I have been on a low dose of prozac (10 Mg) for the last 6 weeks. It seems to be helping with anxiety but dizziness is no better. My doctor wanted me to try a TCA. So I tried to go off the prozac but after about 5 days I became extremely anxious, depressed and more dizzy. Now back on the prozac. My doctor would still like me to try nortriptyline at 10 Mg. Both are very low dose but I am really worried about the possibility of serotonin syndrome. Is anyone else on an ssri and tca concurrently? Any thoughts?
Yes I was a bit worried about this as currently on Nortriptyline 30-40mg and I also take a supplement called 5-HTP to boost serotonin. I seem to have been ok so far so I am sure if you are only taking low doses of both you would be fine, however probably best to run it by your doctor first. x
Common sense tells me that you will be fine because both are such low doses. But Im not a medical professional, so Id trust your doctors word on the issue.
It is a fair question to be thinking about. I’m not sure of the dosage levels at which trouble can occur, but the following link from the NHS sheds some light on the concern.
Certainly fair and appropriate to raise with your doctor.
With regard to 5-HTP (and, I believe L-tryptophan, its precursor), there can be significant unknown effects if you are taking 5-HTP in the presence of B-6 in any form. As I understand it (and I’m also not a medical professional), when these things are converted to serotonin by the introduction of B-6, the resulting serotonin does not cross the blood-brain barrier easily. Thus, most of it gets excreted but, before it does, there is a possibility for it to build up and cause issues in the heart and also serotonin syndrome.
Not trying to scare anyone, but I would definitely make sure I had an understanding of what I was taking and at what levels before I took these things in concert, especially in the case of 5-HTP which is frequently taken without the doctor being aware.
Listen to the following recording by James U Adleman from the Headache and Wellness Centre in North Carolina about migraine management. He mentions that in his patients who are given a TCA for migraine, that if they still feel depressed, he adds in an SSRI. It’s OK to do so but obviously under the supervision of your GP.
Thanks for the links. Will probably start the nort next week. Symptoms are worse than ever right now. Constant internal rocking, dipping and visual movement. Feel so nauseated and sea sick most of the day. Stuck in bed again and feeling very discouraged :x
Leanne,
Did ur doctor ever suggest adding in maybe a anticonvulsant to mix of ur prozac? My mix of paxil and topamax work amazing together. Just a thought. I hope u feel better with very soon!
X ,
lisa
hi
My “migraine specialist” wrote me a script for Ami at 10mg (TCA) and Cymbalta at 60 mg. Which is a pretty robust amount. It is a pretty common thing for him to do, as the scripts were already written out and he just puts your name on them…
I take 5htp at night at 100mg. I was told to keep a look out at your pupils…if they get really big it could be too much sero, but I’ve never had a problem. I would ask your doc, or even speak to your pharmacist.
FYI
Prozac has about a 7 day half life, and can be taken weekly. It also comes in liquid, or can be converted to liquid (by dissolving in cranberry juice) so there’s a lot of wiggle room with it.
Kelley
I have been doing more research. Apparently prozac and nort. also share metabolism pathway in the liver and concurrent use can increase blood levels of nort. several fold. I have yet to start the nort. Spoke with pharmacist today and he felt it should be ok at such low doses. Just yo monitor for symptoms. Still makes me nervous. My symptoms have calmed down a little now that I am back on the prozac. Still homebound but was able to get out of bed yesterday and do a little laundry and make supper after being stuck in bed for over a week.
Has anyone split a nort. capsule? Thinking of starting with half a capsule.
I started with the ami at 2.5 and worked up to 10mg. It didn’t help my dizziness at all, it only helped my anxiety marginally, so I added Cymbalta. Then I got off the Ami and kept the Cymbalta as it worked better and faster for me.
I have been doing more research. Apparently prozac and nort. also share metabolism pathway in the liver and concurrent use can increase blood levels of nort. several fold. I have yet to start the nort. Spoke with pharmacist today and he felt it should be ok at such low doses. Just yo monitor for symptoms. Still makes me nervous. My symptoms have calmed down a little now that I am back on the prozac. Still homebound but was able to get out of bed yesterday and do a little laundry and make supper after being stuck in bed for over a week.
Has anyone split a nort. capsule? Thinking of starting with half a capsule.
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Splitting capsules or drugs doesn’t mean you’ll get half the dose. It’s not a good idea (in my humble opinion). I don’t know if doctors advise it. I would definitely monitor your symptoms if you’re worried about taking dual therapy, but give the medications enough of a time frame to have a chance at working. I think you have to have a fairly huge amount of serotonin in your system to have an SSRI OD, I.e mixing prescription drugs with cocaine for example. I can’t see why a doctor would prescribe a dual therapy that would cause this, especially if you’re starting on low doses. I’d like to think they know better than that…
Just FYI
I have split capsules and tablets, and had no problems. There are some that are enteric coated (meaning they are meant to dissolve in the intestine) that aren’t supposed to be split, but sometimes the pharmacies can change the “usual” way they are dispensed. You just have to ask.
If it’s really important to get an accurate amount and you really want to be precise, then find a compounding pharmacy, and they can do it…it can be costly though so call first.
Kelley
Called the doctor’s office yesterday and expressed my concerns about combining nortriptyline and prozac. The nurse was annoyed that I wouldn’t just start the new med and made me feel like I was being difficult. Very frustrating. People die of drug interactions every year. I should be allowed to be able to express my concern without being treated like I’m an idiot.
I cannot believe how difficult this experience has been and how ridiculous the medical field is. I feel like I am being shuffled from one doctor to the next and nobody is treating me as a whole person, or even a person in general. I went to urgent care, they said they can’t help me I need to see my primary care Dr. I call to get in with a primary and am told it will take 3 weeks to get in with anyone. I go to the er, they say I have a chronic problem and they can’t help me unless I am suicidal, then they can hospitalize me under psych. When I went to the ent I was so dizzy and nauseated I couldnt move. He comes in to the room and swivels my chair and is so surprised that it makes me dizzy. He says he cant help and passes me off to neuro. Neuro does an exam and says it must be stress and to get counselling.
Of course I am stressed. I have been trapped on my couch for 2 months so dizzy and nauseated that I can’t eat or work. I am going to lose my business if I don’t get better. I don’t get it. It seems like all the doctors find it reasonable for me to lay on the couch for months without answers letting my life waste away.
I am a veterinarian. When an animal is sick and suffering I don’t send it home and say “sorry your case is too complicated and I don’t deal with this problem.” I research and try to get to the bottom of things and consult with specialist and actually talk to clients when they have questions. Arghh! Sorry to vent. So frustrated!
Needless to say, I am going to try verapimil instead.
I have been on a low dose of prozac (10 Mg) for the last 6 weeks. It seems to be helping with anxiety but dizziness is no better. My doctor wanted me to try a TCA. So I tried to go off the prozac but after about 5 days I became extremely anxious, depressed and more dizzy. Now back on the prozac. My doctor would still like me to try nortriptyline at 10 Mg. Both are very low dose but I am really worried about the possibility of serotonin syndrome. Is anyone else on an ssri and tca concurrently? Any thoughts?
LeAnne
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Hi LeAnne, I believe some doctors use a tricyclic together with an SSRI where they wish to get a high level of serotonin, for example when dealing with a hard to treat case of OCD. So this combination is not unknown. pharmacy-forum.co.uk/clinica … ether.html
can you ask a pharmacist about this? they tend to know the most about medications and their interactions. Is there any way you can get a referral to see a neurotologist or an otoneurologist? They would know more about MAV probably than a regular neurologist.
Wexan, from what I understand citalopram (celexa) doesn’t interfere as much as other ssris and is less likely to increase tca concentrations thus safer to combine. I have tried celexa in the past for postpartum depression and did not tolerate. Prozac has a much stronger intersction and can increase tca up to 10 times! This makes me really nervous as tcas have a narrow therapeutic range. I guess I would just feel better trying safer options first.
The other part that is frustrating is that I am communicating completely through the nurse. She is relaying info back and forth about med changes and I have yet to talk directly to the doctor about my concerns. Doctor did ok for me to try veripamil. So we will see how that goes.
I am trying to get into the Mayo clinic but it takes 5-6 months to get in. That’s the closest balance specialist.
The weird part is that I didn’t even notice until I was about to leave the site that the doctor who is answering the questions in the most recent neuro I went to see. Struck me as a strange coincidence.
If they said to take a look at your pupils, that’s a tad concerning! Mine are usually huge taking prescription meds
And leanne, I remember being furious at a neuro for saying the exact same thing to me… and GP’s/ENTs/Specialists being unable to figure it out so told me to “get on with my life”… which is impossible with this thing! I would prefer it if they said “I’m sorry, I don’t know so can’t help you but will put you in contact with someone that can” - sigh
