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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by jpa on November 2, 2013, at 14:02:17
I'm currently on remeron and clomipramine for anxiety and sleep, but it's not working for me...not well enough anyhow.
I'm considering adding trimipramine to the mix or as a replacement for remeron. Does trimipramine work on the same receptors as remeron or does it have a different method of action?
The only thing that works is phenibute...unfortunately it's not something a long-term solution, but then again or any of these meds?
jpa
Posted by linkadge on November 2, 2013, at 18:02:36
In reply to trimipramine vs remeron, posted by jpa on November 2, 2013, at 14:02:17
I think that trimipramine would be a more effective as a sleep aid. It has histamine and 5-ht2 angatonism, but it lacks noradrenergic enhancement, which might be better for sleep. It blocks a1 adrenergic receptors which will may reduce alertness.
In addition it has some d2 antagonism which could reduce agitation. I think trimipramine probably has some ion channel inhibition (calcium channel blockade?) which can help sleep.
Linkadge
Posted by jpa on November 3, 2013, at 16:34:43
In reply to Re: trimipramine vs remeron, posted by linkadge on November 2, 2013, at 18:02:36
Thanks for the reply. I'm seeing my doc this week and will ask for a trial of trimipramine. The remeron does not seem to help, neither does the clomipramine for that matter. Though I think I'll stay on the clomipramine and ditch the remeron.
I'm 20 years into this disease and still trying to find something to give me sustained relief... God help me.
Posted by linkadge on November 3, 2013, at 17:42:11
In reply to Re: trimipramine vs remeron, posted by jpa on November 3, 2013, at 16:34:43
What other medications are you taking? Is the insomnia a key factor?
For me, cyproheptadine + melatonin was very effective when other things didn't help.
Linkadge
Posted by sigismund on November 4, 2013, at 15:20:19
In reply to trimipramine vs remeron, posted by jpa on November 2, 2013, at 14:02:17
At least trimipramine does not last until 3pm the next day.
The worst thing about trimip is the RLS it promotes in me, but only in doses above around 12.5. It is quite pronounced and might be due to some dopaminergic blockady thingo. At that dose it is not fantastic at keeping me asleep, but is useful and humane. A bit of temazepam or Ambien with it helps.
Posted by Legm82 on November 6, 2013, at 21:52:53
In reply to Re: trimipramine vs remeron, posted by linkadge on November 2, 2013, at 18:02:36
> I think that trimipramine would be a more effective as a sleep aid. It has histamine and 5-ht2 angatonism, but it lacks noradrenergic enhancement, which might be better for sleep. It blocks a1 adrenergic receptors which will may reduce alertness.
>
> In addition it has some d2 antagonism which could reduce agitation. I think trimipramine probably has some ion channel inhibition (calcium channel blockade?) which can help sleep.
>
> Linkadge
>
>
>
>
>
>Hello Linkadge
It is very interesting what you say about the receptors involved with Trimipramine and compare the two drugs.
Usually Remeron (mirtazapine) is well known as a first choice sleep aid.
I wonder if Trimipramine can help with sleep "ONSET" and "Manteinance" as well as Remeron.
Theorically it should work, but are you sure it would help? .. why isnt trimipramine advertised as much as Remeron for sleep problems?
Thanks for your reply.
Best regards,
Luis.
Posted by jpa on November 8, 2013, at 17:21:11
In reply to Re: trimipramine vs remeron » linkadge, posted by Legm82 on November 6, 2013, at 21:52:53
Very good question Luis. I wondered the same thing. I talked to my doctor today and he was aware of trimipramine, but has not used it clinically.
I asked him to check with his colleagues to see if there is any drug that works along the same lines as phenibute but could be taken long-term. Phenibute is the only thing that works for me.
I'm currently taking clomipramine and remeron, and phenibute on and off. That's it.
Posted by Legm82 on November 8, 2013, at 19:08:21
In reply to Re: trimipramine vs remeron, posted by jpa on November 8, 2013, at 17:21:11
> Very good question Luis. I wondered the same thing. I talked to my doctor today and he was aware of trimipramine, but has not used it clinically.
>
> I asked him to check with his colleagues to see if there is any drug that works along the same lines as phenibute but could be taken long-term. Phenibute is the only thing that works for me.
>
> I'm currently taking clomipramine and remeron, and phenibute on and off. That's it.Hello JPA,
What doses do you use of Remeron and Clompipramine.
Does the phenibute produces tolerance over time?
Kind regards,
Luis.
Posted by linkadge on November 8, 2013, at 19:42:41
In reply to Re: trimipramine vs remeron » linkadge, posted by Legm82 on November 6, 2013, at 21:52:53
I would say that trimipramine and doxapin are more effective sleep aids than remeron. Remeron is good, but trimipramine is probably more effective (haven taken both).
The real reason that they are not used as often? They are older medications. It is similar to schizophrenia medications. A study a few years back showed that the newer antipsychotics are no more effective than the older ones - and they had increased risk of metabolic side effects. So why are older, better, cheaper medications not used? Perception - and heavy money from the drug industry.
Linkadge
Posted by Legm82 on November 8, 2013, at 19:47:29
In reply to Re: trimipramine vs remeron, posted by linkadge on November 8, 2013, at 19:42:41
Hello Linkadge,
Do you consider that tolerance could be delevoped taking Doxepin or Trimipramine over time?
Posted by sigismund on November 8, 2013, at 21:02:52
In reply to Re: trimipramine vs remeron » linkadge, posted by Legm82 on November 8, 2013, at 19:47:29
>Do you consider that tolerance could be delevoped taking Doxepin or Trimipramine over time?
With trimipramine some tolerance yes, but after that no more. Not like with benzos, for example.
Posted by Legm82 on November 8, 2013, at 21:06:04
In reply to Re: trimipramine vs remeron, posted by sigismund on November 8, 2013, at 21:02:52
> >Do you consider that tolerance could be delevoped taking Doxepin or Trimipramine over time?
>
> With trimipramine some tolerance yes, but after that no more. Not like with benzos, for example.When say some tolerance yes, that means trimip stop working for sleep?
Posted by sigismund on November 9, 2013, at 17:33:15
In reply to Re: trimipramine vs remeron » sigismund, posted by Legm82 on November 8, 2013, at 21:06:04
>When say some tolerance yes, that means trimip stop working for sleep?
No, not at all. Just that the first dose was the strongest.
Posted by linkadge on November 9, 2013, at 19:34:00
In reply to Re: trimipramine vs remeron » linkadge, posted by Legm82 on November 8, 2013, at 19:47:29
I think some degree of tolerance can develop to any medication. I don't think it is bound to happen in all cases.
I think the 5-ht2a antagonist medications are more 'disease modifying' for insomnia. 5-ht2a receptors interact with melatonin and gsk-3b which might regulate the circadian rhythm in a more sustainable way. Drugs like mirtazapine, trazodone, seroquel, doxapin etc. can be used effectively for insomnia for years, perhaps indefinitely.
This doesn't mean that one will sleep every single night, but that they can normalize certain cases of chronic insomnia
This is the end of the thread.
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