Posted by zeugma on February 21, 2004, at 1:00:09
In reply to Re: Straterra makes anyone more energetic/alert? » zeugma, posted by Chairman_MAO on February 20, 2004, at 7:41:53
> I think what he's saying is that the half-life of all of those drugs is long enough such that there's a hangover from the antihistamine effect. I experience this from trazodone (which I MUST take to sleep normally) with a profound hangover in the morning. I am so out of it my ADD/energy is WRECKED in the morning, and thus I have to drink coffee, which then agitates me and punches holes in my stomach 2-3 hours later.
>That makes sense- although I thought trazodone had a relatively short half-life- something on the order of 5-8 hours. Nortriptyline has a half-life of about 31 hours, which sounds like hangover hell- but it is a lot more stimulating than trazodone (because of its NE effects) and its metabolite (10-hydroxy-nortriptyline) is more stimulating still (and has no antihistaminic effect). I feel hung over in the a.m., sure, and need to drink gallons of coffee to stay alert. But I was never able to get by without coffee. And when you consider that prior to this drug regimen I would rarely be awake before 2 p.m.- or asleep before 5 a.m. - and now I have to wake up at 5 a.m. every morning in the week- it has been nothing less than a remarkable improvement in both sleep quality and speed of onset (I have terrible, terrible initial insomnia and wakings at sleep onset).
The TCA's seem to be put together like a set of Chinese boxes- both amitriptyline and imipramine have metabolites that are more activating and less sedating, and this is true of the metabolites themselves, also. Nortriptyline pharmokinetics are interesting in this respect because the peak plasma levels which are reached eight hours after beginning of metabolism are of unchanged nortriptyline which is more antihistaminic (and serotonergetic); after that the hydroxylated metabolite kicks in and the noradrenergic effect intensifies, resulting in a more activating profile that presumably helps with getting out of bed.The catch? TCA's are a lot less CONVENIENT than trazodone. You need to take full AD doses to get a real sedating effect, and it can take a while to titrate up to therapeutic level. And that comes complete with s/e. I have a mouthfullof cavities due to dry mouth. On the other hand, I have something like a life.
> Someday I am going to dump this Wellbutrin and trazodone and take Parnate with Gabitril at night.
>
> By the way utopizen, you really should consider asking about Gabitril if he refuses you Ambien/Sonata.
poster:zeugma
thread:314938
URL: http://www.dr-bob.org/babble/20040218/msgs/316324.html