I've had long term problems with treatment-resistant depression and also - in the last 3 or 4 years - have suffered from vertigo, migraines and stomach cramps.
I have been taking 40mg fluoxetine daily which doesn't do much at all - makes me slightly less irritable, give me some very strange & vivid dreams, but not much else.
Doctor has just given me some nortriptyline to take alongside the fluoxetine as a combination therapy. Initial dose 25mg and then increase to 50mg after 10 days.
I started with the 25mg of nortriptyline 4 days ago and it has hit me quite hard. I felt very drowsy at first although this has eased a little now. Sleeping a lot too - possibly not a bad thing because my sleep quality isn't great. Feel "stoned" but not necessarily in a good way. On the other hand, no vertigo, no migraines, no stomach cramps and my mood is ok (albeit in a daze).
I read something about fluoxetine interacting with TCAs like nortriptyline - something to do with liver enzymes that I don't understand - the upshot of it all was that one should be careful with TCA dosages because fluoxetine makes the TCA hang around in the system longer, as if it were a bigger dose than it actually is.
Doctor has talked about gradually getting the nortriptyline dosage up to 75mg - 100mg in due course. But I don't know on reflection how familiar he is with this drug (especially in combination with fluoxetine) - he is following the guidance of a psychiatrist who assessed me, but I don't think the psychiatrist gave any advice on suitable dosages. Also the doctor said it's ok to drink alcohol in moderation when taking nortriptyline , which contradicts what I've read elsewhere (I don't plan to drink btw).
I'm a bit concerned...should I be, do you think?
(I would ask the doctor myself but it can take 3 weeks to get an appointment with him!)