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Nortriptyline Dose Too High?


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#1 Velthir

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Posted 16 July 2011 - 08:41 AM

Been on Nortriptyline for a couple of weeks now, one at 75mg and one at 100mg. Past few days I've been feeling kind of out of it (spacey/almost dizzy I guess) at times, not sure if this is likely to be the Nortriptyline or not since it tends to be happening quite a long time after I've taken it (12+ hours) rather than straight away. Pulse is also maybe a little weaker than normal. Struggling to concentrate on things too, although that can just be a depresison symptom for me.

Admittedly I'm not sure if I metabolise meds at all normally, since I've had awful issues in the past with Citalopram at 20-40mg, Cymbalta at 60-90mg but I'd have still expected to get the issues happening A: shortly after I've taken the Nortriptyline and B: that I'd have gotten problems straight after increasing to 100mg rather than several days later.

Any thoughts on the issue would be appreciated, would just get blood levels checked but it's saturday afternoon and I'm also not sure if the NHS do serum level checks as standard for Nortriptyline (GP didn't mention it at all, although she didn't know anything about it in general since it's not commonly prescribed here for depression anymore).

Edited by Velthir, 16 July 2011 - 08:43 AM.

  • 0
Dx: Dysthymia, recurrent treatment resistant depression, Bipolar II/III (antidepressant induced mixed states/hypomania)
Rx: 400 mg lamotrigine, 800 mg carbamazepine (Tegretol XR), 600 mg of bupropion SR (Wellbutrin)
Failed meds: Citalopram (Celexa), agomelatine (Valdoxan), lofepramine, mirtazapine (Remeron), sertraline (Zoloft), quetiapine (Seroquel), trimipramine (Surmontil)
Partial-success: duloxetine (Cymbalta), nortriptyline, moclobemide, aripiprazole (Abilify), reboxetine



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#2 Velthir

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Posted 17 July 2011 - 12:41 PM

Maybe feeling marginally better today since dropping down to 75mg again, still pretty awful though. Probably take a few days to stabilise at the old level I guess. Really hope I can get a GP appointment tomorrow and convince her to do serum level checks. Also kinda tempted to try to get Amisulpride or Abilify as an addon, but I'm not sure GPs can do combos like that. Especially considering potential interactions there.
  • 0
Dx: Dysthymia, recurrent treatment resistant depression, Bipolar II/III (antidepressant induced mixed states/hypomania)
Rx: 400 mg lamotrigine, 800 mg carbamazepine (Tegretol XR), 600 mg of bupropion SR (Wellbutrin)
Failed meds: Citalopram (Celexa), agomelatine (Valdoxan), lofepramine, mirtazapine (Remeron), sertraline (Zoloft), quetiapine (Seroquel), trimipramine (Surmontil)
Partial-success: duloxetine (Cymbalta), nortriptyline, moclobemide, aripiprazole (Abilify), reboxetine

#3 Velthir

Velthir

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Posted 18 July 2011 - 10:04 AM

Well, if anyone was curious, it definitely seems like my dose was too high. Back to my baseline of meh today, rather than meh + disorientation, headache, etc. Still getting at least some benefit from 75mg, just have to hope that I get more out of it since I apparently can't go higher. Wish I knew why I metabolise stuff so oddly.

Any other stuff I could suggest to GP for augmentation? SSRIs are probably a bad idea due to my experience with Cymbalta/Citalopram combined with presumably increasing levels of Nortriptyline through 2D6 inhibition. Pretty sure the dopamine agonists are only available for parkinsons here, so those are probably out too. Modafinil generally only for narcolepsy, rather than general fatigue unfortunately.
  • 0
Dx: Dysthymia, recurrent treatment resistant depression, Bipolar II/III (antidepressant induced mixed states/hypomania)
Rx: 400 mg lamotrigine, 800 mg carbamazepine (Tegretol XR), 600 mg of bupropion SR (Wellbutrin)
Failed meds: Citalopram (Celexa), agomelatine (Valdoxan), lofepramine, mirtazapine (Remeron), sertraline (Zoloft), quetiapine (Seroquel), trimipramine (Surmontil)
Partial-success: duloxetine (Cymbalta), nortriptyline, moclobemide, aripiprazole (Abilify), reboxetine


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