Ideas

[trd77]

I need to add something to my combo (see signature), possibly switch. Have enough energy to workout, but otherwise anhedonic, asocial and uninterested, cannot work. Would like to add bupropion but it would not play nice with nortrip. Modafinil doesn't cut it anymore. Methylphenidate was a joke. Lamictal gives me anxiety.

Have tried adjusting doses. How good is Vyvanse? Any chance buspirone would do anything useful?

 

[larkspur]

Have you had your nortriptyline blood level tested? You could go up to 150mg and see if that helps you any, but doses above 100mg have to be monitored, so your pdoc would likely want to know where it's at before increasing the dosage. You could also try switching the nortriptyline out for something more activating, like desipramine if you like TCAs. My fear with bupropion is that it would exacerbate your anxiety, as it has been known to do. 

[trd77]

Have you had your nortriptyline blood level tested? You could go up to 150mg and see if that helps you any, but doses above 100mg have to be monitored, so your pdoc would likely want to know where it's at before increasing the dosage. You could also try switching the nortriptyline out for something more activating, like desipramine if you like TCAs. My fear with bupropion is that it would exacerbate your anxiety, as it has been known to do. 

No, not this time, but when I took it years ago when I was on 175mg and I was just above the reference value. I have problems with orthostatic hypotension, especially troublesome when working out. If bupropion helped my depression, anxiety would be less of a problem. What worries me is that bupropion inhibits CYP2D6 which breaks down nortriptyline. But I guess it could be done cautiously and with plasma level monitoring.