desipramine (and perhaps trimipramine) are really the only ones that can be used at full therapeutic dosages. The other TCAs are too serotoninergic and often produce serotonin syndrome when used.
There are people whom respond much better to desipramine than nortriptyline and vice versa. If one fails to respond to one of these two drugs, it can be justified to try the other.
- Scott
Posted by bulldog2 on August 9, 2009, at 16:48:30
In reply to Re: Good Study On Nortriptyline, posted by SLS on August 9, 2009, at 15:41:29
> Great piece.
>
> I noticed that one study chose 150mg as the dosage of nortriptyline tested. If nortriptyline truly has a window of efficacy with an upper bound, I'm surprised that so many people did well. Perhaps even more people would have received benefit from nortriptyline treatment if the initial dosage were lower. It would have been interesting to get a blood level from these people.
>
> From what I have gathered, most people need only 75mg. I am a rapid metabolizer of tricyclics as tested during treatment with imipramine, desipramine, and nortriptyline. It is not surprising that I would need 150mg, but what about for people who are not rapid metabolizers?
>
> I am very happy to see the tricyclics revisited. Nortriptyline is probably the friendliest of all of them. Its side effects are the mildest, and its rate of efficacy is not much lower than imipramine.
>
> With regard to combining a tricyclic with a MAOI, nortriptyline and desipramine (and perhaps trimipramine) are really the only ones that can be used at full therapeutic dosages. The other TCAs are too serotoninergic and often produce serotonin syndrome when used.
>
> There are people whom respond much better to desipramine than nortriptyline and vice versa. If one fails to respond to one of these two drugs, it can be justified to try the other.
>
>
> - ScottYears ago I responded to a dose of only 50 mg. We tried going higher and I did not improve so 50 mg was my dose which is the minimum stated.My p-doc did not do blood work but this time we will check blood levels.
Right now I am on 50-60 mg of percocet a day plus 2400 mg of neurontin. This is for pain control for a bad left hip. My hip will be replaced end of this Sept. The pain meds are working well for depression but eventually will have to be stopped after the surgery.
I used parnate before but my response was incomplete. I will talk to my p-doc about using parnate and nortriptyline once the percocet is stopped.
I believe some have used oxycontin with parnate without a reaction. So I don't know if there is a washout time needed after the percocet is stopped.
I read of some patients whose doctors have used opiates as an ad. Time released oxycontin does help with mood in some patients. I realize there are addiction and tolerance issues with opiates so I don't knw of they will ever become mainstream treatment.
At the turn of the century before the development of ads, opiates and cocaine were used as meds for depression. Perhaps they will stay have a role again for mood issues.
Also notice in the link the docs puts his patients on fish oil and folic acid (cheaper than deplin).
With parnate you elevate all the neurotransmitters. The addition of nortriptyline refines or adds the brains's need for norepinephrine. So for some tinkering with norepinephrine helps with depression.
The developers of ssris touted serotonin as the miracle for depression.
So the $64,000 question is why ssris work for some and tcas and maois work better for others.Maybe stop calling depression a disease when in fact it may be a symptom of many diseases.Maybe more like cancer which has many types and many treatments.
Posted by johnj1 on August 9, 2009, at 17:27:29
In reply to Good Study On Nortriptyline, posted by bulldog2 on August 9, 2009, at 15:11:45
I used nort with good results for over 10 years and only after pneumonia did I react negatively to most meds.
The thing we have to remember is that the people on this site are people you don't know at all really. People may take advice here but if they knew that person outside of this site they might never listen to them. Plus, you can't tell the positive aspects of a med with a one or two day trial, generally speaking.
I hope the drug works for you long term, that would be great.
This is the end of the thread.
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