Hi all. I don’t know if anyone can answer this question. I am trying to figure out how nortriptyline (a tricyclic) and Savella (milnacipran, a serotonin and norepinephrine reuptake inhibitor) might be different in their effects.
If nortriptyline is supposed to “boost” norepinephrine (as I saw somewhere), is that any different from a norepinephrine reuptake inhibitor?
I am hoping to find a drug that might kill three birds with one stone–migraine prevention, improved concentration (to counteract dizziness-induced “brain fog”), and the aching and fatigue that I think might be fibromyalgia. Savella is FDA-approved for fibro, but I’m wondering if nortriptyline might have the same effect.
Going back to my old doctor tomorrow… I hope she will listen and think and research if necessary in order to help me find the best solution.
From what I understand, both drugs you are mentioning affect serotonin and norephinepherine reuptake, and thus work like an SNRI. With that said, even within the drugs labeled specifically as SNRIs (Cymbalta, Effexor, Savella, etc.), their relative effect on each of the two neurotransmitters can be different. Because of this, their uses can vary a bit and an individual response may vary as well. TCAs certainly tend to be cheaper, at least where I live, so it may be an option for you to try something like that before moving on to an SNRI. I’m not sure if that answers your question.
Hi Dizzyforlife–thanks so much; your reply confirms what I’ve kind of been thinking. I guess no matter what the mechanism of the drug, if affects both serotonin and norepinephrine (and for me, the latter considerably more than the former), it just might work! Your thought to try the cheaper one first is also what I’ve been thinking. Will see what my doctor thinks today. (And BTW, thanks so much for the link–that is probably the best article I’ve seen on Savella yet.)
Sarah, your point is good, too… I see lots of people here have tried nortriptyline for migraine. Savella is a newer drug (approved since 2009 for fibro–actually I think you and I have mentioned that fact before!) and maybe it would be just as helpful for migraine for nortriptyline, but then you have the cost issue, too.
Wow! What a difference a knowledgeable and partnership-type doctor makes. My old PCP that I just went back to seems to know a lot about migraine–she didn’t even have to consult her computer to talk about the types of prophylactics and whatnot–she knew it off the top of her head! As well as the relative effects of serotonin and norepinephrine in the various drugs. She really knew this stuff! I was impressed. I had only had her for a year previously and never really talked about migraine with her because I wasn’t looking to make any drug changes at that time.
We decided on nortriptyline and if that doesn’t work we can try Savella. Perfect.
I told her I was hoping to kill three birds with one drug-stone (migraine, concentration, and aching) and she said the nortriptyline might not do much for concentration, so she also gave me an Rx for methylphenidate (Ritalin), which I’d taken successfully in the past. I didn’t even ask her for it, but it might be nice to have in case the nortriptyline does not help as much as the Strattera did. We’ll see. I am very much looking forward to this experiment and hoping I will find the “right stuff” (and the cheaper one).
