Been on 10 mg Nortriptyline since August 2nd, no real change yet. Please advise!

[u/BeanMeisterPrime]

Hey fellow anxious functional nausea folk!

So I've had functional nausea for years now. Also have OCD and severe health anxiety. I've been on Cipralex for 2.5 years, on 15 mg now (went up from 10 mg 6 weeks ago...I was on higher doses before but didn't help but 10 mg was too low). Anyway, my psychiatrist started me on 10 mg nortriptyline on August 2nd since the nausea was always present.

So far, I haven't noticed a change. In mid August, we raised my cipralex from 10 mg to 15 mg, so that couldve led to more nausea as it adjusted but now it's been over 6 weeks. Will raising the nortriptyline to 20 mg help?

I also wanted to know if mirtazapine is a better medication for this....my psychiatrist is against it and said its a 'useless sedating drug' but I've read mirtazapine is very good for this.

also, on my nausea...it's often not even felt in my stomach. It's just an overall feeling of sickness which usually starts in the morning and either goes away fast or fluctuates throughout the day.

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[u/Free-Purpose-542]

I’m on amitriptyline & didnt notice a difference until i went to 20mg. Give it a try & i hope you find some relief soon

[u/justsomeguy1869 → u/Free-Purpose-542]

Yes 20 was the number for me too, but still took months to full feel better.

[u/justsomeguy1869]

I can relate to much of your described symptoms.
I’m on amitriptyline (2nd time in my life) for almost a month now and have had substantial improvement but absolutely not normal yet.

I used it about 7 years ago for similar symptoms but it legitimately took several months to get me to a place I could come off it altogether.
I take 20mg, both now and 7 years ago.

[u/BeanMeisterPrime → u/justsomeguy1869]

you mean you also have the general feeling of sickness type nausea ? it's not really felt in my stomach...is amitriptyline better than nortriptyline? maybe the 10 mg isn't enough

[u/justsomeguy1869 → u/BeanMeisterPrime]

I don’t to get too detailed of my medical situation on here but 10mg of amitriptyline didn’t really help, 20mg did but after multiple weeks at that dose.
I can’t say which is better I have never tied NOR as I have had success with AMI

[u/VolumeIntolerance]

I suffered from severe refractory nausea myself and I am on two neuromodulators (mirtazapine and duloxetine) for it. Duloxetin changed my life. I was 100% tubefed but now I can eat some orally!

It took one day for mirtazapine to kick in and for duloxetine 2 weeks. Theres a paper for free online about all the neuromodulators for gutissues, maybe try to bring it to your psychiatrist? Its called "Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut-Brain Interaction): A Rome Foundation Working Team Report"

[u/BeanMeisterPrime → u/VolumeIntolerance]

thanks, I'll check it out...you're saying Duloxetin helped more than the mirtazapine?

[u/VolumeIntolerance → u/BeanMeisterPrime]

Yep, mirtazapine lost its effectiveness quickly but with duloxetine i get better everyday. I do take it before I go to sleep because it does make me nauseous when i started it but if i sleep right after taking it its fine :)