Posted by ChicagoKat on October 12, 2012, at 13:26:55
In reply to Re: How right you were Scott » ChicagoKat, posted by SLS on October 12, 2012, at 8:46:02
> > > > About recovery not being a straight line up and getting periodic worsenings. I'm back in the depths. Was it just another blip? Will it get better again, do you think?
> > >
> > > I wouldn't call your most recent improvement a blip. You will probabably improve again, though. Please take note that you are probably not taking a therapeutic dose of amitriptyline yet (125 - 200 mg/day). Things might not "stick" until you do. I question the belief that you can get away with subtherapeutic doses of two drugs when they are combined. This has not been my experience with MAOI + TCA and SRI + TCA combinations.
> > >
> > > It is hard to see any light when you are in the midst of darkness.
> > >
> > > All in all, I think you should remain optimistic.
> > >
> > >
> > > - Scott
> >
> > As always Scott, I believe you are right. I'm at my target dose of Nardil now, 45mg/day, and thankfully no ataxia. But I'm afraid to go up anymore on my Elavil b/c of my BP problems. I'm not seeing PCP or pdoc til next tuesday.
> >
> > I'm really thinking adding a stim might help me more than a TCA. I've just never had any luck with any of the TCAs, and I've tried them all. What are your thoughts, Scott?
>
>
> There are no guarantees. You are already in the middle of a trial of amitriptyline and are approaching a therapeutic dosage with it. It might make sense to continue with it. It is unusual that your BP should rise. Your idea of adding a stimulant is a good one, but I don't know your history of reactions to them.
>
> It is unusual for one's blood pressure to rise from taking amitriptyline, although it is listed as a possible side effect. However, the frequency at which this happens might be higher when it is combined with Nardil. I don't know. Can you describe in more detail your history of blood pressure problems and how different drugs have affected it? My only concern is serotonin syndrome, which, in my mind, is a possibility with this combination. Of course, you realize that methyphenidate might produce an increase in BP as well, although through a noradrenergic mechanism.
>
> > And thanks for the encouragement. I'm happy to say that I'm feeling better today. :)
>
> This is indeed encouraging.
>
> > Has the Prazosin started to really kick in yet? Are you feeling any better?
>
> Yes, it started kicking-in yesterday, and is even better today (so far). Finessing the dosage has been problematic in the past, probably because prasosin has such a short half-life. I was a little over my therapeutic window at 8 mg/day. I am hoping that 6 mg/day will be optimal and consistent. This dosage is lower than I would have anticipated. I will be taking it 2 mg t.i.d. Perhaps I need less now that I am also taking minocycline.
>
> Thanks for caring.
>
> :-)
>
>
> - ScottScott, my history with HTN is a complex one. It can be very labile, and I can have very strange reactions to meds also. For instance, when I was first put on Vyvanse, rather than a feared-for worsening of my BP, I actually got HYPOtension!! So low that some days I had to stay in bed. We finally figured out that I was having a very weird interaction of the Vyvanse with Trazodone which I was taking at the time for sleep. As soon as I stopped the Trazodone, my BP went back to normal.
My BP has gotten better over the past few days; maybe Nardil's intrinsic hypotensive effects are starting to kick in. But I'm not gonna increase my Elavil til I talk with both my PCP and my pdoc on Tuesday.
Out of curiosity, what do you think of a combo of my low-dose Nardil, with low-dose Elavil (merely to help me sleep), with low-dose Ritalin added in? Ritalin REALLY helps me, much more than any other stim, I've found. Problem was it gave me anxiety. But the Nardil has the anxiety well-controlled, so I thought maybe I could add low-dose Ritalin. I must admit, I did go ahead and try it several days ago at just 10mg, and I felt great. BP did increase just a little bit (to about 150/90), but certainly not to the point where it could not be controlled with antihypertensives. Would appreciate your thoughts on this combo.
I'm so glad to hear you are doing better! May it continue for a long time!! :)
Kat
poster:ChicagoKat
thread:1028313
URL: http://www.dr-bob.org/babble/20121009/msgs/1028430.html