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Re: Nortriptyline and Seroquel, etc

Posted by tonyz on May 23, 2009, at 15:02:37

In reply to Re: Nortriptyline and Seroquel, etc, posted by desolationrower on May 22, 2009, at 17:43:08

> i can't tell if you are increasing or decreasing the nortr. now... have you had plasma measurement. i'm not sure what the ideal dose of it is for sleep, i guess it would depend on 5ht2 and alpha1 occupancy. gapentin might help too.
>
> have you asked about using mirtazipine instead of quitiapine
>
> temazepam seems to tbe the prefered benzo for sleep.
>
> Have you had sleep test and cbt for insomnia? i think anyone would have difficulting during the day on that little sleep. was depression or insomnia the first thing?
>
> -d/r


Always starts with high anxiety which leads to confusion and lack of sleep and rapidly turns into a very bad depression. 10 years ago when this would happen I would treat it with amitryptyline and a little valium and/or temazepam. The recovery was usually pretty quick maybe 3 months or so and I maintained some level of functionality during that time period.

I never had much faith in the SSRIs because of the anxiety component of my depression.

Started back on the seroquel last night, I can't be sure but I think I got about 6.5 hours sleep - the quality of it is questionnable.

The problem with all of these drugs is that they interfere with sleep architecture. I wish I could find a different alternative. I have not been to a sleep lab. I'm not sure what they would do - could they adjust your medication based on what they observe? Not sure what cbt is?

Nortriptyline is being increased will probably go up to 150-175 mg. I've had blood levels in those ranges before so I know that is the therapeutic point for me.

For maintenance they seem to think I should be on either lithium or lamictal although no one thinks I'm bipolar.

Because of side effects Nortriptyline is not something I could stay on for the long haul.



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