At the moment, I can't give you feedback on any part of this except for how to get off of nortryptyline. I do have experience with getting off of antidepressants, but I'm not clear on why you were prescribed the nortrptyline in the first place -- and that makes a difference. The difficulty you are having with letting go of the half dose could be due to one of two things, and I don't know which one it is, or it could be a combination of both. The first possibility, and this is unlikely unless you were on the nortyptyline for a long time, is that your brain has gotten so used to the drug that it is going to take you a very long, slow, extended taper to get off of it without experiencing major symptoms of what the docs call "discontinuation" effects. In other words, the symptoms you have when you try to discontinue the drug are symptoms of withdrawal itself. The other possibility, and again, the two things aren't mutually exclusive, is that when you reduce the nortryptyline below a certain level, you get a recurrence of the full symptoms of the original disorder that caused you to have to take the medication in the first place. Is it your and your doc's working theory that it is nerve pain that is causing you to have early morning awakening? Because early morning awakening is a classic symptom of severe depression. If it is depression that is the issue, then you may simply need an antidepressant that works better for you than nortryptyline.
Oddly enough I was prescribed it for the early awakening. I wasn't even aware at the time that it was an antidepressant. I do at times have issues with depression, but I haven't noticed any effect of the nortryptyline on that.
I have been on it for about five years, which probably qualifies as a long time, so I suspect you are correct in that I need to taper off more gradually. That is tough right now though, since the drug comes in capsules and currently I am breaking them open and eyeballing about half my regular dose.
I will discuss it with my doctor, but I suspect he will be resistant to change it since I've been on it so long. Plus he wasn't the doc who prescribed it. I am no longer seeing her (she left the practice).
Do you know of any alternatives to nortryptyline for early awakening? I occasionally have problems falling asleep, but not enough to take something for it yet.
I need to stop the sluggishness I feel in the morning which I have discovered is due to the nortryptyline. Looks like I'm stuck with it for a while.
Yeah, I'd say five years qualifies as a long time, at least in terms of getting off of an antidepressant that you've been on for that long. If you were able to reduce your dose by half within a short period of time, you did pretty well. You can do a search for "nortryptyline how supplied" and you will find that it does seem to come in capsules only. What I found is that it is available in capsules of 10, 25, 50, and 75 mg.
You've got choices. You could ask your doc to rx the 50mg capsules instead of the 75's and just go with 50 for a while, so as not to rock the boat too much. If your goal is to get off of it entirely and not to substitute anything, that is what I would do, and I would plan to stay on the 50 until I was as comfortable with it as I had been on the 75. Then the next step would probably be to get some 25's and 10's and combine then to go 45, 35, 25, 20, 10, and zero. It might take a year, total -- don't be surprised. That last 10 mg (or 5mg, if you split the capsule) might be as hard to get off of as it was to go from 75 to 50. This stuff is powerful, and your brain adjusts to having it.
Your other choice is to ask for a different antidepressant -- one that, as you say, offers the prospect of better controlling your early morning awakening. I can't really advise you about that, as it has been 20 years since I was on antidepressants. (Once I was totally off of them, I never wanted to go through the withdrawal again.) You will have to ask your doc for a recommendation as to which one to switch to. But once you make the switch, that should take care of the "discontinuation" effects associated with getting off nortryptyline. It's possible that you might have to experiment with two or three different antidepressants to find one that works well for you. But I bet your doc will be more than happy to work with you on that, LOL.
I agree with you, doctors do seem to like prescribing meds more than they seem to like helping people get off of meds. But you're the customer, so you can do whatever you want. Good luck.
Oh, and another choice that I can think of would be to switch to another tricyclic antidepressant, but one that came in tablets, rather than capsules only. Another tricyclic -- in other words, a drug in the exact same family -- would probably be fairly similar in it's effects to nortryptyline, and it might or might not help you any better with the early morning awakening. It just might do so, because back in the days before SSRI's and all of the other new-fangled antidepressants, psychiatrists did switch patients among different tricyclics to try to improve therapeutic efficacy. Tricyclics and MAOI's were all we had, and nobody wanted to do MAOI's because of the food interactions. So yes, it was common in the 1970's and 80's for some patients to have to try multiple tricyclics in succession. I think most of the other tricyclics, besides nortryptyline, do come in tablets, and if that would make it easier for you to taper down, then maybe it would be an option for you.
Thanks skydnsr. I'm slowly getting it through my thick skull to ask the obvious questions. Why my doctor didn't discuss with me the type of medication, the possible side effects & the withdrawal issues, I'll never know. I guess it's just easier for them to not tell the patient these things.
I am discovering that some drugs are better than others, some are better (or worse) for me than for someone else, and combinations of drugs can be truly awful.
I discovered the effects nortryptyline was having on me when I went to a neurologist because of some bizarre symptoms I was having. Memory & attention issues, shaking of my hands and a lot of fatigue and exhaustion. He turned out to be a great doctor and instead of having me take a lot of tests, he took a look at my list of meds & recent blood tests. Right away he said I was severely dehydrated. I'm a big guy & I drink a lot of water (and other beverages), I am diabetic, but I carefully control my blood sugar, so I knew it wasn't that.
It turns out that another doctor, had been adjusting my blood pressure meds & had me on 3 different diuretics! It didn't matter how much water I drank it wasn't going to stick around long enough to do me any good. I stopped one of the diuretics (spironolactone) and immediately my symptoms went away.
Anyway, the neurologist also suggested getting off of nortryptyline which is where I am now.
I am really starting to take charge of my health (& healthcare) better. My eyes are slowly opening as to how the medical system really works and it's not always pretty. This website really helps me to see where I'm at and to make associations between events, symptoms & behaviors.
IMO, a lot of medical doctors underestimate the side effects, the drug interaction effects, and the longterm effects of the medications that they prescribe. Also strictly IMO, a lot of doctors especially underestimate the difficulty of discontinuing antidepressant medications,especially antidepressant medications that the patient has been on for a prolonged period of time. Probably the reason that most docs don't tell you about the withdrawal effects of antidepressants is because the drug company reps are their main source of information about he medications they prescribe, and bad withdrawals are not something that a drug company is likely to admit to.
The good thing about your situation is that you have a neurologist who suggested that you get off of the nortryptyline, and so I imagine the neurologist will be willing to write scripts for the 10, 25, and 50 mg nortryp capsules, if you want to go that route.
I have ME/CFS and Autonomic and Peripheral Neuropathy. I have been on Gabapentin since 2007 and was on Nortriptyline at the same time. I switched to Duloxetine instead last year...big mistake. It brought on worse sleep problems as it was less sedative and my bowel and autonomic nervous system are in a mess now. Nortriptyline is drug of choice with IBS etc. I have sleep apnoea and other sleep disorders and will be going back on Nortriptyline this week. I wish I had never come off it. It's not the case for everyone, but I have had to suffer with night sweats, gut clenching, sleepiness, diarrhoea etc all because I came off one drug and tried another for a year. I did my own research and realised my mistake. Hope you have found something that suits you :)
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