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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by metamorphosis on January 8, 2013, at 13:36:13
Okay. I am at day 12 on Parnate, and the sleep issue is killing me. I'm talking 3 hrs of fitful sleep if I am lucky. I need to find a solution. So, I am on line at 2am last night researching this because, surprise!!! I couldn't sleep.
I want to be careful but not to the point that I think every med. will give me a hypertensive crisis. I have looked through a ton of the P.B. threads and the drugs that keep pooping up are
- Trazadone
- Seroquel
- Amitriptyline
- Doxepin
- cyproheptadine ???
- and over the counter OTC's
- Benadryl
- DoxylamineSo, then I go to cross reference each one on google. And every site I go to says they are all contraindicated.
Now, I know this cannot be true for all of the meds. I mean even otc. anti-histamines. Which would be my last choice. I know they have to give a warning about any little potential interaction but they never mention or give a list of sleep aids that are okay. Could be a liability issue. But it would be nice if one of these sites actually listed Anything to use. Apparently every single site but this one and maybe a few others mention anything. You guys/girls are my go to for MAOI's.
So, I have a few of these meds. on hand because I have always been an insomniac but haven't used any of them yet.
If this keeps up,I'm concerned that I won't be able to stay on Parnate. and now I'm finally starting to feel the antidepressant effects.
So, here are the meds. I have at the house.
-
Amitriptyline- 10mg, was going to use for sleep but never did because people said it made them feel awful. Would 10mg be a good starting point?Trazadone- 100mg, have used throughout the yrs. at 25-100mg. Made me feel hungover the next day but did help me sleep. The sertonergic actions apparently don't kick in until around 200mgs. So, I wouldn't want to take more tahn 100mgs. If that would even help.
Doxepin- 10mg caps, Heard it's excellent for sleep
at 5-10mg. Where it basically acts as an antihistamine. But higher doses act like the normal TCA's that are contraindicated.Doxylamine and Diphenhydramine- Even thses otc,s have warnings on websites.
So my questions are-
From what I have in hand
-Which would you choose?
-At what dose and why?
-What would be the lowest starting dose to try?
-Which do you prefer?
-And when I go see my pdoc. What meds. would you mention?
-Baically you're overall first choice?
Finally, and this sounds like an oxymoron.
-Is there one or more meds. that actually give you any kind of healthy deep sleep on MAOI's?
Thanks for any and all replies!!! :)I really am in a bad situation sleep wise and that is the only side effect that I cannot tolerate for to long. I maen even 5-6 hrs would help immensley. I really want to give Parnate a good trial run!!!
Posted by jono_in_adelaide on January 8, 2013, at 18:49:44
In reply to Parnate and no sleep suffering bad/help!, posted by metamorphosis on January 8, 2013, at 13:36:13
Can you get a prescription for a benzo or a Z drug? Temazepam, Ambien etc.
I think a lot of those claims of contraindication are overly cautions btw
Posted by baseball55 on January 8, 2013, at 18:56:51
In reply to Re: Parnate and no sleep suffering bad/help!, posted by jono_in_adelaide on January 8, 2013, at 18:49:44
I take trazadone with parnate. Yeah, it's contra-indicated, but my p-doc had never seen a problem and just reminded me to look out for the symptoms of serotonin syndrome. No problem for three years. Take 100-200mg. But I find trazadone is better for staying asleep than falling asleep, so I also take a benzo before bed. I've built up tolerance though.
Parnate insomnia can be awful. I should also add that, at the beginning, I was taking 16mg of perphenazine and didn't get the insomnia until I went off that. My p-doc wanted me off because he felt the dangers of EPS were too great when other less dangerous drugs could be used for sleep. But, if nothing else works, a low dose of perphenazine or seroquel might help.
Posted by caller on January 9, 2013, at 16:58:29
In reply to Re: Parnate and no sleep suffering bad/help!, posted by baseball55 on January 8, 2013, at 18:56:51
I feel you man, I know how horrible Parnate induced insomnia can be.. For me it got better with time but Parnate still disturbs my sleep a lot. I use zolpidem and promethazine as well as a low dose melatonin, this gives me a fairly restful sleep every night.
My advice would be to try promethazine or some other more selective antihistamine. For example, hydroxyzine and other antihistamines with stronger 5HT2a antagonism worsen my (atypical) depression significantly, as does higher doses of melatonin. (I'd really want to try some diphenydramine as it's supposed to have a more preferable half-life than promethazine but the fact that it may be serotonergic disturbs me).I also think that with Parnate it's very important to improve your sleep cycle as much as you can, as the drug itself seems to mess it up quite badly.. At night I'm supplementing with melatonin and have amber light in my room (and f.lux if I'm using the computer).
Then first thing in the morning I use a huge bright-light device for 15 - 30 min when eating breakfast (with strong black coffee), take amphetamine and modafinil along with the first dose of Parnate and then try as often as I can to go out and do HIIT training, either running or at the gym (and every now and then I may go for a longer run when the sun is at its highest - all this to dry to surpress melatonin as much as I can in the mornign.. It's only been some days since I've gotten more serious with this but it seems to be helping already. Should also do good for the depression itself :)
Next step will be to go to bed two hours earlier and try to get up at 6 am instead of 8 - 9 am every day, should improve circadian rhythm further I think. (Excuse me if this got lengthy and somewhat incomprehensible, the zolpidem just started to kick in! Need to hit the bunk!
Take care!
Posted by Parnate User1 on January 12, 2013, at 1:23:35
In reply to Parnate and no sleep suffering bad/help!, posted by metamorphosis on January 8, 2013, at 13:36:13
Don't worry, it gets better. You will slowly start to sleep longer. Follow all of the sleep hygiene techniques and get enough sunlight during the day. Hang in there
Posted by Parnate User1 on January 12, 2013, at 1:27:00
In reply to Parnate and no sleep suffering bad/help!, posted by metamorphosis on January 8, 2013, at 13:36:13
Don't worry, it gets better. You will slowly start to sleep longer. Follow all of the sleep hygiene techniques and get enough sunlight during the day. Hang in there
This is the end of the thread.
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