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Hi Dr. On My Current Regimen Of Lamctial 150mg And
Question: Hi Dr.
On my current regimen of Lamctial 150mg and 15mg tianeptine, plus small klonopin or ativan dose at night, I have been waking up with racing thoughts that were very fractured, confusing, and uncomfortable....not the kind of thing I could meditate out of. Coffee would slow it a little bit.
I tried taking 25mgs nortriptyline last night hoping that the NE reuptake inhibition would take care of the fractured thoughts. It did, and energy and mood seemed to be better today, however I have felt a lot of nervousness and physical anxiety all day...it got a lot worse after taking the tianeptine. I took a small doses of klonopin, propranolol, and agmatine sulfate and it made the anxiety mostly better.
The symptoms are back now at 4:30, somewhat physically uncomfortable. Do you have any idea what is happening? I'm wondering if I should take it again tonight.
Thanks
On my current regimen of Lamctial 150mg and 15mg tianeptine, plus small klonopin or ativan dose at night, I have been waking up with racing thoughts that were very fractured, confusing, and uncomfortable....not the kind of thing I could meditate out of. Coffee would slow it a little bit.
I tried taking 25mgs nortriptyline last night hoping that the NE reuptake inhibition would take care of the fractured thoughts. It did, and energy and mood seemed to be better today, however I have felt a lot of nervousness and physical anxiety all day...it got a lot worse after taking the tianeptine. I took a small doses of klonopin, propranolol, and agmatine sulfate and it made the anxiety mostly better.
The symptoms are back now at 4:30, somewhat physically uncomfortable. Do you have any idea what is happening? I'm wondering if I should take it again tonight.
Thanks
Brief Answer:
This probably happened because of first dose effect.
Detailed Answer:
Hello thanks for using ask a doctor service again
You took 25 mg Nortriptyline last night while you are on Lamictal and Tianeptine. Nortriptyline is a TCA drug and like most of mono-aminergic drugs this drug too is known to worsen anxiety and restlessness a little bit especially in first few days of starting the therapy. This is normal with this drug and no need to get worried. You should continue to take this and the anxiety and nervousness will go away by own.
Thanks.
Please don't hesitate to ask again for more clarifications.
This probably happened because of first dose effect.
Detailed Answer:
Hello thanks for using ask a doctor service again
You took 25 mg Nortriptyline last night while you are on Lamictal and Tianeptine. Nortriptyline is a TCA drug and like most of mono-aminergic drugs this drug too is known to worsen anxiety and restlessness a little bit especially in first few days of starting the therapy. This is normal with this drug and no need to get worried. You should continue to take this and the anxiety and nervousness will go away by own.
Thanks.
Please don't hesitate to ask again for more clarifications.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you Doctor.
i tried Nortriptyline before when I was taking MAOIs hoping to help with sleep and offset side effects. It did neither, but it certainly didn't make me nervous like yesterday. I was a little nervous/irritable at first, but it got exponentially worse after taking the tianeptine, which normally has an overly "calming" effect if anything. We don't understand tianeptine in the US so I'm wondering what sparked the sudden spike in physical and mental anxiety?
I am just concerned that I needed 20mgs propranolol plus a benzo, beta blocker, and a clonidine-like supplement to keep me from feeling that I would have a heart attack.
thank you
i tried Nortriptyline before when I was taking MAOIs hoping to help with sleep and offset side effects. It did neither, but it certainly didn't make me nervous like yesterday. I was a little nervous/irritable at first, but it got exponentially worse after taking the tianeptine, which normally has an overly "calming" effect if anything. We don't understand tianeptine in the US so I'm wondering what sparked the sudden spike in physical and mental anxiety?
I am just concerned that I needed 20mgs propranolol plus a benzo, beta blocker, and a clonidine-like supplement to keep me from feeling that I would have a heart attack.
thank you
to add to this:
-I have taken desipramine alone in the past with no initial anxiety; Wellbutrin and ritalin (with Tianeptine) has not created this nervousness either.
-genetic testing has told me I am a slow metabolizer of nortriptyline
-Drugbank ranks tianeptine as an 5ht1-a inhibitor as well as a SE reuptake enhancer...would this explain the clash with 25mgs of nortriptyline?
-I have taken desipramine alone in the past with no initial anxiety; Wellbutrin and ritalin (with Tianeptine) has not created this nervousness either.
-genetic testing has told me I am a slow metabolizer of nortriptyline
-Drugbank ranks tianeptine as an 5ht1-a inhibitor as well as a SE reuptake enhancer...would this explain the clash with 25mgs of nortriptyline?
Brief Answer:
Yes Tianeptine might be a contributing factor.
Detailed Answer:
Hello again
Tianeptine too is a drug that activates brain and use of Nortriptyline probably triggered this and which ultimately resulted in nervousness. This might be an attack of severe anxiety.
Yes activating effect of Tianeptine along with slight nervousness because of Nortriptyline probably resulted in attack of anxiety. This can be a possibility.
Thanks.
Please don't hesitate to ask again.
Yes Tianeptine might be a contributing factor.
Detailed Answer:
Hello again
Tianeptine too is a drug that activates brain and use of Nortriptyline probably triggered this and which ultimately resulted in nervousness. This might be an attack of severe anxiety.
Yes activating effect of Tianeptine along with slight nervousness because of Nortriptyline probably resulted in attack of anxiety. This can be a possibility.
Thanks.
Please don't hesitate to ask again.
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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