Tricyclic Antidepressants

I'm new-questions about medicines

Question:

Nichole, I think that Keiths response was about all that can be said. I wouild add that Depakote seems to have about the least amount of sides at all. Ive been on it a while and prety high doses with little more than hand tremor. Keep with it, you can feel better > Hi everyone.  I have been on lithium since December of ‘98 (that’s when I was > diagnosed with bipolar).  Since I started treatment with the lithium I have > become increasingly nauseated.  Since January I have also been severly > depressed, so along with lithium my doctor has tried Zoloft, nortriptyline, and > Celexa- none of which had results.  While on nortriptyline I was not as > nauseated, but I had no improvements with the depression and I could not sleep > because my doctor said I could not take Desyrel and nortriptyline together (I > take Desyrel for sleep).  So after that my doctor switched me back to Desyrel > and gave me Celexa.  I had been on the combination of Lithium, Celexa, Desyrel, > and Ativan for about two weeks when I became so nauseated that I could not eat > anything.  After about three days of not eatting my doctor told me to stop the > Celexa.  After stopping the Celexa I still felt sick.  A few days after > stopping Celexa I began vomitting and my doctor told me to stop the Lithium

or > a few days.  I have been off Lithium for about a week and I am eatting very > little which is an acomplishment.  I am very underweight and can’t afford to > lose any more weight.  My psychiatrist, his nurse, and my medical doctor are > all very concerned with my weight.  I’m afraid to go back on lithium because of > my weight but I also know what happens when I am not on it.  Has anyone else > had a similiar experience with lithium?  If so, are there any alternatives that > aren’t as nauseating?  Thanks for reading this.  Any advice or suggestions are > greatly appreciated. > -Nichole

Still thinking of what to write here???? Feel free to email.

Response:

[snip] > a few days.  I have been off Lithium for about a week and I am eatting very > little which is an acomplishment.  I am very underweight and can’t afford to > lose any more weight.  My psychiatrist, his nurse, and my medical doctor are > all very concerned with my weight.  I’m afraid to go back on lithium because of > my weight but I also know what happens when I am not on it.  Has anyone else > had a similiar experience with lithium?  If so, are there any alternatives that > aren’t as nauseating?  Thanks for reading this.  Any advice or suggestions are > greatly appreciated. > -Nichole

Welcome to ASDM Nichole! There are many alternatives to Li.  Depakote and Tegretol have been around more and I believe have the side effects of gaining weight (So does Li if your stomach can handle it)  These two I believe are the more heavy weight stabilizers with their own set of nasty sideeffects.  There are a whole bunch of other newer anticonvulsants with fewer side-effects, a list increasing everyday.  Lamictal is the most proven of the bunch.  Lots of people on the NG’s have had great success with Neurontin.  Sometimes these are used in combination with others or with lower doses of Li, Depakote or Tegretol. Many people can not get completely off these less desirable meds but lowering dosages by adding one of these new meds is often enough to get rid of the problem sideeffects. I have been trying to get off Li, can’t get below 900mg by taking Lamictal. New pdoc even put me at 1200mg and I was a zombie.  So I went back to 900 and called pdoc and now adding Neurontin and we will see, now I take 600mg Li and I have more energy, seems to be OK. I am surprised that your pdoc is not looking into other options. If he only knows of Li and not even Depakote and Tegretol that is pathetic. I think you need a new pdoc. *        *       *    *      *      *      *        *   *       *    *    *   *    *   *        Aurora  *   *     *     *     *      * *     *   *    *       *   *     *   *      *     *   *   *    *  *

Response:

Lithium can be very difficult to adjust to, and you really haven’t been on it long enough to build up tolerance to the side effects. If the nausea is so bad that you can not eat then of course you must do something. The problem with stopping lithium is that when you restart it you have lost whatever improvements you have made as far as the side effects go. I have been on lithium for 12 years. I had severe diarrhea which I managed with Imodium (loperamide Hcl) and Pepto-bismol type products. I found that I could no longer eat corn. Recently I stopped drinking sodas and my diarrhea vanished. I gained about 40 pounds in the first couple of months I was on lithium, which is about average, and I lost all of it within the next year. If you can not tolerate lithium there are many other drugs to try: depakote, tegretol, neurontin, lamictal, gabatril, and topamax. The last tends to cause weight loss. The middle two have the fewest side effects, and depakote tends to cause continual weight gain. It seems that your doctor has his hands full. You really haven’t had a sufficient trial on any of the drugs you have tried, but until that nausea and vomiting is under control it won’t be possible to really evaluate any antidepressants. I hope your doctor will try harder to help you tolerate lithium before he gives up and moves on to another drug. It might be good to take something like depakote while you slowly increase your lithium. These are ideas to present to your doc. They still won’t let me practice medicine. Keith [:+)Hi everyone.  I have been on lithium since December of ‘98 (that’s when I was [:+)diagnosed with bipolar).  Since I started treatment with the lithium I have [:+)become increasingly nauseated.  Since January I have also been severly [:+)depressed, so along with lithium my doctor has tried Zoloft, nortriptyline, and [:+)Celexa- none of which had results.  While on nortriptyline I was not as [:+)nauseated, but I had no improvements with the depression and I could not sleep [:+)because my doctor said I could not take Desyrel and nortriptyline together (I [:+)take Desyrel for sleep).  So after that my doctor switched me back to Desyrel [:+)and gave me Celexa.  I had been on the combination of Lithium, Celexa, Desyrel, [:+)and Ativan for about two weeks when I became so nauseated that I could not eat [:+)anything.  After about three days of not eatting my doctor told me to stop the [:+)Celexa.  After stopping the Celexa I still felt sick.  A few days after [:+)stopping Celexa I began vomitting and my doctor told me to stop the Lithium for [:+)a few days.  I have been off Lithium for about a week and I am eatting very [:+)little which is an acomplishment.  I am very underweight and can’t afford to [:+)lose any more weight.  My psychiatrist, his nurse, and my medical doctor are [:+)all very concerned with my weight.  I’m afraid to go back on lithium because of [:+)my weight but I also know what happens when I am not on it.  Has anyone else [:+)had a similiar experience with lithium?  If so, are there any alternatives that [:+)aren’t as nauseating?  Thanks for reading this.  Any advice or suggestions are [:+)greatly appreciated.   [:+)-Nichole

Response:

Hi everyone.  I have been on lithium since December of ‘98 (that’s when I was diagnosed with bipolar).  Since I started treatment with the lithium I have become increasingly nauseated.  Since January I have also been severly depressed, so along with lithium my doctor has tried Zoloft, nortriptyline, and Celexa- none of which had results.  While on nortriptyline I was not as nauseated, but I had no improvements with the depression and I could not sleep because my doctor said I could not take Desyrel and nortriptyline together (I take Desyrel for sleep).  So after that my doctor switched me back to Desyrel and gave me Celexa.  I had been on the combination of Lithium, Celexa, Desyrel, and Ativan for about two weeks when I became so nauseated that I could not eat anything.  After about three days of not eatting my doctor told me to stop the Celexa.  After stopping the Celexa I still felt sick.  A few days after stopping Celexa I began vomitting and my doctor told me to stop the Lithium for a few days.  I have been off Lithium for about a week and I am eatting very little which is an acomplishment.  I am very underweight and can’t afford to lose any more weight.  My psychiatrist, his nurse, and my medical doctor are all very concerned with my weight.  I’m afraid to go back on lithium because of my weight but I also know what happens when I am not on it.  Has anyone else had a similiar experience with lithium?  If so, are there any alternatives that aren’t as nauseating?  Thanks for reading this.  Any advice or suggestions are greatly appreciated.   -Nichole

Response:

Filed under: Nortriptyline (Allegron)