Dr. Saraswat Kumarshri Shriniwas
Psychiatry
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Patient's Query
Hello doctor,
I have anxiety. The current medications I am using are Escitalopram 15 mg, Flupentixol 0.5 mg, and Nortriptyline 50 mg (to manage sleeplessness caused by Flupentixol). Since I started taking the tablet Nortriptyline 50 mg, my sleep issues have been resolved. However, I have developed photosensitivity ever since the tablet Nortriptyline was added. I visited an eye doctor who diagnosed an allergy under my eyelids. I was prescribed steroid drops for 20 days, and the issue improved with their use. After completing the 20-day course, I stopped using the eye drops. Around the same time, the Nortriptyline dosage was reduced to 25 mg. For the following month, I did not experience any sensitivity to computer screens. However, the Nortriptyline dosage was increased back to 50 mg due to recurring sleeplessness. Unfortunately, at the same time, the photosensitivity returned. I went back to the eye doctor, and the doctor once again diagnosed an eye allergy. And, the doctor informed me that long-term use of steroid drops is not recommended and suggested that I consult with a psychiatrist to consider discontinuing the medication causing the issue. What should I do in this situation? Please help.
Hello,
Welcome to icliniq.com.
I have reviewed your case, and I understand your concern.
Nortriptyline (Nortriptyline hydrochloride) could be the cause of dry eyes. In this case, you can use eye drops with fake tears, like Refresh Tears (Carboxymethylcellulose Sodium). They keep the eyes moist and can make them less sensitive to light. Another suggestion is to reduce the dosage of the tablet of Nortriptyline to 25 mg. It is very rare to have a reaction to Nortriptyline that affects the eyes and makes you afraid of or sensitive to light. But Nortriptyline is much more likely to make your eyes dry. Trying tear drops made from chemicals can help ease the symptoms. If reducing the dosage of Nortriptyline and using fake tears do not help, you might want to look into other tricyclic antidepressants like Dosulepin, which is made of Dothiepin Hydrochloride. Dosulepin comes in dosages of 25 mg and 50 mg, which are both about the same. Kindly consult a specialist, talk with them, and take the medications with their consent.
I hope that this information helps.
Warm regards.
Patient's Query
Hello doctor,
Lowering the dose of Nortriptyline reduces photosensitivity but again insomnia comes back. Earlier the plan was to stay on 25 mg but again it was made to 50 mg due to sleeplessness. The usage of anti-allergy drops helped me along with artificial tears given by the eye doctor. Since you believe that this can be dry eyes, I will try artificial tears four times a day for 10 days and see if there is improvement and come back.
Hello,
Welcome back to icliniq.com.
I hope your photophobia settles down with artificial tears. If it does not help, we will discuss alternatives to Nortriptyline.
Thank you.
Patient's Query
Hi doctor,
I have used artificial tear drops alone for 12 days. I do not see any improvement in photosensitivity. Now I too believe that photo-sensitivity is due to an allergy under eye lips. I also got to know that artificial tear drops were given to compensate for the dry eyes that can be caused by anti-allergic eye drops. Can we try the alternative TCA and see the response? What about the sedation of Dosulepin when compared to Desipramine or Nortriptyline?
Hello,
Welcome back to icliniq.com.
If artificial tears are not helping much, then changing TCA can be considered. Dosulepin is a bit more sedating than Nortriptyline or Desipramine. Nortriptyline and Desipramine are the least sedating among all TCA. Dosulepin has moderate sedation. Amitriptyline and Doxepin have maximal sedation. Dosulepin is quite well tolerated and can be titrated from 25 mg to 150 mg as needed. I usually begin it at 25 mg and then titrate up to 50, 75, or 100 mg as per need and tolerability. You can increase it by 25 mg every four to five days. It helps with mood and anxiety too.
Thank you.
Patient's Query
Hello doctor,
Do we need to taper Nortriptyline 50 mg and then to Dosulepin 25 mg or can we stop Nortriptyline 50 mg one day and switch to Dosulepin 25 mg the next day?
Hello,
Welcome back to icliniq.com.
At this dose, there is no need to taper. You can directly switch from Nortriptyline to Dosulepin.
Thank you.
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Psychiatry
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