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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by maggiemae on October 29, 2010, at 20:08:59
even at the tiny dose of 10 mg, nortriptyline, which i have just started for migraine and headache prevention and fm pain, gives me a racing heart and keeps me up if i take it in the evening. but it does seem to help the headaches and alleviate some pain and improve my overall mood, even at such a low dose. i tried going down to 5mg per day, but the headaches came back.
previously i had taken propranolol, and wonder if adding propranolol to the low dose of nortriptyline would be a good way to counter the racing heart and be a reasonable combo?
Posted by Conundrum on November 8, 2010, at 12:58:55
In reply to nortriptyline low dose and tachychardia, posted by maggiemae on October 29, 2010, at 20:08:59
I think some doctors prescribe beta blockers for this side effect. I would ask your doc about that.
http://www.ncbi.nlm.nih.gov/pubmed/11349386Also if I am understanding the above study correctly, taking the parent drug amitriptyline may have less cardiac effects than its metabolite nortriptyline, due to its more sedating effects.
> even at the tiny dose of 10 mg, nortriptyline, which i have just started for migraine and headache prevention and fm pain, gives me a racing heart and keeps me up if i take it in the evening. but it does seem to help the headaches and alleviate some pain and improve my overall mood, even at such a low dose. i tried going down to 5mg per day, but the headaches came back.
>
> previously i had taken propranolol, and wonder if adding propranolol to the low dose of nortriptyline would be a good way to counter the racing heart and be a reasonable combo?
Posted by maggiemae on November 9, 2010, at 16:05:07
In reply to Re: nortriptyline low dose and tachychardia, posted by Conundrum on November 8, 2010, at 12:58:55
Thank you. I have been trying the two together, and the heart racing is gone, but now each afternoon (I take the nortriptyline in the morning) I get a tightness in my chest that is so uncomfortable and nothing alleviates it. i also feel wheezy, if that makes any sense. seems i can't win. i suspect this treatment won't last long - i go to the pdoc soon and i am hopefull he will come up with a better plan of attack for my problems...
> I think some doctors prescribe beta blockers for this side effect. I would ask your doc about that.
> http://www.ncbi.nlm.nih.gov/pubmed/11349386
>
> Also if I am understanding the above study correctly, taking the parent drug amitriptyline may have less cardiac effects than its metabolite nortriptyline, due to its more sedating effects.
>
>
> > even at the tiny dose of 10 mg, nortriptyline, which i have just started for migraine and headache prevention and fm pain, gives me a racing heart and keeps me up if i take it in the evening. but it does seem to help the headaches and alleviate some pain and improve my overall mood, even at such a low dose. i tried going down to 5mg per day, but the headaches came back.
> >
> > previously i had taken propranolol, and wonder if adding propranolol to the low dose of nortriptyline would be a good way to counter the racing heart and be a reasonable combo?
>
>
Posted by Conundrum on November 9, 2010, at 20:58:04
In reply to Re: nortriptyline low dose and tachychardia » Conundrum, posted by maggiemae on November 9, 2010, at 16:05:07
When you say you are taking the two together, do you mean nort + a beta blocker or nort and at another time amitriptyline?
Can you take nort at night?
> Thank you. I have been trying the two together, and the heart racing is gone, but now each afternoon (I take the nortriptyline in the morning) I get a tightness in my chest that is so uncomfortable and nothing alleviates it. i also feel wheezy, if that makes any sense. seems i can't win. i suspect this treatment won't last long - i go to the pdoc soon and i am hopefull he will come up with a better plan of attack for my problems...
>
> > I think some doctors prescribe beta blockers for this side effect. I would ask your doc about that.
> > http://www.ncbi.nlm.nih.gov/pubmed/11349386
> >
> > Also if I am understanding the above study correctly, taking the parent drug amitriptyline may have less cardiac effects than its metabolite nortriptyline, due to its more sedating effects.
> >
> >
> > > even at the tiny dose of 10 mg, nortriptyline, which i have just started for migraine and headache prevention and fm pain, gives me a racing heart and keeps me up if i take it in the evening. but it does seem to help the headaches and alleviate some pain and improve my overall mood, even at such a low dose. i tried going down to 5mg per day, but the headaches came back.
> > >
> > > previously i had taken propranolol, and wonder if adding propranolol to the low dose of nortriptyline would be a good way to counter the racing heart and be a reasonable combo?
> >
> >
>
>
Posted by maggiemae on November 9, 2010, at 21:36:16
In reply to Re: nortriptyline low dose and tachychardia, posted by Conundrum on November 9, 2010, at 20:58:04
> When you say you are taking the two together, do you mean nort + a beta blocker or nort and at another time amitriptyline?
>
> Can you take nort at night?
>
I can not take the nort at night - it is paradoxically stimulating for me. so, i am taking it with extended release propranolol la in the morning.i have been reading about the genetic differences that cause people to metabolize drugs (like tcas and others) differently. not sure it if is why i cannot tolerate more than 10mg of nortriptryline or why i have the stimulating effect from it, but it is pretty interesting.
recently i have developed some sort of weird insomnia and anxious depression - i can't enjoy things anymore - my joy is gone. it is worse in the mornings and i get a bit of relief sometimes in the evenings.
i wake up repeatedly at night and then at 4 am i am awake in a weird limbo agitated state of unspecified anxiety/depression. i am too tired and unmotivated to get up (what would i do anyway? I can't read or watch tv when i feel like this). i don't really even feel sad - just empty and incapable of doing anything that requires any concentration or energy.
it has been quite insidious and crazy making. i feel so out of control of it - it feels like i have have lost all the brain chemicals that control joy and motivation.
i go to pdoc again later this week. i really hope he will have a plan that will work for me.
Posted by Conundrum on November 9, 2010, at 21:52:13
In reply to Re: nortriptyline low dose and tachychardia, posted by maggiemae on November 9, 2010, at 21:36:16
Maybe nortriptyline is not the drug for you. You know I just read an interesting article about high norepinpehrine possibly being linked to a loss of joy. It also talks about beta and adrenergic receptors. Here is the link.
http://www.uplink.com.au/lawlibrary/Documents/Docs/Doc25.html
Go to the section titled "norepinephrine studies," The 2nd paragraph in this section talks about anhedonia(loss of pleasure) and how high norepinphrine can cause it.
Good luck at the appointment!
> > When you say you are taking the two together, do you mean nort + a beta blocker or nort and at another time amitriptyline?
> >
> > Can you take nort at night?
> >
> I can not take the nort at night - it is paradoxically stimulating for me. so, i am taking it with extended release propranolol la in the morning.
>
> i have been reading about the genetic differences that cause people to metabolize drugs (like tcas and others) differently. not sure it if is why i cannot tolerate more than 10mg of nortriptryline or why i have the stimulating effect from it, but it is pretty interesting.
>
> recently i have developed some sort of weird insomnia and anxious depression - i can't enjoy things anymore - my joy is gone. it is worse in the mornings and i get a bit of relief sometimes in the evenings.
>
> i wake up repeatedly at night and then at 4 am i am awake in a weird limbo agitated state of unspecified anxiety/depression. i am too tired and unmotivated to get up (what would i do anyway? I can't read or watch tv when i feel like this). i don't really even feel sad - just empty and incapable of doing anything that requires any concentration or energy.
>
> it has been quite insidious and crazy making. i feel so out of control of it - it feels like i have have lost all the brain chemicals that control joy and motivation.
>
> i go to pdoc again later this week. i really hope he will have a plan that will work for me.
Posted by maggiemae on November 11, 2010, at 16:12:21
In reply to Re: nortriptyline low dose and tachychardia, posted by Conundrum on November 9, 2010, at 21:52:13
well, that is just crazy and fascinating - an antidepressant would cause loss of joy? what the hell?
i am pretty convinced this is not the drug for me. i was given it for the fm pain and migraine prevention after trials of lyrica and cymbalta didn't work out. i was previously on effexor xr, and it could be i have to go back to that. but i never liked the way i felt on it. prior to that, zoloft, but again, never liked what it did for me.
i have had a rough day today with the empty feeling, but i still have my hope, so that is a good thing. i have faith that this new doctor really knows his stuff and will get me back on the mend so i can get on with my life. patience, i suppose, is going to be what i need to pray for, as i know any med he gives me will take time to have any benefit....
> Maybe nortriptyline is not the drug for you. You know I just read an interesting article about high norepinpehrine possibly being linked to a loss of joy. It also talks about beta and adrenergic receptors. Here is the link.
>
> http://www.uplink.com.au/lawlibrary/Documents/Docs/Doc25.html
>
> Go to the section titled "norepinephrine studies," The 2nd paragraph in this section talks about anhedonia(loss of pleasure) and how high norepinphrine can cause it.
>
> Good luck at the appointment!
Posted by Conundrum on November 11, 2010, at 21:54:11
In reply to Re: nortriptyline low dose and tachychardia, posted by maggiemae on November 11, 2010, at 16:12:21
I wonder if the betablocker could be causing this feeling as well. Depression is listed as a side effect. Do they make 5 mg nortriptyline? Maybe you could get by on 5 mg with no beta blocker?
> well, that is just crazy and fascinating - an antidepressant would cause loss of joy? what the hell?
>
> i am pretty convinced this is not the drug for me. i was given it for the fm pain and migraine prevention after trials of lyrica and cymbalta didn't work out. i was previously on effexor xr, and it could be i have to go back to that. but i never liked the way i felt on it. prior to that, zoloft, but again, never liked what it did for me.
>
> i have had a rough day today with the empty feeling, but i still have my hope, so that is a good thing. i have faith that this new doctor really knows his stuff and will get me back on the mend so i can get on with my life. patience, i suppose, is going to be what i need to pray for, as i know any med he gives me will take time to have any benefit....
>
> > Maybe nortriptyline is not the drug for you. You know I just read an interesting article about high norepinpehrine possibly being linked to a loss of joy. It also talks about beta and adrenergic receptors. Here is the link.
> >
> > http://www.uplink.com.au/lawlibrary/Documents/Docs/Doc25.html
> >
> > Go to the section titled "norepinephrine studies," The 2nd paragraph in this section talks about anhedonia(loss of pleasure) and how high norepinphrine can cause it.
> >
> > Good luck at the appointment!
>
Posted by maggiemae on November 16, 2010, at 16:00:07
In reply to Re: nortriptyline low dose and tachychardia » maggiemae, posted by Conundrum on November 11, 2010, at 21:54:11
ok, so i figured out that propranolol and i don't get along. which is weird, as i had taken before and never had a problem with it. but now, it is causing me breathing problems - asthma wheezing.
i was still trying to see if i could slowly up the dose of nortriptyline and not have the tachy heart, but no, now i have the high pulse rate AND wheezing. argh. so i stopped the propranolol last week.
i got up to 12 mg (from 5) and was so uncomfortable - wheezing and heart racing, that both cause anxiety and insomnia. lovely.
today i recalled that i have a bottle of toprol xl that was given to me a few months back for high blood pressure, but that i never took, because i was trying another med at the time.
so, this morning i took half a tablet when the heart racing started again a few hours after taking my backed down 8mg dose of nortriptyline.
within an hour i felt normal! no racing heart. no wheezing and a wave of calm. so weird.
why did toprol stop the tachy heart while propranolol made it feel worse (by adding the difficulty breathing.)?
Posted by Maggiemae on November 27, 2010, at 20:42:35
In reply to Re: nortriptyline low dose and tachychardia, posted by Conundrum on November 9, 2010, at 20:58:04
An update in case anyone is interested. I gave up on propranolol or toprol for counting the tachycardia- it was causing asthma and wheezing and tiredness. Instead of trying to up the dose for antidepressant effect I tried stopping one day to see uf heart racing high pulse would stop. It did. However, a day after, the body pain was back. So I took a smaller dose (6mg) to see how it would go. Body pains lessened and so far no high pulse, however, anxiety is sky high. I can't win.
So, to recap, tiny dose of nortiptyline helps my pain and headaches, but in the past 6 weeks I have developed diurnal depression (solved somewhat by Xanax to improve fragmented sleep) and in the past few days, increased interna l anxiety.
I give up. Anyone have any ideas for me? What the heck are my brain chemicals are doing?
Posted by desolationrower on March 23, 2011, at 4:24:24
In reply to Re: nortriptyline low dose and tachychardia, posted by Conundrum on November 9, 2010, at 21:52:13
the parent drug will not be as 'direct' since it targets more receptors.
too many heartbeats, yeah.-d/r
This is the end of the thread.
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