Meds: slow improvement over time or sudden when you hit the right dose?

Diagnosed with intractable VM. I am slowing titrating up my nortriptyline. I started at 10mg and have increased to 30mg. My doctor is only increasing me 10mg every 4 weeks. (I am also on 12.5mg of propranolol). I increased from 20–>30 two weeks ago. My question is this: If nort was going to work for me, would I be experiencing slight improvement as I increase my meds? Or do I have to hit the right therapeutic dose in order to see any improvement at all? So, for instance, I have not seen improvement at 30mg. Does that mean nort will not work for me? Or shall I keep increasing my dose (until a certain point) and once I hit the right dose it will start working?

I hope this question makes sense. :slight_smile:

Question makes perfect sense. To answer your title … Slow Improvement over time.

Ah, if only it were that simple. My take for what it’s worth would be …

No I would expect anybody to see an immediate improvement on raising the dose even if it later transpired to be their particular Sweet Spot. Far more likely with nearly all drugs they would be worse for a time before beginning to feel better. Propranolol which I take I have found to be a particularly slow worker. It can take months. So don’t expect there to be a sudden dramatic improvement. I would not say it never happens. Never is a long time but it’s not a common occurrence. Some drugs (Nort isn’t one) are expected to show some improvement within one month, Pizotifen is certainly one. Some people have found Amitriptyline works quite quickly and some (most probably not people who have ‘persistent’ or ‘intractable’ in their diagnosis) have stopped pure classical migraine virtually in its tracts from first off. Not seeing improvement two weeks in on Nort doesn’t mean it won’t work eventually for you. After maybe three months or many medics state four if it had done absolutely nothing they would then abandon it and move on to another. Currently, as I see it, you should be thinking ‘I haven’t seen improvement at 30mg yet. This whole process takes time. Staff at one popular English clinic reckon on average patients should see improvement after nine months I think it was. I guess you will have to slowly increase and await developments. It’s all very individual but with Nort 70mg seems quite a good level for some. Others need to add in further medication on top over time. I’m very afraid it’s a Case of trial n error as much as wait n see.

I remember reading a success story on here that said “Dr Surenthiran says that people respond to it (meds) in different ways: some get incremental benefits whilst for others, reaching a certain dose can be like flicking an ‘off’ switch on the condition.” I think it’s “Daniel’s Success Story” if you search for that thread.

Thank you both!! This was very helpful info. So hard to be patient. It’s a mental exercise as much as a physical one…

The whole MAV experience will bring you new life skills and teach you things about yourself, and medical issues, more than you can ever yet of dreamt of, believe me. You will emerge a person far better prepared to face everything else that life will throw at you in future with aplomb.

Daniel’s Success Story was a great read! And very applicable. Thanks for the hope.

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