Posted by zeugma on May 3, 2004, at 16:14:23
In reply to Re: which plan sounds more reasonable, posted by Keith Talent on May 3, 2004, at 6:11:31
> Why are you taking nortriptyline if you're taking atomoxetine (Strattera)? They both work by blocking the noradrenaline transporter, only atomoxetine is more potent. Do you need the histamine-1 antagonistic effect of nortriptyline for sleep? You'd be better off taking Ambien or triazolam (Halcion) for sleep. By the way, clomipramine (and its metabolite desmethylclomipramine) kick nortriptyline's and atomoxetine's butts re noradrenaline reuptake inhibition. Sounds to me like you could drastically rationalise your medication regimen. I'd either go for:
>
> clomipramine
> clonazepam
> Ambien or triazolam
>
> or
>
> an SSRI
> atomoxetine
> clonazepam
> Ambien or triazolam
>
> Clomipramine has a reputation as being an EXTREMELY powerful antidepressant, but my psychiatrist said that it doesn't sedate at all (and I agree, having taken it).I am as nonplussed as you are (maybe more, seeing as I'm the one taking these things) by the redundancy of my medication regimen. In part it's a quirk of med approval history: when I went to my current pdoc, I was off meds (and doing miserably) and needed something to help my inattentive ADD and depression symptoms. Atomoxetine hadn't been approved in the US yet, and nortriptyline had demonstrated some efficacy (less than desipramine) in ADD, besides being a tolerable antidepressant. And yes, the H-1 blockade helped me to sleep, though for some reason it works much better when I take 15 mg buspirone about 3 hours after my nortriptyline dose (it potentiates the sedative effects).
75 mg nortriptyline was enough to relieve my depressive symptoms, but I was still suffering severely from ADD, and being severely underweight (people who see me routinely wonder if I have an eating disorder) I can't take stimulants, because every time I have taken ANY stimulant in the past I have been yanked right off two weeks into treatment, because the weight-loss effect on my already emaciated frame is so sudeen and dramatic. So my pdoc added atomoxetine, and somehow, it worked: I was finally able to obtain, and more importantly, to keep, full-time employment (somehow atomoxetine cut into the fog enough to function). I have to hypothesize that i have massive noradrenergic dysfunction if I can tolerate 75 mg nortriptyline plus 80 mg atomoxetine. i don't know. I want to rationalize my treatment by getting rid at least of some of the redundancy. If clomipramine is more energizing than nortriptyline, that would be a good thing, because I am fatigued all the time. what I am wondering is if atomoxetine has any special potency re inattentive ADD, apart from its NE reuptake blocking properties which it shares with TCA's and other drugs. In any case, I feel that my present regimen has my ADD under control, but my anxiety, and anxiety-induced depression, isn't. I've raised the clonazepam to .75 mg, but while it helps with some aspects of anxiety, it doesn't give me any energy or desire to socialize, and doesn't help the frquent dysphoria I feel due to my social inhibition (and I feel pretty sure that a higher dose wouldn't help either, although it would be helpful in other ways). How do you find clomipramine compares with other TCA's (I assume you've taken a few?) How is its s/e profile, compared to other TCA's and SSRI's? I think that by trading in the nortriptyline, I would at least make a start at streamlining my meds. To make it more rational still, I suppose I should raise my atomoxetine dose to 120 mg, add some Lexapro, take about 1 mg clonazepam and maybe some buspirone for sleep. How does that sound?
poster:zeugma
thread:341936
URL: http://www.dr-bob.org/babble/20040429/msgs/342932.html