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Re: Amitriptyline - Therapeutic window or not

Posted by SLS on June 13, 2005, at 21:17:11

In reply to Amitriptyline - Therapeutic window or not, posted by cliffstone on June 13, 2005, at 18:13:05

> Hi,
>
> I have found various studies and a few posts on this message board concerning a possible therapeutic window of amitriptyline. By further investigating this topic I found that there are quite a lot of contradicting information.
>
> Which seems to be clear is that nortriptyline definitely has a therapeutic window. What remains unclear to me if the same applies to amtrip as well. I had a super response at 175 mg which faded after two days or so. Now I´m on 300 mg with fairly poor results.
>
> Also I would appreciate any input in regards to augmenting the amtrip with an additional med.


Amitripytline doesn't seem to have a therapeutic window in the same way nortriptyline does. You can take too much nortriptyline and lose an antidepressant response. I don't think you can take too much amitriptyline, despite nortriptyline being its metabolite. I can't account for why this is, but I don't think there has ever been a well-established explanation for the window of nortriptyline.

If you try reducing the dosage quickly, you might experience a reboud improvement that lasts a few hours to a few days. Such a reaction would not be representative of a therapeutic window. However, given how little is understood regarding our psychobiology, I would probably want to try an intermediate dosage just to be sure.

Can you better describe the features of your illness and what you've tried in the past?


- Scott

 

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