So, I'm bipolar, type 2. I tend to live in depression and only occasionally get the kind of manic you could replicate with a good caffeine high. I've been on Sertraline for over a year. I can't actually remember how long. I'm currently at 150 mg once daily, and I have been since October of last year. I also take Trileptal, recently reduced from 300 mg twice a day to 150 mg twice a day at my request. I requested the decrease in Trileptal because my pdoc said that it was the more likely cause of my persistent brain fog and exhaustion. I've been on that for a long time. 4 years? 5? Around there. The reduction in Trileptal doesn't seem to have made any difference.
I can't think straight anymore. I'm making mistakes at work, and my last mistake caused a minor injury. I'm tired from the moment I wake up until I finally pass out at the end of the day. But getting to sleep is difficult. No matter how tired I am, it takes forever to sleep. And then I tend to sleep lightly. I'm forgetting things. Important things. But not interpersonal things- just work things. I can remember the details about a coworker's date last week or what my boyfriend said about something two months ago, but conversations my boss has had with me about what she wants? Gone. Either I'm being gaslit (possible, she's known to think she had conversations with people that never happened, but this is happening more and more often) or I've got some big holes opening up in my head. And it's concerning.
One of my coworkers is also bipolar, and when we talked, she suggested that it's from having been on sertraline for as long as I have. Anyone had that happen? On sertraline or anything else?
I also take allegra for my allergies, vitamin b complex as well as a vitamin d supplement. Aside from a vitamin D deficiency, my bloodwork always comes back damn near perfect, though with COVID I haven't gotten it done this year. I tend to be very very sensitive to sedating medications- klonopin and benadryl both leave me groggy for at least a day afterwards and when I was on venlafaxine I couldn't stay awake. Wellbutrin xl gave me massive stomach cramps, and I got the lamotrigine rash.
Both are quite similar, and that is no surprise, given that Notrtiptyline is Amitriptyline's major metabolite.
When comparing both, we can ascertain the following: Amitriptyline has somewhat more SERT blocking going on, so might be slightly more "serotonergic" than Nortriptyline, although I am not quite sure if clinically relevant. Both are equally strong NRIs and 5HT2 antagonists. Amitriptyline is a stronger ALPHA1 blocker compared to Nortriptyline, so might cause more postural hypotension. Amitrptyline is a stronger antihistamine than Nortriptyline, so might cause more sedation and appetite. Amitriptyline is a stronger anticholinergic than Nortriptyline, so will probably cause more side effects. (Although stronger sedative and anticholinergic properties might be welcome, depending on the condition)
What I am interested in: Who's been on both and how did they compare? (not only theoretically, but practically)
picture source: https://abload.de/img/nortgpk1f.png
"Clomipramine, Tryptophan and Lithium in Combination for Resistant Endogenous Depression: Seven Case Studies" - August 1987 | A. S. Hale (a1), A. W. Procter (a2) and P. K. Bridges (a3)By Skeletor
Unquestionably an extreme combination, but it seems to exhibit powerful antidepressant effects. Clomipramine on its own is regarded by many as maybe the most powerful non-MAOI antidepressant, at least in clinical practice and inpatient care, although the side effects can be quite rough, but combined with Tryptophan and Lithium it seems to be further boosted in its effect size and response rate.
Maybe worth trying before hopping on ECT / MAOIs...
One has to be careful because it is a small sample case "study", but nonetheless quite interesting to read. I encourage all those who have a view or experience to share it with us, regarding the aforementioned medications and especially the combination. Greetings!
Both are second-generation SSRIs, both exhibit minimal drug interactions via Cytochrome P450, both are the most prescribed SSRIs and are considered first line antidepressants. Who's been taking both and what were your experiences? (How did they compare to each other?). I am looking forward to read your experiences...
Which one did you like more?
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?