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Dr. Andrew Rynne

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Suggest treatment for depression even after Nortriptyline intake

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Dr. Saatiish Jhuntrraa

Sexologist

Practicing since :1983

Answered : 1525 Questions

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Posted on Sat, 9 Aug 2014 in Sexual Health
Question: I was prescribed nortriptyline for depression and. anxiety I could not tolerate ssri or snri. I am on 20 mg now fo about 10 days. Still feel quite low and non social. What should I expect. ery sensitive. Ii have to titrate slow as very sensitive. I take no other meds except klonopin.25 prn. No alcohol or smoking.
doctor
Answered by Dr. Saatiish Jhuntrraa 9 hours later
Brief Answer:
please write in detail about your symptoms

Detailed Answer:
Hello
Thanks for choosing wwwhealthcaremagic
10 days is a very short time to start expecting results. Please write in detail about your symptoms and past / family history.
Dr Saatiish Jhuntrraa
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saatiish Jhuntrraa 9 minutes later
I have had anxiety with periods of depression that have become worse. Tried several SSRI but could not increase dose to therapuetic level due to side effects. Symptoms began about 3 yearss ago with job and relationship stressors. Job still stress but ok relationaship ended abruptly in 2/14 after 6 years he walkws out no communication from that day on. headache, poor concentration, 20 lb weight loss, anxietyand poor sleep. Before this no other mood sx ? family hx of some anxiety with mom- no meds. Dose of nortriptyline increased to 25 mg tonight- does not make me sleepy. No other medical problems
doctor
Answered by Dr. Saatiish Jhuntrraa 8 minutes later
Brief Answer:
Please slowly increase dose of medicine

Detailed Answer:
Hello
Therapeutic dose for Nortriptyline is 50-150 mg . Actually there is a narrow window of effective drug level for this medicine . You should increase the dose by 25 mg every 7-10 days till you start feeling better. If no response till 75 mg, get a serum level and inform me. You can take Trazadone 25 mg for sleeping . There are many other options for sleep medicine because if you start sleeping well, your symptoms are reduced by 30%
Dr Saatiish Jhuntrraa
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saatiish Jhuntrraa 9 hours later
There is a major concern with trazadone and nortriptyline like serotonin syndrome-correct? and increased anti-cholinergic effects. Does Nortriptyline help with both the anxiety and depression or will I still need the low dose klonopin to help.
doctor
Answered by Dr. Saatiish Jhuntrraa 7 minutes later
Brief Answer:
This is a good drug for both anxiety and depressio

Detailed Answer:
Hello
Trazadone is a partial agonist of 5 HT1A , not antagonist. We intend to use it in doses enough to induce sleep so no issues. Nortriptyline is effective against both anxiety and depression . You have predominantly depression associated with anxiety . It is best amongst TCA for this but has to be used in a scientific way.
Dr Saatiish Jhuntrraa
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saatiish Jhuntrraa 11 hours later
I was given trazodone25 to sleep with the nortriptyline 25 mg the first time I took the nortriptyline but the next day was not a good day. Anxiety was overwhelming. I really limit the Klonopin to once a day from .125 to .25 mg per day as needed. Si i stopped the trazodone but could start again and not take the klonopin at night. When should I expect to feel the effects of the Nortriptyline with the anxiety and depression. Thus far tolerating 25 mg titrated up from 10 mg.
Excercising as well
doctor
Answered by Dr. Saatiish Jhuntrraa 10 hours later
Brief Answer:
Take adequate dose for adequate time

Detailed Answer:
Hello
Please don't change medicines or the dosage by yourself. It can lead to poor response to medicines. Please understand, Nortriptyline is being given for relieving depression and Trazadone is for sleep . but for antidepressant effect, you have to take adequate dose (50-150mg a day ) for adequate time( generally effect. may take 13 weeks to start showing) . It is a very tricky disease and the aim should be complete remission of symptoms.
Dr Saatiish Jhuntrraa
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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