Traffic cop pills

When I was a little boy, the story goes, I asked my dad to tell me about all the pills he took. He carefully emptied a little box of pills into his hand and began, "The little round white pill is to strengthen my blood; the orange and white capsule is to keep my stomach from getting upset; the long blue pills are to help my kidneys; and the large pink pill is to make my heart pump slower.

"But Dad," I complained, "what does that little red pill do?"

"Oh, that," Dad replied, "is the most important pill of all. It is like a traffic cop. It tells all the other pills where they're supposed to go!"

I recently visited my doctor (primary care physician, to be exact) because I've been having some pain in my feet when I walk much and sometimes the left foot tingles like its gone asleep. The doctor, after checking for potential side effects from my current medications, said I had "peripheral neuropathy" and prescribed Nortriptyline. (My doctor thinks I won't think he's done his job unless he prescribes something so I didn't think anything of picking up the prescription.)

When I got home and read the insert material for Nortriptyline, I was really puzzled and thought about asking the doctor for one of those little red pills my dad used to have. The insert says,

This medication is used to treat mental/mood problems such as depression. It may help improve mod and feelings of well-being, relieve anxiety and tension, help you sleep better, and increase your energy level.

A later paragraph in the insert material says this:

Other Uses: This medication may also be used to treat other mental/mood problems (e.g. anxiety, bipolar disorder) and certain types of pain (e.g. nerve pain such as peripheral neuropathy). It may also be used as an aid to quitting smoking.

Even more wonders for this drug. But at least I found the magic phrase which cause my doctor to prescribe it. The official designation for my sore feet is "peripheral neuropathy"

Obviously, what we have here is a wonder drug that just needs a little direction. Where is that little red pill when you need it? With so many options, How is the Nortriptyline going to know where to start and what to start changing?

Another thing I found interesting with this medication was the "starter pack" which consists of 5 blister packs labled week 1 through week 5. The first week's pack had one row of capsules; the second week, 2 rows; etc. When you've reached you optimum dosage, you call a special number where they will prepare a refill with the proper number of capsules for continued doage at that level. Titration of medication to get just the right dosage is becoming more and more common