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Dr. Bob is Robert Hsiung, MD,
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Posted by Lamdage22 on September 25, 2015, at 21:09:57
In reply to Re: My doc presribed nortriptyline. Wish me luck. » Lamdage22, posted by Tomatheus on September 25, 2015, at 15:42:44
My psychosis is related to MAOI..
They kicked it off.
I had grandiose delusions as well as the opposite (while on nardil),.
Posted by Tomatheus on September 25, 2015, at 21:33:46
In reply to Re: My doc presribed nortriptyline. Wish me luck., posted by Lamdage22 on September 25, 2015, at 21:09:57
> My psychosis is related to MAOI..
>
> They kicked it off.
>
> I had grandiose delusions as well as the opposite (while on nardil),.So then, you were in a mixed state of sorts (with some delusions that were grandiose and some delusions that were more of the opposite nature) while taking Nardil? If you don't mind me asking, what have your symptoms looked like since having discontinued Nardil? How would you describe your affective state? Mostly depressed? Mixed? Mostly euthymic? Would you say that you still experience delusions? Or is it hard to tell because you've been taking antipsychotics and other medications for a while?
I know I just bombarded you with a lot of questions, so feel free to answer what you feel comfortable answering. I'm just curious, in part because I feel like the symptoms associated with being in a mixed affective state seem to fit at least somewhat closely with the symptoms that I've been experiencing for the last eight years.
Tomatheus
Posted by Lamdage22 on September 26, 2015, at 5:08:52
In reply to Re: My doc presribed nortriptyline. Wish me luck. » Lamdage22, posted by Tomatheus on September 25, 2015, at 15:42:44
Tomatheus,
i am not treating a mixed state, i am treating depression. The mixed state was under the influence of Nardil.
I dont take Nardil anymore.
> > I will pick it up in a few minutes and will begin the trial tomorrow.
> >
> > Doc asked if i ever was psychotic and manic, i said no. I think i was psychotic and mixed.
>
> So your psychosis is related to being in a mixed affective state? I have a hard time telling whether my untreated state (and treated state, to a lesser extent) consists of a mixed affective state with a psychotic mania overlapping with strong anergic depressive symptoms or whether it's basically a manifestation of schizophrenia. I lean toward the former explanation, as most medications tend to aggravate my depressive symptoms, my psychotic symptoms, or my irritability.
>
> Treating mixed affective states can be tough, and I hope that adding nortriptyline to your regimen will help provide you with the kind of balance that you're looking for. Good luck with it.
>
> Tomatheus
Posted by Lamdage22 on September 26, 2015, at 10:28:31
In reply to Re: My doc presribed nortriptyline. Wish me luck., posted by Lamdage22 on September 26, 2015, at 5:08:52
When can i expect to feel something?
Im on 25mg until Thursday 8th. Since this morning.
Posted by Lamdage22 on September 26, 2015, at 10:30:51
In reply to Re: My doc presribed nortriptyline. Wish me luck. » Lamdage22, posted by SLS on September 25, 2015, at 14:29:37
> > I have a good feeling with this.
> >
> > The pharmacist said 30-60 mins after food or at least 30 Minutes before food.
>
> After all of these years, I have never heard that. I guess I should look into it.I think that pharmacist was talking trash. In the piece of paper inside the box it said independently of food.
Posted by SLS on September 26, 2015, at 14:38:22
In reply to @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 26, 2015, at 10:28:31
> When can i expect to feel something?
>
> Im on 25mg until Thursday 8th. Since this morning.25 mg/day is a good dosage to start at. Some start at 10 mg/day. If you are a nortiptyline "virgin", you might experience somnolence and become very sedated and sleepy. Should this occur, it should wear off in a few days. The usual side effects that apply to most TCAs apply to nortriptyline as well, but are usually significantly milder. Most of them involve anticholinergic/pronoradrenergic: dry mouth, elevated heart rate, sweating, nasal congestion, tremulousness, blurred vision, constipation, urinary retention, etc. You may not get any of these.
My impression is that TCAs work a bit faster than SSRIs. You might feel a small improvement by the end of week 2. A good response will continue to grow so that by the end of week 4, you will be feeling significantly better. With me, I recover mental energy and sex drive before I experience an improvement in interest, motivation, and mood. I find the sex drive thing very interesting. I don't know if this is just idiosyncratic for me, or more generalized.
I wish you luck with nortriptyline. Since you are still taking antipsychotics - particularly Zyprexa - I believe you will be mostly protected from a manic or psychotic reaction that the TCAs sometimes produce. My rare severe MAOI manic reactions are quickly extinguished by using Zyprexa or Depakote. You should be okay.
Be patient with time to improvement, and allow a week or two for startup side effects to mitigate. Elevated heart rate will probably persist, but it is not dangerous. You might have a resting rate of about 110 bpm at first, but this should level off to 80 - 90 bpm. Heart electrical rhythm abnormalities are uncommon, but you might want to get a ECG if you are worried about this.
Because we were just talking about this in another thread, one can have an increase in suicidal ideations with TCAs, although my impression is that this happens less often than with SSRIs. Suicidality can emerge in two scenarios:
1. The drug creates a genuine neurobiological substrate that makes someone "feel" suicidal independent of thought or type of depression. The emergence of anxiety, anger, or impulsivity leaves these people particularly vulnerable.
2. This patient is extremely vegetative at baseline, including anergia, paychomotor retardation, slow thinking, flat affect, and feeling numb to one's surroundings. He is too vegetative to think about, plan, or act on suicidal ideation. They are often content to remain motionless and stare into space. The problem is this. When someone like this is given an effective antidepressant, the first thing that improves is mental energy and an increase in thinking and psychomotor speed. The last things to return are improvements in mood, interest to do things, desire, motivation, and reward. Unfortunately, the increase in mental energy occurs before improved mood and outlook does. What sometimes happens in these cases is that while they still have depressed mood and poor outlook, the mental energy necessary to produce suicidal thoughts and formulate plans appear. This is only a temporary phase in the process of recovery, though. This state can pass in a week, leaving room for the good thoughts and enjoyment that are beginning to emerge.
With either, scenario, the first 3 weeks can be a dangerous time. A good doctor will warn their patients of the possibility that they might feel worse, and monitor them with weekly or biweekly appoints early in treatment.
Good luck.
- Scott
Posted by Tomatheus on September 26, 2015, at 16:34:20
In reply to Re: My doc presribed nortriptyline. Wish me luck., posted by Lamdage22 on September 26, 2015, at 5:08:52
Thank you for your response, Lamdage. Again, I wish you the best of luck with nortriptyline -- as a treatment for the depression that you've been experiencing.
Tomatheus
Posted by Lamdage22 on September 26, 2015, at 22:37:53
In reply to Re: @SLS whats the word on nortriptyline? » Lamdage22, posted by SLS on September 26, 2015, at 14:38:22
Is Nortriptyline less likely to produce a psychotic reaction than MAOI?
I am a bit worried.
Posted by SLS on September 27, 2015, at 0:27:09
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 26, 2015, at 22:37:53
> Is Nortriptyline less likely to produce a psychotic reaction than MAOI?
>
> I am a bit worried.In my experience, MAOIs are more likely than nortriptyline to produce psychosis. Almost any antidepressant can cause a switch into mania for people who are bipolar, though. Given your diagnosis, it is good to have a healthy respect for these medications. If I were in your situation, I would continue with your nortriptyline trial. Try to be patient with both therapeutic response and side effects. Many side effects lessen with time. Raising the dosage gradually will help. If you feel a need to stop taking it, please call your doctor first and tell him about your concerns. I imagine you are scared.
Nortriptyline has some pluses and minuses. The pluses include a high rate of success, little or no sexual side effects, and a low probability of pooping-out. Since people tend to gain weight rather than lose weight, begin managing your diet now. You might feel a little foggy-brain at first, but that should disappear. The plus is that you will not experience the apathy, emotional numbness, and amotivation that SSRIs can cause.
People often respond to 75 mg/day. Rapid metabolizers need more. It is not unusual to need 150 mg/day. Use blood tests to help determine what kind of metabolizer you are. It probably makes sense to get a blood test before moving higher than 75 mg/day. I guess it depends on how much experience your doctor has with this drug. He might feel confident in his ability to titrated without blood tests.
Try not to be too scared of the elevated heart rate.
- Scott
Posted by Lamdage22 on September 27, 2015, at 0:44:41
In reply to Re: @SLS whats the word on nortriptyline? » Lamdage22, posted by SLS on September 27, 2015, at 0:27:09
Thanks so much Scott.
It is probably superstition, but i have a good feeling with this. It would seem only fair if this works for me.
I dont know if i will experience much additional weight gain since i am on Seroquel Zyprexa and Metformin.
Posted by Lamdage22 on September 27, 2015, at 1:08:38
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 27, 2015, at 0:44:41
No, i will not abort this trial early. I woke up early-ish (7AM) today which is not a bad sign. Also it will be good for my bowel movements if i get some "constipation" in there. Metformin softens that stuff big time.
You know what, Scott? When i further reduce my antipsychotics, i could get on 300-400 mg Lithium like you. (With the help of Metformin against the weight gain). Have you ever tried to lower the Lithium dosage? Does your current dosage give you more effect than a low dosage like, say 50mg? I am asking because i wonder if higher dose lithium would give me any benefits beyond cutting out suicidal thoughts. Currently it only curbs suicidal thoughts. Nothing more and nothing less. Its a pie in the sky though because i will need significant amounts of time to wein off of the antipsychotics further.
Ha, i love me some english sayings.
What do you think?
Posted by SLS on September 27, 2015, at 7:15:15
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 27, 2015, at 1:08:38
> No, i will not abort this trial early. I woke up early-ish (7AM) today which is not a bad sign. Also it will be good for my bowel movements if i get some "constipation" in there. Metformin softens that stuff big time.
>
> You know what, Scott? When i further reduce my antipsychotics, i could get on 300-400 mg Lithium like you. (With the help of Metformin against the weight gain). Have you ever tried to lower the Lithium dosage? Does your current dosage give you more effect than a low dosage like, say 50mg? I am asking because i wonder if higher dose lithium would give me any benefits beyond cutting out suicidal thoughts. Currently it only curbs suicidal thoughts. Nothing more and nothing less. Its a pie in the sky though because i will need significant amounts of time to wein off of the antipsychotics further.
>
> Ha, i love me some english sayings.
>
> What do you think?I have not tried dosages of lithium below 300 mg/day for any length of time. I am reluctant to make any changes right now. I need to allow things to stabilize since increasing Parnate to 120 mg/day without jumping up and down in dosage. From what I understand, even 100 mg/day of lithium can help prevent Alzheimers Dementia. For sure, 450 mg/day is too much for me. At that dosage, I experience dysphoria and flat affect.
If I were in your position, I would make the addition of nortriptyline the only change you make. Hopefully, you will find the right dosage, respond, and stabilize. If you still feel like you would like to adjust your other drugs, you will be able to more accurately evaluate the need for each one and its optimal dosage. This might take some time to accomplish, but if you are feeling well, what's the rush?
Have you ever heard of a supplement called resveratrol? Nobody seems to know much about it.
Good luck.
- Scott
Posted by Lamdage22 on September 27, 2015, at 8:28:15
In reply to Re: @SLS whats the word on nortriptyline? » Lamdage22, posted by SLS on September 27, 2015, at 7:15:15
No i have not tried resveratrol!
You?
Posted by SLS on September 27, 2015, at 9:07:48
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 27, 2015, at 8:28:15
> No i have not tried resveratrol!
>
> You?I bought some yesterday. I'll probably start it next week. Theoretically, it might be helpful for depression. In the 1980s, I followed the development of an antidepressant drug called rolipram. I believe it is sold in Japan only. Rolipram acts sort of like an MAOI does, but for the second messenger, cAMP. It is what's known as a phosphodiesterase-4 inhibitor, and prevents the breakdown of cAMP. Resveratrol may have some anti-aging properties.
http://www.ncbi.nlm.nih.gov/pubmed/22304913
- Scott
Posted by Lamdage22 on September 28, 2015, at 2:38:41
In reply to Re: @SLS whats the word on nortriptyline?, posted by SLS on September 27, 2015, at 9:07:48
Scott,
can it be ordered from overseas?
Is it safe?
Posted by SLS on September 28, 2015, at 6:33:37
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 2:38:41
> Scott,
>
> can it be ordered from overseas?I'm not sure. I would think so. It is not a drug and is not bound by FDA regulations. This is the stuff that comes from red grape skins. Resveratrol is fairly expensive locally.
> Is it safe?
Resveratrol has been studied pretty extensively in humans and in lab animals at high dosages. I have not yet seen anything that would lead me to believe that it is at all dangerous. I don't know what the ideal dosage of resveratrol is yet. I think the minimum is 500 mg/day. I have seen 2000 mg/day.
I guess you have already read that resveratrol reduces depressive reactions to stress in rats. I like the idea that it increases BDNF and cAMP.
- Scott
Posted by SLS on September 28, 2015, at 6:41:31
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 2:38:41
Both resveratrol and the drug, rolipram, are PDE4 inhibitors that increase cAMP. I should add that as an antidepressant, rolipram by itself is not terribly effective. I am hoping that resveratrol is helpful as an augmenter.
I might be reaching. I don't have reason to be tremendously optimistic, but I think it is worth a try.
- Scott
Posted by Lamdage22 on September 28, 2015, at 8:22:21
In reply to Re: @SLS whats the word on nortriptyline? » Lamdage22, posted by SLS on September 28, 2015, at 6:41:31
Good luck.
Most of the supplements i bought disappointed me.
The next thing i will do is check if i have that nmda receptor encephalitis.
Posted by Lamdage22 on September 28, 2015, at 9:51:44
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 8:22:21
I wish i could speed up the process with Nortiptyline!
Posted by Lamdage22 on September 28, 2015, at 11:30:26
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 9:51:44
is it possible that i feel worse initially?
Posted by Lamdage22 on September 28, 2015, at 13:57:21
In reply to Re: @SLS whats the word on nortriptyline?, posted by Lamdage22 on September 28, 2015, at 9:51:44
is it possible that i feel worse initially?
Posted by SLS on September 28, 2015, at 16:09:47
In reply to I feel kind of weird though.., posted by Lamdage22 on September 28, 2015, at 13:57:21
> is it possible that i feel worse initially?
I prefer your subject line. "feel kind of weird"
Weird is not necessarily a bad thing. Does it feel like a tingly brain fog? If the depression itself is getting worse, I should think that this would be unmistakable to you. In the past, feeling "weird" has sometimes been a prelude to a subsequent therapeutic response for me.
Can you describe what you are experiencing? Try to be objective in your observations and not describe them having already concluded that they are depressive symptoms.
- Scott
Posted by Lamdage22 on September 29, 2015, at 4:46:47
In reply to Re: I feel kind of weird though.., posted by SLS on September 28, 2015, at 16:09:47
Yes kind of a brain fog and some apathy. The apathy may very well be my illness though and not the med.
Spacy might be a good description.
Posted by Lamdage22 on September 29, 2015, at 7:49:05
In reply to Re: I feel kind of weird though.., posted by Lamdage22 on September 29, 2015, at 4:46:47
> Yes kind of a brain fog and some apathy. The apathy may very well be my illness though and not the med.
>
> Spacy might be a good description.I mean spacey.
Posted by SLS on September 29, 2015, at 14:49:49
In reply to Re: I feel kind of weird though.., posted by Lamdage22 on September 29, 2015, at 7:49:05
> > Yes kind of a brain fog and some apathy. The apathy may very well be my illness though and not the med.
> >
> > Spacy might be a good description.
>
> I mean spacey.
>I misspell that word all of the time, especially when a drug makes me feel spacy.
<stupid joke>
Actually, I really do misspell that word. Thanks for the correction.
I hope things are heading in the right direction for you. You have been incredibly frustrated and disappointed, especially in modern psychiatry, that has not yet been able to provide you with an adequate improvement in your conditions.
- Scott
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