Posted by Questionmark on May 8, 2004, at 19:36:58
In reply to ok, here's what my pdoc said, posted by zeugma on May 7, 2004, at 21:21:06
> so as you know, i have had buckets of despair lately, crying buckets, i walked the dark way home last night from the store because i didn't want anyone to see me crying.
>
> so i had written out some things before the session because i felt i had to be prepared. the balamce of power between pdoc and patient is a touchy thing, one likes to think that pdoc knows something we don't, if we are going to shell out cash for the session. Conversely on e may worry that a pdoc who is too 'agreeable' merely has no clue as to what he or she is doing and is trying to keep the patient happy (as opposed to well) because we are a clientele in great need. ok, so here's what happened:
>
> i called last night to leave the message that i was 'severely depressed and anxious.' read: this was not going to be the usual ritual of chitchat about 'concentration' followed by the monthly bp check because i am on noradrenergic meds. that was the opening move.
>
> ok, so this happened: i opened by saying that desipramine might work better than nortriptyline and strattera combined. his answer was that he wasn't sure of that. <sorry, things will get complicated> i said, welll, they are all NE reuptake inhibitors, and why be on 2 meds when 1 can do the same thing? ok, here's what he said:
>
> Nortriptyline and desipramine work more in the brainstem, while strattera works more in the frontal lobes. He said, that's why strat is more effective for ADD than nortrip. He also said desip and nortrip are more or less interchangeable,(ie, both work mainly in the brainstem). i objected that desipramine was as effective for ADD as strattera. he agreed that such were reports, but that he wasn't sure about it ( i can only register a ? here and wonder what other experts in the field say).
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> ok, so he is keeping me on klon, .75 mg for now, which he agreed was a low dose. i am lowering the nortrip to 50 mg. i am going to see what happens. i have a sample pack of lex, which he told me to 'keep around.' that is one i respect in him, he does not seem beholden to drug marketers- ie he did not say i should take lex, only that it would interact less than anafranil, but he agreed that if this move (lowering nortrip) doesn't help, i can add anafranil, lex, or up the klon. what do you guys (experts and not) think? i remember Scott saying that where drugs act is as important as putastive mechanism of action, but i have seem little about this topic. it is an fascinating one though. obviously it will take a few days for the dose lowering to have a discernible effect. what my doc said did tally, though, with what i ahve observed about strat's and nortript's different effects- nortrip semed more emotional, and not in an anesthetic way, it heightens tham actually <for me>. strat seemed more alerting somehow, and i moved up quickly in my workplace than landed a new job not long afeter starting it. thoughts?
Hi. Since you seem to have severe anxiety, i would increase the Klonopin dosage regardless of what else you do (as long as you're not tOO afraid of physical dependency, though i think it's worth it anyway).
Beyond that, my suggestion would be to add in clomipramine (Anafranil) since you're already on a TCA and the side effects would probably not be as severe (and since you already appear to be able to tolerate TCAs' side effects fairly well). Also, you sound as if pro-NE effects are beneficial to you, which is another reason to go with the clomipramine over the Lexapro. If you find that the clomipramine is not suitable or helpful enough, then you should move to the Lexapro. Furthermore, it would be easier to move from nortriptyline to clomipramine and then Lexapro than from nortriptyline to Lexapro to clomipramine.
Good luck.
poster:Questionmark
thread:343353
URL: http://www.dr-bob.org/babble/20040505/msgs/344893.html