# Nortriptyline (Tricyclic): Seratonin/norepinephrine ratio question



## peaceandlove09 (Aug 10, 2010)

Hi there, 

I was recently prescribed a tricyclic called "Nortriptyline" ... I had previously tried Wellbutrin for depression, but I felt too anxious and jittery on it. 

From what I understand, Nortriptyline targets both seratonin and norepinephrine.

From what I have read, as you increase the dose, you increase the norepinephrine more than the seratonin. So the higher the dose, the higher the norepinephrine to seratonin ratio. 

Is this true or false? 

How has your experience been w. Nortriptyline? 


Thanks,


----------



## redtogo72 (Jun 7, 2008)

I haven't tried it, and don't know much about it.

Here's some user reviews for it: http://www.askapatient.com/viewrating.asp?drug=18013&name=PAMELOR

http://www.askapatient.com/viewrating.asp?drug=73553&name=NORTRIPTYLINE HCL


----------



## hensley258 (Apr 24, 2010)

Eric69 said:


> Hi there,
> 
> I was recently prescribed a tricyclic called "Nortriptyline" ... I had previously tried Wellbutrin for depression, but I felt too anxious and jittery on it.
> 
> ...


Yes you are correct. I took Nortriptilyne for 18 months, but had to switch AD meds after it pooped out on me. (That doesn't mean it will poop out on you) I am a freak of nature and for some odd reason I build up antidepressant resistance super fast. Hence why I take MAOI now.

I found Nortriptilyne to feel and act almost the same as High Dosage Effexor XR. Granted Nortrip is a tricyclic and Effexor is an SNRI, but they both do the same thing just in a little different way.

Nortriptilyne at low dosage effects mainly Serotonin, but at higher dosages the Norephinepherine action kicks in good. It's kind of in between Amitriptilyne and Protriptilyne. It's like the middle child.

Hey, I got 1 year of remission from Nortrip so you can't beat that with a stick. It's a good safe drug and I think under prescribed. Many people think that Tricyclics always have a higher occurance of side effects than SSRI's and SNRI's, but studies indicate this is not at all true. I trust those studies because the side effects I had from a few different tricyclics were no worse than with SSRI or SNRI.

I wish I could remember for you the Nortrip dosage I was taking, but it was long ago. I do know it was a high dosage, but Nortrip is a safe drug. I think good chance you will really like Nortriptilyne. I know I did. If it worked for my stubborn Severe depression then I know it can work for most people. My depression has always been a tough nut to crack.

Parnate (MAOI) now then we can start talking some VERY nasty side effects most can't handle. MAOI is the only drug that is really kicking my butt in the side effect department.


----------



## Noca (Jun 24, 2005)

I tried Nortriptyline at 50mg for 5 months, it did nothing. I since switched to Paxil and it has helped me a lot! Nortriptyline didn't work as an anti-depressant at that dose apparently according to a psychiatrist, which is prolly why it didn't work.

The only side effect I got was dry mouth.


----------



## peaceandlove09 (Aug 10, 2010)

Hey hensley, thanks for your reply.

Did you have libido side effects with Nortriptilyne? The reason I am taking it, is because the doctor said it had less sexual side effects than an SSRi.

It's too early to tell if it's gonna work for me but so far very few side effects aside from dry mouth. I pretty much feel normal on it. Whereas on Wellbutrin i felt like i was "ON" something. I didn't like that.

I think i'm gonna aim for a medium dose. I'm sensitive to Norephinepherine, and i want a good seratonin/norephinepherine balance.

I am pretty optimistic about this medication because of the low side effect profile.

What sides are you experiencing from Parnate? I asked my doctor about an MAOI and he almost prescribed it, but then said "let's try this first"

Cheers,



hensley258 said:


> Yes you are correct. I took Nortriptilyne for 18 months, but had to switch AD meds after it pooped out on me. (That doesn't mean it will poop out on you) I am a freak of nature and for some odd reason I build up antidepressant resistance super fast. Hence why I take MAOI now.
> 
> I found Nortriptilyne to feel and act almost the same as High Dosage Effexor XR. Granted Nortrip is a tricyclic and Effexor is an SNRI, but they both do the same thing just in a little different way.
> 
> ...


----------



## peaceandlove09 (Aug 10, 2010)

Dr House said:


> The only side effect I got was dry mouth.


Yeah, i'm already experiencing the dry mouth. I asked the pharmacist and he recommended "sugarless candy" .. and sipping water throughout the day.

Cheers,


----------



## hensley258 (Apr 24, 2010)

Eric69 said:


> Yeah, i'm already experiencing the dry mouth. I asked the pharmacist and he recommended "sugarless candy" .. and sipping water throughout the day.
> 
> Cheers,


Sexual side effects for me were not too bad, but they were there. About the same as Effexor.

Parnate? Ugh, I can speak for all on this MAOI, but the side effects are almost too many for me to list and they are powerful side effects. If you take your whole dosage at one time, it will cause a really hard heart beat that pounds your chest. Your beats per minute will also raise to an uncomfortable level even though your BP is ok.

Bowl problems, sleepiness, fatuge, yet the drug will not allow sleep. At this point I am ready to taper off only because it's just not working that well to help my depression or anxiety. This really comes as a shock and huge dissapointment for me because MAOI was sort of my last ditch swan song effort to get relief. It works for most that try it and when it fails that means my options after 20 years on meds are severly limited.

I'm afrade my condition has just gotten to the point where ECT may be the only real option left for me. 7 years ago I did get a few really good years from Effexor before it faded on me, but much time has gone by and I may try Effexor XR at 375Mgs a day combined with Remeron at night. I hear the combination can be very potent.

First I need to talk my doc into giving me Diazipam so I can have a better lighter benzo to do a slower taper with. (she wants me off Klonopin) Which I think sucks because the withdrawls are like living hell. Diazepam with it's 200 hour half life and larger tablet will allow a smoother progression off.


----------



## jim_morrison (Aug 17, 2008)

Nortriptyline is actually primarily Noradrenergic, and only has a weak effect on serotonin reuptake. It does have some sedating effects so it may cause less jitteriness than wellbutrin.


----------



## crayzyMed (Nov 2, 2006)

hensley258 said:


> Sexual side effects for me were not too bad, but they were there. About the same as Effexor.
> 
> Parnate? Ugh, I can speak for all on this MAOI, but the side effects are almost too many for me to list and they are powerful side effects. If you take your whole dosage at one time, it will cause a really hard heart beat that pounds your chest. Your beats per minute will also raise to an uncomfortable level even though your BP is ok.
> 
> ...


The last resort is a MAOI+Nortriptyline+Stimulant, try and get that, fredericmurea here had some good tips on getting that combo.

http://www.dr-bob.org/babble/20090801/msgs/911205.html


----------



## hensley258 (Apr 24, 2010)

crayzyMed said:


> The last resort is a MAOI+Nortriptyline+Stimulant, try and get that, fredericmurea here had some good tips on getting that combo.
> 
> http://www.dr-bob.org/babble/20090801/msgs/911205.html


Whew! That sounds dangerous. I honestly don't think I would be able to talk my P-doc into adding a Tricyclic and stimulant to my Parnate.

Isn't that combo asking for a hypertensive reaction? They always say never combine MAOI with other AD meds or Stimulants. Sounds scary.


----------



## crayzyMed (Nov 2, 2006)

It isnt dangerous if the drugs are combined carefully, not something i recommend for everything but its something for very treatment resistant patients.



> 1: J Clin Psychopharmacol. 1991 Apr;11(2):127-32.
> 
> CNS stimulant potentiation of monoamine oxidase inhibitors in
> treatment-refractory depression.
> ...


----------



## peaceandlove09 (Aug 10, 2010)

jim_morrison said:


> Nortriptyline is actually primarily Noradrenergic, and only has a weak effect on serotonin reuptake. It does have some sedating effects so it may cause less jitteriness than wellbutrin.


Yeah i think you are right.

I think that's why my doc recommended it, bceause if it was primarily serotonin, I would have more sexual dsyfunction issues. I think as you raise the dose, it becomes more and more noradrenergic.

But compared to Wellbutrin it's a walk in the park. Wellbutrin gave me the feeling that i was "ON" something. Nortriptyline feels much more gentle, and doesn't feel like i'm on some drug or medication.

Cheers,


----------



## peaceandlove09 (Aug 10, 2010)

hensley258 said:


> Bowl problems, sleepiness, fatuge, yet the drug will not allow sleep. At this point I am ready to taper off only because it's just not working that well to help my depression or anxiety. This really comes as a shock and huge dissapointment for me because MAOI was sort of my last ditch swan song effort to get relief. It works for most that try it and when it fails that means my options after 20 years on meds are severly limited.


This forum seems to love the medication, Nardil. Have you tried that already?

Cheers,


----------



## hensley258 (Apr 24, 2010)

Eric69 said:


> This forum seems to love the medication, Nardil. Have you tried that already?
> 
> Cheers,


I thought about Nardil, but I hear people say it's kind of sedating and given I have Atypical depression sedation is not what you want.

On the flip side Parnate has pissed me off because it has made me sleepy, lathargic, and tired, yet I swear the drug will not allow the brain to shut down for sleep. My P-doc refuses to give me anything for sleep because she's afrade to combine anything with MAOI Parnate.

This is resulting in periods where I don't sleep for up to 48 hours. Not manic, I just can't sleep on it which is having a negitive effect on my Depression. That's how the brain replenishes needed chemicals to fuction. Thus any good AD effect I am getting on Parnate is being destroyed by lack of sleep.

It a really weird drug.


----------



## BearFan (Mar 22, 2008)

Pamelor is still readily prescribed and works well for some people. Although I am not aware that the dosage change causes different reuptake ratios. I believe it works on NE slightly more than SE but on SE much more than desimpramine. Some people combine it with SSRIs


----------



## areq1987 (Jul 10, 2010)

In my country doctors can use it only in hospitals. Really strong ****.


----------



## peaceandlove09 (Aug 10, 2010)

BearFan said:


> Pamelor is still readily prescribed and works well for some people. Although I am not aware that the dosage change causes different reuptake ratios. I believe it works on NE slightly more than SE but on SE much more than desimpramine. Some people combine it with SSRIs


Thanks for your reply.

I feel a bit calmer, but that's about it.

Hopefully i'll see some more benefits over the next few weeks.

Cheers


----------



## peaceandlove09 (Aug 10, 2010)

areq1987 said:


> In my country doctors can use it only in hospitals. Really strong ****.


Really?

The side effect profile doesn't seem that bad. It feels fairly gentle so far.

I think because it is an older medication, people assume the "new shiny" SSri's are safer and better. But from what i have researched, this med seems pretty solid, and has good feedback on it.

Cheers


----------



## areq1987 (Jul 10, 2010)

Eric69 said:


> But from what i have researched, this med seems pretty solid, and has good feedback on it.


I agree. Now I'm on paroxetine, but if it fails for my SA I'll try something from TCAs like anafranil or maybe amitriptyline..


----------



## hensley258 (Apr 24, 2010)

Eric69 said:


> Really?
> 
> The side effect profile doesn't seem that bad. It feels fairly gentle so far.
> 
> ...


I have to say that weird also because I took Nortriptilyne for 18 months and never noticed it being any more potent or powerful than drugs like Effexor, Protriptilyne or the dozens of others I have taken in the past.

I don't know for sure if Nortriptilyne has a higher Norephinepherine effect at higher dosages such as we know Effexor does, but I do know when I raised dosage that the drug felt more energizing so I'm going on a hunch.


----------



## meyaj (Sep 5, 2009)

nortriptyline was a pretty awesome drug for me at 150mg. Didn't do everything I needed (which is why I'm now on Parnate... which I also take with Dexedrine), but it definitely did a lot of good things. Sleep quality and daytime energy really improved. The only real side effect was dry mouth, which can be dealt with in a few different ways.


----------



## hensley258 (Apr 24, 2010)

meyaj said:


> nortriptyline was a pretty awesome drug for me at 150mg. Didn't do everything I needed (which is why I'm now on Parnate... which I also take with Dexedrine), but it definitely did a lot of good things. Sleep quality and daytime energy really improved. The only real side effect was dry mouth, which can be dealt with in a few different ways.


What is your Parnate dosage? I finnaly got mine up to 30Mgs but it's still just barly working except for the side effects.


----------



## Medline (Sep 23, 2008)

hensley258 said:


> What is your Parnate dosage?


Look at his signature.


----------



## meyaj (Sep 5, 2009)

hensley258 said:


> What is your Parnate dosage? I finnaly got mine up to 30Mgs but it's still just barly working except for the side effects.


50mg, just in case for some weird reason you CAN'T see my signature :lol


----------



## jim_morrison (Aug 17, 2008)

meyaj said:


> nortriptyline was a pretty awesome drug for me at 150mg. Didn't do everything I needed (which is why I'm now on Parnate... which I also take with Dexedrine), but it definitely did a lot of good things. Sleep quality and daytime energy really improved. The only real side effect was dry mouth, which can be dealt with in a few different ways.


That's really cool that this med managed to improve both your sleep quality and daytime energy, sounds like it would actually be a really good med for chronic fatigue syndromes.


----------



## peaceandlove09 (Aug 10, 2010)

meyaj said:


> nortriptyline was a pretty awesome drug for me at 150mg. Didn't do everything I needed (which is why I'm now on Parnate... which I also take with Dexedrine), but it definitely did a lot of good things. Sleep quality and daytime energy really improved. The only real side effect was dry mouth, which can be dealt with in a few different ways.


Hey that's cool.

Do you remember how long it took to feel some benefits?

I'm on week 1 and i just feel kinda spacey. No mood or energy benefits yet.

Thanks,

Cheers,


----------



## peaceandlove09 (Aug 10, 2010)

Today I feel very sad. 

I almost feel like cryin' 

Is this normal????????????? :um

I would have thought the Nortriptyline would have kicked in a little bit by now. 


Cheers.


----------



## jim_morrison (Aug 17, 2008)

What dose are you currently on, and do you usually take it before bed?


----------



## peaceandlove09 (Aug 10, 2010)

jim_morrison said:


> What dose are you currently on, and do you usually take it before bed?


I am on 50mg. I am supposed to taper up soon.

But i feel so freakin' sad today. Worse than before I started!!!?!!


----------



## jim_morrison (Aug 17, 2008)

I would assume that you will probably need to hit a higher dose before it's energizing and antidepressant effects are felt. 

But when you take it, it does have an immediate acting sedative effect, which is why most people take it before bed. Just checking that you weren't taking it during the daytime then experiencing the sedative effects and mistaking them for feeling depressed.


----------



## peaceandlove09 (Aug 10, 2010)

jim_morrison said:


> I would assume that you will probably need to hit a higher dose before it's energizing and antidepressant effects are felt.
> 
> But when you take it, it does have an immediate acting sedative effect, which is why most people take it before bed. Just checking that you weren't taking it during the daytime then experiencing the sedative effects and mistaking them for feeling depressed.


Hey Jim,

I'm taking it a few hours before bed. It definetly knocks me out. I had a very deep/restful sleep last night.

I think i'm expecting TOO MUCH, TOO SOON. I will give it another few weeks, and reevaluate at that time.

Best,

Cheers,


----------



## peaceandlove09 (Aug 10, 2010)

UPDATE: 

All of a sudden i feel a bit better. I felt awful until about 12:30pm this morning. Then I started to feel a bit better, and better, and now I feel OK. 

It makes me think the med is doing SOMETHING in my system, and it'll take time to stabilize. 


Cheers,


----------



## hensley258 (Apr 24, 2010)

meyaj said:


> 50mg, just in case for some weird reason you CAN'T see my signature :lol


I see now. I guess I wasn't looking hard enough. I'm still having a lot of break thru depression and anxiety on 30Mgs a day Parnate. Do you think going up in dosage might help?

Also, I have this damn hand tremmor again in both hands. You know of anything I can take to help this that's safe with MAOI?


----------



## jim_morrison (Aug 17, 2008)

Eric69 said:


> Hey Jim,
> 
> I'm taking it a few hours before bed. It definetly knocks me out. I had a very deep/restful sleep last night.
> 
> ...


That's good that it helps you achieve a restful sleep, that in itself can help with depression sometimes.

But yeah give it time, and also I think the max dose is 150 mg, so you may require a higher dose to feel it's antidepressant effect (tapering up slowly.)


----------



## meyaj (Sep 5, 2009)

It took a while to start working really well, but after I got on the maximum dose (150mg), it had by far the best benefits after only a few weeks at that dose. I don't know what does you are on now (anything less than 100mg isn't really good for this, but lower doses can be used to treat OTHER things), but if you can tolerate it, I strongly recommend working your way up to 150mg. With SSRIs I really had no issue just going straight to the highest dose, but with nortriptyline and other tricyclics it's probably a much better idea to increase the dose slowly (like 25mg every 1-2 weeks, even).


----------



## peaceandlove09 (Aug 10, 2010)

Hey man

Thanks for your reply.

Cheers,



meyaj said:


> It took a while to start working really well, but after I got on the maximum dose (150mg), it had by far the best benefits after only a few weeks at that dose. I don't know what does you are on now (anything less than 100mg isn't really good for this, but lower doses can be used to treat OTHER things), but if you can tolerate it, I strongly recommend working your way up to 150mg. With SSRIs I really had no issue just going straight to the highest dose, but with nortriptyline and other tricyclics it's probably a much better idea to increase the dose slowly (like 25mg every 1-2 weeks, even).


----------



## peaceandlove09 (Aug 10, 2010)

meyaj said:


> It took a while to start working really well, but after I got on the maximum dose (150mg), it had by far the best benefits after only a few weeks at that dose.


When you say "to start working really well" what type of benefits did you feel?

How did you feel when it started to work really well?

Thanks man,


----------



## meyaj (Sep 5, 2009)

Eric69 said:


> When you say "to start working really well" what type of benefits did you feel?
> 
> How did you feel when it started to work really well?
> 
> Thanks man,


Definitely somewhat less anxiety, though just a modest boost. I should point out though that I've been classified as "very severe" in the areas of depression, SA, and GAD, to the point where a few doctors have recommended I try ECT (electroconvulsive therapy aka electroshock). So modest improvements for me MIGHT still be huge improvements for other people.

The boost in sleep quality and daytime energy that I mentioned earlier were absolutely HUGE improvements though. I was able to significantly cut down on my sleeping medication, and I felt like I could actually do stuff :lol It was a great feeling. And when I still did feel anxious, I wasn't sweating nearly as much, if at all (but that's largely due to the anticholinergic effects).

The side effects were MOSTLY dry mouth, but my dental hygienist suggested a mouthwash called Biotene which fixed that (it's an enzymatic mouthwash that is, for all functional purposes, artificial saliva :lol). Alcohol-based mouthwashes are a no-no, they will just dry out your mouth even more. Dry mouth might not seem like such a big deal, but it's actually a very serious side effect. When you see pictures of meth-heads and all their teeth have fallen out, that's not really from any actual toxic effects of the drugs. It's a result of chronically dry mouth, where the lack of enzymes normally present in spit allow bacteria to run free (lack of hygiene is also an issue, but wouldn't be nearly as much without the problem of dry mouth.) So yeah, it's important to take care of your oral health. The only other problem is occasional constipation, which can be aided by a diet high in fiber, or, failing that, a fiber "bulking agent", like metamucil, can provide some additional help as well. In the worst cases, which is very unlikely, it is pretty safe to take a laxative called lactulose on a daily basis for decades even, and is typically the laxative of choice for opioid-induced constipation which can be far more severe and dangerous, so there's really no way you're going to need something stronger than that.

Nortriptyline did a lot of good things for me though, not all of which I can remember. In fact, I wish my pdoc would let me add it to my Parnate :lol, as many studies SUPPORT the use of an MAOI + Tricyclic (though MAOI + SSRI is always dangerous), but there's a lot of fear and uneasiness about using such a combination among doctors.


----------

