# Why is Nortriptyline a good augment to Zoloft?



## Iwillovercomeanxiety1 (Aug 23, 2010)

What makes Nortriptyline a good augment to Zoloft? I just got it prescribed. I am currently on 200 mg of Zoloft. I'm curious as to how it interacts with Zoloft to effectively augment it. And will it helps with the symptoms that I'm experiencing? 

Some of my symptoms are low confidence, moderate depression, fatigue, unmotivated, anhedonia, don't get refreshing sleep, difficulty concentrating, and anxiety.


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## watertouch (Nov 4, 2013)

Iwillovercomeanxiety1 said:


> What makes Nortriptyline a good augment to Zoloft? I just got it prescribed. I am currently on 200 mg of Zoloft. I'm curious as to how it interacts with Zoloft to effectively augment it. And will it helps with the symptoms that I'm experiencing?
> 
> Some of my symptoms are low confidence, moderate depression, fatigue, unmotivated, anhedonia, don't get refreshing sleep, difficulty concentrating, and anxiety.


Then it will probably work well, Nortriptyline works as an antihistamine that can help with anxiety, and also has some anticholinergic effect, that can boost dopamine...

Another combo is Wellbutrin/bupropion its works as an NRI combo comon refered to as "well-loft" or "well-oft" if one got some gallow humor 
But that could probably increase anxiety, atleast at first.

http://psychotropical.com/clomipramine-potent-snri-anti-depressant


> It is worth observing also that the SNRI combination of sertraline with nortriptyline is in my view superior to sertraline with reboxetine (a 'pure' NRI drug). That suggests the extra properties enumerated above (and which are possessed to a similar degree by most TCAs, including nortriptyline)


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## ladysmurf (Jan 3, 2012)

Notriptyline takes a while to work from what my psychiatrist told me and it can have some pretty nasty side effects. I remember my mind was VERY foggy for the first 2 weeks, I was sleepy, tired, I could barely function at work/school. Plus I had vivid dreams. Eventually I had to stop it because it was bothering my heart and I had muscle pain and other side effeccts

But give it some time, that was my experience, everyone reacts different. Good luck!


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## Iwillovercomeanxiety1 (Aug 23, 2010)

watertouch said:


> Then it will probably work well, Nortriptyline works as an antihistamine that can help with anxiety, and also has some anticholinergic effect, that can boost dopamine...
> 
> Another combo is Wellbutrin/bupropion its works as an NRI combo comon refered to as "well-loft" or "well-oft" if one got some gallow humor
> But that could probably increase anxiety, atleast at first.
> ...


Thanks. How long do you think I should give it to kick in and at what dose? I'm dosing at 25 mg for one week and then 50 mg after that. Will 50 mg be a high enough dose?


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## Iwillovercomeanxiety1 (Aug 23, 2010)

Anyone know how long I should give nortriptyline to work with Zoloft and at what dose? Also, do side effects like sedation and foggy thinking usually subside or persist?


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## watertouch (Nov 4, 2013)

Ive been on it several times, and with different augmentations... What i feel when it "starts" working is that Caffeine and Nicotine doesn't effect me as much as before.

This could of course be due to "downregulation" of Beta receptors and would explain how Medicins that works on Noradrenalin actually can be used for anxiety...

The Anticholinergic side effects you feel, like someone punched you in the face,+ dry mouth, it will get better. You will also get "used" to it...

I have yeat to try this, but adding some Cholinergic supplement, Or eat more eggs. Altough one of the effect of being anticholinergic is to increase Dopamin...

For your mix there, I would Maybe go for 100+ Zoloft... and 50-75mg Nortriptylin. You probably gonna need higher dose later on the Nortriptyline

Nortriptyline is one of those drugs that has a "therapeutic" range one could messure in blood, If one has time and money. or the energy. And as you can see the marginal i kinda big...
50–150 ng/ml (equal 200–600 nmol/l)


As my Grampa used to say, when in doubt, Always use more explosives!


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## jaiho (Feb 14, 2015)

It's best to try to find the therapeutic range with Nortriptyline. the anti cholingergic side effects kick in harder above 75mg.
It augments well with SSRIs. It's Dr Gillman's first choice before moving a patient to an MAOI.

In a pharmalogical sense, the Zoloft is blocking SERT, and at higher doses, some DAT inhibition.
Nortriptyline covers the NE, and blocks 5HT2A & 5HT2C quite strongly. This will disinhibit dopamine in the prefrontal cortex, and allow you to sleep better.

To start with, Nortriptyline i find isn't pleasant, you might feel stimulated, then sleepy, as it has both stimulating and sedating properties, as it blocks the histamine receptor.
You'll get used to the side effects within a few weeks, and the only thing that seems to stick around is the dry mouth.
I find it isn't that bad, at around 75mg.


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## Iwillovercomeanxiety1 (Aug 23, 2010)

Thanks a lot for all of the information. I'm about a week in on 50 mg of Nortriptyline and am feeling pretty tired. Also feeling kind of sad and unmotivated so far. I hope it kicks in soon. I really need some relief from my anxiety and depression.


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## Iwillovercomeanxiety1 (Aug 23, 2010)

My anxiety is pretty bad right now. I'm wondering if Baclofen would be a nice add on to the Zoloft and nortriptyline? Then I'd have serotonin, dopamine, norepinephrine, and gaba all in play. I know I've only been on nortriptyline for a little over a week but I'm just frustrated and need some relief fast!


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## Iwillovercomeanxiety1 (Aug 23, 2010)

I'm like a week and a half in on Nortriptyline. On 50 mg. I'm having a lot of side effects. I'm really tired. It's making me want to throw in the towel.


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## watertouch (Nov 4, 2013)

Iwillovercomeanxiety1 said:


> I'm like a week and a half in on Nortriptyline. On 50 mg. I'm having a lot of side effects. I'm really tired. It's making me want to throw in the towel.


Thats seems like a strong reaction, or to low dose...
Are known to be sensitive to medicines? 
U could be a Slow Metaboliser...

Have you taken medicines that have AntiHistamine or anticholinergic propertys before?

But you should probably call your Dr. If its making you feel that bad that you wan't to throw in the towel!


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## Iwillovercomeanxiety1 (Aug 23, 2010)

watertouch said:


> Ive been on it several times, and with different augmentations... What i feel when it "starts" working is that Caffeine and Nicotine doesn't effect me as much as before.
> 
> This could of course be due to "downregulation" of Beta receptors and would explain how Medicins that works on Noradrenalin actually can be used for anxiety...
> 
> ...





jaiho said:


> It's best to try to find the therapeutic range with Nortriptyline. the anti cholingergic side effects kick in harder above 75mg.
> It augments well with SSRIs. It's Dr Gillman's first choice before moving a patient to an MAOI.
> 
> In a pharmalogical sense, the Zoloft is blocking SERT, and at higher doses, some DAT inhibition.
> ...





watertouch said:


> Thats seems like a strong reaction, or to low dose...
> Are known to be sensitive to medicines?
> U could be a Slow Metaboliser...
> 
> ...


Yeah I think I'm going to stop taking it. It didn't seem worth the side effects. Do you know other medications that could be good augments to Zoloft? Reboxetine maybe? Anything else that would work synergically for anxiety and depression and help hit the right receptors along with Zoloft?


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## watertouch (Nov 4, 2013)

Wellbutrin seems comen, the "well-loft" combo as it called... It has more effect on Dopamine then Reboxetin.

I tried Edronax/Reboxetin but by itself, I think i was sweating abit more/altough it was in the summer, i also got more tolerant to caffeine and nicotine.... It have that effect that the body get used to it... But it was pretty mild side effect if any, from what i recall.

You can read here from Stahl's prescribersguide on Augments for Zoloft

http://stahlonline.cambridge.org/pr...erapeutics&name=Sertraline&title=Therapeutics


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