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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by g_g_g_unit on October 4, 2009, at 9:19:53
i'm meeting with my pdoc in a couple of days to try and add a TCA to parnate to assist with sleep.
nortriptyline has never really helped me sleep in the past, so i was wondering what another good option might be?
my pdoc is acting entirely based on my suggestion, so some ideas of a suitable (minimum) dose to try might be good.
i'm attracted by the notion that Trimipramine supposedly preserves sleep architecture. i would like to avoid dumbing effects at all costs though, if possible. is this much of a concern at doses used for sleep? anti-cholinergics seem to have a deleterious effect on word recall, which doesn't help me as a writer :>
low-dose Trimipramine/Doxepin sounds ideal
Posted by viper1431 on October 4, 2009, at 12:50:59
In reply to cleanest TCA for sleep, after nortrip?, posted by g_g_g_unit on October 4, 2009, at 9:19:53
Imipramine helps me with sleep, i'm not sure if that's normal though.
I can't remember if dozepin did though, i remember it made me stack on weight like nothing else before though.
Posted by linkadge on October 4, 2009, at 14:28:28
In reply to Re: cleanest TCA for sleep, after nortrip?, posted by viper1431 on October 4, 2009, at 12:50:59
They're all anticholinergic, some more than others. Doxapin and trimipramine are pretty anticholinergic. You can usually take them in really low doses though.
Linkadge
Posted by Phillipa on October 4, 2009, at 15:56:15
In reply to Re: cleanest TCA for sleep, after nortrip?, posted by linkadge on October 4, 2009, at 14:28:28
Pamelor at l0mg was great for sleep with benzos. Knocked me out. Phillipa
Posted by Sunbath on October 4, 2009, at 16:53:05
In reply to cleanest TCA for sleep, after nortrip?, posted by g_g_g_unit on October 4, 2009, at 9:19:53
Hi g_g_g!
I think it's a great decision not to ditch parnate already!!
The only thing I'd like to tell you is that you need to try it out all yourself!
Theoretical doxepine is nice, because you can take really low doses of it, without much or any anticholinergic activity, because it's such a strong antihistaminergic drug. BUT also it could be very well that you don't like it. For me it's sedating me too much during the day, even in very low doses...
Maybe amitriptyline would feel better, maybe trimipramine would.. But also keep in mind that trimipramine's also a somewhat dirty drug because it's a moderate d2 antagonist and relatively strong anticholinergic.
Also I personally (might be wrong of course) don't think that it has much sense to go for a sleep aid only because it doesn't suppress rem sleep, when you are already taking a drug which almost completely abolishes rem sleep.. Parnate is doing that by a GREAT deal on its own!Also, as far as I understand it, trimipramine isn't known for its very strong antidepressant properties, but for example amitriptyline is. Maybe your sleep aid could also be a synergistic medication for parnate as Scott is telling us could be very important? But of course maybe you'd like something else better.. it's really hard and strange that everyone's so different..
Good luck!! I'm sure you will find something that's working well for you!
Posted by g_g_g_unit on October 4, 2009, at 19:41:28
In reply to Re: cleanest TCA for sleep, after nortrip? » g_g_g_unit, posted by Sunbath on October 4, 2009, at 16:53:05
> Hi g_g_g!
>
> I think it's a great decision not to ditch parnate already!!
> The only thing I'd like to tell you is that you need to try it out all yourself!
> Theoretical doxepine is nice, because you can take really low doses of it, without much or any anticholinergic activity, because it's such a strong antihistaminergic drug. BUT also it could be very well that you don't like it. For me it's sedating me too much during the day, even in very low doses...
> Maybe amitriptyline would feel better, maybe trimipramine would.. But also keep in mind that trimipramine's also a somewhat dirty drug because it's a moderate d2 antagonist and relatively strong anticholinergic.
> Also I personally (might be wrong of course) don't think that it has much sense to go for a sleep aid only because it doesn't suppress rem sleep, when you are already taking a drug which almost completely abolishes rem sleep.. Parnate is doing that by a GREAT deal on its own!
>
> Also, as far as I understand it, trimipramine isn't known for its very strong antidepressant properties, but for example amitriptyline is. Maybe your sleep aid could also be a synergistic medication for parnate as Scott is telling us could be very important? But of course maybe you'd like something else better.. it's really hard and strange that everyone's so different..
>
> Good luck!! I'm sure you will find something that's working well for you!hey thanks. i spoke to him again and he's actually decided against using a TCA for safety's sake. he said we can discuss some other options next week. unfortunately, he's quite in favor of using a hypnotic or antipsychotic longterm, which i'm not. i can't really think of anything else though. if anyone has any suggestions for relatively clean, safe sleep agents besides trazodone (not available where i live) that'd be appreciated.
i like the idea of Remeron, but he seems quite bound by literature, and i think it's officially contraindicted isn't it?
Posted by desolationrower on October 4, 2009, at 20:54:30
In reply to cleanest TCA for sleep, after nortrip?, posted by g_g_g_unit on October 4, 2009, at 9:19:53
half of the 'unclean' comes from the same paths tahat are causing the hypnotic effect. feeling tired is the problem for taking them.
anyway waht the better (as in, should try them first) hypnotics are depends on what the problem is for you.
-d/r
Posted by g_g_g_unit on October 5, 2009, at 0:53:17
In reply to Re: cleanest TCA for sleep, after nortrip?, posted by desolationrower on October 4, 2009, at 20:54:30
>
> anyway waht the better (as in, should try them first) hypnotics are depends on what the problem is for you.
>
> -d/ri guess the problem is i'd like a longterm sleep med to take with parnate that won't cause akathisia, TD, or physical dependence
Posted by linkadge on October 5, 2009, at 16:16:41
In reply to no-go on tca » Sunbath, posted by g_g_g_unit on October 4, 2009, at 19:41:28
You may wish to let your doc know that doxapin has been proven effective as a hypnotic at doses ranging from 1-3mg. This is far less than what is used for depression and needed for significant anticholingeric / cardiac effects.
Linkadge
Posted by g_g_g_unit on October 5, 2009, at 20:11:23
In reply to Re: no-go on tca, posted by linkadge on October 5, 2009, at 16:16:41
> You may wish to let your doc know that doxapin has been proven effective as a hypnotic at doses ranging from 1-3mg. This is far less than what is used for depression and needed for significant anticholingeric / cardiac effects.
>
> Linkadgethanks. i will try and convince him. i guess i was misusing the word 'hypnotic'; sounds silly but i thought it had something to do with the way agents like Imovane (which is what i take right now) + Seroquel actually induce sleep - and the subsequent quality of the experience. if i wake up in the middle of the night to use the bathroom on Seroquel or Imovane i literally feel drunk/hypnotized and stagger around.
This is the end of the thread.
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