![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by rod on June 8, 2004, at 16:12:15
Well, I actually started Doxepine (Sinequan) at only 25mg a few days ago. I am not sure if this is the right drug for me, because its really sedating and prolongs my sleep time, which is already too long. And also not really makes a social life at night possible, because of its unpleasant sedation.
But it seems to reduce cortisol secretion, because I look less ugly in the morning, if I interpretate this right.
Anyway, there is also Maprotiline, which I could often read in context with burnout or "exhaustion depression" (sorry, if the spelling is wrong).
Can anyone compare this two drugs. Is Maprotiline energizing, disstressing? The right thing if one permanently feels exhausted for no reason?
Other drugs I take are
Nortriptyline 150mg
Lamictal 50mg (dropping this)
Neurontin 1500mg
Abilify 7,5mg (I am not sure about this drug)
Amisulpride 50mg
Diphenhydramine 100mg
Clonazepam 0,5mgthanks for reading
Roland
Posted by King Vultan on June 8, 2004, at 19:19:51
In reply to Maprotiline or Doxepine? Maprotiline for Burnout?, posted by rod on June 8, 2004, at 16:12:15
Doxepin is known as being quite sedating, as it has an extremely powerful histamine blockade. My reference "Psychotropic Drugs" describes both as sedating, but you get the impression that doxepin is more so:
"Doxepin (Sinequan) is a TCA that potentiates serotonin preferentially. Doxepin is sedating, has significant anticholinergic activity, and is often touted as a drug that effectively enhances sleep and reduces anxiety. Doxepin has often been recognized as a compound well tolerated among cardiac patients; however, there is no substantial evidence to show that doxepin is superior to other tertiary (or secondary amine) TCAs.""Maprotiline (Ludiomil) represents a tetracyclic antidepressant. It potentiates norepinephrine, has relatively mild potential for anticholinergic effects, and is sedating. Its neurochemical effects are similar to those of desipramine. Dosage increases are generally made more slowly than with the tertiary amine TCAs because this drug is almost twice as potent."
Looking at maprotiline's pharmacologic profile, it is similar to that of desipramine, but with a much more powerful histamine blockade; although, this blockade is not as powerful as that of doxepin (which I believe is similar in that regard to Remeron--ridiculously powerful). From what I can see, maprotiline does look to be more noticeably more activating than doxepin, even though it still may be sedating in absolute terms.
Todd
Posted by King Vultan on June 8, 2004, at 21:34:59
In reply to Maprotiline or Doxepine? Maprotiline for Burnout?, posted by rod on June 8, 2004, at 16:12:15
Thinking about this a little bit more, and comparing the pharmacological profile of maprotiline to that of nortriptyline, I question if there's really that much difference between the two. Since you are already on a hefty dose of nortriptyline, you may want to consider a different drug than maprotiline if you are looking into effecting a change in your current condition.
Todd
Posted by Sad Panda on June 9, 2004, at 3:47:25
In reply to Maprotiline or Doxepine? Maprotiline for Burnout?, posted by rod on June 8, 2004, at 16:12:15
> Well, I actually started Doxepine (Sinequan) at only 25mg a few days ago. I am not sure if this is the right drug for me, because its really sedating and prolongs my sleep time, which is already too long. And also not really makes a social life at night possible, because of its unpleasant sedation.
> But it seems to reduce cortisol secretion, because I look less ugly in the morning, if I interpretate this right.
> Anyway, there is also Maprotiline, which I could often read in context with burnout or "exhaustion depression" (sorry, if the spelling is wrong).
> Can anyone compare this two drugs. Is Maprotiline energizing, disstressing? The right thing if one permanently feels exhausted for no reason?
>
>
> Other drugs I take are
> Nortriptyline 150mg
> Lamictal 50mg (dropping this)
> Neurontin 1500mg
> Abilify 7,5mg (I am not sure about this drug)
> Amisulpride 50mg
> Diphenhydramine 100mg
> Clonazepam 0,5mg
>
> thanks for reading
> Roland
Hi Roland,Maprotiline & Doxepin are nearly gone & forgotten because the remaining TCA's do everything they can but better. Doxepin comes with the same side effects as Amitriptyline but it isn't an SRI which renders it rather useless except for sleep.
I would be inclined to use Amitriptyline at a dosage you can live with and adjust your Nortriptyline level accordingly using blood tests. You could drop Diphenhydramine too, it is rather weak compared to Amitriptyline & especially Doxepin. Also, it takes me about a month to develop tolerance to histamine blockade & then my sleep becomes very normal, YMMW.
As for your AED's & AP's, I think you might feel better after you get rid of one or two of them. It's an impressively long list, what is your DX? :)
Cheers,
Panda.
Posted by rod on June 9, 2004, at 6:17:09
In reply to Re: Another thought, posted by King Vultan on June 8, 2004, at 21:34:59
> Thinking about this a little bit more, and comparing the pharmacological profile of maprotiline to that of nortriptyline, I question if there's really that much difference between the two. Since you are already on a hefty dose of nortriptyline, you may want to consider a different drug than maprotiline if you are looking into effecting a change in your current condition.
>
>
> Todd
>
Tahnk you Todd, for taking the time to think about this!
The Nortriptyline is just the right thing for me. But meanwhile its effect is rather mild. So I look for something which works similar to this. I tried 175mg of Nortripyline, but I just feel "stonded" on that. It seems the inverse U shaped dose response curve of Nortripyline is true.
BTW, Nortriptyline is the "TCA" of choice for parkinson accompanied despression...
And about Doxepine. I am quite confused about your quote. All abstracts say its primarily a noradrenaline reuptake inhibitor. I wonder if this is true or not. anyway.I think I will give Maprotiline a try. I can go back to doxepine at anytime...
thank you
Roland
Posted by rod on June 9, 2004, at 6:52:32
In reply to Re: Maprotiline or Doxepine? Maprotiline for Burnout? » rod, posted by Sad Panda on June 9, 2004, at 3:47:25
> > Well, I actually started Doxepine (Sinequan) at only 25mg a few days ago. I am not sure if this is the right drug for me, because its really sedating and prolongs my sleep time, which is already too long. And also not really makes a social life at night possible, because of its unpleasant sedation.
> > But it seems to reduce cortisol secretion, because I look less ugly in the morning, if I interpretate this right.
> > Anyway, there is also Maprotiline, which I could often read in context with burnout or "exhaustion depression" (sorry, if the spelling is wrong).
> > Can anyone compare this two drugs. Is Maprotiline energizing, disstressing? The right thing if one permanently feels exhausted for no reason?
> >
> >
> > Other drugs I take are
> > Nortriptyline 150mg
> > Lamictal 50mg (dropping this)
> > Neurontin 1500mg
> > Abilify 7,5mg (I am not sure about this drug)
> > Amisulpride 50mg
> > Diphenhydramine 100mg
> > Clonazepam 0,5mg
> >
> > thanks for reading
> > Roland
>
>
> Hi Roland,
>Hi Sad Panda
> Maprotiline & Doxepin are nearly gone & forgotten because the remaining TCA's do everything they can but better. Doxepin comes with the same side effects as Amitriptyline but it isn't an SRI which renders it rather useless except for sleep.
>Well, yes, but Doxepines side effects are much lesser than Amitriptyline. Ami has much higher affinity for cholinergic receptors for example.
> I would be inclined to use Amitriptyline at a dosage you can live with and adjust your Nortriptyline level accordingly using blood tests.
Amitriptyline was the best drug that I have taken, but I doesnt work anymore and makes me somewhat worse now. I once was quite happy on 150mg of Amitriptyline until a super smart doctor didnt want to increase beyond 150mg and put me on the Prozac - Zyprexa combo. I still was on 75mg of Ami. when I was taking 40mg of Prozac. 20mg of Prozac can increase, via liver enzyme interaction, 75mg Ami up to if one takes 300mg of Ami alone. And I took 40 mg. Who knows. Since then, I dont respond to ami anymore. But luckily to Nortripyline :) .
These TCAs, Maprotiline and Doxepine, are one of the few I havent tried out yet. Anafranil is serotonergic nonsense for me like the SSRIs...And good idea, I will make a blood test for Nortripyline, because I havent made one yet, just out of curiosity. But adjusting it by the results isnt a must I think, because I just take as much that I feel good. Everyone respondes different to it IMO.
>You could drop Diphenhydramine too, it is rather weak compared to Amitriptyline & especially Doxepin. Also, it takes me about a month to develop tolerance to histamine blockade & then my sleep becomes very normal, YMMW.
But Diphenhydramine has also a weak but valuable antidepressing, refreshing effect for me. I dont know exactly why is that. But Diphen. is also a weak dopamine reuptake inhibitor, and is effective in treating Neuroleptic Malignant Syndrome, maybe because of its reuptake inhibition.
>
> As for your AED's & AP's, I think you might feel better after you get rid of one or two of them.Yes, I am already tapering down Lamictal. But in general, Neuontin is a good Lamictal augmentor for Bipolar depression, I could read (there was a study about this).
Amisulpride works agains dystymic symptoms, but also lost much of its effect. And I wont quit it, because there is still some effect.
And about Abilify. Amisulpride and Abilify have different mechanisms of action. So it inst a studip idea to combine them. And Abilify is also a 5-HT7 antagonist, which schould, as far as I know, relax cerebral blood vessels, but dont quote me on that. Feel free to correct me on that if its wrong.
But I a not sure about Abilify, because on the one hand is motivating, but on the other hand makes me a bit dysphoric. Might sound strange, but thats how I experience it.>It's an impressively long list, what is your DX? :)
>Thats a good question! :)
I heard many DXs in the past. I think I fit best on dystymia with deficit syndrome like symptoms, social withdrawness, ipaired concentration, attention and memory, and inreased sleep time. Its not classic major depression, because I am not crying, am not suicidal. But never heard schizophrenia, nor had I psychotic episodes.
And maybe also ultra rapid (speaking in terms of hours) cycling with a 5% up and 95% down ratio.> Cheers,
> Panda.
>thanks for responding
Roland
Posted by linkadge on June 9, 2004, at 11:24:04
In reply to Re: Another thought » King Vultan, posted by rod on June 9, 2004, at 6:17:09
Thats what I've read everywhere. Old texts seem to suggest that sinequan has high affinity for serotonin, but all of the recent research I have read suggests that sinequan works mainly on norepinephrine.
Linkadge
Posted by rod on June 9, 2004, at 15:18:22
In reply to Maprotiline or Doxepine? Maprotiline for Burnout?, posted by rod on June 8, 2004, at 16:12:15
Back to my question...
Has anyone taken Maprotiline here for depression or burnbout? How would you describe its effect on you?thanks
Roland
Posted by Sad Panda on June 9, 2004, at 23:22:31
In reply to Re: Maprotiline or Doxepine? Maprotiline for Burno » Sad Panda, posted by rod on June 9, 2004, at 6:52:32
> > > Well, I actually started Doxepine (Sinequan) at only 25mg a few days ago. I am not sure if this is the right drug for me, because its really sedating and prolongs my sleep time, which is already too long. And also not really makes a social life at night possible, because of its unpleasant sedation.
> > > But it seems to reduce cortisol secretion, because I look less ugly in the morning, if I interpretate this right.
> > > Anyway, there is also Maprotiline, which I could often read in context with burnout or "exhaustion depression" (sorry, if the spelling is wrong).
> > > Can anyone compare this two drugs. Is Maprotiline energizing, disstressing? The right thing if one permanently feels exhausted for no reason?
> > >
> > >
> > > Other drugs I take are
> > > Nortriptyline 150mg
> > > Lamictal 50mg (dropping this)
> > > Neurontin 1500mg
> > > Abilify 7,5mg (I am not sure about this drug)
> > > Amisulpride 50mg
> > > Diphenhydramine 100mg
> > > Clonazepam 0,5mg
> > >
> > > thanks for reading
> > > Roland
> >
> >
> > Hi Roland,
> >
>
> Hi Sad Panda
>
> > Maprotiline & Doxepin are nearly gone & forgotten because the remaining TCA's do everything they can but better. Doxepin comes with the same side effects as Amitriptyline but it isn't an SRI which renders it rather useless except for sleep.
> >
>Hi Roland,
> Well, yes, but Doxepines side effects are much lesser than Amitriptyline. Ami has much higher affinity for cholinergic receptors for example.My bad, my info for M1 blockade says Ami is by far the worst while Doxepin compares with Nort. My info for A1 blockade say they are both the same and are the worst.
> > I would be inclined to use Amitriptyline at a dosage you can live with and adjust your Nortriptyline level accordingly using blood tests.
>
> Amitriptyline was the best drug that I have taken, but I doesnt work anymore and makes me somewhat worse now. I once was quite happy on 150mg of Amitriptyline until a super smart doctor didnt want to increase beyond 150mg and put me on the Prozac - Zyprexa combo. I still was on 75mg of Ami. when I was taking 40mg of Prozac. 20mg of Prozac can increase, via liver enzyme interaction, 75mg Ami up to if one takes 300mg of Ami alone. And I took 40 mg. Who knows. Since then, I dont respond to ami anymore. But luckily to Nortripyline :) .
>
>My knowledge of P450 enzymes is vague, I would have to look that up, but I thought Ami was metablised by more than one enzyme.
> These TCAs, Maprotiline and Doxepine, are one of the few I havent tried out yet. Anafranil is serotonergic nonsense for me like the SSRIs...
>What kind of Serotinergic nonsense do you experience?
Have you tried Trimipramine?
> And good idea, I will make a blood test for Nortripyline, because I havent made one yet, just out of curiosity. But adjusting it by the results isnt a must I think, because I just take as much that I feel good. Everyone respondes different to it IMO.
>I suggest a blood test so you know what level of Nort is your blood does the most good. As you would know Ami metabolises to Nort, so if you were to take some Ami you would have to take less Nort to get the Nort level in your blood the same as before. No matter what TCA you use, you are probably going to have to lower your Nort intake to avoid NE overload.
> >You could drop Diphenhydramine too, it is rather weak compared to Amitriptyline & especially Doxepin. Also, it takes me about a month to develop tolerance to histamine blockade & then my sleep becomes very normal, YMMW.
>
> But Diphenhydramine has also a weak but valuable antidepressing, refreshing effect for me. I dont know exactly why is that. But Diphen. is also a weak dopamine reuptake inhibitor, and is effective in treating Neuroleptic Malignant Syndrome, maybe because of its reuptake inhibition.
>In teresting that you like Diphenhydramine and Prozac, I have read somewhere that Diphenhydramine was the original molecule the Lily worked on to come up with Prozac.
I'd like to have info on Phenergan just for entertainment as it spawned the TCA's & a fleet of AP's.
> >
> > As for your AED's & AP's, I think you might feel better after you get rid of one or two of them.
>
> Yes, I am already tapering down Lamictal. But in general, Neuontin is a good Lamictal augmentor for Bipolar depression, I could read (there was a study about this).
> Amisulpride works agains dystymic symptoms, but also lost much of its effect. And I wont quit it, because there is still some effect.
> And about Abilify. Amisulpride and Abilify have different mechanisms of action. So it inst a studip idea to combine them. And Abilify is also a 5-HT7 antagonist, which schould, as far as I know, relax cerebral blood vessels, but dont quote me on that. Feel free to correct me on that if its wrong.
> But I a not sure about Abilify, because on the one hand is motivating, but on the other hand makes me a bit dysphoric. Might sound strange, but thats how I experience it.
>
> >It's an impressively long list, what is your DX? :)
> >
>
> Thats a good question! :)
> I heard many DXs in the past. I think I fit best on dystymia with deficit syndrome like symptoms, social withdrawness, ipaired concentration, attention and memory, and inreased sleep time. Its not classic major depression, because I am not crying, am not suicidal. But never heard schizophrenia, nor had I psychotic episodes.
> And maybe also ultra rapid (speaking in terms of hours) cycling with a 5% up and 95% down ratio.
>I am just depressed & thankfully only need just two AD's to cover it. However I am taking a bunch of tablets for other problems & I too rattle when I walk. :)
Cheers,
Panda.
Posted by rod on June 10, 2004, at 5:30:03
In reply to Re: Maprotiline or Doxepine? Maprotiline for Burno » rod, posted by Sad Panda on June 9, 2004, at 23:22:31
> > > > Well, I actually started Doxepine (Sinequan) at only 25mg a few days ago. I am not sure if this is the right drug for me, because its really sedating and prolongs my sleep time, which is already too long. And also not really makes a social life at night possible, because of its unpleasant sedation.
> > > > But it seems to reduce cortisol secretion, because I look less ugly in the morning, if I interpretate this right.
> > > > Anyway, there is also Maprotiline, which I could often read in context with burnout or "exhaustion depression" (sorry, if the spelling is wrong).
> > > > Can anyone compare this two drugs. Is Maprotiline energizing, disstressing? The right thing if one permanently feels exhausted for no reason?
> > > >
> > > >
> > > > Other drugs I take are
> > > > Nortriptyline 150mg
> > > > Lamictal 50mg (dropping this)
> > > > Neurontin 1500mg
> > > > Abilify 7,5mg (I am not sure about this drug)
> > > > Amisulpride 50mg
> > > > Diphenhydramine 100mg
> > > > Clonazepam 0,5mg
> > > >
> > > > thanks for reading
> > > > Roland
> > >
> > >
> > > Hi Roland,
> > >
> >
> > Hi Sad Panda
> >
> > > Maprotiline & Doxepin are nearly gone & forgotten because the remaining TCA's do everything they can but better. Doxepin comes with the same side effects as Amitriptyline but it isn't an SRI which renders it rather useless except for sleep.
> > >
> >
>
> Hi Roland,
>hi
>
> > Well, yes, but Doxepines side effects are much lesser than Amitriptyline. Ami has much higher affinity for cholinergic receptors for example.
>
> My bad, my info for M1 blockade says Ami is by far the worst while Doxepin compares with Nort. My info for A1 blockade say they are both the same and are the worst.
>
> > > I would be inclined to use Amitriptyline at a dosage you can live with and adjust your Nortriptyline level accordingly using blood tests.
> >
> > Amitriptyline was the best drug that I have taken, but I doesnt work anymore and makes me somewhat worse now. I once was quite happy on 150mg of Amitriptyline until a super smart doctor didnt want to increase beyond 150mg and put me on the Prozac - Zyprexa combo. I still was on 75mg of Ami. when I was taking 40mg of Prozac. 20mg of Prozac can increase, via liver enzyme interaction, 75mg Ami up to if one takes 300mg of Ami alone. And I took 40 mg. Who knows. Since then, I dont respond to ami anymore. But luckily to Nortripyline :) .
> >
> >
>
> My knowledge of P450 enzymes is vague, I would have to look that up, but I thought Ami was metablised by more than one enzyme.
>I also dont know much about this issue. I just read about the Ami Prozac interaction, and thats what they said.
> > These TCAs, Maprotiline and Doxepine, are one of the few I havent tried out yet. Anafranil is serotonergic nonsense for me like the SSRIs...
> >
>
> What kind of Serotinergic nonsense do you experience?
>Concentration and memory problems, sexual problems. etc. Any constructive thought process becomes very difficult. My higher cognitive skills like abstract thinking becaomes nearly impossible.
> Have you tried Trimipramine?
>No, and I dont expect much from this one.
> > And good idea, I will make a blood test for Nortripyline, because I havent made one yet, just out of curiosity. But adjusting it by the results isnt a must I think, because I just take as much that I feel good. Everyone respondes different to it IMO.
> >
>
> I suggest a blood test so you know what level of Nort is your blood does the most good. As you would know Ami metabolises to Nort, so if you were to take some Ami you would have to take less Nort to get the Nort level in your blood the same as before. No matter what TCA you use, you are probably going to have to lower your Nort intake to avoid NE overload.
>
> > >You could drop Diphenhydramine too, it is rather weak compared to Amitriptyline & especially Doxepin. Also, it takes me about a month to develop tolerance to histamine blockade & then my sleep becomes very normal, YMMW.
> >
> > But Diphenhydramine has also a weak but valuable antidepressing, refreshing effect for me. I dont know exactly why is that. But Diphen. is also a weak dopamine reuptake inhibitor, and is effective in treating Neuroleptic Malignant Syndrome, maybe because of its reuptake inhibition.
> >
>
> In teresting that you like Diphenhydramine and Prozac, I have read somewhere that Diphenhydramine was the original molecule the Lily worked on to come up with Prozac.
>No, maybe I expressed me not clearly. I hated Prozac. And calling this doctor smart was ironically. But I really like Diphenhyrdramine.
> I'd like to have info on Phenergan just for entertainment as it spawned the TCA's & a fleet of AP's.
>
> > >
> > > As for your AED's & AP's, I think you might feel better after you get rid of one or two of them.
> >
> > Yes, I am already tapering down Lamictal. But in general, Neuontin is a good Lamictal augmentor for Bipolar depression, I could read (there was a study about this).
> > Amisulpride works agains dystymic symptoms, but also lost much of its effect. And I wont quit it, because there is still some effect.
> > And about Abilify. Amisulpride and Abilify have different mechanisms of action. So it inst a studip idea to combine them. And Abilify is also a 5-HT7 antagonist, which schould, as far as I know, relax cerebral blood vessels, but dont quote me on that. Feel free to correct me on that if its wrong.
> > But I a not sure about Abilify, because on the one hand is motivating, but on the other hand makes me a bit dysphoric. Might sound strange, but thats how I experience it.
> >
> > >It's an impressively long list, what is your DX? :)
> > >
> >
> > Thats a good question! :)
> > I heard many DXs in the past. I think I fit best on dystymia with deficit syndrome like symptoms, social withdrawness, ipaired concentration, attention and memory, and inreased sleep time. Its not classic major depression, because I am not crying, am not suicidal. But never heard schizophrenia, nor had I psychotic episodes.
> > And maybe also ultra rapid (speaking in terms of hours) cycling with a 5% up and 95% down ratio.
> >
>
> I am just depressed & thankfully only need just two AD's to cover it. However I am taking a bunch of tablets for other problems & I too rattle when I walk. :)
>:-)
I know what you mean.
> Cheers,
> Panda.
>Roland
Posted by zeugma on June 10, 2004, at 12:45:33
In reply to Re: Maprotiline or Doxepine? Maprotiline for Burno » rod, posted by Sad Panda on June 9, 2004, at 23:22:31
I suggest a blood test so you know what level of Nort is your blood does the most good. As you would know Ami metabolises to Nort, so if you were to take some Ami you would have to take less Nort to get the Nort level in your blood the same as before. No matter what TCA you use, you are probably going to have to lower your Nort intake to avoid NE overload.>
Hi, I just want to second Panda's advice to get a plasma level done for nortriptyline. And I agree that if you add any drug that is an NRI, including any TCA, there is an increased possibility that you are going to get counterproductive results from NE overload. I think that some of the symptoms I have experienced recently, including severe fatigue, were due to my simultaneous intake of two NE reuptake inhibitors (nortriptyline and Strattera).
I am currently on 75 mg nortriptyline, 1 mg clonazepam, plus 15 mg buspirone as needed to combat insomnia.
Posted by rod on June 10, 2004, at 13:54:12
In reply to Re: Maprotiline or Doxepine? Maprotiline for Burno » Sad Panda, posted by zeugma on June 10, 2004, at 12:45:33
> I suggest a blood test so you know what level of Nort is your blood does the most good. As you would know Ami metabolises to Nort, so if you were to take some Ami you would have to take less Nort to get the Nort level in your blood the same as before. No matter what TCA you use, you are probably going to have to lower your Nort intake to avoid NE overload.>
>
> Hi, I just want to second Panda's advice to get a plasma level done for nortriptyline. And I agree that if you add any drug that is an NRI, including any TCA, there is an increased possibility that you are going to get counterproductive results from NE overload. I think that some of the symptoms I have experienced recently, including severe fatigue, were due to my simultaneous intake of two NE reuptake inhibitors (nortriptyline and Strattera).
>
> I am currently on 75 mg nortriptyline, 1 mg clonazepam, plus 15 mg buspirone as needed to combat insomnia.
>
>
>
>
Hi
sure, this can end in counterproductive symptoms due to NE overload. And thank you for caring about me. :)
But I think its the simplest way to just try out, and see what happens. I mean, what if I know my Nortriptyline plasma level. What does this tell me about the outcome of augmenting with anouther NE reuptake inhibitor (except Amitriptyline). I mean I have *no* cardicac effects from nortrip. or other side effect. they are zero. It just got a bit better than without meds. And if a additonal TCA produces an improvement in my functionality, I take it, if its counterproductive, I quit the newly started one.
Well, I dont really know which symptoms represent NE overload. Are there specific ones? if so, please tell me.But I will make one the next time I visit my doc. Just out of curiosity.
Roland
Posted by zeugma on June 10, 2004, at 20:42:55
In reply to Re: Maprotiline or Doxepine? Maprotiline for Burno, posted by rod on June 10, 2004, at 13:54:12
> > I suggest a blood test so you know what level of Nort is your blood does the most good. As you would know Ami metabolises to Nort, so if you were to take some Ami you would have to take less Nort to get the Nort level in your blood the same as before. No matter what TCA you use, you are probably going to have to lower your Nort intake to avoid NE overload.>
> >
> > Hi, I just want to second Panda's advice to get a plasma level done for nortriptyline. And I agree that if you add any drug that is an NRI, including any TCA, there is an increased possibility that you are going to get counterproductive results from NE overload. I think that some of the symptoms I have experienced recently, including severe fatigue, were due to my simultaneous intake of two NE reuptake inhibitors (nortriptyline and Strattera).
> >
> > I am currently on 75 mg nortriptyline, 1 mg clonazepam, plus 15 mg buspirone as needed to combat insomnia.
> >
> >
> >
> >
>
>
> Hi
> sure, this can end in counterproductive symptoms due to NE overload. And thank you for caring about me. :)
> But I think its the simplest way to just try out, and see what happens. I mean, what if I know my Nortriptyline plasma level. What does this tell me about the outcome of augmenting with anouther NE reuptake inhibitor (except Amitriptyline). I mean I have *no* cardicac effects from nortrip. or other side effect. they are zero. It just got a bit better than without meds. And if a additonal TCA produces an improvement in my functionality, I take it, if its counterproductive, I quit the newly started one.
> Well, I dont really know which symptoms represent NE overload. Are there specific ones? if so, please tell me.
>
> But I will make one the next time I visit my doc. Just out of curiosity.
>
> RolandI don't really know, except from my own experience. My blood pressure and vital signs were not affected by my combination, but my fatigue became completely uncontrollable (that may only be the Strattera effect, however). The pertinent question is what the MAP or other NRI would do for you that nortriptyline can't.
Several posters in the archives have pointed out that while nortriptyline has an inverted U-shaped dose response curve, 'open-ended' but otherwise similar TCA's like desipramine don't, and that is one of the great mysteries of psychopharmacology. You could try desipramine and push the dose to 300 mg (under competent supervision, of course). I think it's better, as a principle, to escalate the dosage of a single drug rather than add a similar one simply to get around a glitch in the dose-response curve :)One other note- the curvilinear response pattern for nortriptyline is not tied to cardiac or other side effects. As I said, it's a mystery. It just works less well at higher plasma concentrations, and no one knows if this has anything to do with NE overload, or any known property of the drug. My experience with Strattera was that it seemed to boost the AD effect for a good long time, but wound up bringing back the depression with the added, unendurable fatigue. I did think for a while that I had gotten around the U shape, but I wound up feeling worse than ever :)
Posted by rod on June 11, 2004, at 12:14:26
In reply to Re: Maprotiline or Doxepine? Maprotiline for Burno » rod, posted by zeugma on June 10, 2004, at 20:42:55
>I think it's better, as a principle, to escalate the dosage of a single drug rather than add a similar one simply to get around a glitch in the dose-response curve :)
Thats a good point. I have to think about that...
thanks
Roland
This is the end of the thread.
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