![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by jonh kimble on October 30, 2004, at 1:51:37
Hi. I take ritalin (more as needed). It CAN make me very alert and focused and all is good. But it can easily switch over to something very bad, actually the opposite of the abbove. I become stressed and extremely self conscious, pessimistic, cant concentrate on things from one second to the next and basically anxiety goes way up. I tried dex in the past but it did nothing. Maybe my dose was low. Anyway, I can ask my doc on Tues. for rit. adderall, strattera, ect. Im thinking higher dose adderall, like 50 60 mgs. Well who knows, just more than 30 mgs. of dex I tried. And just as a guiding hint, methamphetamine when I snorted it once, was great. (dont worry I know this aint a good long term deal) So amphetamines can have an effect on me. Thanks Tom
Posted by Sad Panda on October 30, 2004, at 2:59:00
In reply to Stimulant with least anxiety side effects?, posted by jonh kimble on October 30, 2004, at 1:51:37
The old TCA Nortriptyline is both a stimulant & an anxiolytic. It also has a long half life which smooths out the ups & downs. I would take as much Nortriptyline as possible & then use ritalin or amphetamines to fine tune.
Cheers,
Paul.
Posted by King Vultan on October 30, 2004, at 11:15:12
In reply to Stimulant with least anxiety side effects?, posted by jonh kimble on October 30, 2004, at 1:51:37
> Hi. I take ritalin (more as needed). It CAN make me very alert and focused and all is good. But it can easily switch over to something very bad, actually the opposite of the abbove. I become stressed and extremely self conscious, pessimistic, cant concentrate on things from one second to the next and basically anxiety goes way up. I tried dex in the past but it did nothing. Maybe my dose was low. Anyway, I can ask my doc on Tues. for rit. adderall, strattera, ect. Im thinking higher dose adderall, like 50 60 mgs. Well who knows, just more than 30 mgs. of dex I tried. And just as a guiding hint, methamphetamine when I snorted it once, was great. (dont worry I know this aint a good long term deal) So amphetamines can have an effect on me. Thanks Tom
From what I've read, too much of these drugs can cause problems like this. I believe Adderall is worse than dexedrine as far as "wiring" a person and causing anxiety, but I have no personal experience with true stimulants myself. I've also seen people advocate the slower release forms, such as Concerta and Adderall XR, as being smoother and helping to avoid these periods of overstimulation. They are more expensive, but how much so depends on your insurance situation.Todd
Posted by Kristel on October 30, 2004, at 19:15:42
In reply to Nortriptyline, posted by Sad Panda on October 30, 2004, at 2:59:00
> The old TCA Nortriptyline is both a stimulant & an anxiolytic. It also has a long half life which smooths out the ups & downs. I would take as much Nortriptyline as possible & then use ritalin or amphetamines to fine tune.
>
> Cheers,
> Paul.
>Does Nortriptyline cause the typical SSRI's sexual side effets?
Thanx
Posted by ed_uk on October 30, 2004, at 19:24:14
In reply to Re: Nortriptyline » Sad Panda, posted by Kristel on October 30, 2004, at 19:15:42
Sexual side effects are uncommon with nortriptyline. The typical anorgasmia experienced with SSRIs is unlikely to occur with nortriptyline.
Ed
Posted by banga on October 31, 2004, at 12:51:47
In reply to Re: Nortriptyline » Sad Panda, posted by Kristel on October 30, 2004, at 19:15:42
So what's the down side of nortryptiline ?? Is there weight gain? It sounds like my next best try if Cymbalta doesn't work out...I responded to clomipramine but the weight gain was too much, two weeks of cabbage soup diet and exersise didn't solve it.....
Posted by ed_uk on October 31, 2004, at 12:56:38
In reply to Re: Nortriptyline-Sad Panda, posted by banga on October 31, 2004, at 12:51:47
Hi,
Nortriptyline sometimes causes weight gain but it's generally thought to be less problematic than most TCAs in that sense. Desipramine rarely causes weight gain.
Ed
Posted by banga on October 31, 2004, at 13:30:54
In reply to Re: Nortriptyline-Sad Panda, posted by ed_uk on October 31, 2004, at 12:56:38
What action of nortriptyline in theory acts as an anxiolytic? Is there a link somewhere where its action is mapped out? I have this handy pie-chart of method of action for Geodon (I think it's gone now from the "geodon" website), wouldn't it be nice if all drugs used this system?
Posted by blnch on October 31, 2004, at 15:38:05
In reply to Re: Nortriptyline-Sad Panda, posted by banga on October 31, 2004, at 12:51:47
re: downside - if you are prone to GERD (reflux disease), I'd avoid nortrip. like the plague.
Posted by banga on October 31, 2004, at 17:20:49
In reply to Re: Nortriptyline » banga, posted by blnch on October 31, 2004, at 15:38:05
>>re: downside - if you are prone to GERD (reflux disease), I'd avoid nortrip. like the plague.
How ironic...never had a stomach problem, but just last month I have come down with what seems to be stomach wall erosion. Befor that, Nortriptyline would have not been a problem it seems...
Given cymbalta's profile, does it not sound a little like a "cleaned up" TCA?
Posted by blnch on October 31, 2004, at 19:51:37
In reply to Re: Nortriptyline, posted by banga on October 31, 2004, at 17:20:49
Did tests determine this "stomach wall erosion?" (am not familar with term) Are you saying that this erosion happened to coincide with Cymbalta? If so....YIKES!
In my darker moments, I do believe that we are supposed to be content with irony over efficacy!
Posted by Sad Panda on November 1, 2004, at 3:57:10
In reply to Re: Nortriptyline-Sad Panda, posted by banga on October 31, 2004, at 12:51:47
> So what's the down side of nortryptiline ?? Is there weight gain? It sounds like my next best try if Cymbalta doesn't work out...I responded to clomipramine but the weight gain was too much, two weeks of cabbage soup diet and exersise didn't solve it.....
>
>Hi Banga,
If you gain weight on Clomipramine, you will probably gain weight on Nortriptyline. They are fairly similar, the only real difference is Nortriptyline is an insignifcant SRI which means you can add it on to some of the SSRI's & Effexor. This produces a combination that has less side effects than an SSRI or TCA alone.
Cheers,
Paul.
Posted by Sad Panda on November 1, 2004, at 4:08:37
In reply to Re: Nortriptyline » banga, posted by blnch on October 31, 2004, at 15:38:05
> re: downside - if you are prone to GERD (reflux disease), I'd avoid nortrip. like the plague.
>
>I don't know anything about GERD, but the TCA's such as Nort reduce stomach acid. Doxepin is prescribed for people with stomach ulcers.
Cheers,
Paul.
Posted by banga on November 1, 2004, at 5:08:40
In reply to Re: Nortriptyline » banga, posted by blnch on October 31, 2004, at 19:51:37
No, the gastric problems occurred before I started Cymbalta. With Cymbalta, I had very mild nausea for one day. The only med that could have been involved is amantadine, which I had started one month before this problem. They haven't diagnosed exactly what is wrong, I had constant nausea for 8 weeks and my lipase levels were high (possible pancreas problems) but since pancreas looks fine, and Prevacid has helped, they are thinking pre-ulcerative condition...
Posted by banga on November 1, 2004, at 5:19:07
In reply to Re: Nortriptyline-blnch, posted by banga on November 1, 2004, at 5:08:40
Thanks! In my seeking out candidates for the next miracle combo, I now have put down nortryptiline as an option...someone wrote that amantadine may counteract weight gain? I'm on that now. The reason I am interested in nortryptiline are its possibilities with helping anxiety-I cant take benzos.
Would Cymbalta and notryptiline work together, or would that be NE overload do you think? For depression/anxiety/braindead feeling, I was thinking possibly a Cymbalta/Provigil/nortryptiline (small small dose) combo.
Thanks for your help, it's so great to have this board and people for support...
Posted by ed_uk on November 1, 2004, at 9:00:33
In reply to Re: Nortriptyline-Sad Panda, posted by banga on November 1, 2004, at 5:19:07
Hello :) ........
Combining nortriptyline with duloxetine isn't the most logical combination because they both inhibit the reuptake of norepinephrine. It would be more usual to combine nortriptyline with an SSRI, Provigil could then be added if necessary. It would be sensible to try nort on its own first, and then combine it with other drugs at a later date if need be. Some SSRIs alter the metabolism of nort whereas others have little effect. Zoloft, Celexa and Lexapro are probably the easiest SSRIs to combine with nort because they would only minimally effect its metabolism. Nortriptyline may be expected to reduce anxiety by acting as a 5-HT2a antagonist, this property may also reduce some of the side effects of SSRIs. Btw, why can't you take benzos?
You are right to be worried about weight gain with nort- it could be a problem but not necessarily. As far as I know nort is relatively easy to come off, probably a lot easier than clomipramine (so if you did have problems you could always discontinue it.)
Nortriptyline isn't a problem for people with stomach ulcers, it slightly reduces the secretion of gastric acid. It may worsen reflux though because it slows the motility of the stomach.
Ed
Posted by banga on November 1, 2004, at 12:59:18
In reply to Re: Nortriptyline-Sad Panda, posted by ed_uk on November 1, 2004, at 9:00:33
Thanks for the response. I guess I'm tackling from the other end, starting with Cymbalta. I'm leery of benzos due to a past hx of alcohol dependence. Even though my guess is I wouldn't overly abuse them, the potential is there. I did try xanax a couple of times, but I was using alcohol so I can't say it helped; and lorazepam intermittently for a while, but also wasn't sure; I think if I twisted my doc's arm he'd let me try klonopin, I almost want to just to see how I feel--for diagnosis of how much my troubles are specifically anxiety as opposed to depression.
But for now, I'm looking at all kinds of meds with a supposed anxiolytic effect. Currently: Cymbalta 40mg, Lexapro 5mg(weaning off), ziprasidone 40mg, amantadine 200mg. Ziprasidone seems to help--it too is a 5HT2a antagonist,maybe that's why? but it also leaves me in a fog. I haven't been able to locate what specific nt sites (all they ever say is "serotonin and norepinephrine reuptake inh")Cymbalta affects, do you by chance know??
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.