It would seem so, at least according to many studies... Gillman regularly mentions that his patients did substantially better on TCAs than on SSRIs (Sertraline might be an exception). Especially Amitriptyline, Clomipramine and Imipramine seem to be superior in effectivity. Is it wise to completely shun those very effective older antidepressants?
Sertraline standalone makes many people somewhat apathetic, indifferent and unmotivated, and that's why doctor Gillman suggests augmenting it with Nortriptyline OR alternatively taking Clomipramine standalone for the full SNRI effect...
Did anyone here try both combos? I am getting back on antidepressants and not sure how to proceed... but if I had to choose, I would preferably go for one of the two possibilities.
As far as I am informed you need stimulants for treatment of ADHD. Most commonly used are Methylphenidate and Atomoxetine. Sometimes stuff like Bupropion is applied. But what about classic antidepressants with stimulant (NRI) properties? Let's say Desipramine or Nortriptyline, Reboxetine!? Can they help to some degree?
Now that I have been on this cocktail for two weeks, I am noticing a new reality. I want to be more outgoing, I am alot calmer and want to socialize more.
The downside is that I lack good social skills and the consequences scare me. I would be laying vulnerable and not knowing how to protect myself.
Can I handle the changes with the new me? The old me, heck, I knew what to expect and how to handle this.
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!)