Posted by fachad on February 28, 2002, at 14:43:00
In reply to Re: doxepin for insomnia?, posted by Elizabeth on February 28, 2002, at 1:24:25
My previous pdoc was very much against antipsycotics, and he always drilled into me the horror of tardive diskinesia and EPS.
He would generally let me try anything I asked for, but he would not let me try amoxapine (an old TCA similar to an AP) and he gave me the worst lecture ever about permanent disfigurement, etc. when I asked for it.
He even called my wife's GP to caution him about giving her too much Compazine for nausea and vomiting because of the potential for TD and EPS.
I am still amazed at how many people here who are not psychotic who take APs for sleep or to augment ADs.
Maybe my pdoc was just an AP-phobic, the way some docs are benzo-phobic.
> I'm sort of iffy about the doxepin idea. It is generally agreed to be the most sedating tricyclic, and lots of people use it to good effect for insomnia. But I don't see it being more effective or less likely to cause tolerance than Seroquel. I also think that doxepin is more likely to cause side effects (based on its binding profile), particularly if she has to keep increasing the dose.
>
> I think Zyprexa might be worth a try. It seems to be more sedating than the other atypical antipsychotics (except Clozaril). The tolerance problem may still be an issue, of course. Another option would be to use one of the older antipsychotic drugs. I tried taking Mellaril -- an itty bitty dose of it, 10 mg I think -- one night, and I slept extremely well. The disadvantage is the risk of extrapyramidal symptoms, although this is dose-dependent (and Mellaril is among the least likely of the phenothiazines to cause EPS).
>
> There are a lot of other things you could try. I could list a bunch of them if you want (I think I did recently in response to someone else's post, in fact).
>
> BTW, a note to fachad:
>
> > I knew someone who was treated for Xanax withdrawl with it, and she was told she could take a 10mg capsule every hour, all day, every day, if she felt she needed it (and that was still only 240mg/day, less than the max dose.
>
> Tricyclic antidepressants are not very good for people who are in benzodiazepine withdrawal, IMO. A sedating anticonvulsant would have been my choice (possibly in conjunction with clonidine or guanfacine). TCAs lower the seizure threshold, which is bad for somebody who's in benzo withdrawal.
>
> -elizabeth
poster:fachad
thread:95022
URL: http://www.dr-bob.org/babble/20020222/msgs/95845.html