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Prozac + Nortriptyline?

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I met with my pnurse today as we continue to search for the right combination of meds that will help my depression. 


The idea we're trying next is adding a TCA to my SSRI. Specifically, 10mg of nortriptyline being added to my 40mg of Prozac. She said the nortriptyline (man, that's hard to type) dose is so low because when combined with the Prozac, it acts as if it was a much higher dose. 


Has anyone else had experience mixing nortriptyline and Prozac, or any TCA with an SSRI? Reading about the interactions, side effects, etc. are freaking me out as usual, but my pnurse says that's why we're starting with a low dose. She seems to think it will be helpful. Looking for any other stories or advice...



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Nortriptyline is the metabolite of Amitriptyline I believe?  either that or it is related some how.   I know that Prozac is supposed to raise the levels of Amtriptyline by slowing down the metabolism of it or something - to the point where it is dangerous if both are being prescribed at high doses (eg. 40    prozac + 150mg amitriptyline = very bad).


However, I think your Pnurse is right about lower doses.   I've mixed low does TCA with SSRI and know others who have done so too.... but I would be wary about taking a full dose of TCA AND an SSRI. Some of the TCA meds act as quite strong SRI so add that to an SSRI = too much serotonin. 


I've tried two TCAs as per signature. Overall I preferred the side effects vs SSRI but didn't get any benefits from depression either (nor did I from SSRI). 

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i'm taking now 10mgs of escitalopram and 25mg of nortriptyline, just started really, the target dose of nort will be 75, although i'd prefer 150. In your case, i wouldn't go over 75mgs of nort, because of metabolism interactions, escitalopram and sertraline have fewer of those than fluoxetine

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