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.
poster:fachad
thread:108844
URL: http://www.dr-bob.org/babble/20020609/msgs/109544.html