Posted by bleauberry on August 9, 2010, at 17:00:53
In reply to Is 4 weeks a fair trial of celexa ? Insomnia, posted by rculater on August 4, 2010, at 6:17:47
I haven't followed this post. I am just looking at the title...Is 4 weeks a fair trial of celexa?
Answer = no.
8 weeks minimum, 12 weeks better, 16 even better. I know, that's hard when things are rough. But for a fair trial, it takes that long for the longterm brain adaptations to take place.
Sleep. IMO one of the best insomnia aids is tiny dose remeron. We're talking a 15mg tab and literally cutting off crumbs...maybe 1mg to 6mg. In the sleep med category my personal favorite was lunesta. I never took it continuously though. Only to break the cycle and get a good sleep for a night. The tiny dose remeron is a better longterm route. Many use seroquel but I personally do not favor that approach for a variety of reasons. Antipsychotics are for special purpose, and I do agree with using a potent med like that merely for sleep.
My insomnia from paxil and later prozac never really went away. I mean, it got better over the months, but I never slept deep. I tried all kinds of stuff. I mention remeron because of them all, it was the best. Pros and cons with everything. Mileage varies. But you need some sleep! I think you could get a free sample of lunesta from your doc and use it just once or twice a week. You could get a cheap generic script for 15mg remeron and using only tiny crumbs it would last for months.
Having said all that, I do not favor a pure serotonin approach to treating any kind of depression. Celexa is a pure serotonin approach. Something like 5mg to 20mg of Nortriptyline added to it would probably boost the antidepressant speed and thoroughness a great deal as well as give you better sleep. Actually, that's probably what I would try first before anything else. It covers a lot more bases than just sleep. And the dose is low enough to not be much of a burden in terms of side effects. The minimum dose is 10mg, but I personally found half a capsule (5mg) to be a good dose for me. Slept good, a lot of aches and pains disappeared, and zoloft seemed to kick in pretty quick which it did not do until the nortriptyline was added.
You have already shown that you are sensitive to celexa doses. You can't go higher. So it makes sense to add in a complimentary med, which nortriptyline is, also at a low dose. One plus one equals three in this case. Synergism. Different mechanisms that compliment each other and allow lower doses to be effective.
A general rule of thumb in my book, as evidenced by a couple studies on milnacipran, is that low doses can work just as good as higher doses.....but...they take longer.
poster:bleauberry
thread:957155
URL: http://www.dr-bob.org/babble/20100731/msgs/958059.html