Medication Poop Out - Second Time Round Is Different

[Mermaid16]

Was just wondering if there are other people who have had medication Poop out and the have tried a different medication, if it just doesn't do the same as the first time you took medication. I am finding with my new medication that I am still having some anxiety and panic and am having to do a lot of therapy myself to not get sucked down the anxiety drain again. Just this last week, I have started having early morning waking with panic. I don't know has caused it. I'm wondering if I have become tolerant to the Clonazepam, which I was hoping to start tapering soon, but I have got a lot of anxious feelings back. Now I'm wondering if the new medication Nortriptyline is even doing anything. The anxiety isn't as bad as before, but it is still there. I kind of expected, new medication and goodbye anxiety. I'm not really looking for answers but would like to hear other peoples experiences. I have been on Klonopin since December and Valium from June to December before that. I really don't want to taper when I'm feeling anxious already. I am working full time, so can't really afford to do anything to drastic.

[panic_down_under]

I am finding with my new medication that I am still having some anxiety and panic and am having to do a lot of therapy myself to not get sucked down the anxiety drain again.

...Now I'm wondering if the new medication Nortriptyline is even doing anything.

How much nortriptyline are you taking and how long have you been taking it?

I have been on Klonopin since December and Valium from June to December before that. I really don't want to taper when I'm feeling anxious already.

The fact you're having panic attacks suggests Klonopin isn't working at your current dose. You should also know that there is evidence benzodiazepines significantly reduce the effectiveness of antidepressants by inhibiting hippocampal neurogenesis which creates their therapeutic response so it might be a good idea to begin weaning of Klonopin soon (see: Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Wu X, 2009; Stefovska VG, 2008).

[pulisa]

Are you a practising psychiatrist, panic down under?

[panic_down_under]

Are you a practising psychiatrist, panic down under?

No, just an amateur. I'm now long retired, but my field of expertise was the polar opposite of the healing arts.

[Mermaid16]

Hi Panic, I have been taking 100mg of Nortriptyline since December. I have recently cut down on Sertraline to 25mg and this is when the early morning waking started. So psych has recommended that I go back up to 50mg as apparently the sert can boost the Nort??? The weird thing is with the Klonopin is that I have the early morning waking, it isn't really like waking with panic and then I am quite good for the rest of the day, as in the anxiety doesn't get that bad, so I can't really understand what has caused it. I will go back up to 50 and see if that helps, I might also ask to get my Nort levels checked. If that doesn't help, I may just have to put up with it and hope it passes. It really sucks waking up at 3:50am though.

[bdale1234]

I know it's hard, sending warm wishes and hugs.

[panic_down_under]

Hi Panic, I have been taking 100mg of Nortriptyline since December. I have recently cut down on Sertraline to 25mg and this is when the early morning waking started. So psych has recommended that I go back up to 50mg as apparently the sert can boost the Nort???

It doesn't increase the effectiveness of nortriptyline, but it will add to it by inhibiting serotonin reuptake. You've effectively created a bespoke SNRI. This was quite common in the past before SNRIs became available and arguably is still be best way of doing it as it enables fine-tuning of the noradrenaline-serotonin reuptake balance, plus SNRIs have a few other issues.

If you don't want to take two meds you could try desipramine (Norpramin) instead. It is a more potent noradrenaline, aka norepinephrine reuptake inhibitor than nortriptyline, but also a fairly potent serotonin reuptake inhibitor. Its side-effects profile is a little better than nortriptyline too, though, as antidepressants are highly unpredictable, your YMMV.

I might also ask to get my Nort levels checked.

Good idea. You might be a fast metabolizer. I have the same problem as my liver apparently metabolizes TCAs by an unusual route so I need to take very high doses to get a response.