Posted by SLS on December 16, 2002, at 13:36:27
In reply to Re: TCA discontinuation???, posted by oracle on December 16, 2002, at 11:16:57
> > For some people, nortriptyline can have a very narrow therapeutic window. If you take too much, you can lose the antidepressant effect. I don't know if this is one of those instances, but I had a similar experience with the drug.
> >> Do you find that ~75 mgs is the lower limit for
> AD activity in nortriptyline ?
Hi Oracle.The dosage of nortriptyline most often used is 75mg. The normal range is between 50-100mg. It is rather simple to figure out how much to take. After years of study, it has been found that one can determine the right dosage of nortriptyline by measuring blood levels. The therapeutic range for blood levels is 50-150 ng/ml. What this means is that you need a minimum of 50 ng/ml to respond. However, once the blood level exceeds 150 ng/ml, the response tends to disappear. This is what is called a "therapeutic window". Blood levels act more as a guideline. It is still necessary to test at what value in the therapeutic range an individual responds. Some people need to take as much as 150mg of nortriptyline to establish a therapeutic level. In rare cases, higher dosages (up to 200mg) are necessary to maintain a response despite blood levels being above 150 ng/ml.
Nortriptyline can be a pain in the ass, but when it works, it works great!
I have what seems to be some sort of bipolar depression that is resistant to treatment. I am currently adding desipramine (very slowly) to a combination of Lamictal 300mg + Nardil 90mg + Zyprexa 5mg. If this doesn't work, I'll try duloxetine (Cymbalta) if it becomes available or Lexapro if it doesn't. I am also waiting to see how people react to a drug named Abilify (aripiprazole). It was recently approved by the FDA to be used as an antipsychotic in treating schizophrenia. However, it looks like it might have antidepressant properties as well. I'm taking Zyprexa because it, too, has antidepressant properties, especially when combined with antidepressants.
- Scott
poster:SLS
thread:131944
URL: http://www.dr-bob.org/babble/20021210/msgs/132020.html