Emsam and Nortriptyline

[weordmyndum]

My psychiatrist and I are out of ideas to try to treat my depression. During daytime, I'm lethargic, exhausted, anhedonic, unable to concentrate/think, and spend most of my time lying in bed. I rarely leave my apartment. By nighttime, I swing into agitated depression, self-destructive behaviors, and (increasingly) suicidal ideation.

I had a prior doctor suggest adding Emsam, and I mentioned this to my current psychiatrist. He said it would be a possibility but wanted to do more research into possible interactions--particularly with nortriptyline, which is the only one of my meds I'm not willing to go off. (Without it, I go days without sleep.) I've been doing some of my own research as well, both through Google and through my university's academic databases. There are plenty of sources saying not to take them together, but I've had two doctors tell me it might be all right and found a source that stated studies had shown there's a very low incidence of interactions between Emsam and nortriptyline. I cannot, however, locate these studies--the only relevant hits I've found via academic databases pertain to treating Parkinson's and Alzheimer's.

You folks seem knowledgeable about this kind of thing, so I'm hoping someone might be able to point me toward some sources/studies.

[weordmyndum]

I should probably clarify--I'm on nortriptyline for a sleep disorder, not as an AD. I've been on AD dosages before, but it didn't do anything for the depression. I've been on lithium before--a last-ditch effort to improve my chronic suicidality--but it didn't seem to do anything. (I'm not bipolar, but my doc had seen a study using lithium to treat severe unipolar depression.)

My doctor and I were looking at Emsam in particular because it requires fewer dietary modifications and is less likely to interact with other meds, but I didn't realize it tends to be less effective than MAOI-A's. I'll bring that up with my psychiatrist. Do you have a link or reference for the study you quoted? I'd love to read the full thing.

[weordmyndum]

Just a quick update.

Met with my psychiatrist, and I'm starting the Emsam tomorrow. He said he was more worried that I'd seriously harm myself due to my levels of depression than that I might have a drug interaction. So I guess I'll see how it goes.

I really need this to work.

[Moil]

Good luck.

I can't remember if you said this before, but did you use the lithium along with a more traditional AD or did you take it by it's self?

[weordmyndum]

^

I was on it along with Pristiq as well as with nortriptyline.