Posted by SLS on August 9, 2009, at 15:41:29
In reply to Good Study On Nortriptyline, posted by bulldog2 on August 9, 2009, at 15:11:45
Great piece.
I noticed that one study chose 150mg as the dosage of nortriptyline tested. If nortriptyline truly has a window of efficacy with an upper bound, I'm surprised that so many people did well. Perhaps even more people would have received benefit from nortriptyline treatment if the initial dosage were lower. It would have been interesting to get a blood level from these people.
From what I have gathered, most people need only 75mg. I am a rapid metabolizer of tricyclics as tested during treatment with imipramine, desipramine, and nortriptyline. It is not surprising that I would need 150mg, but what about for people who are not rapid metabolizers?
I am very happy to see the tricyclics revisited. Nortriptyline is probably the friendliest of all of them. Its side effects are the mildest, and its rate of efficacy is not much lower than imipramine.
With regard to combining a tricyclic with a MAOI, nortriptyline and desipramine (and perhaps trimipramine) are really the only ones that can be used at full therapeutic dosages. The other TCAs are too serotoninergic and often produce serotonin syndrome when used.
There are people whom respond much better to desipramine than nortriptyline and vice versa. If one fails to respond to one of these two drugs, it can be justified to try the other.
- Scott
poster:SLS
thread:911146
URL: http://www.dr-bob.org/babble/20090801/msgs/911154.html