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Dr. Bob is Robert Hsiung, MD,
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Posted by fachad on June 9, 2002, at 1:37:51
In reply to Re: Trimipramine (SLS info) » Ritch, posted by Chloe on June 7, 2002, at 21:32:07
Chloe,
Here is the link which has the references I posted for Trimip a bit ago:
http://www.dr-bob.org/babble/20020525/msgs/107821.html
Regarding the price, yes trimp is not generic; it is only available as Surmontil brand.
Regarding being whacked from the smallest pill, I'm the same way. For now, I open the capsule into a tall glass of water then stir til it’s completely dissolved, then drink 1/2 or 1/3 of the glass, for an approx dose of 12.5 or 8 mg.
Next visit to my pdoc I'm going to get a RX for custom 2.5 mg capsules. They can be made at a compounding pharmacy. The one I called quoted me about $35 for 100 2.5 mg tablets. After I figure out the right dose (2.5, 5, 7.5, or 10mg) I'll get the tablets in that strength.
> > Chloe,
> >
> > I went to www.mentalhealth.com and went into their research topics (Medline) through the drug monograph. It seems like it was used (as doxepin was) to treat ulcers back in the '70's and '80's before the modern H2 antagonists were available. What it appears to me after reading a lot of the stuff about it is that it may not be as potent an antidepresant as other TCA's are, but doesn't hose up sleep architecture like other TCA's can and still has some antidepressant effect and helps sleep. One study I checked into showed that it tends to reduce cortisol similar to AP's, without other major changes in other hormone levels (that caught my attention). So, perhaps you might not get as irritable as on amitrip.? However, you are partly using the amitrip. for neuropathic pain, and I didn't see any studies on neuropathic pain. Oh, well.
> >
> > Mitch
>
> Mitch,
> I like the part about it being a dopamine antagonist without it being a true AP. My pdoc emailed me tonight, and thought trimipramine was a great idea especially because of this property. She called in the script, ASAP. I was shocked she moved that fast on a friday night, hum...
> BTW, Trimipramine, for me, is NOT generic. It cost $21 for sixty caps! I was shocked. My ami is $7 no matter the quantity. Strange that a TCA is not generic. I thought all these meds were from the stone age, and long lost their patents. The pharmacist couldn't tell me why it was so pricy either. Hope it works!
>
> I was looking through SLS's extensive list of meds and their properties and I can outline the difference between ami and trimipi, if you are interested...
>
> TRIMIPRAMINE:
> dibenzazepine
> tertiary TCA
> DA2 antagonist
> Ca2+channel inhibition
> ACh(m) antagonist---not sure what this one is??
> NE-Alpha1 antagonist
> H1 antagonist
>
> AMITRIPTYLINE:
> dibenzocycloheptadiene
> tertiary TCA
> NE reuptake inhibition***
> 5-HTP reuptake inhibition
> 5 HT2 antagonist
> ACh antagonist
> NE-alpha1 antagonist
> H1 antagonist
>
> ***I wonder if it's the NE reuptake inhibition that makes me get so grouchy and short fused?
>
> Anyway, that is the difference between the two according to SLS (thanks, SLS!). Do you have any thoughts on this, Mitch?
>
> Oh, lastly, I did read on the medline drug list, that an unlabeled use of trimip is *neurogenic* pain. So I am hoping I will continue to have some relief in that area. Phew, my agitated depression has swung into frenzied energy and giddiness. It's so hard to sit and focus! Can you tell?
>
> Catch ya later, oh and how are you??
> Chloe
Posted by Ritch on June 9, 2002, at 6:13:38
In reply to Re: Trimipramine=dreams!-Ritch,Jon, posted by Chloe on June 8, 2002, at 17:38:06
> Mitch, Jon,
>
> I am a bit whalloped by the Trimip. It feels so much like an AP. I kinda have a fuzzy head this morning. Which I don't mind, and know will go away. A strange thing did happen though. I slept from about midnight til 5 am very soundly, then I could NOT fall back to sleep. I felt refreshed, like I should start the day. Yeah, right. I wasn't getting up at that ungodly hour. So about 7 am, I fell back to sleep with tons of dreams. All kind of things I wanted to write down. They were so vivid. I would wake, say to myself, I got to remember that, then turn over and fall back to dreamland. Then my faithful dog woke me at 10:20 am to go out, and I just did not want to move. I wanted to keep dreaming and dreaming...
>
> But I did get up. But what a clumsy mess I was. I didn't feel very hungry, but kept seeing those little spots in front of my eyes, so I decided to eat, and that helped.
>
> This med, from what I read from the abstracts in the cortisol thread, is just the polar opposite of amitrip. Instead of decreasing REM, trimip. increases REM. And I sure had my fill this morning! Another notable thing about this med, is my inability to regulate my body temp. I was freezing in the night, though it was rather cold. But then in the morning I got so hot. When I went outside, I got this petina of sweat with little exertion. I hope this settles down. I really hate excess sweating side effect. Blick. Do you know what causes that one, Mitch? I thought it was Seratonin...
>
> I did take 5 mgs more of trimip. than I usually do of ami; that I was taking 20 mgs hs. But trimip's smallest dose is a 25 mgs capsule. So that could attribute to some of my feeling out of sorts and snowed. Or it's the "AP" effect...oh is there any TD potential with trimip? Forgot to ask the pdoc.
>
> Hum, I feel photosensitive too. Gee, anything else? I am not complaining, just reporting. It sure is different than amitrip. Do you think the excess dreaming will stop? That is somewhat disruptive. Perhaps I was in some kind of amitrip withdrawal? Since I just substituted one for the other?
>
> I am glad I started it on a weekend. I am med sensitive. But I would not have wanted to drive or do anything essential. I ended up painting some lattice. That seemed safe enough.
> So, I hope this helps...I will see how tonight goes. I hope I have ZZZZZZ all the way through the night this time.
>
> Chloe
Hi,I like having a lot of dreams, too. Yes, some of what you are experiencing may be a little rebound effect from stopping the amitrip. In fact, I remember reading something about that. Increased REM sleep, and also an anticholinergic rebound-which might explain some of the sweating. I don't think trimip. has as strong an anticholinergic effect as ami. It might take a few days for it to even out. So, it appears to be *more* sedative than amitrip? Just curious how the "brain fog* is during the middle of the day. The TD risk? Well, one thing that is good is that the mfg. doesn't have the usual CYA statement about TD included in the monograph. Although it does list EPS as a potential side effect-however the SE list is inclusive of all TCA's. Given your sensitivity to meds, it probably won't be long if you notice any EPS stuff. I had an early morning awakening myself, and couldn't go back to sleep, but I feel OK. I think it was the pinch of Celexa I took yesterday morning, it always shortens my sleep duration. Anyhow, let us know how things go with the Trimip.?
Mitch
Posted by Chloe on June 9, 2002, at 16:46:26
In reply to Re: Trimipramine- references, cost, low dose, etc. » Chloe, posted by fachad on June 9, 2002, at 1:37:51
That link is useful, I really like hearing personal experiences. Thanks for reposting it. I also printed out the abstracts. But I am finding Surmontil is not putting me to sleep at all. I was awake all last night, listening to my heart pound away. I was very disappointed, because all I have read is so positive. I guess I will keep at it, an hope that it helps. 25 mgs did not seem at all too much last night. But thanks for the tip on lessening the dose. That might come in handy down the road. And, wow, I was shocked at the price. I thought all these old TCA's were generic. Oh well!
Chloe
Posted by Chloe on June 9, 2002, at 17:21:28
In reply to Re: Trimipramine=dreams!-Ritch,Jon » Chloe, posted by Ritch on June 9, 2002, at 6:13:38
Well Mitch,
I am sorry you are having sleep troubles too. I really dislike all this daylight in the summer...It's so hard to sleep past 4:30 am for me.Anyway, I had a horrible night with the Surmontil. I took it around ten pm, because I did not want to be "hung over" for a brunch with a friend this am. Well, I never got tired last night. It was well past midnight when I got into bed, and I just lied there, unable to sleep. And then it seemed all I had to do was pee every half an hour. I must have gotten out of bed 20 times last night. I was also never the right tempature. Either cold, so I would bundle up, then I would start to sweat! Then I would feel chilled, etc. I NEVER really crashed or even had any dreams. So finally at 5 am I was so frustrated, I took 2.5 diazapam and slept lightly until 9am.
It was so uncomfortable being awake, and everytime I felt a little relaxed and might be able to sleep, I would have to get up to pee. Where did all the water come from??? My heart also was pounding away. I kinda felt like I was jogging in the dark or something. My stomach has been really off too. I feel hungry, but don't want to eat, then I get awful epigastic pain. That lasted for about 5 hours yesterday. Ouch that hurts, and nothing seemed to help it.
My tongue is also raw at the tip, like I have been rubbing it hard against my teeth (TD). I didn't think much of it yesterday, because I was painting for hours. When I do repetitive things my tongue can really can get going. But it has not stopped since yesterday noon. I know anxiety can drive the whole tongue thing as well. So I am going to try and not freak out. But I am not sure this was the greatest experiment...You asked my in a former post why my pdoc jumped on getting me a script so fast. Well, I think it might be because I had a lot of success with Clozaril, but got agranulocytosis so abruptly had to come off. And things haven't really been so great since...and that was about 10 years ago.
Gee, I guess I did not think this switch would be such a big deal. I thought it was just from one sedating TCA to another that had a bit of a DA kick. Well, it seems that Surmontil or trimipramine is a totally different animal than ami or doxepin or nortrip. I feel totally awful. Heachache, upset stomach, tired, but of course I haven't slept, jittery, heart poundy, and just basically crappy. I really miss the "calm" of ami. I would love to abort this mission right now. But I *guess* I have not given this med a fair trial. But I thought it was good for sleep and anxiety, too. But so far, I am not getting that. I think I slept soundly the first half of the first night, because I still had residual ami on board.
I DO feel LESS ready to pick a fight or lose my temper, however. Probably the lack of NE reuptake. Doxepin has the NE reuptake, too, doesn't it? Hum
Anyway, sorry for the long reply. I just feel miserable and had to share it with you. Lucky you!
Thanks for listening, my friend :)
Chloe
Posted by Ritch on June 9, 2002, at 23:10:25
In reply to Re: Trimipramine= no sleep! » Ritch, posted by Chloe on June 9, 2002, at 17:21:28
> I DO feel LESS ready to pick a fight or lose my temper, however. Probably the lack of NE reuptake. Doxepin has the NE reuptake, too, doesn't it? Hum
>
> Anyway, sorry for the long reply. I just feel miserable and had to share it with you. Lucky you!
> Thanks for listening, my friend :)
> ChloeOh, that's Ok, that's interesting. It seems that Trimipramine isn't near as sedative as amitrip. then huh? I suppose you could flip right back to the amitrip. and tell your pdoc tomorrow. Amitrip. definitely kicked ass as far as sedation. I remember stopping it a long time ago because people I worked with complained I was getting boring and blah to be around! I had also quit doxepin before that. I wanted to reduce the dose to help get rid of the zombification and as I reduced the dose I become less tolerant of the sedation and wound up just as zombified as I was on the higher dose! I am trying an experiment tonite to try to sleep straight through and not have an early morning awakening (I have had several in a row the last few nites). I have noticed that I am getting fatigued and tired earlier in the evening. So..I am drinking a couple of cups of coffee to force myself to stay awake until much later. Then take my meds and crash. Sort of a forced sleep shift of sorts. I will let you know if it seemed to help.
Mitch
Posted by Chloe on June 10, 2002, at 20:31:48
In reply to Re: Trimipramine= no sleep! » Chloe, posted by Ritch on June 9, 2002, at 23:10:25
Did keeping yourself up let you sleep in? Never works for me. I try to never go to bed before 11pm, if I have no ami, I am always awake before sunrise. Sleep is work without ami. But, I was getting a bit tolerant to ami sedative effects at 20 mgs, but I was scared to increase, because of the negative mood affect it can have. I get a really short unpredictable fuse...That's why I thought trimiprimine would be good. No substancial NE reuptake, and some DA.
Well, I think I have some EPS. When I awoke this am, my teeth were loose from clenching. And my tongue really hasn't stopped going since I started trimip. So, with the EPS, total inability to sleep, severe restlessness, and anxiety, I aborted mission last night. I took just 10 mgs of ami and it was a God send. I slept! It was like getting an old friend back.
But I am wondering how much off my bad experience with trimip was ami withdrawal? I probably should have tapered, but I just assumed, and wasn't instructed otherwise, I could substitute one TCA for the other. Maybe all the sweating and foggy head on that first day was just withdrawal? But from all I have read, Trimip is supposed to be very sedating, in the same class of doxepin and ami. But 25 mg of trimip wasn't enough to cover the lack of 20 mg of ami, clearly.
Could you relate in your experience the difference betweeen Doxepin and Ami. Do you think dox. would be less likely to cause anger outburst at low doses? Is it less or more sedating? How about dry mouth, constipation, wt gain, etc. Would you mind comparing the two for me? If you have done this before, could you send me to the sight? I am just wondering if dox may have less AD punch at low doses like 25 mgs than ami, but same sedative or hypnotic, anxiety effect.
Mucho thanks,
And I really hope you conquered your early am awakening.
Chloe
Posted by Ritch on June 10, 2002, at 23:43:05
In reply to Re: Trimipramine= no sleep! » Ritch, posted by Chloe on June 10, 2002, at 20:31:48
> Did keeping yourself up let you sleep in? Never works for me. I try to never go to bed before 11pm, if I have no ami, I am always awake before sunrise. Sleep is work without ami. But, I was getting a bit tolerant to ami sedative effects at 20 mgs, but I was scared to increase, because of the negative mood affect it can have. I get a really short unpredictable fuse...That's why I thought trimiprimine would be good. No substancial NE reuptake, and some DA.
>
> Well, I think I have some EPS. When I awoke this am, my teeth were loose from clenching. And my tongue really hasn't stopped going since I started trimip. So, with the EPS, total inability to sleep, severe restlessness, and anxiety, I aborted mission last night. I took just 10 mgs of ami and it was a God send. I slept! It was like getting an old friend back.
>
> But I am wondering how much off my bad experience with trimip was ami withdrawal? I probably should have tapered, but I just assumed, and wasn't instructed otherwise, I could substitute one TCA for the other. Maybe all the sweating and foggy head on that first day was just withdrawal? But from all I have read, Trimip is supposed to be very sedating, in the same class of doxepin and ami. But 25 mg of trimip wasn't enough to cover the lack of 20 mg of ami, clearly.
>
> Could you relate in your experience the difference betweeen Doxepin and Ami. Do you think dox. would be less likely to cause anger outburst at low doses? Is it less or more sedating? How about dry mouth, constipation, wt gain, etc. Would you mind comparing the two for me? If you have done this before, could you send me to the sight? I am just wondering if dox may have less AD punch at low doses like 25 mgs than ami, but same sedative or hypnotic, anxiety effect.
>
> Mucho thanks,
> And I really hope you conquered your early am awakening.
> ChloeYep, it worked! There is something that I have been noticing about my seasonal depressions.. I start getting sleepier earlier in the evening and that tends to get a tiny bit earlier every night (it is like an automotive ignition timing becoming "retarded"). Until it reaches the point where my sleep gets "broken" in the early morning (usually around 4-5am. I wake up and I have a hell of a time trying to get back to sleep. Then usually around 8am (three-four hrs later), I get very very tired and fall off and wind up sleeping till noon if I don't have other stuff to do. I wasn't staying up so I could "sleep in", I stayed up late so my sleep wouldn't be "broken up", so I *wouldn't* sleep in. When I have hypomania in the spring and fall, it reverses (the "timing" starts to advance) I notice having a little trouble getting to sleep, and just springing out of bed in the mornings after five or six hours sleep fully refreshed. So, anyhow I think a mild stimulant a few hours before bedtime sets up a blood sugar *crash* right at the time I want it (just a theory).
Well, if you had any EPS from the trimip., you might as well write it off! Doxepin and amitriptyline, hmmm. Doxepin is more sedating, definitely. Less robust antidepressant effect, however. Honestly, I don't think you would benefit much from switching from amitrip. to doxepin. If your pdoc likes the idea of you taking doxepin instead-go for it and see, you never know YMWV. So, I guess you could say that it (doxepin) would have less AD punch, and would be a stronger hypnotic. I just can't stand super sedative meds, though, yuck.
Mitch
Posted by fachad on June 11, 2002, at 16:42:16
In reply to Re: Trimipramine= no sleep! » Ritch, posted by Chloe on June 10, 2002, at 20:31:48
I've taken all three, and also have researched the pharmacological differences between these three. Each one has unique properties.
The three parameters that accout for the way the drugs effect you are:
Histamine blockade (sedation, increased appetite)
Cholenergic blockade (dry mouth, consitpation, etc.)
Re-uptake of NE and 5HT.
Ami is the most potent at cholenergic blockade. At the same doses, it causes much more dry mouth and constipation than Dox or Trimip. Also, there is a withdrawl symptom from "cholenergic rebound" that could explain why you felt bad subing trimip for ami.
Doxepin is the most potent at Histamine blockade. At the same doses it is the most potent sedative. Trimip is very close to doxepin, slighty less H1 blockade than dox, but much more than ami.
Trimp is nearly as potent as dox at H1 blockade, and should be much more sedating than ami. It is slightly more potent than dox at cholenergic blockade. The other unique things about trimp are lack of re-uptake of NE and 5HT, and very slight DA blockade
Here are the numbers for the three on H1 and Ach blockade from one study I read:
Drug------H1------Ach
Ami-------91------5.1
Dox------410------1.3
Trim-----370------1.7
So for me dox and trimp seem much stronger, but much cleaner for sleep. I would not underestimate the severity of the cholenergic rebound if switching from ami to one of the other two.> Did keeping yourself up let you sleep in? Never works for me. I try to never go to bed before 11pm, if I have no ami, I am always awake before sunrise. Sleep is work without ami. But, I was getting a bit tolerant to ami sedative effects at 20 mgs, but I was scared to increase, because of the negative mood affect it can have. I get a really short unpredictable fuse...That's why I thought trimiprimine would be good. No substancial NE reuptake, and some DA.
>
> Well, I think I have some EPS. When I awoke this am, my teeth were loose from clenching. And my tongue really hasn't stopped going since I started trimip. So, with the EPS, total inability to sleep, severe restlessness, and anxiety, I aborted mission last night. I took just 10 mgs of ami and it was a God send. I slept! It was like getting an old friend back.
>
> But I am wondering how much off my bad experience with trimip was ami withdrawal? I probably should have tapered, but I just assumed, and wasn't instructed otherwise, I could substitute one TCA for the other. Maybe all the sweating and foggy head on that first day was just withdrawal? But from all I have read, Trimip is supposed to be very sedating, in the same class of doxepin and ami. But 25 mg of trimip wasn't enough to cover the lack of 20 mg of ami, clearly.
>
> Could you relate in your experience the difference betweeen Doxepin and Ami. Do you think dox. would be less likely to cause anger outburst at low doses? Is it less or more sedating? How about dry mouth, constipation, wt gain, etc. Would you mind comparing the two for me? If you have done this before, could you send me to the sight? I am just wondering if dox may have less AD punch at low doses like 25 mgs than ami, but same sedative or hypnotic, anxiety effect.
>
> Mucho thanks,
> And I really hope you conquered your early am awakening.
> Chloe
Posted by Chloe on June 11, 2002, at 18:13:24
In reply to Re: Trimipramine= no sleep! (Ami vs. Dox vs. Trim) » Chloe, posted by fachad on June 11, 2002, at 16:42:16
> I've taken all three, and also have researched the pharmacological differences between these three. Each one has unique properties.
>
> The three parameters that accout for the way the drugs effect you are:
>
> Histamine blockade (sedation, increased appetite)
>
> Cholenergic blockade (dry mouth, consitpation, etc.)
>
> Re-uptake of NE and 5HT.
>
> Ami is the most potent at cholenergic blockade. At the same doses, it causes much more dry mouth and constipation than Dox or Trimip. Also, there is a withdrawl symptom from "cholenergic rebound" that could explain why you felt bad subing trimip for ami.
>
> Doxepin is the most potent at Histamine blockade. At the same doses it is the most potent sedative. Trimip is very close to doxepin, slighty less H1 blockade than dox, but much more than ami.
>
> Trimp is nearly as potent as dox at H1 blockade, and should be much more sedating than ami. It is slightly more potent than dox at cholenergic blockade. The other unique things about trimp are lack of re-uptake of NE and 5HT, and very slight DA blockade
>
> Here are the numbers for the three on H1 and Ach blockade from one study I read:
>
> Drug------H1------Ach
>
> Ami-------91------5.1
> Dox------410------1.3
> Trim-----370------1.7
>
>
> So for me dox and trimp seem much stronger, but much cleaner for sleep. I would not underestimate the severity of the cholenergic rebound if switching from ami to one of the other two.
>Fachad,
that information is so helpful. But I am not sure why trimip's sedative effect did not allow me to sleep some...I had to resort to benzo's to sleep. But I do think I had the cholinergic rebound. I was sweating and peeing, etc like crazy. It was very uncomfortable. Really a withdrawal syndrome. I guess, or maybe I am just oversensitive???, that I should have stayed on the ami and added the trimip? Then gradually decrease the ami?However, Trimip is out for me. I have bad eps in my mouth, clenching, tongue wagging, it exacerbated some old td symptoms. :(
But I am really curious about doxepin. If it wouldn't be so drying. I have sores in my mouth that just won't go away. My mouth gets so dry when I sleep (so soundly!) that my gums, lips never heal up. But maybe the H1 in doxepin would also cause drying? You said the H1 causes weight gain. Did you experience this? And if you know, how strong is the NE reuptake compared to ami? I think that is the component in ami that makes me incredibly grouchy and short fused. I get nasty really fast, no warning. It's awful. That's why I had high hopes for trimip. And for those two day+ on trimip, my mood was exceptionally even with an long fuse.
Hope you don't mind all the questions. I just want to have as much info as possible before I ask my pdoc about doxepin. I only have such a short time to talk to her, I have to be totally prepared.
Thanks again, your researched info is so appreciated. Have you found the "right" dose of trimip for you yet? I know 25 is too much still, right?
Chloe
Posted by fachad on June 12, 2002, at 0:58:28
In reply to Re: Trimipramine= no sleep! (Ami vs. Dox vs. Trim) » fachad, posted by Chloe on June 11, 2002, at 18:13:24
Chloe: I am not sure why trimip's sedative effect did not allow me to sleep some...I do think I had the cholinergic rebound. I was sweating and peeing, etc like crazy.
fachad: I really think it was the cholinergic rebound. Ami is far more potent at Ach blockade than trimip.
REM sleep suppression, urinary retention, and temperature regulation are all caused by cholinergic blockade. If you have been taking ami for awhile, your body has equilibrated to that, and if you take something the does not suppress Ach as much, those are the symptoms you would expect.
Chloe: However, Trimip is out for me. I have bad eps in my mouth, clenching, tongue wagging, it exacerbated some old td symptoms. :(
fachad: I don't know if you know this or not, but cholinergic blockade actually reduces TD symptoms.
I don't know the exact mechanism, but anti-cholinergics are used to alleviate TD and EPS symptoms. If your recurrence of EPS was due to the sudden absence of anti-cholinergic effects, you would do worse on doxepin than trimp, even though doxepin has no effect on DA.
In fact, if the EPS was being suppressed by ami, you would have worse EPS on nothing at all than on trimip. A question for your pdoc.
Chloe: But I am really curious about doxepin. If it wouldn't be so drying. I have sores in my mouth that just won't go away. My mouth gets so dry when I sleep (so soundly!) that my gums, lips never heal up.
fachad: It is the anti-cholinergic effect that causes that awful drying. H1 blockade does not cause drying at all. Remeron (mirtazapine) is far more potent at H1 blockade than even doxepin, almost 10 times more than ami, without any anti-cholinergic effects, and it is not drying at all.
So it's safe to say that you would be less dried out on dox than you are on ami, but I'd bet you'd have constant peeing, and maybe EPS too if you didn’t taper slowly off ami or substitute another Ach blocker (which would dry you out).
Chloe: You said the H1 causes weight gain. Did you experience this?
fachad: Well, that's really a difficult question, one that research has not been able to answer with certainty. Some meds (esp. non-psych antihistamines) block H1 very potently without causing weight gain. Many psych meds cause weight gain without blocking H1 (MAOIs, lithium, many others). But there does seem to be some general correlation between weight gain and H1 blockade.
My personal experience is that ami and dox caused some mild weight gain, while trimip does not. Literature reports show weight gain from all three. Avoiding weight gain is my main reason for trying to find the lowest effective dose.
Chloe: how strong is the NE reuptake compared to ami? I think that is the component in ami that makes me incredibly grouchy and short fused
fachad: I've seen other people become short fused on ami. I don't know if anyone has tried to tie it to NE reuptake or anything else.
As far as the NE potency, here are a few numbers:
Drug-------NE reuptake
ami----------4-------
nortrip-----25-------
imimp--------8-------
desip------110-------
trimp------0.2-------
dox----------5-------Note that when you take ami, it is metabolized into nortrip, so you get NE uptake from both drugs, same for imipramine and desipramine. So even though dox is more potent, than ami, it is far less potent than nortrip.
Chloe: Hope you don't mind all the questions. I just want to have as much info as possible before I ask my pdoc about doxepin.
fachad: I don't mind at all - I like to be able to share some of this stuff I've picked up. Another cool thing about doxepin, it comes in a liquid form. I just like that idea both on general principal, and because it allows for very minute dosage adjustments. Doxepin is also a dirt cheap generic.
Chloe: I only have such a short time to talk to her, I have to be totally prepared.
fachad: I hear you there. I have never achieved my "holy grail" of getting the entire 15 minutes of an already too short 15 minute med check appt. with my pdoc. The evils of managed care.
Chloe: Have you found the "right" dose of trimip for you yet? I know 25 is too much still, right?
fachad: I know I would love the sleep from 25mg, but I'm afraid I'd have more side effects. When I get the RX for the 2.5 mg capsules, I'll be able to know exactly how little I can take and still get good sleep. For now, I'm just taking less than 25mg, but I can't accurately tell you how much it is.
Hope doxepin works for you.
Posted by johnj on June 12, 2002, at 9:04:58
In reply to Trimip= cholenergic rebound, EPS, etc (long expl.) » Chloe, posted by fachad on June 12, 2002, at 0:58:28
Fachad:
That is great info you posted. I was hoping you could post the same type of info (ACh, H1) for nortry as compared to the others?
I might have told you, but here is my problem: I get severe rebound of side effects and mood disturbance when I excercise. It takes days to recover and usually it doesn't hit until a day or so after working out. I get dizzy, sleep disturbance and then mood decline.
I have heard from two other people one on amit.(nortry mother drug) and one on notryp that had the same or similar problem. One person told me they didn't get this effect on imipramine, but I had some terrible jitterness and night sweats when I added just a few 10 mgs of impramine to my norty. Is that an Ach effect?
Maybe it is the NE reuptake? As you said amit metabolizes to despramine so the combo has high NE reuptake. I am seriously looking at adding some trimp since I have had trouble sleeping, but I added some omega 3's last week and had to up my benzo a bit and have slept better. I thought the omega 3's were just crap, but I may have to re-evaluate that. Anyway, I would like to switch(with my docs help) and see if things stabilize and then try working out again. It is a mystery why excercise hoses things up, and the doc doesn't quite believe me. This has been going on for years so I know it is not in my head. I may find it is just TCA's that do it or I may find it is just nortry for some odd reason. Well, thanks for reading my rambling. Take care and keep us posted on your trimp dosing. Thank you
Johnj
Posted by Chloe on June 12, 2002, at 9:42:41
In reply to Trimip= cholenergic rebound, EPS, etc (long expl.) » Chloe, posted by fachad on June 12, 2002, at 0:58:28
>> fachad: I've seen other people become short fused on ami. I don't know if anyone has tried to tie it to NE reuptake or anything else.
Fachad,
This info is so invaluable. It is so wonderful to correspond with you. You have helped so much. Google, medline, etc search hasn't been as helpful as you have been to me. I am so appreciative!That is interesting you have heard of others getting short fused on Ami. Do you think this is simply related to Ami? Have you heard of Doxepin causing grouchiness too??? I wonder if all the ACh properties have something to do with this the grouchiness. Can you speculate?
>> As far as the NE potency, here are a few numbers:
>
> Drug-------NE reuptake
>
> ami----------4-------
> nortrip-----25-------
> imimp--------8-------
> desip------110-------
> trimp------0.2-------
> dox----------5-------
>Your charts are so helpful! I love the science part of meds.
Well, if it is the NE reuptake, Doxepin has slightly more! So I guess it wouldn't make a difference...But I am just really wanting to find out if I could be more civil on another TCA.BTW, Trimipramine really is out, because even though I have been back on the Ami for 3 days, I still have awful EPS. This happens when I take an AP. It takes weeks to stop the EPS that only a pill or two with dopamine can cause :(.
>>fachad: I don't mind at all - I like to be able to share some of this stuff I've picked up. Another cool thing about doxepin, it comes in a liquid form. I just like that idea both on general principal, and because it allows for very minute dosage adjustments. Doxepin is also a dirt cheap generic.Thanks again for sharing your insights and experiences. Look forward to hearing more, if you have the energy!
>> Hope doxepin works for you.
Me too! But I am kinda scared to try...Med changes are always such an adjustment! And a gamble.
Chloe
Posted by fachad on June 12, 2002, at 23:00:15
In reply to Re: Norty compared to trimp (fachad), posted by johnj on June 12, 2002, at 9:04:58
Here is the earlier table with nortrip and benedryl added for comparison:
Drug------H1------Ach
Ami---------91------5.1
Dox--------410------1.3
Trim-------370------1.7
Nortrip-----10------0.7
Benadryl-----7---------
Atropine-------------42I have no idea what the underlying mechanism of the exercize problem could be. The only thing you could do is to try other meds.
> Fachad:
>
> That is great info you posted. I was hoping you could post the same type of info (ACh, H1) for nortry as compared to the others?
>
> I might have told you, but here is my problem: I get severe rebound of side effects and mood disturbance when I excercise. It takes days to recover and usually it doesn't hit until a day or so after working out. I get dizzy, sleep disturbance and then mood decline.
>
> I have heard from two other people one on amit.(nortry mother drug) and one on notryp that had the same or similar problem. One person told me they didn't get this effect on imipramine, but I had some terrible jitterness and night sweats when I added just a few 10 mgs of impramine to my norty. Is that an Ach effect?
>
> Maybe it is the NE reuptake? As you said amit metabolizes to despramine so the combo has high NE reuptake. I am seriously looking at adding some trimp since I have had trouble sleeping, but I added some omega 3's last week and had to up my benzo a bit and have slept better. I thought the omega 3's were just crap, but I may have to re-evaluate that. Anyway, I would like to switch(with my docs help) and see if things stabilize and then try working out again. It is a mystery why excercise hoses things up, and the doc doesn't quite believe me. This has been going on for years so I know it is not in my head. I may find it is just TCA's that do it or I may find it is just nortry for some odd reason. Well, thanks for reading my rambling. Take care and keep us posted on your trimp dosing. Thank you
> Johnj
Posted by fachad on June 12, 2002, at 23:07:53
In reply to Re: Trimip= cholenergic rebound, EPS, etc (long expl.) » fachad, posted by Chloe on June 12, 2002, at 9:42:41
Chloe,
I think the information about receptor affinities is very interesting and it does provide some basis of comparison between different TCAs.
However, as my pdoc put it, this data is derived from rat brain tissue that had been blenderized, centrifuged, and then put into a test tube.
How closely that data is going to predict the way the meds are going to act a living human body is very difficult to predict.
Hence the origin of the PSB saying, "Your Mileage May Vary" (YMMV).
> >> fachad: I've seen other people become short fused on ami. I don't know if anyone has tried to tie it to NE reuptake or anything else.
>
>
> Fachad,
> This info is so invaluable. It is so wonderful to correspond with you. You have helped so much. Google, medline, etc search hasn't been as helpful as you have been to me. I am so appreciative!
>
> That is interesting you have heard of others getting short fused on Ami. Do you think this is simply related to Ami? Have you heard of Doxepin causing grouchiness too??? I wonder if all the ACh properties have something to do with this the grouchiness. Can you speculate?
>
>
> >> As far as the NE potency, here are a few numbers:
> >
> > Drug-------NE reuptake
> >
> > ami----------4-------
> > nortrip-----25-------
> > imimp--------8-------
> > desip------110-------
> > trimp------0.2-------
> > dox----------5-------
> >
>
> Your charts are so helpful! I love the science part of meds.
> Well, if it is the NE reuptake, Doxepin has slightly more! So I guess it wouldn't make a difference...But I am just really wanting to find out if I could be more civil on another TCA.
>
> BTW, Trimipramine really is out, because even though I have been back on the Ami for 3 days, I still have awful EPS. This happens when I take an AP. It takes weeks to stop the EPS that only a pill or two with dopamine can cause :(.
>
>
> >>fachad: I don't mind at all - I like to be able to share some of this stuff I've picked up. Another cool thing about doxepin, it comes in a liquid form. I just like that idea both on general principal, and because it allows for very minute dosage adjustments. Doxepin is also a dirt cheap generic.
>
> Thanks again for sharing your insights and experiences. Look forward to hearing more, if you have the energy!
>
> >> Hope doxepin works for you.
> Me too! But I am kinda scared to try...Med changes are always such an adjustment! And a gamble.
> Chloe
Posted by Cece on June 13, 2002, at 0:54:44
In reply to Nortrip vs. other TCAs on H1 and Ach Blockade » johnj, posted by fachad on June 12, 2002, at 23:00:15
Hi Fachad-
I've posted earlier on this thread, but have some new developments/questions/feedback.
I've been taking 25 mg Trim for over 6 mos. having switched from Nortiptyline- my pdoc thought that it would give me less morning grogginess and better sleep. And it did.
But I've been weaning off benzos, and since my nighttime dose of xanax has gone from .75mg to .25mg I have been dreaming 'too much'. And I have not been falling asleep very fast, which is okay cuz I used to fall out like a log, and sleeping more restlessly which is not so okay. My body temp is fine and I don't wake up too early.
I used to have a problem with spending too much time in REM sleep and not enough in the deeper restorative level. I would wake up feeling like I had been working all night. My various combo of meds seemed to take care of that. (I was diagnosed a few years ago with "Upper Airway Obstructive Disorder"- a step below sleep apnea, and set up with a CPAP machine- but eventually decided that it was a crock (a long story)).
Anyway, I thought that you had said that Trim promotes deep level sleep- ? If that's so, am I just adjusting to less benzo? I really need that deep sleep.
My pdoc has just encouraged me to take a small dose of zyprexa (1/4 to 1/2 of a 2.5mg tab) regularly as I am becoming destabilized by summer's approach (I have reverse SAD). I have taken it very occassional PRN at that dose and it definitely makes me saner, but I dread the weight gain. I took half a tab yesterday and slept better last night.
So now I'm confused- again- and wondering what to do. Take the zyprexa and deal with the weight somehow? Take more Trim? Going back up on benzos is out- I need to clear my brain of their cobwebs, and you said earlier that benzos mess with "sleep architecture".
You seem to be pretty knowledgeable; do you have any feedback to offer?
Thanks, Cece
Posted by fachad on June 13, 2002, at 12:34:11
In reply to Trim and sleep » fachad, posted by Cece on June 13, 2002, at 0:54:44
Cece,
Suggestions:
increase trimip dose
try doxepin
try ambien
try sleep restriction
Funny that you say you have "reverse SAD". I've always told my docs that I have that, and they smiled at me like, "sure, whatever". But I really do much worse in the summer.Quality of sleep is a very slippery thing. People who take benzos will report that they believe that they had good sleep, but a polysomnigraph will say otherwise.
We tend to think of sleep like pain, where if you say, "I am in pain", your subjective experience of pain is truly the essence of pain. But in reality, sleep is a physical function that can be measured, and there is not always total correlation between subjective quality and objective quality of sleep.
One thing I discovered about why I seem to sleep better on benzos is the amnesia they cause. I dream a lot, I wake up, but I forget that I had dreamed and waked in the night.
If you have reduced your dose of benzo recently, that could cause rebound REM; if that is it, it will go away with some time.
As far as to what to do, ask your pdoc if you could take more trimip and see if that helps. Or you could try doxepin, which does suppress REM some which may be what you need.
Have you ever tried Ambien? It's very short acting, but it is quite powerful and does not disturb sleep like benzos.
Finally, I think the stuff about sleep hygiene is over hyped by benzo-phobic docs, but it is good to make sure you are not missing anything here.
And the most powerful thing to induce deep quality sleep is still sleep deprivation / sleep restriction. If you are not sleeping well in an 8 hour night, try a 7 hr. sleep period the next night, if poor sleep a 6 hr night etc. Get up earlier is far better than staying up later - it really does make a difference.
> Hi Fachad-
>
> I've posted earlier on this thread, but have some new developments/questions/feedback.
>
> I've been taking 25 mg Trim for over 6 mos. having switched from Nortiptyline- my pdoc thought that it would give me less morning grogginess and better sleep. And it did.
>
> But I've been weaning off benzos, and since my nighttime dose of xanax has gone from .75mg to .25mg I have been dreaming 'too much'. And I have not been falling asleep very fast, which is okay cuz I used to fall out like a log, and sleeping more restlessly which is not so okay. My body temp is fine and I don't wake up too early.
>
> I used to have a problem with spending too much time in REM sleep and not enough in the deeper restorative level. I would wake up feeling like I had been working all night. My various combo of meds seemed to take care of that. (I was diagnosed a few years ago with "Upper Airway Obstructive Disorder"- a step below sleep apnea, and set up with a CPAP machine- but eventually decided that it was a crock (a long story)).
>
> Anyway, I thought that you had said that Trim promotes deep level sleep- ? If that's so, am I just adjusting to less benzo? I really need that deep sleep.
>
> My pdoc has just encouraged me to take a small dose of zyprexa (1/4 to 1/2 of a 2.5mg tab) regularly as I am becoming destabilized by summer's approach (I have reverse SAD). I have taken it very occassional PRN at that dose and it definitely makes me saner, but I dread the weight gain. I took half a tab yesterday and slept better last night.
>
> So now I'm confused- again- and wondering what to do. Take the zyprexa and deal with the weight somehow? Take more Trim? Going back up on benzos is out- I need to clear my brain of their cobwebs, and you said earlier that benzos mess with "sleep architecture".
>
> You seem to be pretty knowledgeable; do you have any feedback to offer?
>
> Thanks, Cece
Posted by Cece on June 13, 2002, at 15:18:32
In reply to Re: Trim and sleep » Cece, posted by fachad on June 13, 2002, at 12:34:11
Thanks for your response Fachad.
I was interviewed recently by a reporter for the NY Times for a story on Reverse SAD. She found me through a post that I made last year on P-B (Dr. Bob did not give her my personal info- just forwarded her inquiry to me and left it to me whether to respond or not). It will be appearing soon in a special supplement on Women's Health although it is not a problem unique to women. It has been reasearched some but the cause is not known. I suffer from the bright light of summer, and although where I live is relatively cool (Northern CA), I become virtually non-functional in a heat spell. I've been thinking of starting a new thread on this since the season is here- feel free to start it yourself.
My pdoc is very interested in the effect of artificial light on BP disorders. He and others believe that living out of synch with the natural cycles of night and day stimulate cycling. There is an interesting article on this issue as a link off of:
http://www.psycheducation.org/.
This seems right to me intuitively, and as much as possible (not often enough) I take his suggestion of no electrical lighting after sunset, just candles and kerosene lanterns. It is very relaxing, and I do sleep better and wake up more easily. My neice who is BPI decided to try the idea out and has done it for 3 months! It's one of those things that it's hard to evaluate direct cause and effect, but she is feeling strong enough to take a very challenging graduate class that she had postponed for a long time.I may try raising my Trim a little- fine with my pdoc. Re the other med ideas, I am really trying to pare the meds that I take down to the bare bones- the reverse process of the layering that created a cumbersome cocktail that is a lot of work to maintain. I'm tired of running my own major pharmacy. I think that I'm going to try doing the Zyprexa, but consider it short-term, or maybe just a summer med. But thanks for the other suggestions, I'll keep them in mind.
I have been told, and experience, that sleep deprivation is a short-term fix. I'm really someone who does best with a solid 8 hours, but it does only really work if I keep 'sensible' hours which is hard for me- I tend to be a night owl. My previous pdoc told me that the quality of sleep between 10 and 6 is much better than say 2 and 10. I agree that some of the sleep hygiene stuff is 'bunky'- I'll use my bed for any activities that I choose thank you!
Cece
Posted by Chloe on June 13, 2002, at 17:29:04
In reply to Speculation on Blenderized Rat Brains » Chloe, posted by fachad on June 12, 2002, at 23:07:53
Yuck, the poor rats! but you are so right. One never knows how one is going to feel until one swallows the pill.
I am going to try doxepin and and have been tapering the amit. Boy, is that awful, I am not sleepoing great, depressed and kinda grumpy, instead of agitated and grumpy. Go figure!
I can't believe how much H1 blockage dox has! The dry mouth must be unbearable. And that was one thing I was try to lessen (thinking it was an ACh problem...) because I have such sores on my tongue and raw insides of my lips.But in your experience, Doxepin is a better sleep aid than ami? You did not mention amitrip. to Cece who had some Q's about sleep/dreaming etc. Have you tried ami, and if so, what was your response?
Thanks, Fachad. How true about YMMV!
Posted by fachad on June 13, 2002, at 19:10:41
In reply to Re: Speculation on Blenderized Rat Brains » fachad, posted by Chloe on June 13, 2002, at 17:29:04
> I am going to try doxepin and and have been tapering the amit.
How much ami are you taking? You could probably just switch from one day to the next unless your ami dose is really high.
My wife once switched from 150 mg ami every day to 150 mg dox the next day and it seemed ok, but her GI problem that the ami was treating came back on dox.
> I can't believe how much H1 blockage dox has! The dry mouth must be unbearable. And that was one thing I was try to lessen
The dry mouth is an Ach thing, not an H1 thing. Dox causes much much less dry mouth than ami. Remeron is much stronger at H1 blockade than even dox, with no ach blockade, and it does not cause any dryness.
I can't stand the dry mouth from ami, that's why I switched to dox years ago.
> But in your experience, Doxepin is a better sleep aid than ami? You did not mention amitrip. to Cece who had some Q's about sleep/dreaming etc. Have you tried ami, and if so, what was your response?
Yes, I tried ami, and, like I said, I absolutely hated the dry mouth. Since dox has more of what you want (H1) with less of what you don't want (Ach) I just can't see why someone who was aware of those facts would choose ami.
I think most likely it's because docs are very comfortable and familiar with ami. Your doc may have chosen it for the Ach blockade to control EPS, but more likely that was just a fortunate coincidence.
> Yuck, the poor rats! but you are so right. One never knows how one is going to feel until one swallows the pill.
>
> I am going to try doxepin and and have been tapering the amit. Boy, is that awful, I am not sleepoing great, depressed and kinda grumpy, instead of agitated and grumpy. Go figure!
> I can't believe how much H1 blockage dox has! The dry mouth must be unbearable. And that was one thing I was try to lessen (thinking it was an ACh problem...) because I have such sores on my tongue and raw insides of my lips.
>
> But in your experience, Doxepin is a better sleep aid than ami? You did not mention amitrip. to Cece who had some Q's about sleep/dreaming etc. Have you tried ami, and if so, what was your response?
>
> Thanks, Fachad. How true about YMMV!
Posted by Chloe on June 13, 2002, at 20:46:27
In reply to Re: Speculation on Blenderized Rat Brains » Chloe, posted by fachad on June 13, 2002, at 19:10:41
Your post was most helpful...
I was only on 20 of ami, and have been taking ten for the last 3 days. Today, I have the worst epigastric pain. I know it's a withdrawal thing from ami. My body wants it's ami. I just picked up 10 mg size of Doxepin. I am supposed to take one or two at night. So I guess I will just jump in and take 2 caps of doxepin...What was the stomach ailment of your wife, if you don't mind me asking. The constipation on ami for me is awful. Even with flaxseed oil, fiberous diet, lots of water. It's a loosing battle with ami! But for some problems I imagine this is a good thing. I assume dox would be binding with less ACh?
I am so glad the H1 doesn't necessarily mean terrible dry mouth. You should see the inside of my mouth. It's so raw. I try to use rinses for mouth sores, but they burn so...
Oh, I was given amitriptyline initially for neurogenic scalp pain induced from lithium, I think...I didn't really help the pain and burn, but it did help me sleep at night. It was hard sometimes to lie on my pillow without my hair hurting, and it would keep me up.
My hope is that dox will be less drying in general, because I think I am on so many drying meds, it makes the scalp pain worse. And Dox is supposed to be good for itching. I have ezcema, and when I get under stress, I can really get scatching. So lets hope this is a bit more targeted to my needs.
Oh, one last thing. I did read that dox has a much shorter half life than ami. Dox, about 6-8 hours, where ami is 10-50 hours. Do you ever find some rebound anxiety or edginess the next day from the dox? I tend to notice when meds run out...I wonder if this is an issue?I can't thank you enough for taking the time and energy to discuss these TCA's in such detail.
Chloe
Posted by fachad on June 13, 2002, at 22:12:02
In reply to Re:Doxepin » fachad, posted by Chloe on June 13, 2002, at 20:46:27
> I was only on 20 of ami, and have been taking ten for the last 3 days. Today, I have the worst epigastric pain. I know it's a withdrawal thing from ami.
That is a pretty small dose, but I bet the epigastric pain is ami withdrawal.
>I just picked up 10 mg size of Doxepin. I am supposed to take one or two at night. So I guess I will just jump in and take 2 caps of doxepin...
I would. When used for depression, ami, doxepin, trimip, typical doses are 150mg/day, and can be as high as 300mg/day. So even if you still had 20 mg of ami in your system, and you took the full 20 mg of doxepin, it would be a relatively tiny total TCA dose.
> What was the stomach ailment of your wife, if you don't mind me asking.
She has pain dominant Irritable Bowel Syndrome (IBS). Here's a link to the full story of how ami worked when nothing else did. (I referred to ami by it's brand name, "Elavil" in that post.)
http://www.dr-bob.org/babble/20020322/msgs/99806.html
Anyway, that whole ordeal was quite amazing, and left me with a renewed respect for TCAs.
>The constipation on ami for me is awful. Even with flaxseed oil, fiberous diet, lots of water. It's a loosing battle with ami!
Yes, the ami constipation is pretty bad.
>I assume dox would be binding with less ACh?
Yes. For blenderized rat brains it is almost 5 times less potent at blocking ACH, and ACH blockade is definitely the cause of dry mouth and constipation. ACH neurons mediate both salivation and intestinal motility. ACH blockade is the highest thing on my personal "yuck" scale.
> I am so glad the H1 doesn't necessarily mean terrible dry mouth. You should see the inside of my mouth. It's so raw. I try to use rinses for mouth sores, but they burn so...
No, H1 blockade does not mean dryness. Some people believe that because most conventional H1 blockers (antihistamines) cause dryness, that H1 blockade is the culprit. But those antihistamines also block ACH, and that's why they cause dry mouth. But it's the ACh, not the H1, that's drying them out.
Regarding the mouth sores, in the past few weeks I've had a few mouth ulcers spring up, and I found an OTC remedy that seems to help. It's called DGL, de glyceryzed licorice. It sooths the sores, and it contains some chemical which stimulates the flow of mucous to the membranes, helping them heal. You can get it in lozenge form at a health food store.
>And Dox is supposed to be good for itching. I have ezcema, and when I get under stress, I can really get scatching. So lets hope this is a bit more targeted to my needs.
Dox is stronger at H1 blockade, so it should be better for both blocking itching and inducing sleep. Regarding the itching, they acutally make a doxepin topical creme for severe itching. People say it works better than anything else, but it makes them too tired, just from being absorbed thru the skin!
> Oh, one last thing. I did read that dox has a much shorter half life than ami. Dox, about 6-8 hours, where ami is 10-50 hours. Do you ever find some rebound anxiety or edginess the next day from the dox?
For me that is a big plus because it means less next day grogginess. I was a little worried that because trimp has so much longer half life than dox that I would want to sleep thru the next morning, but it's been OK.
One final comment since we're talking about doxepin pharmacokenetics: doxepin has a very high "first pass" effect. This means that after it is absorbed from your GI, it passes thru the liver before it gets to your brain. All meds do this, but doxepin is broken down very extensively during this first pass, so much less of it gets to your brain than ami, even though you've taken the same dose. So you might need a higher dose of dox to do the same job as the ami because of this. Just a possibility to consider if it seems like it's not working.
Posted by Ritch on June 13, 2002, at 22:32:03
In reply to Re: Reverse SAD, sleep, light, meds » fachad, posted by Cece on June 13, 2002, at 15:18:32
> Thanks for your response Fachad.
>
> I was interviewed recently by a reporter for the NY Times for a story on Reverse SAD. She found me through a post that I made last year on P-B (Dr. Bob did not give her my personal info- just forwarded her inquiry to me and left it to me whether to respond or not). It will be appearing soon in a special supplement on Women's Health although it is not a problem unique to women. It has been reasearched some but the cause is not known. I suffer from the bright light of summer, and although where I live is relatively cool (Northern CA), I become virtually non-functional in a heat spell. I've been thinking of starting a new thread on this since the season is here- feel free to start it yourself.
>
> My pdoc is very interested in the effect of artificial light on BP disorders. He and others believe that living out of synch with the natural cycles of night and day stimulate cycling. There is an interesting article on this issue as a link off of:
> http://www.psycheducation.org/.
> This seems right to me intuitively, and as much as possible (not often enough) I take his suggestion of no electrical lighting after sunset, just candles and kerosene lanterns. It is very relaxing, and I do sleep better and wake up more easily. My neice who is BPI decided to try the idea out and has done it for 3 months! It's one of those things that it's hard to evaluate direct cause and effect, but she is feeling strong enough to take a very challenging graduate class that she had postponed for a long time.
>
> I may try raising my Trim a little- fine with my pdoc. Re the other med ideas, I am really trying to pare the meds that I take down to the bare bones- the reverse process of the layering that created a cumbersome cocktail that is a lot of work to maintain. I'm tired of running my own major pharmacy. I think that I'm going to try doing the Zyprexa, but consider it short-term, or maybe just a summer med. But thanks for the other suggestions, I'll keep them in mind.
>
> I have been told, and experience, that sleep deprivation is a short-term fix. I'm really someone who does best with a solid 8 hours, but it does only really work if I keep 'sensible' hours which is hard for me- I tend to be a night owl. My previous pdoc told me that the quality of sleep between 10 and 6 is much better than say 2 and 10. I agree that some of the sleep hygiene stuff is 'bunky'- I'll use my bed for any activities that I choose thank you!
>
> CeceCece,
That is very interesting reading. I have two SAD episodes a year-one in the winter and one in the summer. The summer one is already starting and it is marked by early morning awakenings (most of the last week or so). Imipramine is making this worse and I have stopped it (because of REM suppression?). I work evenings with artificial light and don't have the option of synching myself with nature. However, my take on the origin of the "reverse" SAD symptoms isn't the *bright* light-it is the *DURATION* of the available light. Let me start from scratch. I get depressed the worst in the winter centered around the winter solstice (lack of light). BUT, there are a lot of factors influencing the amount of light that you expose yourself to. One is the amount of natural vegetation in your environment and how much time you spend indoors versus outdoors. Anyhow, I notice that I feel *recovery* from the wintertime episode about mid-January. Snow makes things better. I have to get outside to shovel the snow away, walk to the store after a blizzard, etc. But, by the end of February I clearly notice the marked intensity of light coming through my windows (no trees yet). That is when I start developing hypomanic and mixed states. That worsens *until* the tree "canopy" is fully developed (which provides shade). So, though the temperature is increasing outside, the amount of light *INTENSITY* is drastically reduced, however the light *DURATION* is increasing. That is when I start to get my 2nd "reverse" SAD depression. It starts to significantly remit (and another hypomanic spell usally happens-however less intense) whenever the trees start dropping leaves and there is no storms or rain and the sky is cloudless and bright during the fall, while the light *DURATION* is decreasing and decreased, but the light *INTENSITY* is coming back up again-everything is very bright and "contrasty" outside.
Mitch
Posted by Cece on June 13, 2002, at 22:40:30
In reply to Re: Reverse SAD, sleep, light, meds » Cece, posted by Ritch on June 13, 2002, at 22:32:03
Hey Ritch-
Let's start a thread on Reverse SAD! I think that I'll copy some of my last post here and expand upon it. It would be great if you could repost your last message to me on the new thread. I know that there are more of us out there and it could make a good discussion. You and I have a number of similarities.
By the way, I'm a horticulturalist and landscaper and spend a lot of time outdoors.
Cece
Posted by Chloe on June 14, 2002, at 20:54:45
In reply to Re:Doxepin » Chloe, posted by fachad on June 13, 2002, at 22:12:02
Fachad,
I have to say, you really have done your research! I have a whole new respect for TCA's and your ability to understand and relay the information.I really don't want to jinx anything, because it was only one night. But the doxepin worked great! I was anxious that I would not fall asleep like with Trimip. But I fell into the black hole of sleep. God, that experience is priceless. In hind sight, I think I had a paradoxical reaction to trimip. It really caused a great deal of anxiety and angst, as well as profound insomnia and restlessness. Not to mention all the ACh rebound peeing, etc.
I did wake up very refreshed this morning and in a very pleasant mood. This is highly uncharacteristic of me on ami. I am usually nasty and short fused and fussy. I AM starting to notice some reemerging scalp pain. Perhaps related to less doxepin being available to the body at only 20 mgs? I will stay at 20 for a while and hope it gets better. But as you say, I may need to bump the dose to continue to get sleep and pain relief. (AND I didn't even think the ami was doing much for the scalp burn/pain! I guess it was..)
I am only taking the TCA for sleep and pain. I also take a tiny tiny (1.5 mgs) amount of Celexa. I am BP2 so I don't require alot of AD, and of course too much can make me hypomanic. But with ami, I was always in this dysphoric angry state, just with more energy to a pick fight with a good friend or family member or anyone for that matter.
So I hope the doxepin will ease some of the grouchy, short fuse stuff, and boost my mood a bit. I got enough mood stabilizers to support taking a bit more doxepin than I did with ami...I know this is highly individualized, but what is the usual dose for "sleep" or pain? I have only seen the AD dose recommendations...They couldn't be the same. Isn't 150 mgs of Dox pretty sedating? Or does one acclimate quickly?
Thanks for the link about elavil and your wife. I am so glad she found a med that has helped her control her disease, despite the miserable side effects. She must be a brave person.
Thanks Fachad for sharing
Chloe
Posted by fachad on June 14, 2002, at 23:10:00
In reply to Re:Doxepin » fachad, posted by Chloe on June 14, 2002, at 20:54:45
I think the usual TCA dose for sleep or pain is 25mg or 50mg.
Some people may get by with only 10mg but others may need the full AD dose of 150 - 300mg.
I think a dr. would usually titrate the dose up until you are sleeping fine and the pain is gone, or the side effects become intolerable, whichever comes first.
Regarding the sedation at 150mg, my wife slept around the clock at first, but over a few months she got back to normal. Almost 10 years later, it still knocks her out at night, and she sleeps really hard, but by the next morning she is fine.
I hope the dox works for you.
> Fachad,
> I have to say, you really have done your research! I have a whole new respect for TCA's and your ability to understand and relay the information.
>
> I really don't want to jinx anything, because it was only one night. But the doxepin worked great! I was anxious that I would not fall asleep like with Trimip. But I fell into the black hole of sleep. God, that experience is priceless. In hind sight, I think I had a paradoxical reaction to trimip. It really caused a great deal of anxiety and angst, as well as profound insomnia and restlessness. Not to mention all the ACh rebound peeing, etc.
>
> I did wake up very refreshed this morning and in a very pleasant mood. This is highly uncharacteristic of me on ami. I am usually nasty and short fused and fussy. I AM starting to notice some reemerging scalp pain. Perhaps related to less doxepin being available to the body at only 20 mgs? I will stay at 20 for a while and hope it gets better. But as you say, I may need to bump the dose to continue to get sleep and pain relief. (AND I didn't even think the ami was doing much for the scalp burn/pain! I guess it was..)
>
> I am only taking the TCA for sleep and pain. I also take a tiny tiny (1.5 mgs) amount of Celexa. I am BP2 so I don't require alot of AD, and of course too much can make me hypomanic. But with ami, I was always in this dysphoric angry state, just with more energy to a pick fight with a good friend or family member or anyone for that matter.
> So I hope the doxepin will ease some of the grouchy, short fuse stuff, and boost my mood a bit. I got enough mood stabilizers to support taking a bit more doxepin than I did with ami...
>
> I know this is highly individualized, but what is the usual dose for "sleep" or pain? I have only seen the AD dose recommendations...They couldn't be the same. Isn't 150 mgs of Dox pretty sedating? Or does one acclimate quickly?
>
> Thanks for the link about elavil and your wife. I am so glad she found a med that has helped her control her disease, despite the miserable side effects. She must be a brave person.
>
> Thanks Fachad for sharing
> Chloe
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