![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 37. Go back in thread:
Posted by Bookgurl99 on May 27, 2002, at 22:04:52
In reply to Unable to sleep yet again!, posted by Angel Girl on May 27, 2002, at 2:13:35
Something else -- my naturopath has me doing a castor oil pack for 45 minutes at night. (You might want to do a web search on castor oil pack.) Part of the procedure involves putting a hot water bottle or heating pad on my stomach and doing deep breathing. The combo of heat on the stomach and deep breathing really knocks me out, if not to sleep.
Posted by SassyMom33 on May 28, 2002, at 3:10:52
In reply to Unable to sleep yet again!, posted by Angel Girl on May 27, 2002, at 2:13:35
There is an herb out there called Valerian Root! It is a great help with sleeping. It helps you to fall asleep, without making you 'dead to the world.' Just do some research on the net to look for any adverse reactions to meds you might be taking. There shouldn't be any, but better to check. Valerian Root is a savior to me with sleep problems. Aimee
Posted by fachad on May 28, 2002, at 9:48:24
In reply to Unable to sleep yet again!, posted by Angel Girl on May 27, 2002, at 2:13:35
Hi Angel Girl,
I have been around and around with different sleep meds.
For me, as far as pure quality and quantity of sleep, there is nothing better than trimipramine. It is a brand only TCA, Surmontil. If that costs too much for you, doxepin is a cheap generic that is similar, but not quite as good.
Although trimipramine is classed as a TCA, it is actually very unique and different from all other TCAs. It does not inhibit reuptake of either norepenephrine or serotonin. It has very mild dopamine blocking ability.
I will attach some trimipramine abstracts at the end for those who like that sort of thing.
Ambien is very effective at inducing sleep, but worthless in maintaining sleep. It is also a very expensive brand only med. Its main value is that it brings on sleep very reliably and potently with no real side effects.
So, anyway, now I am taking trimipramine 25 mg and Ambien 5 mg and that is a very effective combo for me.
A very important thing about both of these sleep meds is that they do not disturb normal sleep architecture. Benzodiazapines like triazolam and Xanax make you FEEL like you slept well, but if you had been monitored in a sleep lab, the PSG and EEG printout would show that in reality, you did not.
Trimipramine has been shown to produce normal sleep patterns in sleep lab studies.
***********************
Trimipramine for Sleep Abstracts
Drugs 1989;38 Suppl 1:14-6; discussion 49-50 Related Articles, Books, LinkOut
Sleep polygraphic effects of trimipramine in depressed patients. Preliminary report.Mouret J, Lemoine P, Minuit MP, Sanchez P, Taillard J.
Clinical Unit of Biological Psychiatry, Hopital du Vinatier, Lyon, France.
Preliminary results are presented from an ongoing study in hospitalised depressed patients. Changes in sleep parameters were assessed on days 1 to 3 and 12 to 14 of a 4-week study in which patients received trimipramine 150 mg on day 1 and 100 mg thereafter. On days 1 to 3 and 12 to 14, 7 depressed patients had a significantly increased total sleep time and sleep efficiency index and a significantly decreased total wake time and number of intrasleep wake episodes per hour of sleep. Trimipramine treatment had no significant effect on REM sleep, percentage of REM sleep, REM duration and REM sleep stability index. However, a significant increase in REM latency was noted on days 1 to 3 but not on days 12 to 14. These polygraphic data suggest that trimipramine effects a very rapid and maintained sleep improvement in these depressed patients without significant alterations to the parameters of REM sleep.
Drugs 1989;38 Suppl 1:17-24; discussion 49-50 Related Articles, Books, LinkOut
A review of trimipramine. 30 years of clinical use.Lapierre YD.
University of Ottawa, Royal Ottawa Hospital, Canada.
The hybrid chemical structure of trimipramine incorporates an imipramine nucleus and levomepromazine side chain. This structure predicts much of the clinical profile of trimipramine. The initial studies on trimipramine date back nearly 30 years. It now has a well-recognised clinical profile with some characteristics akin to other tricyclic antidepressants (TCA) and others which are quite distinct. It is well established as a highly effective antidepressant with an efficacy profile similar to the other TCAs. Clinically, its anxiolytic and sedative properties distinguish it from most other TCAs. Its effects on sleep architecture are unique and explain some of its unique properties. The side effect profile of trimipramine is in some ways similar to those of the tertiary amine TCAs with a preponderance of anticholinergic and sedative effects. Its cardiotoxic properties are minimal, with some findings suggesting a very favourable profile. Interactions with other drugs, psychotropic or non-psychotropic, are compatible with its pharmacological profile. These are reviewed with its clinical applications in mind. The pharmacokinetic characteristics of trimipramine differ from those of many of the other TCAs. The application of this to clinical situations is addressed. Based on experience using trimipramine, a profile of 'ideal' patient characteristics has been built up. Finally, the use of trimipramine in selected patient populations is reviewed.
Eur J Clin Pharmacol 1989;37(2):145-50 Related Articles, Books, LinkOut
Modulation of sleep by trimipramine in man.Nicholson AN, Pascoe PA, Turner C.
Royal Air Force Institute of Aviation Medicine Farnborough, Hampshire, UK.
We have studied the acute effect of trimipramine (25, 50 and 75 mg) on nocturnal sleep in 6 young men. Fluoxetine (60 mg) and diazepam (10 mg) were included as controls for the potential changes in sleep measures. Trimipramine reduced awake activity, Stage 1 (drowsy) sleep, and the duration of rapid eye movement (REM) sleep. Non-REM (Stage 2) sleep was increased. Residual effects of trimipramine were present the next morning (9 h after ingestion) with impaired coding ability. The effects of trimipramine on sleep and daytime alertness are consistent with its complex pharmacological profile. Reduced wakefulness and sedation are most likely due to synergism between histamine H1, alpha 1-adrenoceptor, and dopamine receptor antagonism. Anticholinergic activity and possibly blockade of alpha 1-adrenoceptors would disturb the balance of transmitter activities which facilitates the optimal appearance of REM sleep. In this way the effects of trimipramine on nocturnal wakefulness and REM sleep are similar to drugs which inhibit the uptake of noradrenaline.
Sleep 1989 Dec;12(6):537-49 Related Articles, Books, LinkOut
Effects on sleep: a double-blind study comparing trimipramine to imipramine in depressed insomniac patients.Ware JC, Brown FW, Moorad PJ Jr, Pittard JT, Cobert B.
Department of Psychiatry and Behavioral Medicine, Eastern Virginia Medical School, Norfolk.
Trimipramine, a sedating tricyclic antidepressant, and imipramine were compared on polysomnographic parameters during a 4-week double-blind trial in depressed patients with insomnia and anxiety. Trimipramine eliminated objective evidence of sleep disturbance. This was not the case with imipramine, although depression improved similarly in both groups. Subjects' sleep appeared unchanged or more disturbed at the end of the treatment with imipramine. For trimipramine, the major changes in sleep parameters occurred during the first week of drug administration and did not parallel the gradual changes seen in the measures of depression. Additionally, trimipramine did not suppress REM sleep even in a subgroup of six trimipramine patients who had short rapid-eye-movement (REM) sleep latencies during the placebo baseline period, even though their depression was alleviated. The data demonstrate that (a) antidepressants may vary in their effects on sleep, even though they have similar effects on depression; (b) REM sleep suppression does not necessarily accompany improvement in depression; and (c) reports of improved sleep by patients undergoing antidepressant therapy may not reflect improvement on objective measures of sleep. The different sleep effects suggest the possibility of different antidepressant pathways.
J Affect Disord 1992 Mar;24(3):135-45 Related Articles, Books, LinkOut
Trimipramine: acute and lasting effects on sleep in healthy and major depressive subjects.Feuillade P, Pringuey D, Belugou JL, Robert P, Darcourt G.
Clinique de Psychiatrie et de Psychologie Medicale, Hopital Pasteur, Nice, France.
The acute effects of trimipramine on sleep EEG patterns were investigated in six depressed inpatients and six healthy volunteers. The effects of long-term administration were then assessed in depressed patients after 4 weeks of treatment. Sedative effects of the drug were more pronounced in healthy subjects while sleep parameters of depressed patients seemed less sensitive to the drug. Chronic effects tended to correct most of the sleep disturbances seen in depressed subjects with respect to the natural organization of sleep. The major sleep effect of trimipramine concerned REM latency which was lengthened in both groups, independently of the treatment protocol.
Eur Arch Psychiatry Clin Neurosci 1994;244(2):65-72 Related Articles, Books, LinkOut
Treatment of primary insomnia with trimipramine: an alternative to benzodiazepine hypnotics?Hohagen F, Montero RF, Weiss E, Lis S, Schonbrunn E, Dressing H, Riemann D, Berger M.
Department of Psychiatry, University of Freiburg, Germany.
A group of 19 middle aged patients suffering from primary insomnia according to the DSM-III-R were treated in a single-blind study with trimipramine, a sedating antidepressant. A total of 15 patients completed the study protocol and were evaluated. The present pilot study aimed at investigating the sleep-inducing properties of trimipramine, and at clarifying the question of whether short- or long-term rebound insomnia occurs after discontinuation of this drug. At four measurement points, i.e. under baseline conditions, under treatment and 4 and 14 days after drug discontinuation, sleep was recorded with an ambulatory-electroencephalogram (EEG) monitoring device in the patient's home environment. Simultaneously, psychometric tests were applied to measure withdrawal symptoms, subjective sleep quality and well-being during daytime. Trimipramine at a mean dose of 166 +/- 48 mg led to a significant increase in sleep efficiency, total sleep time, and stage 2% sleep-period time (SPT), whereas a significant decrease in wake time and stage 1% SPT was noted. Insomniac patients reported an improvement in subjectively perceived sleep quality following trimipramine. Additionally, an improvement in well-being during the daytime occurred. Negative side effects were limited to dry mouth due to the anticholinergic properties of the drug. Discontinuation of trimipramine did not provoke either short- or long-term rebound insomnia in objective and subjective sleep measurements considering mean values of the whole sample, although a subgroup of patients did display total sleep times below baseline values during short- and long-term withdrawal, but generally without a concomitant worsening of sleep quality according to the sleep questionnaire.
Eur Arch Psychiatry Clin Neurosci 1996;246(5):235-9 Related Articles, Books, LinkOut
Trimipramine: a challenge to current concepts on antidepressives.Berger M, Gastpar M.
Klinikum, Albert-Ludwigs-Universitat, Freiburg, Germany.
Although it is chemically a classical tricyclic antidepressant agent, trimipramine shows atypical pharmacological properties. Its well-documented antidepressant action cannot be explained by noradrenaline or serotonin reuptake inhibition or by a down-regulation of beta-adrenoceptors. Furthermore, its receptor affinity profile resembles more that of clozapine, a neuroleptic drug, than that of tricyclic antidepressants. Trimipramine does not reduce, but rather increases, rapid eye movement sleep. It stimulates nocturnal prolactin secretion and inhibits nocturnal cortisol secretion and may act at the level of the hypothalamus on corticotropin-releasing hormone secretion. Trimipramine is of particular value in depressed patients with insomnia, and it has been shown to be effective in the therapy of primary insomnia. As the pharmacological profile indicates, and an open clinical study has shown, trimipramine might also be active as an antipsychotic. The drug is both a tool for increasing our understanding of depression and a potential therapy for several psychiatric disorders.
Depression 1996;4(1):1-13 Related Articles, Books, LinkOut
Trimipramine and imipramine exert different effects on the sleep EEG and on nocturnal hormone secretion during treatment of major depression.Sonntag A, Rothe B, Guldner J, Yassouridis A, Holsboer F, Steiger A.
Max Planck Institute of Psychiatry, Department of Psychiatry, Munich, Germany.
In a 4-week double-blind clinical trial we compared the effects of the tricyclic antidepressants trimipramine and imipramine on the sleep EEG and on nocturnal bormone secretion in 20 male inpatients with major depression. Both treatments produced rapid significant clinical improvement in depression without severe adverse effects. However, the two drugs had markedly different neurobiologic profiles. Trimipramine enhanced rapid eye movement (REM) sleep and slow wave sleep, whereas imipramine suppressed REM sleep and showed no effect on slow wave sleep. Total sleep time and the sleep efficiency index increased under trimipramine but not under imipramine. Nocturnal cortisol secretion decreased with trimipramine but remained unchanged with imipramine. In contrast to imipramine, trimipramine induced an increase in prolactin secretion compatible with its known antagonism at dopamine (D2) receptors. Imipramine induced a decrease in growth hormone secretion during the first half of the night. Neither of the drugs induced significant changes in plasma testosterone concentration. We conclude that trimipramine is an antidepressant with sleep-improving qualities that possibly acts through inhibition of hypothalamic-pituitary-adrenocortical system activity by a yet unknown mechanism.
> It seems every night I'm here late, unable to sleep even though I have taken my Triazolam. I've even resorted to also taking a Xanax to help induce sleepiness. All to no avail. :(
>
> Does anybody have any suggestions???
>
> Angel Girl
Posted by johnj on May 31, 2002, at 18:13:07
In reply to Trimipramine for Sleep » Angel Girl, posted by fachad on May 28, 2002, at 9:48:24
HI,
I read the articles you attached with much interest. I suffer from depression with quite a bit of anxiety. Which comes first is still a mystery, but I have a feeling anxiety plays a big role and then my sleep becomes disturbed and depression follows. Has trimipramine helped with anxiety? How sedated are you the following morning? I read the one study that said there was decreased coding ability(I assume this means cognitive impairment?). What have been your experiences? Thanks
Johnj
Posted by katekite on May 31, 2002, at 21:34:11
In reply to Trimipramine for Sleep » Angel Girl, posted by fachad on May 28, 2002, at 9:48:24
Thanks fachad... I am really interested to hear further info on this and about other alternatives to benzos.... I've now been on klonopin for 9 months and it has really screwed up my sleep. But... try to get off and have rebound insomnia.
The dopamine antagonism has me concerned though, esp residual coding probs next am, etc as I need all my dopamine during the day.
have also been looking at clonidine, used in little kids with ADD to make them sleep, wonder if any adults use it.
kate
Posted by fachad on June 1, 2002, at 15:16:45
In reply to Re: Trimipramine for Sleep(fachad), posted by johnj on May 31, 2002, at 18:13:07
JohnJ,
I do not have any anxiety. My problem is the opposite - I don't even feel anxious when really bad things are happening or are about to happen.
Someday I think apathy disorders will be recognized as the polar opposite of anxiety disorders, in the same way as mania is the polar opposite of depression.
So I can't say if trimipramine helps with anxiety, because I don't have any. I will say that it does not aggrivate my apathy and lethargy as much as Ativan.
Comparing the next day effects of Trimip vs. Ativan, trimip makes me feel a little more sleepy first thing in the morning, but fine the rest of the day. Ativan makes me feel apathetic, lethartic, and a little down for the whole rest of the next day.
As always, YMMV.
> HI,
> I read the articles you attached with much interest. I suffer from depression with quite a bit of anxiety. Which comes first is still a mystery, but I have a feeling anxiety plays a big role and then my sleep becomes disturbed and depression follows. Has trimipramine helped with anxiety? How sedated are you the following morning? I read the one study that said there was decreased coding ability(I assume this means cognitive impairment?). What have been your experiences? Thanks
> Johnj
Posted by fachad on June 1, 2002, at 15:30:12
In reply to Re: Trimipramine for Sleep » fachad, posted by katekite on May 31, 2002, at 21:34:11
Were you put on benzos for sleep or anxiety or both? I've heard that for anxiety, benzos are really the best treatment - much better than SSRIs or other alternatives.
For sleep, from an objective standpoint (PSG and EEG), trimipramine is the best med period. I experience better sleep subjectively also, but that will vary from person to person.
The dopamine antagonism of trimpramine is really minimal - much less than the weakest APs. It only looks significant when compared to other ADs, which have little to no DA antagonism.
As far as coding ability, or general cognitive ability, my experience is that trimipramine is far less of problem than Ativan.
Ativan hits me pretty hard the whole next day, both in terms of cognitive impairment and in terms of making me feel a little melancholy.
The trimipramine grogginess dissipates much quicker for me than the Ativan lethargy and melancholy.
Just so you know, my Ativan doses were 1 mg or 2 mg and my trimipramne doses are approx 12.5 mg or 25 mg.
To get 12.5 mg I dump the powder from a 25 mg capsule into a tall glass of water, stir, then drink half the glass. 25mg is the smallest capsule they make, and 12.5 mg does the job for me with less residual effects than 25 mg.
I considered clonadine, but it can cause depression and it can cause rebound high blood pressure when it wears off in the morning. I don't want to introduce any new problems, I already have my lifetime allotment...
> Thanks fachad... I am really interested to hear further info on this and about other alternatives to benzos.... I've now been on klonopin for 9 months and it has really screwed up my sleep. But... try to get off and have rebound insomnia.
>
> The dopamine antagonism has me concerned though, esp residual coding probs next am, etc as I need all my dopamine during the day.
>
> have also been looking at clonidine, used in little kids with ADD to make them sleep, wonder if any adults use it.
>
> kate
Posted by katekite on June 1, 2002, at 20:33:45
In reply to Trimipramine for Sleep - DA, coding, clonidine,etc » katekite, posted by fachad on June 1, 2002, at 15:30:12
thanks. The klonopin was originally for anxiety. But it turned out that was a misdiagnosis as what I actually have is more a 'mental restlessness and overwhelmed behind feeling' of ADD... which disappears on ADD meds. Since starting ADD meds I have found I do experience anxiety occasionally but not to the point of needing medication for it or it interupting sleep -- just finally know what anxiety is versus what I always thought was anxiety.
My sleep problems seem to be a result of being wound up and thinking in circles taking forever to go to sleep, also waking frequently and too early (like when come up to start a new sleep cycle will wake at slightest sound and not go back to sleep).
I'll look into trimipramine, it sounds like its worth a shot.
Thanks again,
kate
Posted by Cece on June 1, 2002, at 20:39:29
In reply to Trimipramine for Sleep » Angel Girl, posted by fachad on May 28, 2002, at 9:48:24
Thanks for all the info on Trimipramine. I have taken it for about a year, replacing Nortiptyline. I like it better than Nort- I feel like I sleep more normally, less like a 'log'. I didn't know that it was so atypical- very interesting.
I just skimmed the articles, catching what I could. I'm wondering if you know what these terms mean: "reduced coding ability" (referred to re morning-after effects, and "latent REM'?
Thanks,
Cece
Posted by Cece on June 1, 2002, at 21:07:02
In reply to Trimipramine for Sleep - DA, coding, clonidine,etc » katekite, posted by fachad on June 1, 2002, at 15:30:12
Fachad-
I see that you already answered my question about "coding".
I take 25mg Trimipramine at night. I do have a slow time waking up in the morning, but always have to some extent. And as you say, any grogginess wears off very fast. I have no anti-cholinergic side effects.
I take other meds too, and am weaning off of benzos. I was taking 1.25 mg/day of xanax (for about 3 years), with .75 of it at night. I've cut down to .5 at night and already feel less overall cognitive problems. I'm going to continue going down and hope to get off it entirely. I've taken .125mg- that is 1/4 of the smallest tab made, a real chopping chore- of klonopin at night for a long time (about 10 years). I'm going to wean off that also. I'd like to get all benzos out of my regime. I find that Neurontin is a better calming med for me.
I've recently been trying out thyroid supplement therapy- moving from the low end of normal to the high end. That is doing wonders for my overall alertness and energy, and for waking up in the morning. I used to be able to sleep through 3 alarm clocks, and sometimes used 976-WAKE as a last resort! Now, my alarm clocks get me out of bed pretty easily. And I don't feel overly activated.
I do have a bad habit of staying up too late, which obviously doesn't help- I'm working on that. I get obsessed with whatever I'm doing and have a hard time telling myself to set it aside for another day. I find that Trimipramine is somewhat subtle in "inducing" sleep, at least at the low dose I take. It doesn't knock me out, I have to cooperate with it.
Cece
Posted by omega man on June 1, 2002, at 22:42:48
In reply to Unable to sleep yet again!, posted by Angel Girl on May 27, 2002, at 2:13:35
i got a new drug called zopiclone..in Uk..it hits really heavy...with less groginess the next day than stuff that usually does that..
Posted by fachad on June 1, 2002, at 22:59:10
In reply to Re: Trimipramine for Sleep- P.S. » fachad, posted by Cece on June 1, 2002, at 21:07:02
Cece,
Have you gained weight from your 25 mg/day? I gained from only 5 or 10 mg/day of doxepin, but so far, after a month, I have not gained from trimip.
Also regarding sleep induction, Ambien is really superior for that. It just wears off too fast and is useless for sleep maintanence. I found trimp becasue of frustration with Ambien short effects.
I frequently take 5 mg of Ambien with my trimip, the Ambien puts me out FAST, and the trimip keeps me asleep. Plus, each med reduces the dosage needs of the other.
> Fachad-
>
> I see that you already answered my question about "coding".
>
> I take 25mg Trimipramine at night. I do have a slow time waking up in the morning, but always have to some extent. And as you say, any grogginess wears off very fast. I have no anti-cholinergic side effects.
>
> I take other meds too, and am weaning off of benzos. I was taking 1.25 mg/day of xanax (for about 3 years), with .75 of it at night. I've cut down to .5 at night and already feel less overall cognitive problems. I'm going to continue going down and hope to get off it entirely. I've taken .125mg- that is 1/4 of the smallest tab made, a real chopping chore- of klonopin at night for a long time (about 10 years). I'm going to wean off that also. I'd like to get all benzos out of my regime. I find that Neurontin is a better calming med for me.
>
> I've recently been trying out thyroid supplement therapy- moving from the low end of normal to the high end. That is doing wonders for my overall alertness and energy, and for waking up in the morning. I used to be able to sleep through 3 alarm clocks, and sometimes used 976-WAKE as a last resort! Now, my alarm clocks get me out of bed pretty easily. And I don't feel overly activated.
>
> I do have a bad habit of staying up too late, which obviously doesn't help- I'm working on that. I get obsessed with whatever I'm doing and have a hard time telling myself to set it aside for another day. I find that Trimipramine is somewhat subtle in "inducing" sleep, at least at the low dose I take. It doesn't knock me out, I have to cooperate with it.
>
> Cece
Posted by johnj on June 2, 2002, at 0:47:47
In reply to Re: Trimipramine for Sleep- P.S. » fachad, posted by Cece on June 1, 2002, at 21:07:02
HI,
I currently take nortryptline 50 mg, and have tried to switch, due to nort. causing things to get screwed up when I excercise. How did you make the switch from one TCA to another? Do you excercise? Did you find norty to have negative effects when you did excercise? My doc tried to switch me to imipramine, but after going up 20 mg the side effects, dry mouth, and some jitterness were too much. I take tranzene, a benzo, for anxiety and that is a big problem with my depression. Thanks
Johnj
Posted by Cece on June 2, 2002, at 23:54:41
In reply to Re: Trimipramine (CECE) Nortryptline question, posted by johnj on June 2, 2002, at 0:47:47
John-
My pdoc had me switch Trim for the Nort directly- no phasing- and it was just fine. I was taking the lowest cap of Nort (forget exactly now how much- maybe 25mg).
I don't officially exercise, but am very active and garden a lot. I don't recall any particular problem from the Nort. But if I went up any higher on my dosage I got very nasty dry mouth.
Cece
Posted by johnj on June 3, 2002, at 8:08:15
In reply to Re: Trimipramine (CECE) Nortryptline question » johnj, posted by Cece on June 2, 2002, at 23:54:41
Hi,
Do you have a lot of anxiety with your depression? I take is that is why you take xanax and klonopin. Have you found the trimipramine helpful with depression also? Thanks
Johnj
Posted by johnj on June 3, 2002, at 13:59:36
In reply to Trimipramine - Wt. Gain and Sleep Induction » Cece, posted by fachad on June 1, 2002, at 22:59:10
Hi,
This has been a great thread and I was wondering how you found all that info on trimipramine? I am looking to get off nortryptline since it causes some problems when I excercise, and wonder if trimipramine might be better. I worked outside yesterday and felt like crap in the evening and woke up early so today is not very good. I need the help with sleep that is for sure.
I think the benzo helps my anxiety, but it can possibly lead to some depression problems so I want to limit my benzo dose.One of the articles stated the following:
<Based on experience using trimipramine, a profile of 'ideal' patient characteristics has been built up. Finally, the use of trimipramine in selected patient populations is reviewed.> Do you have any idea how I can find this information?Was the article posted just an abstract?
You seem to know how to get your hands on some quality info and any pointers would be appreciated. Thanks, and I hope your sleep is better.
Johnj
Posted by Cece on June 4, 2002, at 13:46:26
In reply to Trimipramine - Wt. Gain and Sleep Induction » Cece, posted by fachad on June 1, 2002, at 22:59:10
Fachad-
I don't think that I've gained weight on the trimipramine, but (see previous posts, I think on this thread), I have gained weight sine I went off Topomax.
The Depakote that I take does contribute to weight gain, even though I only take 250mg/day. But I think that that is a permanent med for me- in the past when I've experimented with going off it entirely I have had relapses into terrible moods- getting up on the wrong side of bed style.
I also take Lamictal which for some people seems to cause weight gain. Again, I'm not sure if that's true for me- I don't think so.
I'm hoping that over time the Thyroid will change my metabolism. I've always had to fight with my weight- never a skinny person.
Thanks for the info about the Ambien. I'm actually falling asleep fine these days, but will keep the info in mind. Also, I'm trying to simplify my med regime as much as possible, so hate to think of adding yet another pill. I'm already running my own little pharmacy here and it's a lot of work.
Cece
Posted by Cece on June 4, 2002, at 13:59:04
In reply to One more question (CECE) , posted by johnj on June 3, 2002, at 8:08:15
John-
I have had my share of anxiety, but it's not a constant for me. In the past, I was very anxious. I would characterize my current tendencies more toward franticness.
I started taking xanax, because I took it before I had a MRI (I'm prone to claustrophobia). I felt really good the next day and told my previous pdoc. So, I started taking a little. Then he went to a conference where xanax was discussed as having AD properties, and it became a regular med for me. In retrospect, I'm not so sure that it was necessary except maybe PRN, and probably not such a good idea. I think that he was a little too casual about it.
Klonopin, in a tiny dose, was my first med, prescribed before I started 'real' treatment, for anxiety. It helped, and has stayed in my mix for over 10 years. Since it also has some anti-convulsive properties, it seemed like maybe a good idea. But, I'm not so sure that it's necessary, either (I only take .125mg/day).
My current pdoc thinks that it is a good idea for me to try taking the benzos out- very slowly of course. I do have some cognitive slowing, and they are the most likely culprit. The other meds I take may treat my anxiety just fine.
Cece
Posted by Cece on June 4, 2002, at 14:02:13
In reply to Re: Trimipramine - (fachad), posted by johnj on June 3, 2002, at 13:59:36
Actually, it wasn't I who found all that good info- check the previous posts. I've gotten a lot of new and good info from this thread myself.
Cece
Posted by johnj on June 4, 2002, at 14:56:01
In reply to Re: Trimipramine - (fachad) » johnj, posted by Cece on June 4, 2002, at 14:02:13
Can you tell me what this medication is for? It sounds like we have some similiarties since I take norty. and a benzo(tranzene). Have you ever tried lithium? Thank you
johnj
Posted by Cece on June 4, 2002, at 16:40:33
In reply to Re: Neurotin - (CECE), posted by johnj on June 4, 2002, at 14:56:01
John-
I tried lithium some time ago- couldn't handle the side effects and it didn't seem to work well anyway. My main mood stabilizer now is Lamictal which is working out to be a very good med for me. The Neurontin balances well with it, for me- the Lamictal is an activating MS and has AD effects as well. The Neurontin is calming and gives me a sense of well-being. It also helps my fibromyalgia.
I began Nortriptyline as an AD and to help sleep (I had problems with the quality of my sleep, not being able to fall in to the deep level that is restorative). My current pdoc switched me to the Trim. and I sleep well and get less morning grog than with Nort. Since good sleep is important (probably the key) to treating fibromyalgia, it helps that too. I really can't tell how much AD effect I get off it- too many meds, and I've been on a TCA for so many years. Nort certainly wasn't enough of an AD for me, at least at the very low dose that I could handle (side effects).
I am BPII with much history of depression. I am doing well now- almost normal ups and downs, but still with a lower than normal tolerance for stress.
Cece
Posted by fachad on June 4, 2002, at 19:12:19
In reply to Re: Trimipramine - (fachad), posted by johnj on June 3, 2002, at 13:59:36
I searched a medline database for hypnotics.
I was turned off by benzodiazapines after I found out that they mess up sleep architecture and prevent deep stage 4 sleep.
I had thought there was little difference between the tertiary TCAs (amitriptyline, doxepin, imipramine, trimipramine) except for degrees of H1 blockade (drowsiness) and ACH blockade (dry mouth, etc). But then I found all these articles on trimipramine and how it was unique in structure, lack of reuptake, and beneficial effects on sleep architecture.
I would expect it to have some effect on anxiety, but I don't really know.
> Hi,
>
> This has been a great thread and I was wondering how you found all that info on trimipramine? I am looking to get off nortryptline since it causes some problems when I excercise, and wonder if trimipramine might be better. I worked outside yesterday and felt like crap in the evening and woke up early so today is not very good. I need the help with sleep that is for sure.
> I think the benzo helps my anxiety, but it can possibly lead to some depression problems so I want to limit my benzo dose.
>
> One of the articles stated the following:
> <Based on experience using trimipramine, a profile of 'ideal' patient characteristics has been built up. Finally, the use of trimipramine in selected patient populations is reviewed.> Do you have any idea how I can find this information?Was the article posted just an abstract?
> You seem to know how to get your hands on some quality info and any pointers would be appreciated. Thanks, and I hope your sleep is better.
> Johnj
Posted by johnj on June 4, 2002, at 21:05:51
In reply to Re: Trimipramine - (fachad) » johnj, posted by fachad on June 4, 2002, at 19:12:19
Hi again:
I am a little knew with the lingo so I wondered if you could explain "reuptake" to me. Do you mean trimipramine doesn't affect seratonin very much? Thanks
Johnj
Posted by fachad on June 5, 2002, at 9:58:05
In reply to Re: Trimipramine - (fachad) one more question, posted by johnj on June 4, 2002, at 21:05:51
There are (at least) two known ways a drug can interact with a neurotransmitter/receptor system.
It can inhibit reuptake. This means that when the nerve fires by releasing the neurotransmitter, the transmitter is not sucked back up into the nerve. This makes its effects longer. SSRIs like Prozac, Paxil, etc. inhibit the reuptake of serotonin without effects on norephenepherine or dopamine.
The second major way a drug can interact with a nerve is by blocking its receptor site. This has the opposite effect. Even if the nerve fires and releases it's neurotransmitter, and even if that neurotransmitter stays in the synapse longer, it will have reduced effects because the receptor is blocked.
Most antidepressants were believed to work thru inhibiting reuptake of NE or 5HT or both. Side effects are often caused by blockade.
Trimipramine does not inhibit reuptake of NE or 5HT to any significant degree. It does have blockade properties at H1 histamine receptors, ACH cholenergic receptors (dry mouth) and others.
But as to how it relieves depression, it is not known. It has been shown to be as effective as the drugs that inhibit reuptake.
It may be the lack of reuptake properties that explains why it uniquely enhances sleep.
> Hi again:
> I am a little knew with the lingo so I wondered if you could explain "reuptake" to me. Do you mean trimipramine doesn't affect serotonin very much? Thanks
> Johnj
Posted by katekite on June 8, 2002, at 10:19:52
In reply to Re: Trimipramine - Reuptake and Blockade » johnj, posted by fachad on June 5, 2002, at 9:58:05
Saw my pdoc on Thursday and asked for trimipramine. Am having endrocrine testing done soon and so he said no: trimipramine decreases cortisol and increases prolactin.
Maybe after testing is all done. I really need to sleep well and I have a hunch trimipramine would do it.
Came away instead with ambien and vistoril (the name sounds like it ought to keep you up to see the vistas). Ambien is like sonata for me except lasts 5 hrs instead of 3.5. It also, at least on the first try seems to have less of a drugged feeling the following day. Vistoril is just hydroxyzine a sedating anti-histamine and that is weak weak weak, but not as drying out as benadryl and I did actually sleep for 7 hrs last night with it so I can't say it doesn't work, it just didn't have much kick to it.
I'll be trying to rotate ambien sonata benadryl and hydroxyzine to avoid becoming dependent on sonata or ambien (which are enough like benzos to have at least some dependency potential, despite all the advertising that says they aren't benzos.)
kate
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.