Posted by zeugma on February 24, 2005, at 21:35:49
In reply to Re: no caffeine day » zeugma, posted by SLS on February 24, 2005, at 20:51:53
Hi Scott.
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> I'm very happy that you have been able to optimize your dosing of Provigil to make it unnecessary use caffeine.:)
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> Gosh. We are asked to make so many compromises with these illnesses and the medications we take to treat them. It seems like it never ends.
>No. It's a full-time occupation. And then when the meds stop working, it's a full-fledged emergency. I hope I'm learning how to deal with that.
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> It seems that Seroquel is considered least likely to cause sexual s/e:
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> Hmmm. I didn't know that. I tried Seroquel once about 5 years ago. I didn't have a problem with sedation. However, I felt irritable and a bit dysphoric on it, so I didn't go beyond 2 weeks with it. Thanks for the link.
>Dysphoria above baseline is intolerable. but irritability can sometimes be a sign of lifting depression. But what you say makes sense in light of some info I've come across, to the effect that Zyprexa has the strongest efficacy as an antidepressant among the AP's. Although I wonder if you have ever looked into clozapine as an alternative.
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> On another note... What happens to your REM sleep when you take an antimuscarinic? I don't recall your history, but Parnate and Nardil totally suppressed dreaming for me. They are more powerful in this regard than the TCAs. If these MAOIs cause insomnia, you just treat the insomnia aggressively. Many people describe a period of tiredness, fatigue, or somnolence in the afternoon with Parnate. You could continue to take Provigil to help counteract this. Just a few rambling thoughts.
I came across a case report of a man with severe narcolepsy who was treated with Parnate and high-dose provigil and it worked quite well. So it's good to know there are some options. To answer your questions: I haven't taken a pure antimuscarinic since I was on benztropine for EPS due to perphenazine. that was many years ago, and before I began manifesting the abnormalities of REM sleep that came later. I do recall that nortriptyline (which was substituted later) had a much more suppressant effect on dreaming than the benztropine, though I'm sure the AP had something to do with that. Antimuscarinics haven't found a place in the treatment of cataplexy, though a leading clinician notes that some of the best anticataleptic drugs are antimuscarinic.I've never been on an MAOI. Has your tolerance to the REM suppressant effects of AD's become complete by now? :(
-z
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poster:zeugma
thread:446337
URL: http://www.dr-bob.org/babble/20050222/msgs/462971.html