Posted by tonyz on June 18, 2009, at 21:57:54
In reply to Re: Question about med combinations, posted by bleauberry on June 18, 2009, at 20:04:38
Thanks Blueberry for the lengthy response now you have me wondering. When I went into a day hospital last year I was taking around 125-150mg of Nortriptyline, 300mg seroquel, 150mg of trazodone, and 20mg of valium and lunesta all at bedtime.
The first change the doc made was to lower the NTP to 100mg, stop the lunesta and trazodone and increase the seroquel to 400mg. The next change was to decrease the seroquel to 300mg. The valium stayed constant at 20mg throughout the process. Next change was adding abilify 1.25mg 2x a day and increasing the NTP to 125mg. At some point around that time and this is over a 2-3 week period I was getting some improvement. The seroquel was reduced to 200mg valium to 12.5mg, same amount of Notriptyline (125mg) the abilify was taken every other day, and I asked about taking L-tryptophan and the doc didn't know it was back on the market. So I started taking 1500 mg every night. Within a week I decreased the valium to 10mg. According to my notes I was doing ok with this reduction. The abilify was the first to go completely and then gradual reductions of the seroquel and valium. The Nortriptyline was the last to go and I was med free from May 2007 through most of November which is when I relapsed.
This was not my first experience with a day hospital. Years earlier I was treated with amitriptyline but because of severe constipation the doc switched it to Nortriptyline (he didn't know about Miralax) I don't know off hand what I was taking for sleep but it was either Clonazepam, Valium or temazepam.
You seem to know quite a bit about these meds. My instinct suggested that trazodone might not be a good thing to mix in at this point.
My understanding was that Nortriptyline worked by preventing serotonin and noradrenaline from being reabsorbed back into the nerve cells in the brain.
So doesn't Notriptyline work on serotonin? Or are you saying there just isn't enough serotonin being produced with the current mix of meds.So it's 10:30 now and I have to figure out what to do?
All these guys have different opinions, while my pdoc was on vacation I called to the doc on call and he didn't recommend mixing the NTP with trazodone. So that is at least two docs that agree on something.
For tonight I think my best option is to bump up the Seroquel and continue with the Nortriptyline and try and leave the valium where it is.
I'm just looking at what you suggesting and I think I understand your theory about there not being enough serotonin to go around. I don't want to be taking a whole bunch of meds. That gets too complicated - I'm sure these drugs are never tested in combination in most clinical trials.
I'm wondering how I got better last year with what I was taking?
poster:tonyz
thread:901793
URL: http://www.dr-bob.org/babble/20090611/msgs/901923.html