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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by gman22 on February 20, 2023, at 18:24:31
I've been seeing a lot of articles about the relationship between anticholinergics and dementia in older people (65 and over). I've been taking nortriptyline 50mg, along with sertraline for about 6 months and have achieved remission. I don't want to risk going off nortriptyline right now, but I also don't want dementia in 10 years. Anyone know of a drug similar to nortriptyline with a lower anticholinergic load? Or should I just stay on it for now and worry about it later?
Posted by SLS on February 20, 2023, at 21:23:36
In reply to long term, posted by gman22 on February 20, 2023, at 18:24:31
Hi.
> I've been seeing a lot of articles about the relationship between anticholinergics and dementia in older people (65 and over). I've been taking nortriptyline 50mg, along with sertraline for about 6 months and have achieved remission. I don't want to risk going off nortriptyline right now, but I also don't want dementia in 10 years. Anyone know of a drug similar to nortriptyline with a lower anticholinergic load? Or should I just stay on it for now and worry about it later?
Stay on it for now, stay on indefinitely, and don't worry about it at all.
Your concerns regarding anticholinergic load and Alzheimer's Disease is absolutely warranted. However, nortriptyline is the TCA with the lowest degree of anticholinergic potency. I've been on almost all of them. I think doxepin is the only one I missed. Doxepin is not a terribly effective antidepressant. It is used more for sleep now than for depression.
My suggestion is that you stay on the nortriptyline indefinitely, smile, get high on life in the absence of depression - and don't worry about Alzheimer's Disease. I do have one suggestion regarding lithium. Unless you have already found it problematic, consider taking very low dosages of lithium to prevent Alzheimer's. The lowest dose of lithium carbonate is 150 mg. I have been taking 300 mg/day of lithium to prevent Alzheimer's Disease for over 10 years. My luck has been incredible regarding attaining remission. It turns out that I need the lithium for my treatment to work. Had I not been taking it to prevent Alzheimer's, I would have narrowly missed my miracle.
Don't use me as your sole source of information, of course. Your prudence is reassuring.
https://pubmed.ncbi.nlm.nih.gov/1600482/
https://pubmed.ncbi.nlm.nih.gov/?term=lithium+Alzheimer%27s&size=100
- Scott
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