Posted by SLS on June 9, 2006, at 9:15:03
In reply to Nortriptyline Details Please, posted by blueberry on June 9, 2006, at 7:33:03
> For my endogenous melancholic severe depression I am thinking about nortriptyline. None of the ssri's or snri's do any good, actually make things much worse.
Do you feel worst in the morning?
Will this be the first time that you take a TCA?
Nortriptyline demonstrates a significant degree of antagonism at 5-HT2a/c receptors. It does bind weakly to 5-HT1a receptors, but I don't know whether it acts as an antagonist or agonist (probably antagonist). It also binds with moderate affinity to 5-HT1c receptors. Nortriptyline is more potent at the NE transporter than at the 5-HT transporter by a factor of 5-10. Chronic treatment can desensitize 5-HT1a receptors. However, the stimulation of 5-HT1a receptors can produce an increase in the release of dopamine in the prefrontal cortex. Personally, I think that the downregulation of 5-HT1a is a compensatory adjustment that prevents the chronic depolarization of postsynaptic neurons that results from 5-HT reuptake inhibition, and that this renders them more functional. I guess it is the location of these stimulated 5-HT1a receptors that is important and determines whether they will be inhibitory or facilitatory upon 5-HT neurotransmission. Ratios. Chronic antidepressant treatment is known to increase the release of dopamine in the nucleus accumbens, the reward center, perhaps via 5-HT2c antagonism.
I find nortriptyline to be more calming that desipramine. Be aware, though, that nortriptyline has a therapeutic window. If you increase the dosage too high, the antidepressant response disappears. Most people respond to 75-100mg. Monitoring blood levels is helpful with this drug. The therapeutic range is 50-150 ng/ml. This is really a just guideline to approximate dosing. A clinical titration is still necessary. I would set as a target 75mg and allow 3 weeks before raising the dosage. You will probably want to start at a lower dosage and increase gradaully. For some people, even 25mg can be soporific. You might want to start at 10mg.
Good luck. Nortriptyline is a good drug that I believe is less apt to poop-out than the SSRIs.
- Scott
poster:SLS
thread:654765
URL: http://www.dr-bob.org/babble/20060604/msgs/654790.html