Posted by King Vultan on March 14, 2004, at 15:50:30
In reply to replacing nortriptyline with remeron?, posted by zeugma on March 14, 2004, at 13:02:12
> Nortriptyline is an effective AD for me. However, I am also taking 80 mg Strattera a day, and that should probably give me enough NE reuptake effect, so that 75 mg nortriptyline is unnecessary. The problem is that I seem to need the combination of 75 mg nortriptyline and 15 mg buspirone at night to fall asleep reliably (and not experience hypnagogic hallucinations). I think the anticholiergic effects of nortriptyline are not that bad, however, the combination of the TCA with Strattera definitely results in more constipation and dry mouth than either would alone. Here are my concerns:
>
> 1) Without sedating drugs at night that increase monoaminergic neurotransmission I have insomnia, aggravated by hypnagogic hallucinations which cause sudden (and painful) wakening; less than 75 mg nortriptyline doesn't seem sufficient to block these.
>
> 2) I want to simplify my med regime and minimize the side effects. Remeron combines properties of nortriptyline and buspirone (alpha-2 adrenergic antagonism, 5-HT2A antagonism, histamine blockade). So possibly I could exchange the nortriptyline/buspirone combination for a suitable dose of remeron.
>
> I am not concerned about weight gain, in fact it is extremely difficult for me to gain weight and that would be a desired side effect. I am concerned about possible loss of concentration or motivation, but I am hopeful that remeron, if anything, tends to increase motivation.
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> How realistic does this plan sound?
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> Thanks in advance.
Of the two, I've only tried nortriptyline and not Remeron, but my research seems to indicate that Remeron is much more sedating. I agree that taking both the Strattera and nortriptyline is somewhat redundant, as both are norepinephrine selective reuptake inhibitors. I think substituting the Remeron makes sense, and I think the concomitant administration of the Strattera will tend to minimize excessive weight gain. If the Remeron winds up being too sedating, you might also consider trazodone, which has somewhat similar properties. I am not familiar with hypnagogic hallucinations, but if this is in any way a psychotic effect, might it also not make sense to consider an atypical antipsychotic? These obviously also blockade 5-HT2A receptors and seem to be pretty sedating.Todd
poster:King Vultan
thread:324271
URL: http://www.dr-bob.org/babble/20040313/msgs/324347.html