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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 31 to 55 of 62. Go back in thread:
Posted by fachad on June 13, 2002, at 19:10:41
In reply to Re: Speculation on Blenderized Rat Brains » fachad, posted by Chloe on June 13, 2002, at 17:29:04
> I am going to try doxepin and and have been tapering the amit.
How much ami are you taking? You could probably just switch from one day to the next unless your ami dose is really high.
My wife once switched from 150 mg ami every day to 150 mg dox the next day and it seemed ok, but her GI problem that the ami was treating came back on dox.
> I can't believe how much H1 blockage dox has! The dry mouth must be unbearable. And that was one thing I was try to lessen
The dry mouth is an Ach thing, not an H1 thing. Dox causes much much less dry mouth than ami. Remeron is much stronger at H1 blockade than even dox, with no ach blockade, and it does not cause any dryness.
I can't stand the dry mouth from ami, that's why I switched to dox years ago.
> But in your experience, Doxepin is a better sleep aid than ami? You did not mention amitrip. to Cece who had some Q's about sleep/dreaming etc. Have you tried ami, and if so, what was your response?
Yes, I tried ami, and, like I said, I absolutely hated the dry mouth. Since dox has more of what you want (H1) with less of what you don't want (Ach) I just can't see why someone who was aware of those facts would choose ami.
I think most likely it's because docs are very comfortable and familiar with ami. Your doc may have chosen it for the Ach blockade to control EPS, but more likely that was just a fortunate coincidence.
> Yuck, the poor rats! but you are so right. One never knows how one is going to feel until one swallows the pill.
>
> I am going to try doxepin and and have been tapering the amit. Boy, is that awful, I am not sleepoing great, depressed and kinda grumpy, instead of agitated and grumpy. Go figure!
> I can't believe how much H1 blockage dox has! The dry mouth must be unbearable. And that was one thing I was try to lessen (thinking it was an ACh problem...) because I have such sores on my tongue and raw insides of my lips.
>
> But in your experience, Doxepin is a better sleep aid than ami? You did not mention amitrip. to Cece who had some Q's about sleep/dreaming etc. Have you tried ami, and if so, what was your response?
>
> Thanks, Fachad. How true about YMMV!
Posted by Chloe on June 13, 2002, at 20:46:27
In reply to Re: Speculation on Blenderized Rat Brains » Chloe, posted by fachad on June 13, 2002, at 19:10:41
Your post was most helpful...
I was only on 20 of ami, and have been taking ten for the last 3 days. Today, I have the worst epigastric pain. I know it's a withdrawal thing from ami. My body wants it's ami. I just picked up 10 mg size of Doxepin. I am supposed to take one or two at night. So I guess I will just jump in and take 2 caps of doxepin...What was the stomach ailment of your wife, if you don't mind me asking. The constipation on ami for me is awful. Even with flaxseed oil, fiberous diet, lots of water. It's a loosing battle with ami! But for some problems I imagine this is a good thing. I assume dox would be binding with less ACh?
I am so glad the H1 doesn't necessarily mean terrible dry mouth. You should see the inside of my mouth. It's so raw. I try to use rinses for mouth sores, but they burn so...
Oh, I was given amitriptyline initially for neurogenic scalp pain induced from lithium, I think...I didn't really help the pain and burn, but it did help me sleep at night. It was hard sometimes to lie on my pillow without my hair hurting, and it would keep me up.
My hope is that dox will be less drying in general, because I think I am on so many drying meds, it makes the scalp pain worse. And Dox is supposed to be good for itching. I have ezcema, and when I get under stress, I can really get scatching. So lets hope this is a bit more targeted to my needs.
Oh, one last thing. I did read that dox has a much shorter half life than ami. Dox, about 6-8 hours, where ami is 10-50 hours. Do you ever find some rebound anxiety or edginess the next day from the dox? I tend to notice when meds run out...I wonder if this is an issue?I can't thank you enough for taking the time and energy to discuss these TCA's in such detail.
Chloe
Posted by fachad on June 13, 2002, at 22:12:02
In reply to Re:Doxepin » fachad, posted by Chloe on June 13, 2002, at 20:46:27
> I was only on 20 of ami, and have been taking ten for the last 3 days. Today, I have the worst epigastric pain. I know it's a withdrawal thing from ami.
That is a pretty small dose, but I bet the epigastric pain is ami withdrawal.
>I just picked up 10 mg size of Doxepin. I am supposed to take one or two at night. So I guess I will just jump in and take 2 caps of doxepin...
I would. When used for depression, ami, doxepin, trimip, typical doses are 150mg/day, and can be as high as 300mg/day. So even if you still had 20 mg of ami in your system, and you took the full 20 mg of doxepin, it would be a relatively tiny total TCA dose.
> What was the stomach ailment of your wife, if you don't mind me asking.
She has pain dominant Irritable Bowel Syndrome (IBS). Here's a link to the full story of how ami worked when nothing else did. (I referred to ami by it's brand name, "Elavil" in that post.)
http://www.dr-bob.org/babble/20020322/msgs/99806.html
Anyway, that whole ordeal was quite amazing, and left me with a renewed respect for TCAs.
>The constipation on ami for me is awful. Even with flaxseed oil, fiberous diet, lots of water. It's a loosing battle with ami!
Yes, the ami constipation is pretty bad.
>I assume dox would be binding with less ACh?
Yes. For blenderized rat brains it is almost 5 times less potent at blocking ACH, and ACH blockade is definitely the cause of dry mouth and constipation. ACH neurons mediate both salivation and intestinal motility. ACH blockade is the highest thing on my personal "yuck" scale.
> I am so glad the H1 doesn't necessarily mean terrible dry mouth. You should see the inside of my mouth. It's so raw. I try to use rinses for mouth sores, but they burn so...
No, H1 blockade does not mean dryness. Some people believe that because most conventional H1 blockers (antihistamines) cause dryness, that H1 blockade is the culprit. But those antihistamines also block ACH, and that's why they cause dry mouth. But it's the ACh, not the H1, that's drying them out.
Regarding the mouth sores, in the past few weeks I've had a few mouth ulcers spring up, and I found an OTC remedy that seems to help. It's called DGL, de glyceryzed licorice. It sooths the sores, and it contains some chemical which stimulates the flow of mucous to the membranes, helping them heal. You can get it in lozenge form at a health food store.
>And Dox is supposed to be good for itching. I have ezcema, and when I get under stress, I can really get scatching. So lets hope this is a bit more targeted to my needs.
Dox is stronger at H1 blockade, so it should be better for both blocking itching and inducing sleep. Regarding the itching, they acutally make a doxepin topical creme for severe itching. People say it works better than anything else, but it makes them too tired, just from being absorbed thru the skin!
> Oh, one last thing. I did read that dox has a much shorter half life than ami. Dox, about 6-8 hours, where ami is 10-50 hours. Do you ever find some rebound anxiety or edginess the next day from the dox?
For me that is a big plus because it means less next day grogginess. I was a little worried that because trimp has so much longer half life than dox that I would want to sleep thru the next morning, but it's been OK.
One final comment since we're talking about doxepin pharmacokenetics: doxepin has a very high "first pass" effect. This means that after it is absorbed from your GI, it passes thru the liver before it gets to your brain. All meds do this, but doxepin is broken down very extensively during this first pass, so much less of it gets to your brain than ami, even though you've taken the same dose. So you might need a higher dose of dox to do the same job as the ami because of this. Just a possibility to consider if it seems like it's not working.
Posted by Ritch on June 13, 2002, at 22:32:03
In reply to Re: Reverse SAD, sleep, light, meds » fachad, posted by Cece on June 13, 2002, at 15:18:32
> Thanks for your response Fachad.
>
> I was interviewed recently by a reporter for the NY Times for a story on Reverse SAD. She found me through a post that I made last year on P-B (Dr. Bob did not give her my personal info- just forwarded her inquiry to me and left it to me whether to respond or not). It will be appearing soon in a special supplement on Women's Health although it is not a problem unique to women. It has been reasearched some but the cause is not known. I suffer from the bright light of summer, and although where I live is relatively cool (Northern CA), I become virtually non-functional in a heat spell. I've been thinking of starting a new thread on this since the season is here- feel free to start it yourself.
>
> My pdoc is very interested in the effect of artificial light on BP disorders. He and others believe that living out of synch with the natural cycles of night and day stimulate cycling. There is an interesting article on this issue as a link off of:
> http://www.psycheducation.org/.
> This seems right to me intuitively, and as much as possible (not often enough) I take his suggestion of no electrical lighting after sunset, just candles and kerosene lanterns. It is very relaxing, and I do sleep better and wake up more easily. My neice who is BPI decided to try the idea out and has done it for 3 months! It's one of those things that it's hard to evaluate direct cause and effect, but she is feeling strong enough to take a very challenging graduate class that she had postponed for a long time.
>
> I may try raising my Trim a little- fine with my pdoc. Re the other med ideas, I am really trying to pare the meds that I take down to the bare bones- the reverse process of the layering that created a cumbersome cocktail that is a lot of work to maintain. I'm tired of running my own major pharmacy. I think that I'm going to try doing the Zyprexa, but consider it short-term, or maybe just a summer med. But thanks for the other suggestions, I'll keep them in mind.
>
> I have been told, and experience, that sleep deprivation is a short-term fix. I'm really someone who does best with a solid 8 hours, but it does only really work if I keep 'sensible' hours which is hard for me- I tend to be a night owl. My previous pdoc told me that the quality of sleep between 10 and 6 is much better than say 2 and 10. I agree that some of the sleep hygiene stuff is 'bunky'- I'll use my bed for any activities that I choose thank you!
>
> CeceCece,
That is very interesting reading. I have two SAD episodes a year-one in the winter and one in the summer. The summer one is already starting and it is marked by early morning awakenings (most of the last week or so). Imipramine is making this worse and I have stopped it (because of REM suppression?). I work evenings with artificial light and don't have the option of synching myself with nature. However, my take on the origin of the "reverse" SAD symptoms isn't the *bright* light-it is the *DURATION* of the available light. Let me start from scratch. I get depressed the worst in the winter centered around the winter solstice (lack of light). BUT, there are a lot of factors influencing the amount of light that you expose yourself to. One is the amount of natural vegetation in your environment and how much time you spend indoors versus outdoors. Anyhow, I notice that I feel *recovery* from the wintertime episode about mid-January. Snow makes things better. I have to get outside to shovel the snow away, walk to the store after a blizzard, etc. But, by the end of February I clearly notice the marked intensity of light coming through my windows (no trees yet). That is when I start developing hypomanic and mixed states. That worsens *until* the tree "canopy" is fully developed (which provides shade). So, though the temperature is increasing outside, the amount of light *INTENSITY* is drastically reduced, however the light *DURATION* is increasing. That is when I start to get my 2nd "reverse" SAD depression. It starts to significantly remit (and another hypomanic spell usally happens-however less intense) whenever the trees start dropping leaves and there is no storms or rain and the sky is cloudless and bright during the fall, while the light *DURATION* is decreasing and decreased, but the light *INTENSITY* is coming back up again-everything is very bright and "contrasty" outside.
Mitch
Posted by Cece on June 13, 2002, at 22:40:30
In reply to Re: Reverse SAD, sleep, light, meds » Cece, posted by Ritch on June 13, 2002, at 22:32:03
Hey Ritch-
Let's start a thread on Reverse SAD! I think that I'll copy some of my last post here and expand upon it. It would be great if you could repost your last message to me on the new thread. I know that there are more of us out there and it could make a good discussion. You and I have a number of similarities.
By the way, I'm a horticulturalist and landscaper and spend a lot of time outdoors.
Cece
Posted by Chloe on June 14, 2002, at 20:54:45
In reply to Re:Doxepin » Chloe, posted by fachad on June 13, 2002, at 22:12:02
Fachad,
I have to say, you really have done your research! I have a whole new respect for TCA's and your ability to understand and relay the information.I really don't want to jinx anything, because it was only one night. But the doxepin worked great! I was anxious that I would not fall asleep like with Trimip. But I fell into the black hole of sleep. God, that experience is priceless. In hind sight, I think I had a paradoxical reaction to trimip. It really caused a great deal of anxiety and angst, as well as profound insomnia and restlessness. Not to mention all the ACh rebound peeing, etc.
I did wake up very refreshed this morning and in a very pleasant mood. This is highly uncharacteristic of me on ami. I am usually nasty and short fused and fussy. I AM starting to notice some reemerging scalp pain. Perhaps related to less doxepin being available to the body at only 20 mgs? I will stay at 20 for a while and hope it gets better. But as you say, I may need to bump the dose to continue to get sleep and pain relief. (AND I didn't even think the ami was doing much for the scalp burn/pain! I guess it was..)
I am only taking the TCA for sleep and pain. I also take a tiny tiny (1.5 mgs) amount of Celexa. I am BP2 so I don't require alot of AD, and of course too much can make me hypomanic. But with ami, I was always in this dysphoric angry state, just with more energy to a pick fight with a good friend or family member or anyone for that matter.
So I hope the doxepin will ease some of the grouchy, short fuse stuff, and boost my mood a bit. I got enough mood stabilizers to support taking a bit more doxepin than I did with ami...I know this is highly individualized, but what is the usual dose for "sleep" or pain? I have only seen the AD dose recommendations...They couldn't be the same. Isn't 150 mgs of Dox pretty sedating? Or does one acclimate quickly?
Thanks for the link about elavil and your wife. I am so glad she found a med that has helped her control her disease, despite the miserable side effects. She must be a brave person.
Thanks Fachad for sharing
Chloe
Posted by fachad on June 14, 2002, at 23:10:00
In reply to Re:Doxepin » fachad, posted by Chloe on June 14, 2002, at 20:54:45
I think the usual TCA dose for sleep or pain is 25mg or 50mg.
Some people may get by with only 10mg but others may need the full AD dose of 150 - 300mg.
I think a dr. would usually titrate the dose up until you are sleeping fine and the pain is gone, or the side effects become intolerable, whichever comes first.
Regarding the sedation at 150mg, my wife slept around the clock at first, but over a few months she got back to normal. Almost 10 years later, it still knocks her out at night, and she sleeps really hard, but by the next morning she is fine.
I hope the dox works for you.
> Fachad,
> I have to say, you really have done your research! I have a whole new respect for TCA's and your ability to understand and relay the information.
>
> I really don't want to jinx anything, because it was only one night. But the doxepin worked great! I was anxious that I would not fall asleep like with Trimip. But I fell into the black hole of sleep. God, that experience is priceless. In hind sight, I think I had a paradoxical reaction to trimip. It really caused a great deal of anxiety and angst, as well as profound insomnia and restlessness. Not to mention all the ACh rebound peeing, etc.
>
> I did wake up very refreshed this morning and in a very pleasant mood. This is highly uncharacteristic of me on ami. I am usually nasty and short fused and fussy. I AM starting to notice some reemerging scalp pain. Perhaps related to less doxepin being available to the body at only 20 mgs? I will stay at 20 for a while and hope it gets better. But as you say, I may need to bump the dose to continue to get sleep and pain relief. (AND I didn't even think the ami was doing much for the scalp burn/pain! I guess it was..)
>
> I am only taking the TCA for sleep and pain. I also take a tiny tiny (1.5 mgs) amount of Celexa. I am BP2 so I don't require alot of AD, and of course too much can make me hypomanic. But with ami, I was always in this dysphoric angry state, just with more energy to a pick fight with a good friend or family member or anyone for that matter.
> So I hope the doxepin will ease some of the grouchy, short fuse stuff, and boost my mood a bit. I got enough mood stabilizers to support taking a bit more doxepin than I did with ami...
>
> I know this is highly individualized, but what is the usual dose for "sleep" or pain? I have only seen the AD dose recommendations...They couldn't be the same. Isn't 150 mgs of Dox pretty sedating? Or does one acclimate quickly?
>
> Thanks for the link about elavil and your wife. I am so glad she found a med that has helped her control her disease, despite the miserable side effects. She must be a brave person.
>
> Thanks Fachad for sharing
> Chloe
Posted by fachad on June 14, 2002, at 23:12:50
In reply to Re:Doxepin » fachad, posted by Chloe on June 14, 2002, at 20:54:45
Here's an abstract from an article on using doxepin or ami for scalp pain:
Arch Dermatol 1998 Mar;134(3):327-30 Related Articles, Books, LinkOutScalp dysesthesia.
Hoss D, Segal S.
Department of Dermatology, University of Connecticut Health Center, Farmington 06030, USA.
BACKGROUND: Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings. Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress. These symptoms may be manifestations of an underlying psychiatric disorder or may represent a type of chronic pain syndrome.
OBSERVATIONS: Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only. The patients ranged in age from 36 to 70 years. The duration of symptoms ranged from 9 months to 7 years. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. Seven women reported that stress triggers or exacerbates their symptoms.
Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride.
One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse.
CONCLUSIONS: We describe 11 patients with a new syndrome that we term scalp dysesthesia. Of 11 patients, 9 benefited from treatment with low doses of antidepressants.
PMID: 9521031 [PubMed - indexed for MEDLINE]
Posted by Chloe on June 15, 2002, at 11:25:32
In reply to Re: Abstract on Doxepin for Scalp Pain » Chloe, posted by fachad on June 14, 2002, at 23:12:50
Fachad,
Great abstract!!!
I had read something about "scalp dysesthesia", but only related to men who were or feared they were experiencing hairloss. This abstract describes me to a Tee, I guess. This must be why the dermatologist only spent 30 seconds with me. He knew right off that it is a "psychiatric disorder." Especially after he heard the list of psychtropic meds I was taking.But, the symptoms seemed to come on after being on therapeutic levels of Li with Neurontin for about 3 months. My hair and skin got so dry, but thyroid normal. Then the scalp pain emerged, but like the article said, no evidence like flakes or inflammation. Just a searing burn, so i couldn't brush my hair, etc.
Well, in terms of dose, I know 20 mgs is not enough to control the pain. So I think I will creep it up by 10 or 20, and call my pdoc next week.
Doxepin, IMO is much more tolerable than amitriptyline. (Let's just hope it will knock out the pain too, but at higher doses than ami.) I was grouchy ALL the time on ami. It just made me feel "yucky" physically and mentally. I had asked my pdoc for Dox months ago, but she dismissed my request saying that all TCA's are the same. HOW UNTRUE. Thanks for showing me the light!Be well.
Chloe> Here's an abstract from an article on using doxepin or ami for scalp pain:
>
>
> Arch Dermatol 1998 Mar;134(3):327-30 Related Articles, Books, LinkOut
>
> Scalp dysesthesia.
>
> Hoss D, Segal S.
>
> Department of Dermatology, University of Connecticut Health Center, Farmington 06030, USA.
>
> BACKGROUND: Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings. Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress. These symptoms may be manifestations of an underlying psychiatric disorder or may represent a type of chronic pain syndrome.
>
> OBSERVATIONS: Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only. The patients ranged in age from 36 to 70 years. The duration of symptoms ranged from 9 months to 7 years. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. Seven women reported that stress triggers or exacerbates their symptoms.
>
> Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride.
>
> One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse.
>
> CONCLUSIONS: We describe 11 patients with a new syndrome that we term scalp dysesthesia. Of 11 patients, 9 benefited from treatment with low doses of antidepressants.
>
> PMID: 9521031 [PubMed - indexed for MEDLINE]
Posted by Ritch on June 15, 2002, at 16:05:46
In reply to Re: Abstract on Doxepin for Scalp Pain » fachad, posted by Chloe on June 15, 2002, at 11:25:32
Hi Chloe,
So *that's* what that is! Got a question for you. You said it started when you were taking Neurontin+lithium. Had you ever been on lithium before without being combined with the Neurontin? I just wonder if the Neurontin might have precipitated it. It's a good thing you have nailed it. It helps when it has a *name*! You are also very lucky you don't mind heavy-hitting sedative meds. The first psych meds I was prescribed (all at once, too), was lithium 900mg/day + doxepin 75mg/bedtime + amitripytline 25mg/bedtime + chlordiazepoxide 10mg/bedtime. Needless to say my first night's sleep on that was rather, well.. heavy to say the least. Doxepin is weird in that you get whalloped pretty good when you start a given dose (say 25mg at bedtime). But, after a few weeks the daytime sedation does wear away quite a bit. I can't believe it was possible, but I was up to 150mg/day for a few weeks and actually worked around dangerous machinery! I don't think I could hack that now! I had to give up the imipramine trial. It just screwed up my sleep so badly. I was evidently not sleeping soundly, and it was triggering the early morning awakenings. Since I stopped it my sleep has improved steadily. But, I still feel the depression during the day. It looks like I am going to start a smidge of Effexor starting Monday (to be my sole AD-no more Celexa, etc.). Just 12.5mg first thing in the morning, and then let it wash out later on so it (hopefully) won't wreck my sleep. I got hypomanic and irritable on it before, but that was related to steroids I was taking. Also, I wasn't on Depakote at the time but subtherapeutic lithium instead. So, this will be the Effexor irritability challenge (to see if the Depakote will keep a lid on it).
good luck with the doxepin,
Mitch
> Fachad,
> Great abstract!!!
> I had read something about "scalp dysesthesia", but only related to men who were or feared they were experiencing hairloss. This abstract describes me to a Tee, I guess. This must be why the dermatologist only spent 30 seconds with me. He knew right off that it is a "psychiatric disorder." Especially after he heard the list of psychtropic meds I was taking.
>
> But, the symptoms seemed to come on after being on therapeutic levels of Li with Neurontin for about 3 months. My hair and skin got so dry, but thyroid normal. Then the scalp pain emerged, but like the article said, no evidence like flakes or inflammation. Just a searing burn, so i couldn't brush my hair, etc.
>
> Well, in terms of dose, I know 20 mgs is not enough to control the pain. So I think I will creep it up by 10 or 20, and call my pdoc next week.
> Doxepin, IMO is much more tolerable than amitriptyline. (Let's just hope it will knock out the pain too, but at higher doses than ami.) I was grouchy ALL the time on ami. It just made me feel "yucky" physically and mentally. I had asked my pdoc for Dox months ago, but she dismissed my request saying that all TCA's are the same. HOW UNTRUE. Thanks for showing me the light!
>
> Be well.
> Chloe
>
> > Here's an abstract from an article on using doxepin or ami for scalp pain:
> >
> >
> > Arch Dermatol 1998 Mar;134(3):327-30 Related Articles, Books, LinkOut
> >
> > Scalp dysesthesia.
> >
> > Hoss D, Segal S.
> >
> > Department of Dermatology, University of Connecticut Health Center, Farmington 06030, USA.
> >
> > BACKGROUND: Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings. Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress. These symptoms may be manifestations of an underlying psychiatric disorder or may represent a type of chronic pain syndrome.
> >
> > OBSERVATIONS: Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only. The patients ranged in age from 36 to 70 years. The duration of symptoms ranged from 9 months to 7 years. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. Seven women reported that stress triggers or exacerbates their symptoms.
> >
> > Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride.
> >
> > One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse.
> >
> > CONCLUSIONS: We describe 11 patients with a new syndrome that we term scalp dysesthesia. Of 11 patients, 9 benefited from treatment with low doses of antidepressants.
> >
> > PMID: 9521031 [PubMed - indexed for MEDLINE]
Posted by Chloe on June 15, 2002, at 22:12:30
In reply to Re: Abstract on Doxepin for Scalp Pain » Chloe, posted by Ritch on June 15, 2002, at 16:05:46
> Hi Chloe,
>
> So *that's* what that is! Got a question for you. You said it started when you were taking Neurontin+lithium. Had you ever been on lithium before without being combined with the Neurontin? I just wonder if the Neurontin might have precipitated it.No, I was on lithium for years in the '80's. Neurontin wasn't "born" yet! I never remember Li being drying back then...I had really thick long hair, and never had any problems with scalp or hair. I DO know that neurontin for me, is *extremely* drying. When I started it, I felt everything dry up. My mouth, my *female parts*, my skin. My body doesn't make ANY natural oils. Hence the 1 tbs FSO and 2000 mgs Evening primrose oil. That has helped some...
Whenever I increase the dose of N, I get increased burning of the skin and scalp for about a week. Then it seems to settle down. But then several weeks will go by, and I will run my hand thru my hair, and it will feel so brittle and dry. And I condition the hell out of it too...So I do think N was probably the culprit. But now my body is just so dried out and weary from daily meds. Because any new med or dosage change seems to start the scalp burn now...
>It's a good thing you have nailed it. It helps when it has a *name*!Yes, thanks to Fachad's diligent research. I wish the derm doc had just come out and said it was that. Rather than saying I don't have a rash, this something I need to bring up with my psychiatrist. GEEZ, I felt like a hypochondriac or I was faking the pain. It was rather uncomfortable, though brief!
>You are also very lucky you don't mind heavy-hitting sedative meds. The first psych meds I was prescribed (all at once, too), was lithium 900mg/day + doxepin 75mg/bedtime + amitripytline 25mg/bedtime + chlordiazepoxide 10mg/bedtime.
Just curious, why would you take amitrip and doxepin? Was there a reason for that one? That is alot of meds! You must have felt awful! Or at least not (hypo)manic!
>Needless to say my first night's sleep on that was rather, well.. heavy to say the least. Doxepin is weird in that you get whalloped pretty good when you start a given dose (say 25mg at bedtime). But, after a few weeks the daytime sedation does wear away quite a bit. I can't believe it was possible, but I was up to 150mg/day for a few weeks and actually worked around dangerous machinery! I don't think I could hack that now!
So far, I really like Doxepin, at my low dose of 20 mg. I will probably need to raise it, but I am going to try another night at 20 to give my scalp time to adjust, and let the blood level go up. Maybe 20 will be all I need, but I doubt it.
I have less orthostatic hypotension, less thump, thump, cardiac changes, less constipation, but oddly some heartburn. That ami is powerful in slowing down the gut! I am also glad to report, that *so far* I am not noticing a withdrawal or rebound of anxiety when I wake up on Doxepin. With ami, the alarm would go off, and perhaps startle me, and my heart would pound and race, though I am half asleep. And then I would be in a frantic nasty mood from the moment I was awakened, throughout the entire day.
With Dox, the last two mornings, I have awoken with dreams I can't remember, and I am glad and have some desire to get out of bed. My fear was that anxiety would creep in with dox's short 6-8 hour half-life. But today was so even, and I have been calm. Did this "calmness" wear off with the sedation in your experience with dox? Did you notice any rebound anxiety during the day?>I had to give up the imipramine trial. It just screwed up my sleep so badly. I was evidently not sleeping soundly, and it was triggering the early morning awakenings. Since I stopped it my sleep has improved steadily. But, I still feel the depression during the day.
Maybe imiprimine is just not a good TCA for you. I realized that Trimip. gave me a pradoxical effect. I had anxiety, insomnia, shakes, oh and EPS. It was very unpleasant. Didn't nortrip work well pretty for you?
>It looks like I am going to start a smidge of Effexor starting Monday (to be my sole AD-no more Celexa, etc.). Just 12.5mg first thing in the morning, and then let it wash out later on so it (hopefully) won't wreck my sleep. I got hypomanic and irritable on it before, but that was related to steroids I was taking. Also, I wasn't on Depakote at the time but subtherapeutic lithium instead. So, this will be the Effexor irritability challenge (to see if the Depakote will keep a lid on it).
Gee, I really hope you trial of effexor goes well. Perhaps with the protection from dep. it will be a more positive experience this time. Dep. is definitely better for the short fuse/irritability stuff. So you are no longer on a stimulant? I guess I have lost track a bit.
Shifting meds can really mess up my head. Usually I feel pretty on top of things. But I can't remember anything lately. I keep telling myself to write things down, but I forget everything looking for a damn piece of paper!Let us know how the Effexor goes. I hope it helps your sleep troubles, too...I'll keep my fingers crossed for you
Chloe
>
> good luck with the doxepin,
>
> Mitch
Posted by Chloe on June 15, 2002, at 22:29:30
In reply to Re:Doxepin - Usual Dose for Sleep or Pain » Chloe, posted by fachad on June 14, 2002, at 23:10:00
>I think the usual TCA dose for sleep or pain is 25mg or 50mg.
>Some people may get by with only 10mg but others may need the full AD dose of 150 - 300mg.>I think a dr. would usually titrate the dose up until you are sleeping fine and the pain is gone, or the side effects become intolerable, whichever comes first.
>Regarding the sedation at 150mg, my wife slept around the clock at first, but over a few months she got back to normal. Almost 10 years later, it still knocks her out at night, and she sleeps really hard, but by the next morning she is fine.
>I hope the dox works for you.Fachad
This is very helpful. 25-50 mgs sounds about right for me.
I am very grateful that your could share your copious experience/knowledge/research on TCA's (and pain).
So far Doxepin is quite an improvement with mood and side effects :)
Keep us posted on your trimipramine trials, if you wish...Chloe
Posted by Ritch on June 16, 2002, at 11:33:39
In reply to Re:Doxepin for Scalp Pain, etc » Ritch, posted by Chloe on June 15, 2002, at 22:12:30
> > Hi Chloe,
> >
> > So *that's* what that is! Got a question for you. You said it started when you were taking Neurontin+lithium. Had you ever been on lithium before without being combined with the Neurontin? I just wonder if the Neurontin might have precipitated it.
>
> No, I was on lithium for years in the '80's. Neurontin wasn't "born" yet! I never remember Li being drying back then...I had really thick long hair, and never had any problems with scalp or hair. I DO know that neurontin for me, is *extremely* drying. When I started it, I felt everything dry up. My mouth, my *female parts*, my skin. My body doesn't make ANY natural oils. Hence the 1 tbs FSO and 2000 mgs Evening primrose oil. That has helped some...
> Whenever I increase the dose of N, I get increased burning of the skin and scalp for about a week. Then it seems to settle down. But then several weeks will go by, and I will run my hand thru my hair, and it will feel so brittle and dry. And I condition the hell out of it too...So I do think N was probably the culprit. But now my body is just so dried out and weary from daily meds. Because any new med or dosage change seems to start the scalp burn now...That's interesting. I notice that in the wintertime I can't take more than 100mg of Neurontin at night or I wake up with extremely dry throat and I have to drink a lot of water for the dryness and soreness to fade away. I read somebody else post about that a few weeks ago. However, N. seemed to *add* oil to my facial skin-bizarre! I think it tinkers with collagens or something. Depakote works fine for hypomania and temper, BUT, if I try to stop the Neurontin (I am still just at 100mg tid), my depression worsens, and I feel "tweaky". It definitely helps social anxiety. I have kept everything the same and just reduced Neurontin and I clearly felt worse. I hope that if pregabalin gets out on the market it will work just as good or better, with fewer sfx. Maybe it won't have this dryness thing.
>
>
> >It's a good thing you have nailed it. It helps when it has a *name*!
>
> Yes, thanks to Fachad's diligent research. I wish the derm doc had just come out and said it was that. Rather than saying I don't have a rash, this something I need to bring up with my psychiatrist. GEEZ, I felt like a hypochondriac or I was faking the pain. It was rather uncomfortable, though brief!Yes, I hate polypharmacy because of those kinds of problems. You go and see a GP, or an internist about something and if they don't think you are a hypochrondriac, they don't want to get involved with trying to figure it out-because they are afraid it is just a sfx of all of the psych meds you are taking! That's why I would like to get rid of the N. and the Klonopin, but they both clearly help.
>
> >You are also very lucky you don't mind heavy-hitting sedative meds. The first psych meds I was prescribed (all at once, too), was lithium 900mg/day + doxepin 75mg/bedtime + amitripytline 25mg/bedtime + chlordiazepoxide 10mg/bedtime.
>
> Just curious, why would you take amitrip and doxepin? Was there a reason for that one? That is alot of meds! You must have felt awful! Or at least not (hypo)manic!When I first seen a shrink-it wasn't somebody hauling my ass in for an evaluation. I was in a nasty agitated mixed-state (not psychotic-but probably getting there), and sleeping about 2 hours every nite and getting paranoid while the depression was deepening along with very intense anxiety. I wanted relief NOW! The ami. and chlord. were just for two weeks until my sleep normalized and my anxiety level dropped off. Then I was just on 75mg doxepin and 900mg/LI. Amazingly, I managed to go to work everyday.
>
> >Needless to say my first night's sleep on that was rather, well.. heavy to say the least. Doxepin is weird in that you get whalloped pretty good when you start a given dose (say 25mg at bedtime). But, after a few weeks the daytime sedation does wear away quite a bit. I can't believe it was possible, but I was up to 150mg/day for a few weeks and actually worked around dangerous machinery! I don't think I could hack that now!
>
> So far, I really like Doxepin, at my low dose of 20 mg. I will probably need to raise it, but I am going to try another night at 20 to give my scalp time to adjust, and let the blood level go up. Maybe 20 will be all I need, but I doubt it.
> I have less orthostatic hypotension, less thump, thump, cardiac changes, less constipation, but oddly some heartburn. That ami is powerful in slowing down the gut! I am also glad to report, that *so far* I am not noticing a withdrawal or rebound of anxiety when I wake up on Doxepin. With ami, the alarm would go off, and perhaps startle me, and my heart would pound and race, though I am half asleep. And then I would be in a frantic nasty mood from the moment I was awakened, throughout the entire day.
> With Dox, the last two mornings, I have awoken with dreams I can't remember, and I am glad and have some desire to get out of bed. My fear was that anxiety would creep in with dox's short 6-8 hour half-life. But today was so even, and I have been calm. Did this "calmness" wear off with the sedation in your experience with dox? Did you notice any rebound anxiety during the day?I wouldn't worry too much about increasing it. TCA's have very long half-lives (I wish its half-life would have been 6-8hrs!). Your blood levels are continuing to increase just by taking the same dose every nite. I would wait until you had been on 20mg for two full weeks before bumping it further. As far as the racing heartbeat when waking-I had that on doxepin, but only at the higher doses. It was really bad at 150mg/day. It was there at 75mg/day, too. However, at 25mg/day it went away. So, I stayed at that dose for a few years. The daytime sedation-you will adjust to that.
>
> >I had to give up the imipramine trial. It just screwed up my sleep so badly. I was evidently not sleeping soundly, and it was triggering the early morning awakenings. Since I stopped it my sleep has improved steadily. But, I still feel the depression during the day.
>
> Maybe imiprimine is just not a good TCA for you. I realized that Trimip. gave me a pradoxical effect. I had anxiety, insomnia, shakes, oh and EPS. It was very unpleasant. Didn't nortrip work well pretty for you?If, I ever take another TCA, nortriptyline would be the only one. It was easily the most tolerable one (at lower doses anyhow). It was good for anxiety and attention. It didn't disrupt my sleep as much as the imipramine. But, I don't like the cardio-toxicity potential, and I do a lot of work outside in the heat, and imipramine and to a lesser extent nortrip. aggravated chest pain if overexerting.
>
> >It looks like I am going to start a smidge of Effexor starting Monday (to be my sole AD-no more Celexa, etc.). Just 12.5mg first thing in the morning, and then let it wash out later on so it (hopefully) won't wreck my sleep. I got hypomanic and irritable on it before, but that was related to steroids I was taking. Also, I wasn't on Depakote at the time but subtherapeutic lithium instead. So, this will be the Effexor irritability challenge (to see if the Depakote will keep a lid on it).
>
> Gee, I really hope you trial of effexor goes well. Perhaps with the protection from dep. it will be a more positive experience this time. Dep. is definitely better for the short fuse/irritability stuff. So you are no longer on a stimulant? I guess I have lost track a bit.
> Shifting meds can really mess up my head. Usually I feel pretty on top of things. But I can't remember anything lately. I keep telling myself to write things down, but I forget everything looking for a damn piece of paper!Well, the problem with stimulants is the too short half-life (of most of them anyhow), and they don't have the capacity to really reduce any type of anxiety I have (except some elements of social anxiety with dexedrine), other than that I could tolerate them fairly well without cycling, which I found odd.
>
> Let us know how the Effexor goes. I hope it helps your sleep troubles, too...I'll keep my fingers crossed for you
> ChloeWe'll see. Without any AD my sleeping is better but is starting to lengthen. I am starting to sleep more than 8 hrs (bad sign), and I am still yawning during the day and fairly listless, but my mood isn't that bad.
take care,
Mitch
Posted by fachad on June 16, 2002, at 20:22:35
In reply to Re: Abstract on Doxepin for Scalp Pain » fachad, posted by Chloe on June 15, 2002, at 11:25:32
> Great abstract!!!
> I had read something about "scalp dysesthesia", but only related to men who were or feared they were experiencing hairloss.It really does provide some validation to have a name for your suffering; it also makes you feel less alone if others have the same diagnosis.
> But, the symptoms seemed to come on after being on therapeutic levels of Li with Neurontin for about 3 months.
Do you tell your pdoc about all the misery from side effects? It just seems like your side effect burden is too severe - does the benefit really offset all that suffering? Are there any other meds that might work and not be so intolerable?
> Doxepin, IMO is much more tolerable than amitriptyline.
Yes, I really think so. Hope it works for you.
> Fachad,
> Great abstract!!!
> I had read something about "scalp dysesthesia", but only related to men who were or feared they were experiencing hairloss. This abstract describes me to a Tee, I guess. This must be why the dermatologist only spent 30 seconds with me. He knew right off that it is a "psychiatric disorder." Especially after he heard the list of psychtropic meds I was taking.
>
> But, the symptoms seemed to come on after being on therapeutic levels of Li with Neurontin for about 3 months. My hair and skin got so dry, but thyroid normal. Then the scalp pain emerged, but like the article said, no evidence like flakes or inflammation. Just a searing burn, so i couldn't brush my hair, etc.
>
> Well, in terms of dose, I know 20 mgs is not enough to control the pain. So I think I will creep it up by 10 or 20, and call my pdoc next week.
> Doxepin, IMO is much more tolerable than amitriptyline. (Let's just hope it will knock out the pain too, but at higher doses than ami.) I was grouchy ALL the time on ami. It just made me feel "yucky" physically and mentally. I had asked my pdoc for Dox months ago, but she dismissed my request saying that all TCA's are the same. HOW UNTRUE. Thanks for showing me the light!
>
> Be well.
> Chloe
>
> > Here's an abstract from an article on using doxepin or ami for scalp pain:
> >
> >
> > Arch Dermatol 1998 Mar;134(3):327-30 Related Articles, Books, LinkOut
> >
> > Scalp dysesthesia.
> >
> > Hoss D, Segal S.
> >
> > Department of Dermatology, University of Connecticut Health Center, Farmington 06030, USA.
> >
> > BACKGROUND: Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings. Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress. These symptoms may be manifestations of an underlying psychiatric disorder or may represent a type of chronic pain syndrome.
> >
> > OBSERVATIONS: Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only. The patients ranged in age from 36 to 70 years. The duration of symptoms ranged from 9 months to 7 years. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. Seven women reported that stress triggers or exacerbates their symptoms.
> >
> > Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride.
> >
> > One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse.
> >
> > CONCLUSIONS: We describe 11 patients with a new syndrome that we term scalp dysesthesia. Of 11 patients, 9 benefited from treatment with low doses of antidepressants.
> >
> > PMID: 9521031 [PubMed - indexed for MEDLINE]
Posted by fachad on June 16, 2002, at 20:26:49
In reply to Re: Abstract on Doxepin for Scalp Pain » Chloe, posted by Ritch on June 15, 2002, at 16:05:46
>The first psych meds I was prescribed (all at once, too), was lithium 900mg/day + doxepin 75mg/bedtime + amitripytline 25mg/bedtime + chlordiazepoxide 10mg/bedtime.
Whoa, that's enough to take down a charging Rhino! What were they thinking? Lithium + Doxepin + Elavil + Librium!
It's a wonder you were even conscious enough to swallow the pills.
> Hi Chloe,
>
> So *that's* what that is! Got a question for you. You said it started when you were taking Neurontin+lithium. Had you ever been on lithium before without being combined with the Neurontin? I just wonder if the Neurontin might have precipitated it. It's a good thing you have nailed it. It helps when it has a *name*! You are also very lucky you don't mind heavy-hitting sedative meds. The first psych meds I was prescribed (all at once, too), was lithium 900mg/day + doxepin 75mg/bedtime + amitripytline 25mg/bedtime + chlordiazepoxide 10mg/bedtime. Needless to say my first night's sleep on that was rather, well.. heavy to say the least. Doxepin is weird in that you get whalloped pretty good when you start a given dose (say 25mg at bedtime). But, after a few weeks the daytime sedation does wear away quite a bit. I can't believe it was possible, but I was up to 150mg/day for a few weeks and actually worked around dangerous machinery! I don't think I could hack that now! I had to give up the imipramine trial. It just screwed up my sleep so badly. I was evidently not sleeping soundly, and it was triggering the early morning awakenings. Since I stopped it my sleep has improved steadily. But, I still feel the depression during the day. It looks like I am going to start a smidge of Effexor starting Monday (to be my sole AD-no more Celexa, etc.). Just 12.5mg first thing in the morning, and then let it wash out later on so it (hopefully) won't wreck my sleep. I got hypomanic and irritable on it before, but that was related to steroids I was taking. Also, I wasn't on Depakote at the time but subtherapeutic lithium instead. So, this will be the Effexor irritability challenge (to see if the Depakote will keep a lid on it).
>
> good luck with the doxepin,
>
> Mitch
>
> > Fachad,
> > Great abstract!!!
> > I had read something about "scalp dysesthesia", but only related to men who were or feared they were experiencing hairloss. This abstract describes me to a Tee, I guess. This must be why the dermatologist only spent 30 seconds with me. He knew right off that it is a "psychiatric disorder." Especially after he heard the list of psychtropic meds I was taking.
> >
> > But, the symptoms seemed to come on after being on therapeutic levels of Li with Neurontin for about 3 months. My hair and skin got so dry, but thyroid normal. Then the scalp pain emerged, but like the article said, no evidence like flakes or inflammation. Just a searing burn, so i couldn't brush my hair, etc.
> >
> > Well, in terms of dose, I know 20 mgs is not enough to control the pain. So I think I will creep it up by 10 or 20, and call my pdoc next week.
> > Doxepin, IMO is much more tolerable than amitriptyline. (Let's just hope it will knock out the pain too, but at higher doses than ami.) I was grouchy ALL the time on ami. It just made me feel "yucky" physically and mentally. I had asked my pdoc for Dox months ago, but she dismissed my request saying that all TCA's are the same. HOW UNTRUE. Thanks for showing me the light!
> >
> > Be well.
> > Chloe
> >
> > > Here's an abstract from an article on using doxepin or ami for scalp pain:
> > >
> > >
> > > Arch Dermatol 1998 Mar;134(3):327-30 Related Articles, Books, LinkOut
> > >
> > > Scalp dysesthesia.
> > >
> > > Hoss D, Segal S.
> > >
> > > Department of Dermatology, University of Connecticut Health Center, Farmington 06030, USA.
> > >
> > > BACKGROUND: Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings. Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress. These symptoms may be manifestations of an underlying psychiatric disorder or may represent a type of chronic pain syndrome.
> > >
> > > OBSERVATIONS: Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only. The patients ranged in age from 36 to 70 years. The duration of symptoms ranged from 9 months to 7 years. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. Seven women reported that stress triggers or exacerbates their symptoms.
> > >
> > > Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride.
> > >
> > > One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse.
> > >
> > > CONCLUSIONS: We describe 11 patients with a new syndrome that we term scalp dysesthesia. Of 11 patients, 9 benefited from treatment with low doses of antidepressants.
> > >
> > > PMID: 9521031 [PubMed - indexed for MEDLINE]
Posted by fachad on June 16, 2002, at 20:42:41
In reply to Re:Doxepin for Scalp Pain, etc » Chloe, posted by Ritch on June 16, 2002, at 11:33:39
>I wouldn't worry too much about increasing it. TCA's have very long half-lives (I wish its half-life would have been 6-8hrs!). Your blood levels are continuing to increase just by taking the same dose every nite. I would wait until you had been on 20mg for two full weeks before bumping it further.
Just a quick note on TCAs for conditions other than depression. I think the steady-state plasma concentration notions are more applicable when you are treating a major depressive episode than when you are treating other conditions.
With my wife's IBS, she felt relief within 1 hour of the first ami dose! More relief from the abdominal pain and cramping than she was getting from Percocet, Valium, and atropine.
Even now if she has a flare-up of IBS, she can take an additional 25mg or 50 ami on top of her regular 150mg and it gives immediate relief.
Also with insomnia, you can get relief from the first TCA dose, and it works just as well if you only take it 2 or 3 nights a week PRN.
This is totally unlike depression where you have to achieve and then maintain steady plasma concentrations for weeks before relief becomes apparent.
It seems like a very significant difference to me.
> > > Hi Chloe,
> > >
> > > So *that's* what that is! Got a question for you. You said it started when you were taking Neurontin+lithium. Had you ever been on lithium before without being combined with the Neurontin? I just wonder if the Neurontin might have precipitated it.
> >
> > No, I was on lithium for years in the '80's. Neurontin wasn't "born" yet! I never remember Li being drying back then...I had really thick long hair, and never had any problems with scalp or hair. I DO know that neurontin for me, is *extremely* drying. When I started it, I felt everything dry up. My mouth, my *female parts*, my skin. My body doesn't make ANY natural oils. Hence the 1 tbs FSO and 2000 mgs Evening primrose oil. That has helped some...
> > Whenever I increase the dose of N, I get increased burning of the skin and scalp for about a week. Then it seems to settle down. But then several weeks will go by, and I will run my hand thru my hair, and it will feel so brittle and dry. And I condition the hell out of it too...So I do think N was probably the culprit. But now my body is just so dried out and weary from daily meds. Because any new med or dosage change seems to start the scalp burn now...
>
> That's interesting. I notice that in the wintertime I can't take more than 100mg of Neurontin at night or I wake up with extremely dry throat and I have to drink a lot of water for the dryness and soreness to fade away. I read somebody else post about that a few weeks ago. However, N. seemed to *add* oil to my facial skin-bizarre! I think it tinkers with collagens or something. Depakote works fine for hypomania and temper, BUT, if I try to stop the Neurontin (I am still just at 100mg tid), my depression worsens, and I feel "tweaky". It definitely helps social anxiety. I have kept everything the same and just reduced Neurontin and I clearly felt worse. I hope that if pregabalin gets out on the market it will work just as good or better, with fewer sfx. Maybe it won't have this dryness thing.
>
>
> >
> >
> > >It's a good thing you have nailed it. It helps when it has a *name*!
> >
> > Yes, thanks to Fachad's diligent research. I wish the derm doc had just come out and said it was that. Rather than saying I don't have a rash, this something I need to bring up with my psychiatrist. GEEZ, I felt like a hypochondriac or I was faking the pain. It was rather uncomfortable, though brief!
>
> Yes, I hate polypharmacy because of those kinds of problems. You go and see a GP, or an internist about something and if they don't think you are a hypochrondriac, they don't want to get involved with trying to figure it out-because they are afraid it is just a sfx of all of the psych meds you are taking! That's why I would like to get rid of the N. and the Klonopin, but they both clearly help.
>
> >
> > >You are also very lucky you don't mind heavy-hitting sedative meds. The first psych meds I was prescribed (all at once, too), was lithium 900mg/day + doxepin 75mg/bedtime + amitripytline 25mg/bedtime + chlordiazepoxide 10mg/bedtime.
> >
> > Just curious, why would you take amitrip and doxepin? Was there a reason for that one? That is alot of meds! You must have felt awful! Or at least not (hypo)manic!
>
> When I first seen a shrink-it wasn't somebody hauling my ass in for an evaluation. I was in a nasty agitated mixed-state (not psychotic-but probably getting there), and sleeping about 2 hours every nite and getting paranoid while the depression was deepening along with very intense anxiety. I wanted relief NOW! The ami. and chlord. were just for two weeks until my sleep normalized and my anxiety level dropped off. Then I was just on 75mg doxepin and 900mg/LI. Amazingly, I managed to go to work everyday.
>
> >
> > >Needless to say my first night's sleep on that was rather, well.. heavy to say the least. Doxepin is weird in that you get whalloped pretty good when you start a given dose (say 25mg at bedtime). But, after a few weeks the daytime sedation does wear away quite a bit. I can't believe it was possible, but I was up to 150mg/day for a few weeks and actually worked around dangerous machinery! I don't think I could hack that now!
> >
> > So far, I really like Doxepin, at my low dose of 20 mg. I will probably need to raise it, but I am going to try another night at 20 to give my scalp time to adjust, and let the blood level go up. Maybe 20 will be all I need, but I doubt it.
> > I have less orthostatic hypotension, less thump, thump, cardiac changes, less constipation, but oddly some heartburn. That ami is powerful in slowing down the gut! I am also glad to report, that *so far* I am not noticing a withdrawal or rebound of anxiety when I wake up on Doxepin. With ami, the alarm would go off, and perhaps startle me, and my heart would pound and race, though I am half asleep. And then I would be in a frantic nasty mood from the moment I was awakened, throughout the entire day.
> > With Dox, the last two mornings, I have awoken with dreams I can't remember, and I am glad and have some desire to get out of bed. My fear was that anxiety would creep in with dox's short 6-8 hour half-life. But today was so even, and I have been calm. Did this "calmness" wear off with the sedation in your experience with dox? Did you notice any rebound anxiety during the day?
>
> I wouldn't worry too much about increasing it. TCA's have very long half-lives (I wish its half-life would have been 6-8hrs!). Your blood levels are continuing to increase just by taking the same dose every nite. I would wait until you had been on 20mg for two full weeks before bumping it further. As far as the racing heartbeat when waking-I had that on doxepin, but only at the higher doses. It was really bad at 150mg/day. It was there at 75mg/day, too. However, at 25mg/day it went away. So, I stayed at that dose for a few years. The daytime sedation-you will adjust to that.
>
> >
> > >I had to give up the imipramine trial. It just screwed up my sleep so badly. I was evidently not sleeping soundly, and it was triggering the early morning awakenings. Since I stopped it my sleep has improved steadily. But, I still feel the depression during the day.
> >
> > Maybe imiprimine is just not a good TCA for you. I realized that Trimip. gave me a pradoxical effect. I had anxiety, insomnia, shakes, oh and EPS. It was very unpleasant. Didn't nortrip work well pretty for you?
>
> If, I ever take another TCA, nortriptyline would be the only one. It was easily the most tolerable one (at lower doses anyhow). It was good for anxiety and attention. It didn't disrupt my sleep as much as the imipramine. But, I don't like the cardio-toxicity potential, and I do a lot of work outside in the heat, and imipramine and to a lesser extent nortrip. aggravated chest pain if overexerting.
>
> >
> > >It looks like I am going to start a smidge of Effexor starting Monday (to be my sole AD-no more Celexa, etc.). Just 12.5mg first thing in the morning, and then let it wash out later on so it (hopefully) won't wreck my sleep. I got hypomanic and irritable on it before, but that was related to steroids I was taking. Also, I wasn't on Depakote at the time but subtherapeutic lithium instead. So, this will be the Effexor irritability challenge (to see if the Depakote will keep a lid on it).
> >
> > Gee, I really hope you trial of effexor goes well. Perhaps with the protection from dep. it will be a more positive experience this time. Dep. is definitely better for the short fuse/irritability stuff. So you are no longer on a stimulant? I guess I have lost track a bit.
> > Shifting meds can really mess up my head. Usually I feel pretty on top of things. But I can't remember anything lately. I keep telling myself to write things down, but I forget everything looking for a damn piece of paper!
>
> Well, the problem with stimulants is the too short half-life (of most of them anyhow), and they don't have the capacity to really reduce any type of anxiety I have (except some elements of social anxiety with dexedrine), other than that I could tolerate them fairly well without cycling, which I found odd.
>
> >
> > Let us know how the Effexor goes. I hope it helps your sleep troubles, too...I'll keep my fingers crossed for you
> > Chloe
>
> We'll see. Without any AD my sleeping is better but is starting to lengthen. I am starting to sleep more than 8 hrs (bad sign), and I am still yawning during the day and fairly listless, but my mood isn't that bad.
>
> take care,
>
> Mitch
Posted by Chloe on June 16, 2002, at 21:01:06
In reply to Re: Abstract on Doxepin for Scalp Pain » Chloe, posted by fachad on June 16, 2002, at 20:22:35
> It really does provide some validation to have a name for your suffering; it also makes you feel less alone if others have the same diagnosis.
>> Do you tell your pdoc about all the misery from side effects? It just seems like your side effect burden is too severe - does the benefit really offset all that suffering? Are there any other meds that might work and not be so intolerable?
Thanks for your concern, Fachad,
I told my pdoc, and she was really not much help. She had never really heard of such a thing from lithium. In fact, she thought I had lithium induced psoriasis and Rx'd this awful peanut oil+hyrdrocortisone. I was to wet my hair before bed, and add this oily, awful smelling gook to my scalp, don a plastic shower cap and go to bed. This was before I began tca's, so I didn't sleep a wink. And my head burned more! But I tried it for three nights...That was awful, and I really had scalp burn after that treatment of hydrocortizone on my head for 8 hours...Also, you should know that I was diagnosed major depression at age 12 and it's been a battle all my life trying to find meds that make life manageable so I can function. I am now 36. So I really have tried most all of the meds out there. I did the best on Li, mellaril, ritalin, and a smidge of an SSRI. But, in my 20's I had to stop the AP's due to TD in in my mouth, and life got considerably harder. My mood has never been as stable as it was on the AP's. My Dx is bp2 with "psychotic features".
Anyhow, last spring, I needed to change meds since I had had it with Tegretol (yuck) and depakote was making my hair run off my head. So I tried Lamictal, then Topamax, Trileptal, Zyprexa, Geodon, Seroquel, and they all bombed. So now I take a little of Neurontin, li, depakote, celexa, doxepin, and diazapam. This is the way my pdoc has chosen to handle the side effect problem. Just have subtherapeutic doses of lots of meds...
Probably more info than you needed. But I guess I have tried most everything available. And I take as much as I can of the meds that help without having unbearable scalp burn, or other side effects.
> Hope Doxepin works for you.
So far, I am very pleased with Doxepin. I am a little more tired during the day, but I am sure that will pass. It seems to have much less affect on mood at the same dose as ami. This is very good for me, since AD's tend to make me very irritable and ugly. I am so glad I persued your advise with my pdoc and finally got her to call in Dox. I wish she had done it months ago when I requested. Hey, better late than never!
Thanks Fachad. Hey, if you feel like sharing, what's your story?
Chloe
Posted by fachad on June 17, 2002, at 0:52:44
In reply to Re: Abstract on Doxepin for Scalp Pain » fachad, posted by Chloe on June 16, 2002, at 21:01:06
>Hey, if you feel like sharing, what's your story?
My story goes like this. For as long as I can remember, I felt like something was "wrong". When I was in Elementary school, I used to always ask my pediatrician if he would do blood tests, because although I did not have any specific symptoms, I felt like crap much of the time.
Today, that would probably be diagnosed as childhood depression, but then it was dismissed as nothing. The docs usually granted me the blood work, which of course always showed nothing wrong.
I had several episodes of depression in middle and high school, but I was brought up in a very fundamentalist religion, and I attributed my depression, which included crying a lot and not eating to "spiritual difficulties".
In my late teens in college I renounced all religious belief and much of my severe depression abated. But that feeling like crap most of the time never left me. I tried all sorts of things to feel better like exercise, good diet, vitamins and herbs, internal cleansing, etc., but nothing really worked.
In my late twenties Prozac came out and all the craze with "better than well" and "personality change" and etc. So I thought maybe I had been depressed all this time and that ADs would make me feel good and feel good about myself and that that ADs were what I had needed all this time.
So I got Prozac, first 20mg/day, then 40mg/day and although I took it for a year, it did not really help.
Then I came across an article that suggested that Wellbutrin was more effective in depression that was more toward eating too much and sleeping too much. So I got Wellbutrin. After a few months, I decided that the exhausted feeling that was really my worst symptom was not being helped, so I wanted to try something different.
My pdoc gave me Paxil, which is the shortest trial of any drug in my life. It just made me feel awful, and I quit it after three days.
I then asked my pdoc for desipramine; it is by far the most potent NE uptake med and it has the lowest values for H1, Ach, and other side effect causing blockade. I took that for about 3 weeks, and then I could not stand the dry mouth and constipation any more.
So my pdoc gave me Zoloft. It wasn’t too bad, and I was tired of trials, so I just took it for about three years. I was gradually feeling worse, but I never attributed it to the Zoloft.
Then on the old "Psychopharmacology Tips" that was the original site of Dr. Bob I read about the SSRI induced "frontal lobe" apathy syndrome. It is caused by the interactions between serotonin and dopamine, and it leads to lethargy, apathy, and fatigue. I realized that those problems had become much worse in me since I started taking Zoloft, maybe since I started Prozac!
About this time Effexor was just being introduced. It was being marketed as "Prozac Plus" and the NE uptake was supposed to be more energizing and etc. So I stopped Zoloft and started Effexor.
Effexor caused dry mouth for me, as well as constipation and sexual problems. I endured it for about three weeks then quit. Back then there was not as much awareness of AD discontinuation syndrome; but I suffered immensely from quitting Effexor.
While still trying to stay on Effexor, I had suggested to my pdoc to try Ritalin to both combat the sexual side effects and to reverse the SSRI Induced Apathy. Both ideas came from Dr. Bob's Psychopharmacology Tips.
Well, Ritalin really worked, but I did not see it at the time. After quitting Effexor, I started Serzone. It was not supposed to cause weight gain, or sexual problems, or sleep problems. I took it for a year or so, then I realized that the Ritalin was what was really helping me.
I quit Serzone and took only Ritalin for about 5 years. Those were the best 5 years of my life. I felt good, finally. My mood was good and I did not feel like crap. I could not believe how well Ritalin worked, and I was irritated that it had not been tried earlier.
Then I had a few severe psychosocial stressors, and was hit with another major depressive episode. I had felt that all the ADs I was on before were of questionable worth, but this was bad and I had to start something. I chose Prozac, because I had not remembered having any side effects, and I knew the patient was running out in about a month, so it would be dirt-cheap.
Within two days of starting Prozac, I had terrible insomnia. Then I realized that all that early morning awakening that was used to further confirm my diagnosis of depression was just a side effect of the SSRIs! So both the insomnia and the fatigue/lethargy which were considered part of my depression, were really just medication side effects.
Those two experiences, the SSRI induced apathy and the SSRI induced early morning awakening, have really given me a negative attitude about SSRIs. I am also on the alert for med caused side effects being mistaken for psych disorder symptoms.
Earlier this year I switched my pstim from Ritalin to Dexadrine. I felt like I needed something stronger to reverse the increased SSRI Apathy/Lethargy caused by the Prozac. So far Dex has been OK, but I actually think Ritalin is a superior med for me. Since starting Ritalin many years ago, I have overall felt much better, and pstims will always be my primary medication.
During the whole Zoloft/Efffexor/Serzone era I had taken doxepin for sleep as needed. I know this sounds odd, but when I started Ritalin I started sleeping so much better, and didn't need dox anymore until I re-started Prozac.
I didn't really want to restart dox because I had lost some weight and kept it off for awhile, and I did not want the weight gain risk that comes with so many psych meds, including TCAs.
So my pdoc gave me Ambien. It really knocks me out, but it wears off after about 4 hrs. So I went back to dox for awhile and did OK, no weight gain. Later, I tried Ativan, but it left me groggy and melancholy the next day. Then I came across the trimip articles, and that's where I'm at now.
I think by the end of the year I'll be able to discontinue the Prozac and the trimip, and be back to just Dexadrine.
If the idea of stimulant monotherapy for depression seems odd to you, take a look at a few other postings I've done on this board.
Ritalin for SSRI Induced Apathy Anergia:http://www.dr-bob.org/babble/20020307/msgs/97130.html
Ritalin is not marketed as AD:http://www.dr-bob.org/babble/20020307/msgs/97442.html
Re: Dexedrine Tolerance? A Theory:http://www.dr-bob.org/babble/20020215/msgs/94906.html
Posted by Ritch on June 17, 2002, at 9:36:54
In reply to That's the Most Sedating Combo I've Ever Seen! » Ritch, posted by fachad on June 16, 2002, at 20:26:49
> >The first psych meds I was prescribed (all at once, too), was lithium 900mg/day + doxepin 75mg/bedtime + amitripytline 25mg/bedtime + chlordiazepoxide 10mg/bedtime.
>
> Whoa, that's enough to take down a charging Rhino! What were they thinking? Lithium + Doxepin + Elavil + Librium!
>
> It's a wonder you were even conscious enough to swallow the pills.
>
>Hi,
Yeah, I must admit that I slept very very soundly. I think I took the lithium all at once when I came back from the office visit (as I as told to) in the afternoon. Then I took the rest of the meds at bedtime. WHAM! Good thing I wasn't outside when they kicked in. :) I guess I presented as plenty wirey. The anxiety was so intense it was like being in a perpetual air raid that never stopped-that's what I told them on the phone anyhow.
Mitch
Posted by Chloe on June 17, 2002, at 18:07:53
In reply to My Story (a bit long) » Chloe, posted by fachad on June 17, 2002, at 0:52:44
> >Hey, if you feel like sharing, what's your story?
>
> My story goes like this. For as long as I can remember, I felt like something was "wrong". When I was in Elementary school, I used to always ask my pediatrician if he would do blood tests, because although I did not have any specific symptoms, I felt like crap much of the time.
>
> Today, that would probably be diagnosed as childhood depression, but then it was dismissed as nothing. The docs usually granted me the blood work, which of course always showed nothing wrong.
>
> I had several episodes of depression in middle and high school, but I was brought up in a very fundamentalist religion, and I attributed my depression, which included crying a lot and not eating to "spiritual difficulties".
>
> In my late teens in college I renounced all religious belief and much of my severe depression abated. But that feeling like crap most of the time never left me. I tried all sorts of things to feel better like exercise, good diet, vitamins and herbs, internal cleansing, etc., but nothing really worked.
>
> In my late twenties Prozac came out and all the craze with "better than well" and "personality change" and etc. So I thought maybe I had been depressed all this time and that ADs would make me feel good and feel good about myself and that that ADs were what I had needed all this time.
>
> So I got Prozac, first 20mg/day, then 40mg/day and although I took it for a year, it did not really help.
>
> Then I came across an article that suggested that Wellbutrin was more effective in depression that was more toward eating too much and sleeping too much. So I got Wellbutrin. After a few months, I decided that the exhausted feeling that was really my worst symptom was not being helped, so I wanted to try something different.
>
> My pdoc gave me Paxil, which is the shortest trial of any drug in my life. It just made me feel awful, and I quit it after three days.
>
> I then asked my pdoc for desipramine; it is by far the most potent NE uptake med and it has the lowest values for H1, Ach, and other side effect causing blockade. I took that for about 3 weeks, and then I could not stand the dry mouth and constipation any more.
>
> So my pdoc gave me Zoloft. It wasn’t too bad, and I was tired of trials, so I just took it for about three years. I was gradually feeling worse, but I never attributed it to the Zoloft.
>
> Then on the old "Psychopharmacology Tips" that was the original site of Dr. Bob I read about the SSRI induced "frontal lobe" apathy syndrome. It is caused by the interactions between serotonin and dopamine, and it leads to lethargy, apathy, and fatigue. I realized that those problems had become much worse in me since I started taking Zoloft, maybe since I started Prozac!
>
> About this time Effexor was just being introduced. It was being marketed as "Prozac Plus" and the NE uptake was supposed to be more energizing and etc. So I stopped Zoloft and started Effexor.
>
> Effexor caused dry mouth for me, as well as constipation and sexual problems. I endured it for about three weeks then quit. Back then there was not as much awareness of AD discontinuation syndrome; but I suffered immensely from quitting Effexor.
>
> While still trying to stay on Effexor, I had suggested to my pdoc to try Ritalin to both combat the sexual side effects and to reverse the SSRI Induced Apathy. Both ideas came from Dr. Bob's Psychopharmacology Tips.
>
> Well, Ritalin really worked, but I did not see it at the time. After quitting Effexor, I started Serzone. It was not supposed to cause weight gain, or sexual problems, or sleep problems. I took it for a year or so, then I realized that the Ritalin was what was really helping me.
>
> I quit Serzone and took only Ritalin for about 5 years. Those were the best 5 years of my life. I felt good, finally. My mood was good and I did not feel like crap. I could not believe how well Ritalin worked, and I was irritated that it had not been tried earlier.
>
> Then I had a few severe psychosocial stressors, and was hit with another major depressive episode. I had felt that all the ADs I was on before were of questionable worth, but this was bad and I had to start something. I chose Prozac, because I had not remembered having any side effects, and I knew the patient was running out in about a month, so it would be dirt-cheap.
>
> Within two days of starting Prozac, I had terrible insomnia. Then I realized that all that early morning awakening that was used to further confirm my diagnosis of depression was just a side effect of the SSRIs! So both the insomnia and the fatigue/lethargy which were considered part of my depression, were really just medication side effects.
>
> Those two experiences, the SSRI induced apathy and the SSRI induced early morning awakening, have really given me a negative attitude about SSRIs. I am also on the alert for med caused side effects being mistaken for psych disorder symptoms.
>
> Earlier this year I switched my pstim from Ritalin to Dexadrine. I felt like I needed something stronger to reverse the increased SSRI Apathy/Lethargy caused by the Prozac. So far Dex has been OK, but I actually think Ritalin is a superior med for me. Since starting Ritalin many years ago, I have overall felt much better, and pstims will always be my primary medication.
>
> During the whole Zoloft/Efffexor/Serzone era I had taken doxepin for sleep as needed. I know this sounds odd, but when I started Ritalin I started sleeping so much better, and didn't need dox anymore until I re-started Prozac.
>
> I didn't really want to restart dox because I had lost some weight and kept it off for awhile, and I did not want the weight gain risk that comes with so many psych meds, including TCAs.
>
> So my pdoc gave me Ambien. It really knocks me out, but it wears off after about 4 hrs. So I went back to dox for awhile and did OK, no weight gain. Later, I tried Ativan, but it left me groggy and melancholy the next day. Then I came across the trimip articles, and that's where I'm at now.
>
> I think by the end of the year I'll be able to discontinue the Prozac and the trimip, and be back to just Dexadrine.
>
> If the idea of stimulant monotherapy for depression seems odd to you, take a look at a few other postings I've done on this board.
>
>
> Ritalin for SSRI Induced Apathy Anergia:
>
> http://www.dr-bob.org/babble/20020307/msgs/97130.html
>
>
> Ritalin is not marketed as AD:
>
> http://www.dr-bob.org/babble/20020307/msgs/97442.html
>
>
> Re: Dexedrine Tolerance? A Theory:
>
> http://www.dr-bob.org/babble/20020215/msgs/94906.htmlThanks for telling my your story. It's amazing how many of us have struggled with depression for most of our lives. It's so difficult when depression occurs early in development, because I think it affects how you think as an adult. It takes a lot of therapy and retuning, to change some of the negative thinking and poor self esteem that accompany depression, IMO.
Med changes and trials are so hard on the body. I see that you too have tried your share...
I, like you thought that my life would be "fixed" once Prozac came out. I had been on 125 mgs of amitrip. for about 5 years. I was in such a haze, addicted to diet soda(so thirsty!!!), just trying to get through school. But as you say, the SSRI"s are NO panacea, and I too, think I developed the "early morning wakening" syndrome when I started prozac. Never noticed it on a Ami...My sleep was like anesthesia. But these new, *wonder* SSRI's that are supposed to be so great, carry a whole host of new problems, insomnia, anxiety, sexaul dysfunction, "poop out," ect.I have returned to early morning wakening even on Doxepin, believe it or not! I awaken with the sun, and I sleep so lightly if at all til I get up. I am very calm and sometimes even a little fatigued during the day, but today was not bad at all. Probably because the sun came out after 3 days. I may need to bump up the doxepin, but I wonder if I will help with *extending* my sleep??? This was one of my concerns about it's shorter half life than ami. With ami I never stirred until 8am. But at least with Dox, I can pee!
But, back to your story...Ritalin was a saviour to me,too. During my years of prozac and Mellaril, I was extremely anergic. it was hard to motivate, and I was so teary...Pdoc Rx'd Ritalin, and I perked right up. I had such an amazing out look on life, everything was possible, I was so happy to be alive. But by the end of the day, I would CRASH so hard. I was back in that depressed state where everything is black, and there is no point to anything. It was very disruptive. So pdoc Rx'd Ritalin SR 20 mgs, and 1-2 per day, depending on if I was out all day, smoothed out some of the highs and lows, and the crashes were less frequent. And as you report, sleep was good.
I can see why stims would be a good sole AD for some who don't have issues with anxiety or mania. They are extremely effective for "non-addictive" personalities. IMO, they can change a dark world to one with light and hope. BUT, since I no longer have the major tranquilizers, stimulants are out for me. I get so anxious and grind my teeth, can't be still etc. I so miss the AP's at tiny doses, of course. But they made my thinking clearer and made me cope better in general. It's just such a shame they are so destructive to the nervous system. Another thread...
I too, tried to change to Serzone after years of prozac and zoloft (pooped out). It made me very erratic and overemotional, not to mention some flushing/sweating probs from which I was trying to switch . There is a lot lacking in the available AD's for folks with challenging depressions and mood irregularities. And the side effects that *most* people get, are quite unpleasant. It is nice to have this board to help each other out through the rough med transitions, or to just learn what might be a good alternative/change to the current regime.
I am sorry you are experienceing extra stressors right now. I, too hope soon you can back to just being on a stimulant. However, I thought I read that ritalin worked best for you. Why do you want to return to Dex, then? Did I misunderstand?
Thanks for sharing your story and links. I am also so glad you gave me enough information and encouragament to change TCA's. I really like Doxepin MUCH better. I just wish I could log in more than 5 hours. With ami it was 8. Do you think this is dose related or a half life issue?Take care,
Chloe
Posted by fachad on June 18, 2002, at 1:26:38
In reply to Re: My Story (a bit long) » fachad, posted by Chloe on June 17, 2002, at 18:07:53
I would bet that your sleep duration would increase if you increased the dose of doxepin. As long as it is still more tolerable than 20mg ami, I don't see what you have to lose by trying.
As far as the half life consideration, from what I've found, dox has a half life ranging from 8-24 hrs, but average is 17hrs, which should be plenty for sleep. How long before bed to you take it? I still bet if you increased the doseage you would sleep longer.
A few other suggestions for sleep, in case doxepin doesnt work out, or if it only works for pain.
First, Remeron, which is even more potent at H1 blockade than doxepin, and almost totally free from anticholenergic effects, and it's half life is more like 26 hrs.
Also, Vistaril, hydroxyzine pamoate. It works better for sleep than Atarax, hydroxyzine HCL. They should be the same but they are not, in my experience. Vistaril comes in 25mg, 50mg, and 100 mg caps and used to be given for anxiety.
As far as my going from Ritalin to Dex, it was pretty much curiosity, and they are pretty close, so I haven't bothered switching back. I still may swich back, but I only see my pdoc 15 min every three months so changes happen slowly.
> Thanks for telling my your story. It's amazing how many of us have struggled with depression for most of our lives. It's so difficult when depression occurs early in development, because I think it affects how you think as an adult. It takes a lot of therapy and retuning, to change some of the negative thinking and poor self esteem that accompany depression, IMO.
>
> Med changes and trials are so hard on the body. I see that you too have tried your share...
> I, like you thought that my life would be "fixed" once Prozac came out. I had been on 125 mgs of amitrip. for about 5 years. I was in such a haze, addicted to diet soda(so thirsty!!!), just trying to get through school. But as you say, the SSRI"s are NO panacea, and I too, think I developed the "early morning wakening" syndrome when I started prozac. Never noticed it on a Ami...My sleep was like anesthesia. But these new, *wonder* SSRI's that are supposed to be so great, carry a whole host of new problems, insomnia, anxiety, sexaul dysfunction, "poop out," ect.
>
> I have returned to early morning wakening even on Doxepin, believe it or not! I awaken with the sun, and I sleep so lightly if at all til I get up. I am very calm and sometimes even a little fatigued during the day, but today was not bad at all. Probably because the sun came out after 3 days. I may need to bump up the doxepin, but I wonder if I will help with *extending* my sleep??? This was one of my concerns about it's shorter half life than ami. With ami I never stirred until 8am. But at least with Dox, I can pee!
>
> But, back to your story...Ritalin was a saviour to me,too. During my years of prozac and Mellaril, I was extremely anergic. it was hard to motivate, and I was so teary...Pdoc Rx'd Ritalin, and I perked right up. I had such an amazing out look on life, everything was possible, I was so happy to be alive. But by the end of the day, I would CRASH so hard. I was back in that depressed state where everything is black, and there is no point to anything. It was very disruptive. So pdoc Rx'd Ritalin SR 20 mgs, and 1-2 per day, depending on if I was out all day, smoothed out some of the highs and lows, and the crashes were less frequent. And as you report, sleep was good.
>
> I can see why stims would be a good sole AD for some who don't have issues with anxiety or mania. They are extremely effective for "non-addictive" personalities. IMO, they can change a dark world to one with light and hope. BUT, since I no longer have the major tranquilizers, stimulants are out for me. I get so anxious and grind my teeth, can't be still etc. I so miss the AP's at tiny doses, of course. But they made my thinking clearer and made me cope better in general. It's just such a shame they are so destructive to the nervous system. Another thread...
>
> I too, tried to change to Serzone after years of prozac and zoloft (pooped out). It made me very erratic and overemotional, not to mention some flushing/sweating probs from which I was trying to switch . There is a lot lacking in the available AD's for folks with challenging depressions and mood irregularities. And the side effects that *most* people get, are quite unpleasant. It is nice to have this board to help each other out through the rough med transitions, or to just learn what might be a good alternative/change to the current regime.
>
> I am sorry you are experienceing extra stressors right now. I, too hope soon you can back to just being on a stimulant. However, I thought I read that ritalin worked best for you. Why do you want to return to Dex, then? Did I misunderstand?
> Thanks for sharing your story and links. I am also so glad you gave me enough information and encouragament to change TCA's. I really like Doxepin MUCH better. I just wish I could log in more than 5 hours. With ami it was 8. Do you think this is dose related or a half life issue?
>
> Take care,
> Chloe
Posted by Chloe on June 18, 2002, at 18:31:03
In reply to Doxepin, Sleep Duration, and Other Sleep Meds. » Chloe, posted by fachad on June 18, 2002, at 1:26:38
> I would bet that your sleep duration would increase if you increased the dose of doxepin. As long as it is still more tolerable than 20mg ami, I don't see what you have to lose by trying.
Fachad,
Doxepin is SO much more tolerable than Ami. I do experience some dry mouth and waves of fatigue during the day. But my mood and general sense of well being has improved. I was so irritable and grumpy all the time with Ami. I kept telling my pdoc this, but she dismissed it. I even sent her an abstract about how destabilizing amitriptyline IN PARTICULAR, can be for people with mood dysregulation. Still no response. Somehow, the trimiprimine got her attention and she rx'd quickly, and since I got TD type side effects, that was my chance to get something other than Ami...Phew, sorry for the the rant.
I wonder if I spaced out the Dox to 10 mgs 7pm, then 20 mgs at 11 pm, that I could get some more pain relief and not have the afternoon sleepies. Do some people take Dox during the day? I think I read somewhere you can take it in divided doses...(though ami is just once/day, I thought that was interesting, since dox is more sedating)
> As far as the half life consideration, from what I've found, dox has a half life ranging from 8-24 hrs, but average is 17hrs, which should be plenty for sleep. How long before bed to you take it? I still bet if you increased the doseage you would sleep longer.
I do have to report that last night was my best night on doxepin yet. I slept till 8 am! Very exciting for me. And was able to dream and rest for another hour or so...But I still am toying with increasing the dose, since the hair pain has come back. Ouch. It has been slowly getting worse, but I have been trying to ignore it.In terms of half life, 17 hours is fine. It's interesting though, that I tend to get sleep in the afternoon, I would say about 17 hours after I take my dose before bed at 11 pm.
> A few other suggestions for sleep, in case doxepin doesnt work out, or if it only works for pain.
>
> First, Remeron, which is even more potent at H1 blockade than doxepin, and almost totally free from anticholenergic effects, and it's half life is more like 26 hrs.I did not like Remeron when I tried it about 6 years ago. All I wanted to do was sleep. I couldn't get out of bed. And if I had to do something, like work, I was very cranky. Also, when I wasn't asleep, all I wanted to do was eat. I thought about food 24/7. I didn't like it at all...
>
> Also, Vistaril, hydroxyzine pamoate. It works better for sleep than Atarax, hydroxyzine HCL. They should be the same but they are not, in my experience. Vistaril comes in 25mg, 50mg, and 100 mg caps and used to be given for anxiety.I will keep these in mind, if Dox fails. But as you can probably tell, I am rather pleased with it. As far as tCA's go, I find it very tolerable.
> As far as my going from Ritalin to Dex, it was pretty much curiosity, and they are pretty close, so I haven't bothered switching back. I still may swich back, but I only see my pdoc 15 min every three months so changes happen slowly.
I know what your mean about having such a short time with your pdoc. It's just not enough. Do you live in the US, or is this because of a NHS, if you don't mind me asking?
I live in the US, but my insurance only covers psych appointments or hospitalization up to $10,000. I used that up long ago! At least I still get a little help with meds.Thanks Fachad,
Chloe
>
Posted by fachad on June 18, 2002, at 19:26:29
In reply to Re: Doxepin, Sleep Duration, and Other Sleep Meds. » fachad, posted by Chloe on June 18, 2002, at 18:31:03
> I wonder if I spaced out the Dox to 10 mgs 7pm, then 20 mgs at 11 pm, that I could get some more pain relief and not have the afternoon sleepies. Do some people take Dox during the day? I think I read somewhere you can take it in divided doses...
Yes, I take my trimip around 7 or 8 PM, even though I don't go to bed until 10. I get two benefits from doing it that way: first, I am drowsy by bed time, and second it has had more time to wear off when it is time to wake up.
Taking the dox earlier will help reduce next day sedation. As far as divided doses goes, any of the TCAs can be given divided, but most people take them all at once, at night, to compress the worst of the side effects into the time when they are sleeping.
But my wife will take a little ami in the day if she has stomach pain, and I read a study where they compared dox to valium for anxiety, and gave study sujects multiple doses or either drug durning the day.
> I do have to report that last night was my best night on doxepin yet. I slept till 8 am! Very exciting for me. And was able to dream and rest for another hour or so...But I still am toying with increasing the dose, since the hair pain has come back.
Glad to hear that you are sleeping well! It may take either more time or a higher dose for the pain relief.
I don't see any reason why your pdoc would not be willing to titrate up the dose until you are satisfied or the side effects become troublesome.
> I did not like Remeron when I tried it about 6 years ago. All I wanted to do was sleep. I couldn't get out of bed...all I wanted to do was eat. I thought about food 24/7.
Yeah, I hated Remeron too. But I still think it is the most potent sleep med ever, period. If someone was really in misery because of insomnia, and nothing else worked, I'm sure Remeron would.
> I know what your mean about having such a short time with your pdoc. It's just not enough. Do you live in the US, or is this because of a NHS, if you don't mind me asking?
I live in the US, and have employer provided health insurance.
> I live in the US, but my insurance only covers psych appointments or hospitalization up to $10,000. I used that up long ago! At least I still get a little help with meds.
Is that $10K a yearly cap or a lifetime cap?
I don't know if I have a cap on my psych coverage. I think the reason for my limitation is based more on the way psychiatry is done nowadays than anything else.
I think even if I was 100% self-paying, most pdocs are just doing their thing in 15 min "med check" appointments these days. If they can classify you as "stable" by any stretch of definition, they put you into the quarterly (3month), bi-annual, or annual visit category.
I think the only reason I get to see my pdoc every three months instead of yearly is because dex is Schedule II and he knows he needs to see his CII patients more often to avoid scrutiny from the State Board of Medical Examiners or the DEA. Kind of a lame reason, but at least in gets me 4 appointments per year.
But I sometimes look back with nostalgic yearning to the old days when psychiatrists did insight psychotherapy, and were not solely focused on meds and med management. It was nice to be able to talk with your dr about how your life was going, and how you felt about life, rather than just how the meds were going, and how you were feeling from meds...(insert bitter irony emoticon here)
Posted by Chloe on June 18, 2002, at 20:50:54
In reply to Doxepin Dosing and Health Insurance Constraints » Chloe, posted by fachad on June 18, 2002, at 19:26:29
> Yes, I take my trimip around 7 or 8 PM, even though I don't go to bed until 10. I get two benefits from doing it that way: first, I am drowsy by bed time, and second it has had more time to wear off when it is time to wake up.
>
Fachad,
It's funny, I don't really feel sedated when I wake up with Dox. In fact, I feel refreshed. I take out the dog, throw the ball, fuss a with my garden, weed, all before my shower. The tiredness does not hit until after lunch or mid afternoon. I really feel like a need a nap! But my quandery is if I take the dox earlier, will I wake up too early??? I guess i will have to experiment.> But my wife will take a little ami in the day if she has stomach pain, and I read a study where they compared dox to valium for anxiety, and gave study sujects multiple doses or either drug durning the day.
This is interesting...TCA's prn. Hum. I guess my only concern would be the toxicity of TCA's. They are very deadly in an overdose.
> Glad to hear that you are sleeping well! It may take either more time or a higher dose for the pain relief.
I think you are right on this point.
> I don't see any reason why your pdoc would not be willing to titrate up the dose until you are satisfied or the side effects become troublesome.I agree. I can e-mail my pdoc and tell her what my symtoms are, or how I am doing, etc. We have worked together for over a decade, so she trusts me to use my own judgement within reason. She will have to amend the perscription, though...that could take some time.
> Yeah, I hated Remeron too. But I still think it is the most potent sleep med ever, period. If someone was really in misery because of insomnia, and nothing else worked, I'm sure Remeron would.
I had a friend who had hysterectomy induced menopause. And from the day of the surgery, she could not sleep, at all. So I told her you have got to try remeron! It didn't help her a bit. So I guess we are all individual. But I think Remeron is more like rhino tranquiler, than an AD. I apologize to any Remeron lovers out there!
> I live in the US, and have employer provided health insurance.
> Is that $10K a yearly cap or a lifetime cap?Lifetime, unfortunately. :(
> I don't know if I have a cap on my psych coverage. I think the reason for my limitation is based more on the way psychiatry is done nowadays than anything else.
>
> I think even if I was 100% self-paying, most pdocs are just doing their thing in 15 min "med check" appointments these days. If they can classify you as "stable" by any stretch of definition, they put you into the quarterly (3month), bi-annual, or annual visit category.
>
> I think the only reason I get to see my pdoc every three months instead of yearly is because dex is Schedule II and he knows he needs to see his CII patients more often to avoid scrutiny from the State Board of Medical Examiners or the DEA. Kind of a lame reason, but at least in gets me 4 appointments per year.One appointment a year? This must be troublesome when it comes to refills. My pharamacy will only take 6 months at a time. I am glad you take the stims, so at least you can be "checked" on quarterly. However, I would think a pdoc would want to see you AS MUCH AS POSSIBLE so they can charge you. I went looking for another pdoc, he agreed to be my med doctor if I would see him once a week, at $250 a pop! I thought the price was outrageous, but so was once a week. It was not analysis, it was psychopharmacology. So I passed on that, and decided what I have is good and with this board, I feel I have very adequate med coverage!
>
> But I sometimes look back with nostalgic yearning to the old days when psychiatrists did insight psychotherapy, and were not solely focused on meds and med management. It was nice to be able to talk with your dr about how your life was going, and how you felt about life, rather than just how the meds were going, and how you were feeling from meds...(insert bitter irony emoticon here)I totally agree with you here. I had to transition with my pdoc from being my "shrink", talk and meds, to just meds. And it was difficult. Because there could be other reasons why a med is not working. It's not all biology and neurons. Sometimes "issues" actually enter into how someone feels and responds to a drug. I.e., work problems, family probs, relationship probs, perception probs, etc. And the meds can cause us to feel certain ways that can be troubling too. There are so many nasty side effects that need addressing for some people, like sweating, or sexual dysfunction, agitation. And with the SSRI's, the the insomnia, or apathy you experienced. How can that be addressed in a 15 minute session annually? What a system we have...BUT, I too, see my pdoc very rarely, a few times a year. But I do email her if there is a problem or issue. So being able to touch base (at a cost per email, however!) on how things are going is comforting.
Thanks for all your help.
Take care,
Chloe
Posted by BLPBart on June 20, 2002, at 18:09:29
In reply to My Story (a bit long) » Chloe, posted by fachad on June 17, 2002, at 0:52:44
> >Hey, if you feel like sharing, what's your story?
>
> My story goes like this. For as long as I can remember, I felt like something was "wrong". When I was in Elementary school, I used to always ask my pediatrician if he would do blood tests, because although I did not have any specific symptoms, I felt like crap much of the time.
>
> Today, that would probably be diagnosed as childhood depression, but then it was dismissed as nothing. The docs usually granted me the blood work, which of course always showed nothing wrong.
>
> I had several episodes of depression in middle and high school, but I was brought up in a very fundamentalist religion, and I attributed my depression, which included crying a lot and not eating to "spiritual difficulties".
>
> In my late teens in college I renounced all religious belief and much of my severe depression abated. But that feeling like crap most of the time never left me. I tried all sorts of things to feel better like exercise, good diet, vitamins and herbs, internal cleansing, etc., but nothing really worked.
>
> In my late twenties Prozac came out and all the craze with "better than well" and "personality change" and etc. So I thought maybe I had been depressed all this time and that ADs would make me feel good and feel good about myself and that that ADs were what I had needed all this time.
>
> So I got Prozac, first 20mg/day, then 40mg/day and although I took it for a year, it did not really help.
>
> Then I came across an article that suggested that Wellbutrin was more effective in depression that was more toward eating too much and sleeping too much. So I got Wellbutrin. After a few months, I decided that the exhausted feeling that was really my worst symptom was not being helped, so I wanted to try something different.
>
> My pdoc gave me Paxil, which is the shortest trial of any drug in my life. It just made me feel awful, and I quit it after three days.
>
> I then asked my pdoc for desipramine; it is by far the most potent NE uptake med and it has the lowest values for H1, Ach, and other side effect causing blockade. I took that for about 3 weeks, and then I could not stand the dry mouth and constipation any more.
>
> So my pdoc gave me Zoloft. It wasn’t too bad, and I was tired of trials, so I just took it for about three years. I was gradually feeling worse, but I never attributed it to the Zoloft.
>
> Then on the old "Psychopharmacology Tips" that was the original site of Dr. Bob I read about the SSRI induced "frontal lobe" apathy syndrome. It is caused by the interactions between serotonin and dopamine, and it leads to lethargy, apathy, and fatigue. I realized that those problems had become much worse in me since I started taking Zoloft, maybe since I started Prozac!
>
> About this time Effexor was just being introduced. It was being marketed as "Prozac Plus" and the NE uptake was supposed to be more energizing and etc. So I stopped Zoloft and started Effexor.
>
> Effexor caused dry mouth for me, as well as constipation and sexual problems. I endured it for about three weeks then quit. Back then there was not as much awareness of AD discontinuation syndrome; but I suffered immensely from quitting Effexor.
>
> While still trying to stay on Effexor, I had suggested to my pdoc to try Ritalin to both combat the sexual side effects and to reverse the SSRI Induced Apathy. Both ideas came from Dr. Bob's Psychopharmacology Tips.
>
> Well, Ritalin really worked, but I did not see it at the time. After quitting Effexor, I started Serzone. It was not supposed to cause weight gain, or sexual problems, or sleep problems. I took it for a year or so, then I realized that the Ritalin was what was really helping me.
>
> I quit Serzone and took only Ritalin for about 5 years. Those were the best 5 years of my life. I felt good, finally. My mood was good and I did not feel like crap. I could not believe how well Ritalin worked, and I was irritated that it had not been tried earlier.
>
> Then I had a few severe psychosocial stressors, and was hit with another major depressive episode. I had felt that all the ADs I was on before were of questionable worth, but this was bad and I had to start something. I chose Prozac, because I had not remembered having any side effects, and I knew the patient was running out in about a month, so it would be dirt-cheap.
>
> Within two days of starting Prozac, I had terrible insomnia. Then I realized that all that early morning awakening that was used to further confirm my diagnosis of depression was just a side effect of the SSRIs! So both the insomnia and the fatigue/lethargy which were considered part of my depression, were really just medication side effects.
>
> Those two experiences, the SSRI induced apathy and the SSRI induced early morning awakening, have really given me a negative attitude about SSRIs. I am also on the alert for med caused side effects being mistaken for psych disorder symptoms.
>
> Earlier this year I switched my pstim from Ritalin to Dexadrine. I felt like I needed something stronger to reverse the increased SSRI Apathy/Lethargy caused by the Prozac. So far Dex has been OK, but I actually think Ritalin is a superior med for me. Since starting Ritalin many years ago, I have overall felt much better, and pstims will always be my primary medication.
>
> During the whole Zoloft/Efffexor/Serzone era I had taken doxepin for sleep as needed. I know this sounds odd, but when I started Ritalin I started sleeping so much better, and didn't need dox anymore until I re-started Prozac.
>
> I didn't really want to restart dox because I had lost some weight and kept it off for awhile, and I did not want the weight gain risk that comes with so many psych meds, including TCAs.
>
> So my pdoc gave me Ambien. It really knocks me out, but it wears off after about 4 hrs. So I went back to dox for awhile and did OK, no weight gain. Later, I tried Ativan, but it left me groggy and melancholy the next day. Then I came across the trimip articles, and that's where I'm at now.
>
> I think by the end of the year I'll be able to discontinue the Prozac and the trimip, and be back to just Dexadrine.
>
> If the idea of stimulant monotherapy for depression seems odd to you, take a look at a few other postings I've done on this board.
>
>
> Ritalin for SSRI Induced Apathy Anergia:
>
> http://www.dr-bob.org/babble/20020307/msgs/97130.html
>
>
> Ritalin is not marketed as AD:
>
> http://www.dr-bob.org/babble/20020307/msgs/97442.html
>
>
> Re: Dexedrine Tolerance? A Theory:
>
> http://www.dr-bob.org/babble/20020215/msgs/94906.htmlHi Fachad,
I just read your story and wanted to comment because mine is similar. I remember as a kid always feeling "different", sort of like I was looking in at the world from the outside and always feeling melancholy and down. I realize now that I was extremely depressed all through college and it's amazing to me I even finished. As an adult, I continued to have that different feeling and always felt like I didn't fit in and could never feel as happy go lucky as other people. A couple of years ago, after some very stressful years of trying to deal with infertility and some tough issues at work I was diagnosed with depression. The way it hit me was I was teary all of the time and I got extremely lethargic. I remember feeling like the walk across the parking lot at work seemed like an incredibly difficult task, not to mention just getting up in the morning.I was started on prozac which actually seemed to help for a while. Then I quit the prozac which was dumb because I crashed pretty hard. I went to a new doc who put me on prozac. It seemed to help again with the mood, but I was really starting to gain weight from it so when I mentioned this to my doctor he switched me to wellbutrin. After being on the wellbutrin alone for a while, I had an incredibly horrible week which coincided with when I would have PMS so my doc thought that was what it was and put me back on a low dose of prozac (10mg/day) in addition to the wellbutrin. Again, this seemed to help for a little while but a few months into it I had some horrible side effects from the combination. I started having menstrual irregularities, joint pain that felt like arthritis, muscle pain, horrible fatigue so bad I would sometimes sleep entire days away, and a return of the depression that was not related in any way to PMS.
At that point my doc took me off the prozac entirely and we decided to wait until it was totally out of my system to see what to do next. During the 5 weeks that we were waiting for the prozac to completely wear off, I started doing a lot of research here on p-babble. I came across some of your posts and others and talked to my doc about stimulants. He agreed to try it and I've been on dexedrine spansules since January and I feel better than I have in a very long time. What is adding to that is it has helped me lose the prozac weight and I have the energy to keep up with a regular workout program which I wasn't able to do while on the prozac. IMO, dexedrine has done wonders for me where the anti-depressants have either been extremely detrimental (as in the case of prozac) or of questionable efficacy (as in the wellbutrin).
Just thought I'd share my story plus ask a question. Just a few weeks ago I started having a strange side effect from the dexedrine that I have not experienced before. Several hours after taking the dex which can range to up to 9 - 10 hours later, I get this very strange sensation in the back of my throat that makes me feel a constant need to swallow and I feel a pressure in my sinuses and ears. I have no idea what that is. It's more annoying than anything and was just wondering if you had experienced anything like it.
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