Posted by linkadge on May 5, 2010, at 17:00:11
In reply to Question for Blueberry and others, posted by tonyz on May 5, 2010, at 16:29:31
What is your underlying diagnosis? Do you think the amitriptyline is treating that effectively?
Were you on the benzos before the amitriptyline?
A z drug like zopiclone might be more effective for sleep than a benzo. You might try and consolidate the benzos in to one.
If the core issue is insomnia, something like melatonin might help. It tends to reduce benzo tollerance too which may help.
If the core issue is depression or anxiety, perhps adding a low dose of paroxetine or citalopram might help.
You might try doxapine too. Amitriptyline is good for sleep (in general), but doxapin or trimipramine are better. Sometimes too, the sedating AD's are good for sleep in lower doses, but promote insomnia at higher doses. Higher doses of amitriptyline might not be as sedating as the lower doses.
Perhaps trying an SSRI with lower doses of a sedating tca. Ie citalopram + doxapin, or paroxetine + trimipramine. The problem with TCA's is that in higher doses, you get substantial norepinephrine reuptake inhibition. This tends to reduce deep sleep.
If there is any hint of bipolar, or perhaps unresolved agitated which is promoting the insomnia, a drug like perphenazine (low dose) might help.
Changing the lithium to the morning (if you are taking it at night) might also improve sleep disturbance. Lithium tends to calm you down but it can induce sleep disturbances.
Tryptophan augmentation might be ok, but watch for syptoms of serotonin syndrome.
Linkadge
poster:linkadge
thread:946450
URL: http://www.dr-bob.org/babble/20100504/msgs/946451.html