![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 62. This is the beginning of the thread.
Posted by Chloe on June 5, 2002, at 19:04:27
I am in the pits of dispair again. The cycling was under control, but now I am feeling suicidal. The tears just stream down my face.
1.5 mg Celexa
225 mgs Lithium
250 mgs Depakote
600 mgs Neurontin
20 mgs Amitriptline
10 mgs diazapamAnd I can't really go up on the Li or neurontin, because it make my scalp "burn" worse. More Celexa just makes me more agitated.
I also am so pissed with my pdoc. She never got back to me over my mother's psychotic break. And I am furious and don't want to call her for help. It takes her 24-48 hours to get back to me(if at all!), even if it's an "emergency". There is really nothing she can do any way. I need an Antipsychotic when I get like this, but can't take them due to TD in my mouth. So what is she going to say.
I feel very negative and hopeless. I am so tired of feeling like things are great, and taking on major challenges, and then after exhausting myself, landing in a heap of despair.
Oh, I am also very anemic from prolong menstrual bleeding, but the ferrous gluconate(iron supp) make me nauseated and constipated. The flaxseed oil is also making me queezy, but if I stop that the scalp pain in unbearable.
Crap. I am so mad. Will my whole life be a non stop rollercoater ride? Where can I get help if my shrink just lets me titrate my meds prn without even consulting her. I am so lost and confused.
Chloe
Posted by JonW on June 5, 2002, at 19:40:41
In reply to All these meds and feel AWFUL AWFUL, posted by Chloe on June 5, 2002, at 19:04:27
Hi Chloe,
If your doc isn't working on your behalf, definitely get a new one! Here's a link to a recent post by Dr. Goldberg that I find encouraging:
http://www.dr-bob.org/babble/20020525/msgs/108025.html
Hang in there,
Jon
Posted by Ritch on June 5, 2002, at 23:59:03
In reply to All these meds and feel AWFUL AWFUL, posted by Chloe on June 5, 2002, at 19:04:27
> I am in the pits of dispair again. The cycling was under control, but now I am feeling suicidal. The tears just stream down my face.
>
> 1.5 mg Celexa
> 225 mgs Lithium
> 250 mgs Depakote
> 600 mgs Neurontin
> 20 mgs Amitriptline
> 10 mgs diazapam
>
> And I can't really go up on the Li or neurontin, because it make my scalp "burn" worse. More Celexa just makes me more agitated.
>
> I also am so pissed with my pdoc. She never got back to me over my mother's psychotic break. And I am furious and don't want to call her for help. It takes her 24-48 hours to get back to me(if at all!), even if it's an "emergency". There is really nothing she can do any way. I need an Antipsychotic when I get like this, but can't take them due to TD in my mouth. So what is she going to say.
>
> I feel very negative and hopeless. I am so tired of feeling like things are great, and taking on major challenges, and then after exhausting myself, landing in a heap of despair.
>
> Oh, I am also very anemic from prolong menstrual bleeding, but the ferrous gluconate(iron supp) make me nauseated and constipated. The flaxseed oil is also making me queezy, but if I stop that the scalp pain in unbearable.
>
> Crap. I am so mad. Will my whole life be a non stop rollercoater ride? Where can I get help if my shrink just lets me titrate my meds prn without even consulting her. I am so lost and confused.
>
> Chloe
Chloe,I just thought of this and I wonder if you think this might be a good idea, too. Have you read the posts recently on trimipramine for sleep and depression? It is supposed to have very mild AP properties (weak DA antagonist), and it doesn't screw up your sleep patterns. I wonder if it might be a good swap from amitriptyline? I think you ought to bring it up to your pdoc.
hope you get to feeling better,
Mitch
Posted by Chloe on June 6, 2002, at 9:53:26
In reply to Re: All these meds and feel AWFUL AWFUL » Chloe, posted by Ritch on June 5, 2002, at 23:59:03
Thank you Mitch
I have to go into the archive and look that up. I remember skimming some of the posts.I have no knowledge of this TCA at all. Is it a new one? I also *think* I remember people saying how it *didn't* make them tired. Is it less sedating than Ami? (Less AD props would be nice, though. Ami makes me into a grizzly bear over 20 mgs.) Perhaps I misread. If you don't mind, can you elaborate on trimiprimine? ANd I will do some investigating myself.
Thanks again, Mitch
Chloe
Posted by Ritch on June 6, 2002, at 13:25:34
In reply to Re: All these meds and feel AWFUL AWFUL » Ritch, posted by Chloe on June 6, 2002, at 9:53:26
> Thank you Mitch
> I have to go into the archive and look that up. I remember skimming some of the posts.
>
> I have no knowledge of this TCA at all. Is it a new one? I also *think* I remember people saying how it *didn't* make them tired. Is it less sedating than Ami? (Less AD props would be nice, though. Ami makes me into a grizzly bear over 20 mgs.) Perhaps I misread. If you don't mind, can you elaborate on trimiprimine? ANd I will do some investigating myself.
>
> Thanks again, Mitch
> Chloe
Chloe,Fachad had two good posts on it that I found:
http://www.dr-bob.org/babble/20020602/msgs/108686.htmlhttp://www.dr-bob.org/babble/20020525/msgs/108314.html
He also had some medline stuff on it-but I didn't catch that in the thread above.
I had read something about it a few months ago. It was a flowchart for treatment of bipolar disorder and it recommended trimipramine to treat *insomnia* I believe for breakthrough hypomania or mania in addition or instead of a benzo (I think). Somebody else might know which "flowchart" I am thinking of. You can't get generic from what I understand. It is Surmontil. I might do some more browsing about it. I am going to check the monograph on it.
Talk toya later,
Mitch
Posted by Chloe on June 6, 2002, at 22:34:00
In reply to Re: Trimipramine » Chloe, posted by Ritch on June 6, 2002, at 13:25:34
> > Thank you Mitch
> > I have to go into the archive and look that up. I remember skimming some of the posts.
> >
> > I have no knowledge of this TCA at all. Is it a new one? I also *think* I remember people saying how it *didn't* make them tired. Is it less sedating than Ami? (Less AD props would be nice, though. Ami makes me into a grizzly bear over 20 mgs.) Perhaps I misread. If you don't mind, can you elaborate on trimiprimine? ANd I will do some investigating myself.
> >
> > Thanks again, Mitch
> > Chloe
>
>
> Chloe,
>
> Fachad had two good posts on it that I found:
> http://www.dr-bob.org/babble/20020602/msgs/108686.html
>
> http://www.dr-bob.org/babble/20020525/msgs/108314.html
>
> He also had some medline stuff on it-but I didn't catch that in the thread above.
>
> I had read something about it a few months ago. It was a flowchart for treatment of bipolar disorder and it recommended trimipramine to treat *insomnia* I believe for breakthrough hypomania or mania in addition or instead of a benzo (I think). Somebody else might know which "flowchart" I am thinking of. You can't get generic from what I understand. It is Surmontil. I might do some more browsing about it. I am going to check the monograph on it.
>
> Talk toya later,
>
> MitchMitch,
Thanks for the links. I did some searches on Google too. Not a ton of info on this particular TCA...That I can find (in my messed up state). But hopefully I am starting to come out of this mood.I did send a email to the pdoc about Trimip. I basically outlined what you said. I am not really hopeful that she will go for this change. I wonder if she is familiar with Trimip...
Geez, I hope at least she answers me! That would be decent and helpful.Thanks a million
Chloe
Posted by Ritch on June 6, 2002, at 23:18:29
In reply to Re: Trimipramine » Ritch, posted by Chloe on June 6, 2002, at 22:34:00
> Mitch,
> Thanks for the links. I did some searches on Google too. Not a ton of info on this particular TCA...That I can find (in my messed up state). But hopefully I am starting to come out of this mood.
>
> I did send a email to the pdoc about Trimip. I basically outlined what you said. I am not really hopeful that she will go for this change. I wonder if she is familiar with Trimip...
> Geez, I hope at least she answers me! That would be decent and helpful.
>
> Thanks a million
> Chloe
Chloe,I went to www.mentalhealth.com and went into their research topics (Medline) through the drug monograph. It seems like it was used (as doxepin was) to treat ulcers back in the '70's and '80's before the modern H2 antagonists were available. What it appears to me after reading a lot of the stuff about it is that it may not be as potent an antidepresant as other TCA's are, but doesn't hose up sleep architecture like other TCA's can and still has some antidepressant effect and helps sleep. One study I checked into showed that it tends to reduce cortisol similar to AP's, without other major changes in other hormone levels (that caught my attention). So, perhaps you might not get as irritable as on amitrip.? However, you are partly using the amitrip. for neuropathic pain, and I didn't see any studies on neuropathic pain. Oh, well.
Mitch
Posted by Chloe on June 7, 2002, at 21:07:07
In reply to Re: All these meds and feel AWFUL AWFUL » Chloe, posted by JonW on June 5, 2002, at 19:40:41
> Hi Chloe,
>
> If your doc isn't working on your behalf, definitely get a new one! Here's a link to a recent post by Dr. Goldberg that I find encouraging:
>
> http://www.dr-bob.org/babble/20020525/msgs/108025.html
>
> Hang in there,
> JonThanks for this link, Jon
What Dr. Goldberg is inspriring. It is just not always so easy to get a pdoc that is open minded, creative, informed, somewhat available, affordable, in my insurance plan, etc.So for the moment, I am stick with the pdoc I know and this board. This board is invaluable. Thanks Dr. Bob and all the contributors.
Take care, Jon
Chloe
Posted by Chloe on June 7, 2002, at 21:32:07
In reply to Re: Trimipramine » Chloe, posted by Ritch on June 6, 2002, at 23:18:29
> Chloe,
>
> I went to www.mentalhealth.com and went into their research topics (Medline) through the drug monograph. It seems like it was used (as doxepin was) to treat ulcers back in the '70's and '80's before the modern H2 antagonists were available. What it appears to me after reading a lot of the stuff about it is that it may not be as potent an antidepresant as other TCA's are, but doesn't hose up sleep architecture like other TCA's can and still has some antidepressant effect and helps sleep. One study I checked into showed that it tends to reduce cortisol similar to AP's, without other major changes in other hormone levels (that caught my attention). So, perhaps you might not get as irritable as on amitrip.? However, you are partly using the amitrip. for neuropathic pain, and I didn't see any studies on neuropathic pain. Oh, well.
>
> MitchMitch,
I like the part about it being a dopamine antagonist without it being a true AP. My pdoc emailed me tonight, and thought trimipramine was a great idea especially because of this property. She called in the script, ASAP. I was shocked she moved that fast on a friday night, hum...
BTW, Trimipramine, for me, is NOT generic. It cost $21 for sixty caps! I was shocked. My ami is $7 no matter the quantity. Strange that a TCA is not generic. I thought all these meds were from the stone age, and long lost their patents. The pharmacist couldn't tell me why it was so pricy either. Hope it works!I was looking through SLS's extensive list of meds and their properties and I can outline the difference between ami and trimipi, if you are interested...
TRIMIPRAMINE:
dibenzazepine
tertiary TCA
DA2 antagonist
Ca2+channel inhibition
ACh(m) antagonist---not sure what this one is??
NE-Alpha1 antagonist
H1 antagonistAMITRIPTYLINE:
dibenzocycloheptadiene
tertiary TCA
NE reuptake inhibition***
5-HTP reuptake inhibition
5 HT2 antagonist
ACh antagonist
NE-alpha1 antagonist
H1 antagonist***I wonder if it's the NE reuptake inhibition that makes me get so grouchy and short fused?
Anyway, that is the difference between the two according to SLS (thanks, SLS!). Do you have any thoughts on this, Mitch?
Oh, lastly, I did read on the medline drug list, that an unlabeled use of trimip is *neurogenic* pain. So I am hoping I will continue to have some relief in that area. Phew, my agitated depression has swung into frenzied energy and giddiness. It's so hard to sit and focus! Can you tell?
Catch ya later, oh and how are you??
Chloe
Posted by Ritch on June 8, 2002, at 9:57:21
In reply to Re: Trimipramine (SLS info) » Ritch, posted by Chloe on June 7, 2002, at 21:32:07
> > Chloe,
> >
> > I went to www.mentalhealth.com and went into their research topics (Medline) through the drug monograph. It seems like it was used (as doxepin was) to treat ulcers back in the '70's and '80's before the modern H2 antagonists were available. What it appears to me after reading a lot of the stuff about it is that it may not be as potent an antidepresant as other TCA's are, but doesn't hose up sleep architecture like other TCA's can and still has some antidepressant effect and helps sleep. One study I checked into showed that it tends to reduce cortisol similar to AP's, without other major changes in other hormone levels (that caught my attention). So, perhaps you might not get as irritable as on amitrip.? However, you are partly using the amitrip. for neuropathic pain, and I didn't see any studies on neuropathic pain. Oh, well.
> >
> > Mitch
>
> Mitch,
> I like the part about it being a dopamine antagonist without it being a true AP. My pdoc emailed me tonight, and thought trimipramine was a great idea especially because of this property. She called in the script, ASAP. I was shocked she moved that fast on a friday night, hum...
> BTW, Trimipramine, for me, is NOT generic. It cost $21 for sixty caps! I was shocked. My ami is $7 no matter the quantity. Strange that a TCA is not generic. I thought all these meds were from the stone age, and long lost their patents. The pharmacist couldn't tell me why it was so pricy either. Hope it works!
>
> I was looking through SLS's extensive list of meds and their properties and I can outline the difference between ami and trimipi, if you are interested...
>
> TRIMIPRAMINE:
> dibenzazepine
> tertiary TCA
> DA2 antagonist
> Ca2+channel inhibition
> ACh(m) antagonist---not sure what this one is??
> NE-Alpha1 antagonist
> H1 antagonist
>
> AMITRIPTYLINE:
> dibenzocycloheptadiene
> tertiary TCA
> NE reuptake inhibition***
> 5-HTP reuptake inhibition
> 5 HT2 antagonist
> ACh antagonist
> NE-alpha1 antagonist
> H1 antagonist
>
> ***I wonder if it's the NE reuptake inhibition that makes me get so grouchy and short fused?
>
> Anyway, that is the difference between the two according to SLS (thanks, SLS!). Do you have any thoughts on this, Mitch?
>
> Oh, lastly, I did read on the medline drug list, that an unlabeled use of trimip is *neurogenic* pain. So I am hoping I will continue to have some relief in that area. Phew, my agitated depression has swung into frenzied energy and giddiness. It's so hard to sit and focus! Can you tell?
>
> Catch ya later, oh and how are you??
> Chloe
Hi,I am doing Ok thus far. The imipramine must be starting to work on my ADHD symptoms a little (this makes day 10). I am listening to some music and starting to pick out lyrics!
That is interesting that your pdoc raced about and got a script for you! Oh the ACh antagonism is *anticholinergic* activity-acetylcholine receptors. What interests me especially is the Ca2+ channel inhibition. I seem to benefit from anything that has that property for some reason. Depakote and Neurontin possess it. I hadn't heard about it(trimipramine) having that particular property. I wonder where he got that? Hmmm. Twenty-one bucks still ain't that bad, however. Sixty caps-I am guessing the 25mg dose?
tell us what happens with it?
This feels like English class in high school-compare and contrast.Mitch
Posted by Chloe on June 8, 2002, at 17:38:06
In reply to Re: Trimipramine (SLS info) » Chloe, posted by Ritch on June 8, 2002, at 9:57:21
Mitch, Jon,
I am a bit whalloped by the Trimip. It feels so much like an AP. I kinda have a fuzzy head this morning. Which I don't mind, and know will go away. A strange thing did happen though. I slept from about midnight til 5 am very soundly, then I could NOT fall back to sleep. I felt refreshed, like I should start the day. Yeah, right. I wasn't getting up at that ungodly hour. So about 7 am, I fell back to sleep with tons of dreams. All kind of things I wanted to write down. They were so vivid. I would wake, say to myself, I got to remember that, then turn over and fall back to dreamland. Then my faithful dog woke me at 10:20 am to go out, and I just did not want to move. I wanted to keep dreaming and dreaming...
But I did get up. But what a clumsy mess I was. I didn't feel very hungry, but kept seeing those little spots in front of my eyes, so I decided to eat, and that helped.
This med, from what I read from the abstracts in the cortisol thread, is just the polar opposite of amitrip. Instead of decreasing REM, trimip. increases REM. And I sure had my fill this morning! Another notable thing about this med, is my inability to regulate my body temp. I was freezing in the night, though it was rather cold. But then in the morning I got so hot. When I went outside, I got this petina of sweat with little exertion. I hope this settles down. I really hate excess sweating side effect. Blick. Do you know what causes that one, Mitch? I thought it was Seratonin...
I did take 5 mgs more of trimip. than I usually do of ami; that I was taking 20 mgs hs. But trimip's smallest dose is a 25 mgs capsule. So that could attribute to some of my feeling out of sorts and snowed. Or it's the "AP" effect...oh is there any TD potential with trimip? Forgot to ask the pdoc.
Hum, I feel photosensitive too. Gee, anything else? I am not complaining, just reporting. It sure is different than amitrip. Do you think the excess dreaming will stop? That is somewhat disruptive. Perhaps I was in some kind of amitrip withdrawal? Since I just substituted one for the other?
I am glad I started it on a weekend. I am med sensitive. But I would not have wanted to drive or do anything essential. I ended up painting some lattice. That seemed safe enough.
So, I hope this helps...I will see how tonight goes. I hope I have ZZZZZZ all the way through the night this time.Chloe
Posted by Chloe on June 8, 2002, at 17:48:22
In reply to Re: Trimipramine=dreams!-Ritch,Jon, posted by Chloe on June 8, 2002, at 17:38:06
I also didn't need as much benzo this am. I halved the usually dose, and that worked well.
L8R
Chloe
Posted by fachad on June 9, 2002, at 1:37:51
In reply to Re: Trimipramine (SLS info) » Ritch, posted by Chloe on June 7, 2002, at 21:32:07
Chloe,
Here is the link which has the references I posted for Trimip a bit ago:
http://www.dr-bob.org/babble/20020525/msgs/107821.html
Regarding the price, yes trimp is not generic; it is only available as Surmontil brand.
Regarding being whacked from the smallest pill, I'm the same way. For now, I open the capsule into a tall glass of water then stir til it’s completely dissolved, then drink 1/2 or 1/3 of the glass, for an approx dose of 12.5 or 8 mg.
Next visit to my pdoc I'm going to get a RX for custom 2.5 mg capsules. They can be made at a compounding pharmacy. The one I called quoted me about $35 for 100 2.5 mg tablets. After I figure out the right dose (2.5, 5, 7.5, or 10mg) I'll get the tablets in that strength.
> > Chloe,
> >
> > I went to www.mentalhealth.com and went into their research topics (Medline) through the drug monograph. It seems like it was used (as doxepin was) to treat ulcers back in the '70's and '80's before the modern H2 antagonists were available. What it appears to me after reading a lot of the stuff about it is that it may not be as potent an antidepresant as other TCA's are, but doesn't hose up sleep architecture like other TCA's can and still has some antidepressant effect and helps sleep. One study I checked into showed that it tends to reduce cortisol similar to AP's, without other major changes in other hormone levels (that caught my attention). So, perhaps you might not get as irritable as on amitrip.? However, you are partly using the amitrip. for neuropathic pain, and I didn't see any studies on neuropathic pain. Oh, well.
> >
> > Mitch
>
> Mitch,
> I like the part about it being a dopamine antagonist without it being a true AP. My pdoc emailed me tonight, and thought trimipramine was a great idea especially because of this property. She called in the script, ASAP. I was shocked she moved that fast on a friday night, hum...
> BTW, Trimipramine, for me, is NOT generic. It cost $21 for sixty caps! I was shocked. My ami is $7 no matter the quantity. Strange that a TCA is not generic. I thought all these meds were from the stone age, and long lost their patents. The pharmacist couldn't tell me why it was so pricy either. Hope it works!
>
> I was looking through SLS's extensive list of meds and their properties and I can outline the difference between ami and trimipi, if you are interested...
>
> TRIMIPRAMINE:
> dibenzazepine
> tertiary TCA
> DA2 antagonist
> Ca2+channel inhibition
> ACh(m) antagonist---not sure what this one is??
> NE-Alpha1 antagonist
> H1 antagonist
>
> AMITRIPTYLINE:
> dibenzocycloheptadiene
> tertiary TCA
> NE reuptake inhibition***
> 5-HTP reuptake inhibition
> 5 HT2 antagonist
> ACh antagonist
> NE-alpha1 antagonist
> H1 antagonist
>
> ***I wonder if it's the NE reuptake inhibition that makes me get so grouchy and short fused?
>
> Anyway, that is the difference between the two according to SLS (thanks, SLS!). Do you have any thoughts on this, Mitch?
>
> Oh, lastly, I did read on the medline drug list, that an unlabeled use of trimip is *neurogenic* pain. So I am hoping I will continue to have some relief in that area. Phew, my agitated depression has swung into frenzied energy and giddiness. It's so hard to sit and focus! Can you tell?
>
> Catch ya later, oh and how are you??
> Chloe
Posted by Ritch on June 9, 2002, at 6:13:38
In reply to Re: Trimipramine=dreams!-Ritch,Jon, posted by Chloe on June 8, 2002, at 17:38:06
> Mitch, Jon,
>
> I am a bit whalloped by the Trimip. It feels so much like an AP. I kinda have a fuzzy head this morning. Which I don't mind, and know will go away. A strange thing did happen though. I slept from about midnight til 5 am very soundly, then I could NOT fall back to sleep. I felt refreshed, like I should start the day. Yeah, right. I wasn't getting up at that ungodly hour. So about 7 am, I fell back to sleep with tons of dreams. All kind of things I wanted to write down. They were so vivid. I would wake, say to myself, I got to remember that, then turn over and fall back to dreamland. Then my faithful dog woke me at 10:20 am to go out, and I just did not want to move. I wanted to keep dreaming and dreaming...
>
> But I did get up. But what a clumsy mess I was. I didn't feel very hungry, but kept seeing those little spots in front of my eyes, so I decided to eat, and that helped.
>
> This med, from what I read from the abstracts in the cortisol thread, is just the polar opposite of amitrip. Instead of decreasing REM, trimip. increases REM. And I sure had my fill this morning! Another notable thing about this med, is my inability to regulate my body temp. I was freezing in the night, though it was rather cold. But then in the morning I got so hot. When I went outside, I got this petina of sweat with little exertion. I hope this settles down. I really hate excess sweating side effect. Blick. Do you know what causes that one, Mitch? I thought it was Seratonin...
>
> I did take 5 mgs more of trimip. than I usually do of ami; that I was taking 20 mgs hs. But trimip's smallest dose is a 25 mgs capsule. So that could attribute to some of my feeling out of sorts and snowed. Or it's the "AP" effect...oh is there any TD potential with trimip? Forgot to ask the pdoc.
>
> Hum, I feel photosensitive too. Gee, anything else? I am not complaining, just reporting. It sure is different than amitrip. Do you think the excess dreaming will stop? That is somewhat disruptive. Perhaps I was in some kind of amitrip withdrawal? Since I just substituted one for the other?
>
> I am glad I started it on a weekend. I am med sensitive. But I would not have wanted to drive or do anything essential. I ended up painting some lattice. That seemed safe enough.
> So, I hope this helps...I will see how tonight goes. I hope I have ZZZZZZ all the way through the night this time.
>
> Chloe
Hi,I like having a lot of dreams, too. Yes, some of what you are experiencing may be a little rebound effect from stopping the amitrip. In fact, I remember reading something about that. Increased REM sleep, and also an anticholinergic rebound-which might explain some of the sweating. I don't think trimip. has as strong an anticholinergic effect as ami. It might take a few days for it to even out. So, it appears to be *more* sedative than amitrip? Just curious how the "brain fog* is during the middle of the day. The TD risk? Well, one thing that is good is that the mfg. doesn't have the usual CYA statement about TD included in the monograph. Although it does list EPS as a potential side effect-however the SE list is inclusive of all TCA's. Given your sensitivity to meds, it probably won't be long if you notice any EPS stuff. I had an early morning awakening myself, and couldn't go back to sleep, but I feel OK. I think it was the pinch of Celexa I took yesterday morning, it always shortens my sleep duration. Anyhow, let us know how things go with the Trimip.?
Mitch
Posted by Chloe on June 9, 2002, at 16:46:26
In reply to Re: Trimipramine- references, cost, low dose, etc. » Chloe, posted by fachad on June 9, 2002, at 1:37:51
That link is useful, I really like hearing personal experiences. Thanks for reposting it. I also printed out the abstracts. But I am finding Surmontil is not putting me to sleep at all. I was awake all last night, listening to my heart pound away. I was very disappointed, because all I have read is so positive. I guess I will keep at it, an hope that it helps. 25 mgs did not seem at all too much last night. But thanks for the tip on lessening the dose. That might come in handy down the road. And, wow, I was shocked at the price. I thought all these old TCA's were generic. Oh well!
Chloe
Posted by Chloe on June 9, 2002, at 17:21:28
In reply to Re: Trimipramine=dreams!-Ritch,Jon » Chloe, posted by Ritch on June 9, 2002, at 6:13:38
Well Mitch,
I am sorry you are having sleep troubles too. I really dislike all this daylight in the summer...It's so hard to sleep past 4:30 am for me.Anyway, I had a horrible night with the Surmontil. I took it around ten pm, because I did not want to be "hung over" for a brunch with a friend this am. Well, I never got tired last night. It was well past midnight when I got into bed, and I just lied there, unable to sleep. And then it seemed all I had to do was pee every half an hour. I must have gotten out of bed 20 times last night. I was also never the right tempature. Either cold, so I would bundle up, then I would start to sweat! Then I would feel chilled, etc. I NEVER really crashed or even had any dreams. So finally at 5 am I was so frustrated, I took 2.5 diazapam and slept lightly until 9am.
It was so uncomfortable being awake, and everytime I felt a little relaxed and might be able to sleep, I would have to get up to pee. Where did all the water come from??? My heart also was pounding away. I kinda felt like I was jogging in the dark or something. My stomach has been really off too. I feel hungry, but don't want to eat, then I get awful epigastic pain. That lasted for about 5 hours yesterday. Ouch that hurts, and nothing seemed to help it.
My tongue is also raw at the tip, like I have been rubbing it hard against my teeth (TD). I didn't think much of it yesterday, because I was painting for hours. When I do repetitive things my tongue can really can get going. But it has not stopped since yesterday noon. I know anxiety can drive the whole tongue thing as well. So I am going to try and not freak out. But I am not sure this was the greatest experiment...You asked my in a former post why my pdoc jumped on getting me a script so fast. Well, I think it might be because I had a lot of success with Clozaril, but got agranulocytosis so abruptly had to come off. And things haven't really been so great since...and that was about 10 years ago.
Gee, I guess I did not think this switch would be such a big deal. I thought it was just from one sedating TCA to another that had a bit of a DA kick. Well, it seems that Surmontil or trimipramine is a totally different animal than ami or doxepin or nortrip. I feel totally awful. Heachache, upset stomach, tired, but of course I haven't slept, jittery, heart poundy, and just basically crappy. I really miss the "calm" of ami. I would love to abort this mission right now. But I *guess* I have not given this med a fair trial. But I thought it was good for sleep and anxiety, too. But so far, I am not getting that. I think I slept soundly the first half of the first night, because I still had residual ami on board.
I DO feel LESS ready to pick a fight or lose my temper, however. Probably the lack of NE reuptake. Doxepin has the NE reuptake, too, doesn't it? Hum
Anyway, sorry for the long reply. I just feel miserable and had to share it with you. Lucky you!
Thanks for listening, my friend :)
Chloe
Posted by Ritch on June 9, 2002, at 23:10:25
In reply to Re: Trimipramine= no sleep! » Ritch, posted by Chloe on June 9, 2002, at 17:21:28
> I DO feel LESS ready to pick a fight or lose my temper, however. Probably the lack of NE reuptake. Doxepin has the NE reuptake, too, doesn't it? Hum
>
> Anyway, sorry for the long reply. I just feel miserable and had to share it with you. Lucky you!
> Thanks for listening, my friend :)
> ChloeOh, that's Ok, that's interesting. It seems that Trimipramine isn't near as sedative as amitrip. then huh? I suppose you could flip right back to the amitrip. and tell your pdoc tomorrow. Amitrip. definitely kicked ass as far as sedation. I remember stopping it a long time ago because people I worked with complained I was getting boring and blah to be around! I had also quit doxepin before that. I wanted to reduce the dose to help get rid of the zombification and as I reduced the dose I become less tolerant of the sedation and wound up just as zombified as I was on the higher dose! I am trying an experiment tonite to try to sleep straight through and not have an early morning awakening (I have had several in a row the last few nites). I have noticed that I am getting fatigued and tired earlier in the evening. So..I am drinking a couple of cups of coffee to force myself to stay awake until much later. Then take my meds and crash. Sort of a forced sleep shift of sorts. I will let you know if it seemed to help.
Mitch
Posted by Chloe on June 10, 2002, at 20:31:48
In reply to Re: Trimipramine= no sleep! » Chloe, posted by Ritch on June 9, 2002, at 23:10:25
Did keeping yourself up let you sleep in? Never works for me. I try to never go to bed before 11pm, if I have no ami, I am always awake before sunrise. Sleep is work without ami. But, I was getting a bit tolerant to ami sedative effects at 20 mgs, but I was scared to increase, because of the negative mood affect it can have. I get a really short unpredictable fuse...That's why I thought trimiprimine would be good. No substancial NE reuptake, and some DA.
Well, I think I have some EPS. When I awoke this am, my teeth were loose from clenching. And my tongue really hasn't stopped going since I started trimip. So, with the EPS, total inability to sleep, severe restlessness, and anxiety, I aborted mission last night. I took just 10 mgs of ami and it was a God send. I slept! It was like getting an old friend back.
But I am wondering how much off my bad experience with trimip was ami withdrawal? I probably should have tapered, but I just assumed, and wasn't instructed otherwise, I could substitute one TCA for the other. Maybe all the sweating and foggy head on that first day was just withdrawal? But from all I have read, Trimip is supposed to be very sedating, in the same class of doxepin and ami. But 25 mg of trimip wasn't enough to cover the lack of 20 mg of ami, clearly.
Could you relate in your experience the difference betweeen Doxepin and Ami. Do you think dox. would be less likely to cause anger outburst at low doses? Is it less or more sedating? How about dry mouth, constipation, wt gain, etc. Would you mind comparing the two for me? If you have done this before, could you send me to the sight? I am just wondering if dox may have less AD punch at low doses like 25 mgs than ami, but same sedative or hypnotic, anxiety effect.
Mucho thanks,
And I really hope you conquered your early am awakening.
Chloe
Posted by Ritch on June 10, 2002, at 23:43:05
In reply to Re: Trimipramine= no sleep! » Ritch, posted by Chloe on June 10, 2002, at 20:31:48
> Did keeping yourself up let you sleep in? Never works for me. I try to never go to bed before 11pm, if I have no ami, I am always awake before sunrise. Sleep is work without ami. But, I was getting a bit tolerant to ami sedative effects at 20 mgs, but I was scared to increase, because of the negative mood affect it can have. I get a really short unpredictable fuse...That's why I thought trimiprimine would be good. No substancial NE reuptake, and some DA.
>
> Well, I think I have some EPS. When I awoke this am, my teeth were loose from clenching. And my tongue really hasn't stopped going since I started trimip. So, with the EPS, total inability to sleep, severe restlessness, and anxiety, I aborted mission last night. I took just 10 mgs of ami and it was a God send. I slept! It was like getting an old friend back.
>
> But I am wondering how much off my bad experience with trimip was ami withdrawal? I probably should have tapered, but I just assumed, and wasn't instructed otherwise, I could substitute one TCA for the other. Maybe all the sweating and foggy head on that first day was just withdrawal? But from all I have read, Trimip is supposed to be very sedating, in the same class of doxepin and ami. But 25 mg of trimip wasn't enough to cover the lack of 20 mg of ami, clearly.
>
> Could you relate in your experience the difference betweeen Doxepin and Ami. Do you think dox. would be less likely to cause anger outburst at low doses? Is it less or more sedating? How about dry mouth, constipation, wt gain, etc. Would you mind comparing the two for me? If you have done this before, could you send me to the sight? I am just wondering if dox may have less AD punch at low doses like 25 mgs than ami, but same sedative or hypnotic, anxiety effect.
>
> Mucho thanks,
> And I really hope you conquered your early am awakening.
> ChloeYep, it worked! There is something that I have been noticing about my seasonal depressions.. I start getting sleepier earlier in the evening and that tends to get a tiny bit earlier every night (it is like an automotive ignition timing becoming "retarded"). Until it reaches the point where my sleep gets "broken" in the early morning (usually around 4-5am. I wake up and I have a hell of a time trying to get back to sleep. Then usually around 8am (three-four hrs later), I get very very tired and fall off and wind up sleeping till noon if I don't have other stuff to do. I wasn't staying up so I could "sleep in", I stayed up late so my sleep wouldn't be "broken up", so I *wouldn't* sleep in. When I have hypomania in the spring and fall, it reverses (the "timing" starts to advance) I notice having a little trouble getting to sleep, and just springing out of bed in the mornings after five or six hours sleep fully refreshed. So, anyhow I think a mild stimulant a few hours before bedtime sets up a blood sugar *crash* right at the time I want it (just a theory).
Well, if you had any EPS from the trimip., you might as well write it off! Doxepin and amitriptyline, hmmm. Doxepin is more sedating, definitely. Less robust antidepressant effect, however. Honestly, I don't think you would benefit much from switching from amitrip. to doxepin. If your pdoc likes the idea of you taking doxepin instead-go for it and see, you never know YMWV. So, I guess you could say that it (doxepin) would have less AD punch, and would be a stronger hypnotic. I just can't stand super sedative meds, though, yuck.
Mitch
Posted by fachad on June 11, 2002, at 16:42:16
In reply to Re: Trimipramine= no sleep! » Ritch, posted by Chloe on June 10, 2002, at 20:31:48
I've taken all three, and also have researched the pharmacological differences between these three. Each one has unique properties.
The three parameters that accout for the way the drugs effect you are:
Histamine blockade (sedation, increased appetite)
Cholenergic blockade (dry mouth, consitpation, etc.)
Re-uptake of NE and 5HT.
Ami is the most potent at cholenergic blockade. At the same doses, it causes much more dry mouth and constipation than Dox or Trimip. Also, there is a withdrawl symptom from "cholenergic rebound" that could explain why you felt bad subing trimip for ami.
Doxepin is the most potent at Histamine blockade. At the same doses it is the most potent sedative. Trimip is very close to doxepin, slighty less H1 blockade than dox, but much more than ami.
Trimp is nearly as potent as dox at H1 blockade, and should be much more sedating than ami. It is slightly more potent than dox at cholenergic blockade. The other unique things about trimp are lack of re-uptake of NE and 5HT, and very slight DA blockade
Here are the numbers for the three on H1 and Ach blockade from one study I read:
Drug------H1------Ach
Ami-------91------5.1
Dox------410------1.3
Trim-----370------1.7
So for me dox and trimp seem much stronger, but much cleaner for sleep. I would not underestimate the severity of the cholenergic rebound if switching from ami to one of the other two.> Did keeping yourself up let you sleep in? Never works for me. I try to never go to bed before 11pm, if I have no ami, I am always awake before sunrise. Sleep is work without ami. But, I was getting a bit tolerant to ami sedative effects at 20 mgs, but I was scared to increase, because of the negative mood affect it can have. I get a really short unpredictable fuse...That's why I thought trimiprimine would be good. No substancial NE reuptake, and some DA.
>
> Well, I think I have some EPS. When I awoke this am, my teeth were loose from clenching. And my tongue really hasn't stopped going since I started trimip. So, with the EPS, total inability to sleep, severe restlessness, and anxiety, I aborted mission last night. I took just 10 mgs of ami and it was a God send. I slept! It was like getting an old friend back.
>
> But I am wondering how much off my bad experience with trimip was ami withdrawal? I probably should have tapered, but I just assumed, and wasn't instructed otherwise, I could substitute one TCA for the other. Maybe all the sweating and foggy head on that first day was just withdrawal? But from all I have read, Trimip is supposed to be very sedating, in the same class of doxepin and ami. But 25 mg of trimip wasn't enough to cover the lack of 20 mg of ami, clearly.
>
> Could you relate in your experience the difference betweeen Doxepin and Ami. Do you think dox. would be less likely to cause anger outburst at low doses? Is it less or more sedating? How about dry mouth, constipation, wt gain, etc. Would you mind comparing the two for me? If you have done this before, could you send me to the sight? I am just wondering if dox may have less AD punch at low doses like 25 mgs than ami, but same sedative or hypnotic, anxiety effect.
>
> Mucho thanks,
> And I really hope you conquered your early am awakening.
> Chloe
Posted by Chloe on June 11, 2002, at 18:13:24
In reply to Re: Trimipramine= no sleep! (Ami vs. Dox vs. Trim) » Chloe, posted by fachad on June 11, 2002, at 16:42:16
> I've taken all three, and also have researched the pharmacological differences between these three. Each one has unique properties.
>
> The three parameters that accout for the way the drugs effect you are:
>
> Histamine blockade (sedation, increased appetite)
>
> Cholenergic blockade (dry mouth, consitpation, etc.)
>
> Re-uptake of NE and 5HT.
>
> Ami is the most potent at cholenergic blockade. At the same doses, it causes much more dry mouth and constipation than Dox or Trimip. Also, there is a withdrawl symptom from "cholenergic rebound" that could explain why you felt bad subing trimip for ami.
>
> Doxepin is the most potent at Histamine blockade. At the same doses it is the most potent sedative. Trimip is very close to doxepin, slighty less H1 blockade than dox, but much more than ami.
>
> Trimp is nearly as potent as dox at H1 blockade, and should be much more sedating than ami. It is slightly more potent than dox at cholenergic blockade. The other unique things about trimp are lack of re-uptake of NE and 5HT, and very slight DA blockade
>
> Here are the numbers for the three on H1 and Ach blockade from one study I read:
>
> Drug------H1------Ach
>
> Ami-------91------5.1
> Dox------410------1.3
> Trim-----370------1.7
>
>
> So for me dox and trimp seem much stronger, but much cleaner for sleep. I would not underestimate the severity of the cholenergic rebound if switching from ami to one of the other two.
>Fachad,
that information is so helpful. But I am not sure why trimip's sedative effect did not allow me to sleep some...I had to resort to benzo's to sleep. But I do think I had the cholinergic rebound. I was sweating and peeing, etc like crazy. It was very uncomfortable. Really a withdrawal syndrome. I guess, or maybe I am just oversensitive???, that I should have stayed on the ami and added the trimip? Then gradually decrease the ami?However, Trimip is out for me. I have bad eps in my mouth, clenching, tongue wagging, it exacerbated some old td symptoms. :(
But I am really curious about doxepin. If it wouldn't be so drying. I have sores in my mouth that just won't go away. My mouth gets so dry when I sleep (so soundly!) that my gums, lips never heal up. But maybe the H1 in doxepin would also cause drying? You said the H1 causes weight gain. Did you experience this? And if you know, how strong is the NE reuptake compared to ami? I think that is the component in ami that makes me incredibly grouchy and short fused. I get nasty really fast, no warning. It's awful. That's why I had high hopes for trimip. And for those two day+ on trimip, my mood was exceptionally even with an long fuse.
Hope you don't mind all the questions. I just want to have as much info as possible before I ask my pdoc about doxepin. I only have such a short time to talk to her, I have to be totally prepared.
Thanks again, your researched info is so appreciated. Have you found the "right" dose of trimip for you yet? I know 25 is too much still, right?
Chloe
Posted by fachad on June 12, 2002, at 0:58:28
In reply to Re: Trimipramine= no sleep! (Ami vs. Dox vs. Trim) » fachad, posted by Chloe on June 11, 2002, at 18:13:24
Chloe: I am not sure why trimip's sedative effect did not allow me to sleep some...I do think I had the cholinergic rebound. I was sweating and peeing, etc like crazy.
fachad: I really think it was the cholinergic rebound. Ami is far more potent at Ach blockade than trimip.
REM sleep suppression, urinary retention, and temperature regulation are all caused by cholinergic blockade. If you have been taking ami for awhile, your body has equilibrated to that, and if you take something the does not suppress Ach as much, those are the symptoms you would expect.
Chloe: However, Trimip is out for me. I have bad eps in my mouth, clenching, tongue wagging, it exacerbated some old td symptoms. :(
fachad: I don't know if you know this or not, but cholinergic blockade actually reduces TD symptoms.
I don't know the exact mechanism, but anti-cholinergics are used to alleviate TD and EPS symptoms. If your recurrence of EPS was due to the sudden absence of anti-cholinergic effects, you would do worse on doxepin than trimp, even though doxepin has no effect on DA.
In fact, if the EPS was being suppressed by ami, you would have worse EPS on nothing at all than on trimip. A question for your pdoc.
Chloe: But I am really curious about doxepin. If it wouldn't be so drying. I have sores in my mouth that just won't go away. My mouth gets so dry when I sleep (so soundly!) that my gums, lips never heal up.
fachad: It is the anti-cholinergic effect that causes that awful drying. H1 blockade does not cause drying at all. Remeron (mirtazapine) is far more potent at H1 blockade than even doxepin, almost 10 times more than ami, without any anti-cholinergic effects, and it is not drying at all.
So it's safe to say that you would be less dried out on dox than you are on ami, but I'd bet you'd have constant peeing, and maybe EPS too if you didn’t taper slowly off ami or substitute another Ach blocker (which would dry you out).
Chloe: You said the H1 causes weight gain. Did you experience this?
fachad: Well, that's really a difficult question, one that research has not been able to answer with certainty. Some meds (esp. non-psych antihistamines) block H1 very potently without causing weight gain. Many psych meds cause weight gain without blocking H1 (MAOIs, lithium, many others). But there does seem to be some general correlation between weight gain and H1 blockade.
My personal experience is that ami and dox caused some mild weight gain, while trimip does not. Literature reports show weight gain from all three. Avoiding weight gain is my main reason for trying to find the lowest effective dose.
Chloe: how strong is the NE reuptake compared to ami? I think that is the component in ami that makes me incredibly grouchy and short fused
fachad: I've seen other people become short fused on ami. I don't know if anyone has tried to tie it to NE reuptake or anything else.
As far as the NE potency, here are a few numbers:
Drug-------NE reuptake
ami----------4-------
nortrip-----25-------
imimp--------8-------
desip------110-------
trimp------0.2-------
dox----------5-------Note that when you take ami, it is metabolized into nortrip, so you get NE uptake from both drugs, same for imipramine and desipramine. So even though dox is more potent, than ami, it is far less potent than nortrip.
Chloe: Hope you don't mind all the questions. I just want to have as much info as possible before I ask my pdoc about doxepin.
fachad: I don't mind at all - I like to be able to share some of this stuff I've picked up. Another cool thing about doxepin, it comes in a liquid form. I just like that idea both on general principal, and because it allows for very minute dosage adjustments. Doxepin is also a dirt cheap generic.
Chloe: I only have such a short time to talk to her, I have to be totally prepared.
fachad: I hear you there. I have never achieved my "holy grail" of getting the entire 15 minutes of an already too short 15 minute med check appt. with my pdoc. The evils of managed care.
Chloe: Have you found the "right" dose of trimip for you yet? I know 25 is too much still, right?
fachad: I know I would love the sleep from 25mg, but I'm afraid I'd have more side effects. When I get the RX for the 2.5 mg capsules, I'll be able to know exactly how little I can take and still get good sleep. For now, I'm just taking less than 25mg, but I can't accurately tell you how much it is.
Hope doxepin works for you.
Posted by johnj on June 12, 2002, at 9:04:58
In reply to Trimip= cholenergic rebound, EPS, etc (long expl.) » Chloe, posted by fachad on June 12, 2002, at 0:58:28
Fachad:
That is great info you posted. I was hoping you could post the same type of info (ACh, H1) for nortry as compared to the others?
I might have told you, but here is my problem: I get severe rebound of side effects and mood disturbance when I excercise. It takes days to recover and usually it doesn't hit until a day or so after working out. I get dizzy, sleep disturbance and then mood decline.
I have heard from two other people one on amit.(nortry mother drug) and one on notryp that had the same or similar problem. One person told me they didn't get this effect on imipramine, but I had some terrible jitterness and night sweats when I added just a few 10 mgs of impramine to my norty. Is that an Ach effect?
Maybe it is the NE reuptake? As you said amit metabolizes to despramine so the combo has high NE reuptake. I am seriously looking at adding some trimp since I have had trouble sleeping, but I added some omega 3's last week and had to up my benzo a bit and have slept better. I thought the omega 3's were just crap, but I may have to re-evaluate that. Anyway, I would like to switch(with my docs help) and see if things stabilize and then try working out again. It is a mystery why excercise hoses things up, and the doc doesn't quite believe me. This has been going on for years so I know it is not in my head. I may find it is just TCA's that do it or I may find it is just nortry for some odd reason. Well, thanks for reading my rambling. Take care and keep us posted on your trimp dosing. Thank you
Johnj
Posted by Chloe on June 12, 2002, at 9:42:41
In reply to Trimip= cholenergic rebound, EPS, etc (long expl.) » Chloe, posted by fachad on June 12, 2002, at 0:58:28
>> fachad: I've seen other people become short fused on ami. I don't know if anyone has tried to tie it to NE reuptake or anything else.
Fachad,
This info is so invaluable. It is so wonderful to correspond with you. You have helped so much. Google, medline, etc search hasn't been as helpful as you have been to me. I am so appreciative!That is interesting you have heard of others getting short fused on Ami. Do you think this is simply related to Ami? Have you heard of Doxepin causing grouchiness too??? I wonder if all the ACh properties have something to do with this the grouchiness. Can you speculate?
>> As far as the NE potency, here are a few numbers:
>
> Drug-------NE reuptake
>
> ami----------4-------
> nortrip-----25-------
> imimp--------8-------
> desip------110-------
> trimp------0.2-------
> dox----------5-------
>Your charts are so helpful! I love the science part of meds.
Well, if it is the NE reuptake, Doxepin has slightly more! So I guess it wouldn't make a difference...But I am just really wanting to find out if I could be more civil on another TCA.BTW, Trimipramine really is out, because even though I have been back on the Ami for 3 days, I still have awful EPS. This happens when I take an AP. It takes weeks to stop the EPS that only a pill or two with dopamine can cause :(.
>>fachad: I don't mind at all - I like to be able to share some of this stuff I've picked up. Another cool thing about doxepin, it comes in a liquid form. I just like that idea both on general principal, and because it allows for very minute dosage adjustments. Doxepin is also a dirt cheap generic.Thanks again for sharing your insights and experiences. Look forward to hearing more, if you have the energy!
>> Hope doxepin works for you.
Me too! But I am kinda scared to try...Med changes are always such an adjustment! And a gamble.
Chloe
Posted by fachad on June 12, 2002, at 23:00:15
In reply to Re: Norty compared to trimp (fachad), posted by johnj on June 12, 2002, at 9:04:58
Here is the earlier table with nortrip and benedryl added for comparison:
Drug------H1------Ach
Ami---------91------5.1
Dox--------410------1.3
Trim-------370------1.7
Nortrip-----10------0.7
Benadryl-----7---------
Atropine-------------42I have no idea what the underlying mechanism of the exercize problem could be. The only thing you could do is to try other meds.
> Fachad:
>
> That is great info you posted. I was hoping you could post the same type of info (ACh, H1) for nortry as compared to the others?
>
> I might have told you, but here is my problem: I get severe rebound of side effects and mood disturbance when I excercise. It takes days to recover and usually it doesn't hit until a day or so after working out. I get dizzy, sleep disturbance and then mood decline.
>
> I have heard from two other people one on amit.(nortry mother drug) and one on notryp that had the same or similar problem. One person told me they didn't get this effect on imipramine, but I had some terrible jitterness and night sweats when I added just a few 10 mgs of impramine to my norty. Is that an Ach effect?
>
> Maybe it is the NE reuptake? As you said amit metabolizes to despramine so the combo has high NE reuptake. I am seriously looking at adding some trimp since I have had trouble sleeping, but I added some omega 3's last week and had to up my benzo a bit and have slept better. I thought the omega 3's were just crap, but I may have to re-evaluate that. Anyway, I would like to switch(with my docs help) and see if things stabilize and then try working out again. It is a mystery why excercise hoses things up, and the doc doesn't quite believe me. This has been going on for years so I know it is not in my head. I may find it is just TCA's that do it or I may find it is just nortry for some odd reason. Well, thanks for reading my rambling. Take care and keep us posted on your trimp dosing. Thank you
> Johnj
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