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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 50. Go back in thread:
Posted by Chris O on April 2, 2005, at 16:14:13
In reply to Tabitha, ChrisO, KaraS and anyone else - question, posted by Sarah T. on April 2, 2005, at 15:15:37
Sarah:
I was just saying to my girlfriend yesterday how I should probably have an "in-hospital" sleep study because my sleep is so screwed up. Anyway, yes, I've had two "at home" sleep studies. They use this little box-like machine, which attaches electrodes and other little thingies to your body to monitor heart rate, snoring, body turning, etc. Both times that I had the study, it said I had "mild sleep apnea," which, I was told, can still be fairly traumatic to sleep. However, both times I had the test, the machine said I didn't snore, and didn't turn in my sleep, which I know that I did, so, I don't know how accurate that "at home" machine is. In addition, I think there is something more going on with me than just sleep apnea. I think, I don't I know, I get "night panic attacks" sometimes, I just wake up thinking I'm dying, heart racing, completely disoriented. It's really scary. Seems to go away when I'm on something to raise my serotonin/neurotransmitters, so.... Anyway, I think sleep study is definitely worth a try. I'd go for the "in hospital" one if you can get it. Seems like a better bet to me.
Good luck,
Chris
Posted by KaraS on April 2, 2005, at 21:13:47
In reply to Tabitha, ChrisO, KaraS and anyone else - question, posted by Sarah T. on April 2, 2005, at 15:15:37
> Have any of you ever had a sleep study to find out exactly what's going on (for example, sleep apnea, restless legs, etc.)? If you have had a sleep study, can you tell me a little bit about it?
No, I haven't but I've wanted to at times in the past. At one point I had restless legs but that was when I was on Effexor. I'm sleeping too well right now and I already know that I have a delayed sleep phase cycle so I don't have much interest in getting a sleep test currently. I'm more interested in what my cortisol levels are when I'm sleeping. When I wake up and I've overslept, even a little bit, I'm so much more depressed. There's got to be a good reason for it.
Posted by Sarah T. on April 4, 2005, at 1:39:11
In reply to Sleep Study » Sarah T., posted by Chris O on April 2, 2005, at 16:14:13
Hi Chris,
I replied to you a while ago, but when I tried to send the message, I got a notice saying, "Web site not responding." Let's see whether this works now.I have never heard of an "at home" sleep study. Was the equipment on loan to you from a hospital or doctor's office?
I wonder what causes those panic-like attacks that you have in the middle of the night. It might be a good idea to have an inpatient sleep study done to see whether they can figure out what causes those episodes. You're not on any traditional medications now, so perhaps now would be a good time to have it done. It's interesting that those panic attacks seem to stop when you're on an AD. How about when you were on Wellbutrin? Did you have those panic attacks then? Have you kept a record of the attacks? Perhaps you should write down when they occur and exactly what you've taken that day, including alternative meds.
I think I should definitely have a sleep study. I have to find out how much they cost and, more important, how much my insurance company will pay. As Kara said, the study will probably just confirm what I already know (i.e., that I have delayed sleep phase syndrome), but I'd like to know what else is going on. For example, it would be important to know whether I have apnea.
Thanks again for your help.
Posted by Sarah T. on April 4, 2005, at 1:54:56
In reply to Re: Tabitha, ChrisO, KaraS and anyone else - question » Sarah T., posted by KaraS on April 2, 2005, at 21:13:47
Hi Kara,
So, if you wanted to find out about your cortisol levels when sleeping, would you go to the hospital for that? Would they wake you up periodically to draw blood or do salivary tests? How accurate are those salivary tests anyway? I don't feel well when I wake up either, but for me, it doesn't seem to matter whether I've overslept or not. I just wish I could carry over into the morning the way I feel the night before. May I ask how much sleep you get? I mean, how much sleep is enough for you?
I know that an inpatient sleep study would confirm a lot of what we already know clinically, but I would like to know whether I have apnea. I have often wondered whether my feeling so awful when I wake up might have something to do with oxygen deprivation. It seems that vigorous exercise is just about the only thing that makes me feel better. And, while endorphins and PEA probably have something to do with that, I can't help but think that getting my brain more oxygenated helps, too. If I just go for a walk, even a long walk, I don't feel the same benefits on my mood that I feel from a more vigorous workout.
Did you say that you used to live in a colder climate? If that was you, do you think the cold weather worsened your depression? I think cold temperatures actually affect me more adversely than lack of light.
Posted by Chris O on April 4, 2005, at 14:29:16
In reply to Re: Sleep Study » Chris O, posted by Sarah T. on April 4, 2005, at 1:39:11
Sarah:
I was just looking up the information for the place I went to get the "box" for the home sleep study. The web address is www.sleepdata.com. The phone number is (619) 299-6299, in San Diego (that's where I am). I don't know if they have offices in other parts of the country. I guess you can check that out if you look over the website (if you're interested). As you said, yes, the equipment was "on loan" to me; they bring it to your house, actually and show you how to use it. It's all quite simple, really. Just a little box and some cords you attach to your body when you sleep. The things is, like I said before, I don't think it's as good as going into the hospital and having them stare at you/video you all night. Plus, I think they do a brain wave thing in the hospital, which this machine didn't do. The one benefit of using the machine is that you get to sleep at home, like you normally do, so your sleep patterns are probably more "normal" (yeah, right, whatever that is). And, the box is cheap, even without insurance. So...if you don't mind blowing a couple hundred bucks, it might be worth a try.
Even if the study already confirms what you know, I think it's definitely worth doing. Even the box studies that I did told me some...well, pretty scary stuff (that I was actually choking every night with sleep apnea, be it ever so "mild"). Especially if you're insurance pays, I would do it.
As to my night panic attacks, they are so random and so...unpredictable, I have no idea what causes them. I have tried to note times when they occured, but I just became frustrated after a while because...there is no rhyme or reason to them. Damn frustrating, to put it mildly. I think I have a wonderful combo of some type of "mild" sleep apnea and panic that occurs at sporadic times when I sleep. I think they are related to my brain chemistry (cortisol and various neurotransmitters) and that when I take something to normalize these chemicals, the apnea and panic go away, for the most part. (For example, they were not really there during the 8 months I was on Lexapro.) And, when I was on my Celexa/Wellbutrin combo in 2000, no, I was not getting them. But...it's confusing because...I was twenty pounds lighter (so, less sleep apnea, I'm thinking), and...I don't know, I can't figure why they're happening except that...my anxiety is increasing as I'm getting older. Anyway....
Let me know how it goes if you get the sleep study done. I'm doing another trial now, of inositol, 10-12 grams a day. It seems to have some effect, but I'll give it a few week trial and see what happens.
Good luck, Sara,
Chris
Posted by KaraS on April 5, 2005, at 1:18:22
In reply to Re: Tabitha, ChrisO, KaraS and anyone else - question » KaraS, posted by Sarah T. on April 4, 2005, at 1:54:56
> Hi Sarah,
>
> So, if you wanted to find out about your cortisol levels when sleeping, would you go to the hospital for that? Would they wake you up periodically to draw blood or do salivary tests? How accurate are those salivary tests anyway? I don't feel well when I wake up either, but for me, it doesn't seem to matter whether I've overslept or not. I just wish I could carry over into the morning the way I feel the night before. May I ask how much sleep you get? I mean, how much sleep is enough for you?
I haven't done much research into cortisol tests since I don't have health insurance and can't afford them. If you read some of Elroy's posts (and/or ask him) you'll get a lot info on the various types of cortisol tests as he has done a lot of research on this topic.I've recently realized that 7 hours is ideal for me to sleep each night. If I have a lot more than that, I get extremely depressed (as opposed to my normal morning depression). Even 8 hours a night is too much. How about for you?
> I know that an inpatient sleep study would confirm a lot of what we already know clinically, but I would like to know whether I have apnea. I have often wondered whether my feeling so awful when I wake up might have something to do with oxygen deprivation. It seems that vigorous exercise is just about the only thing that makes me feel better. And, while endorphins and PEA probably have something to do with that, I can't help but think that getting my brain more oxygenated helps, too. If I just go for a walk, even a long walk, I don't feel the same benefits on my mood that I feel from a more vigorous workout.You're probably right - it can't hurt to find out more about how we sleep. It might tell us some other things that we haven't even considered.
I also feel better after exercising. (There was a time in the recent past when I didn't but fortunately now it's helping again.) Even long walks help me. I haven't been in good enough shape to exercise vigorously.
> Did you say that you used to live in a colder climate? If that was you, do you think the cold weather worsened your depression? I think cold temperatures actually affect me more adversely than lack of light.Yes, I did live in a colder climate - for most of my life. I've only lived in this warm climate for a few years. I also think that the cold affected my moods. I was hypothyroid in my last few years back east so that made it more difficult to tolerate the cold.
Posted by Sarah T. on April 5, 2005, at 23:33:33
In reply to At-home sleep studies, other stuff » Sarah T., posted by Chris O on April 4, 2005, at 14:29:16
Hi Chris,
Thank you so much for the information on the at- home sleep monitor. I will definitely look into it. Maybe I can do the at-home study as well as the in-hospital one. It will probably take me a while to get the ball rolling for the latter one.I was thinking about those night-time panic attacks that you get occasionally, and I think it might be better not to take melatonin until more is known about it. The reason I say that is because of something Spriggy mentioned here a few days ago. She said that when her husband took melatonin, he woke up in the middle of the night, gasping for air. I vaguely remember a few other people mentioning that in the distant past, but I think they had been on very high doses. You don't have asthma or any other respiratory problems, do you?
Can you tell me a bit more about the inositol? Does it have an anti-anxiety effect? If so, maybe I should try it, too.
Posted by Sarah T. on April 6, 2005, at 0:03:04
In reply to Re: Tabitha, ChrisO, KaraS and anyone else - question » Sarah T., posted by KaraS on April 5, 2005, at 1:18:22
Hi Kara,
That's interesting that you feel best on seven hours of sleep. Unfortunately, I think I need more than that; however, oddly enough, when I'm not on any antidepressants, I can get by on less, and when I am on AD's, I seem to need more in order to function. For example, I'm not on any AD's now. There have been several times in the last few months when I got only 4-5 or 6 hours of sleep, which is much less than I need, and yet, I was still able to function. I couldn't have done anything that required a lot of abstract thought, but I was able to get through the day and do what I had to do. Contrast that with the times when I was on Celexa, which was disruptive to my sleep. I spent many more hours in bed on Celexa, but I think very few of those hours were spent in any good, restful, restorative sleep. When I got only 4, 5 or 6 hours of sleep on Celexa, I was completely non-functional. That occurs with some other AD's also. I'm starting to believe that the REM-suppression that occurs with many AD's may not be good for me. Or, perhaps some other stages of sleep are so disrupted that I'm severely impaired the following day.
I think that was really wise of you to move to a warmer climate. I'm seriously considering doing that in the next few years. I can't take the long cold winters anymore.
Posted by KaraS on April 6, 2005, at 3:07:19
In reply to Re: Tabitha, ChrisO, KaraS and anyone else - question » KaraS, posted by Sarah T. on April 6, 2005, at 0:03:04
> Hi Kara,
>
> That's interesting that you feel best on seven hours of sleep. Unfortunately, I think I need more than that; however, oddly enough, when I'm not on any antidepressants, I can get by on less, and when I am on AD's, I seem to need more in order to function. For example, I'm not on any AD's now. There have been several times in the last few months when I got only 4-5 or 6 hours of sleep, which is much less than I need, and yet, I was still able to function. I couldn't have done anything that required a lot of abstract thought, but I was able to get through the day and do what I had to do. Contrast that with the times when I was on Celexa, which was disruptive to my sleep. I spent many more hours in bed on Celexa, but I think very few of those hours were spent in any good, restful, restorative sleep. When I got only 4, 5 or 6 hours of sleep on Celexa, I was completely non-functional. That occurs with some other AD's also. I'm starting to believe that the REM-suppression that occurs with many AD's may not be good for me. Or, perhaps some other stages of sleep are so disrupted that I'm severely impaired the following day.
>
> I think that was really wise of you to move to a warmer climate. I'm seriously considering doing that in the next few years. I can't take the long cold winters anymore.
Hi Sarah,That's a good point about possibly needing more sleep time when taking an antidepressant. I don't know if I needed more time when I was on Effexor. It could be. I was under the impression then that I needed at least 8 hours of sleep. I'll have to check it out next time I'm on a significant dosage of an AD. I wonder if maybe the doxepin is actually working to make sleep better. I sleep sooooo soundly on this stuff and I have good dreams.
Warmer weather is great but there are other things that you have to put up with out here. It's very expensive and crowded. Traffic is horrible.... but you won't freeze!
Posted by Sarah T. on April 7, 2005, at 0:52:29
In reply to Re: Tabitha, ChrisO, KaraS and anyone else - question » Sarah T., posted by KaraS on April 6, 2005, at 3:07:19
Hi Kara,
Thanks for your reply. I'm feeling a bit under the weather. I'll be back tomorrow or the next day.Take care.
Sarah
Posted by Sarah T. on April 8, 2005, at 1:56:36
In reply to Re: Tabitha, ChrisO, KaraS and anyone else - question » Sarah T., posted by KaraS on April 6, 2005, at 3:07:19
Hi Kara,
Do you happen to know whether Melatonin suppresses progesterone? I thought I read that it can suppress estrogen, which may or may not be desirable. About 8 years ago, a friend of mine, who was trying to get pregnant, was taking melatonin every night. She was unable to get pregnant, and it wasn't until several years later that she figured out that the melatonin was making her infertile. These hormones are so powerful, and they affect so many systems, directly and indirectly.
I'm glad to hear the doxepin is helping you so much. How many mg are you taking now? If you are still on that low dose, do you find that you are able to keep the anticholinergic side effects to a minimum? Did those palpitations stop?
Have you ever taken nortriptyline? If so, how was it? I took it many years ago for a brief time. Nortriptyline has a so-called "therapeutic window" or narrow dosage range within which it is effective. I never seemed to be able to find the correct window. I might try it again some day.
Posted by Larry Hoover on April 10, 2005, at 11:00:23
In reply to Tabitha, ChrisO, KaraS and anyone else - question, posted by Sarah T. on April 2, 2005, at 15:15:37
> Have any of you ever had a sleep study to find out exactly what's going on (for example, sleep apnea, restless legs, etc.)? If you have had a sleep study, can you tell me a little bit about it?
I just had one. There is no way, no possible way, to duplicate a clinical sleep study with home recording units. I had a ponytail of wires off of my head. Four sensors on my face (glued right into my beard, too). One of those oxygen sensors on the finger. A special device around my chest to measure respiration. EKG leads on my chest. I think there were about thirty recordings of my sleep.
They said I didn't meet the threshold for treatment, despite years of non-restorative sleep. At least I know I don't have sleep apnea, or PLMD, or RLS....but I awakened 27 times in the night. I remember two. I get too much REM sleep, and I usually wake from a dream, when I do awake.
I have no idea if any of this can be controlled with melatonin, or how melatonin affects the five stages of sleep. I took some the night of the test, but I don't use it any more.
I'm on a trial of zopiclone right now (instead of temazepam). It usually works well, but some nights I'm awake for hours (like last night). I don't know what's up with that.
I think my sleep quality has improved a little bit with the zopiclone.
Lar
Posted by KaraS on April 10, 2005, at 17:06:57
In reply to Kara S, posted by Sarah T. on April 8, 2005, at 1:56:36
> Hi Kara,
>
> Do you happen to know whether Melatonin suppresses progesterone? I thought I read that it can suppress estrogen, which may or may not be desirable. About 8 years ago, a friend of mine, who was trying to get pregnant, was taking melatonin every night. She was unable to get pregnant, and it wasn't until several years later that she figured out that the melatonin was making her infertile. These hormones are so powerful, and they affect so many systems, directly and indirectly.
>
> I'm glad to hear the doxepin is helping you so much. How many mg are you taking now? If you are still on that low dose, do you find that you are able to keep the anticholinergic side effects to a minimum? Did those palpitations stop?
>
> Have you ever taken nortriptyline? If so, how was it? I took it many years ago for a brief time. Nortriptyline has a so-called "therapeutic window" or narrow dosage range within which it is effective. I never seemed to be able to find the correct window. I might try it again some day.
Hi Sarah,
I don't know whether melatonin suppresses progesterone. I haven't studied it that thoroughly. I only use it once in a while so haven't bother to do extensive reserach. I think you're wise to be concerned though. Since it is a hormone it could affect a lot of other things.Yes, the doxepin at 25 mg. does keep the side effects to a minimum. I still am aware of the anticholinergic dumbing down effect unfortunately. But right now if I went off of it without a good back-up plan, I'd be in serious trouble. So for now I'll stick with it. I have an increased appetite which I hate but I don't have orthostatic hypotension and rarely have a problem with dry mouth. The palpitations have stopped (thanks for asking) and the EKG was normal so I'm no longer worried about taking it with regard to cario effects. (I really believe now that the excessive use of the light box had something to do with causing the palpitations.) My sleep is incredible on doxepin - sound, restorative, great dreams. The problem is that it makes it even harder to get up in the morning. How is your sleep currently? The last time you posted to me you were going through a bad time. I hope that you're doing better now.
I took nort. many years ago. I couldn't tolerate it. It gave me tachycardia on even a small dosage. My resting heart rate was about 100 bpm and I wasn't even at a therapeutic level yet. I was really disappointed because I think it's a good drug. Someday I might try it with a beta blocker if I'm out of other options and I can get a physician to prescribe them both. Several people on this board have had good results with nort. (as you're probably aware of). Might be worth trying it again. The therapeutic window can be a nuisance but at least you don't have to keep upping the dose a million times before giving up on it.Take care,
Kara
Posted by Sarah T. on April 14, 2005, at 19:12:46
In reply to Re: sleep study question » Sarah T., posted by Larry Hoover on April 10, 2005, at 11:00:23
Hi Larry. Thanks for your reply. Wow! You woke up 27 times during the study??!! I wonder whether that happens regularly or whether the many awakenings might have been due to the discomfort of sleeping in an unfamiliar place with all those electrodes and wires getting in the way.
Am I correct in understanding that you did take melatonin on the night of the sleep study? Why? If you don't take it regularly, why did you take it the night of the study? How much did you take? Did you take regular or sustained release?
You said that you are now trying Zoplicone. Is that also known as "Sonata" or is it "Ambien"?
Posted by Sarah T. on April 14, 2005, at 19:43:59
In reply to Re: Melatonin etc. » Sarah T., posted by KaraS on April 10, 2005, at 17:06:57
Hi Kara,
Thanks for your reply. I've been wondering whether you have noticed an improvement in your depressive symptoms while on doxepin? I understand that your improved sleep could, in and of itself, ameliorate your depression, but if it's possible to separate out the effects of that, do you think that low dose of doxepin is helping in other ways, besides sleep?
I was interested to hear about your response to nortriptyline. Did you ever take imipramine? If so, how did that compare with nortriptyline, for you? For me, the TCA's, which I haven't taken in years, were significantly better for mood improvement than anything that's come out in the past 10-15 years (ssri's, Wellbutrin, Strattera, etc., etc), but I had severe cardiovascular effects on the TCA's. I would wake up with resting heart rates of >100 bpm. Before I even got out of bed, my heart rate was often around 105-106. That is absolutely unacceptable. I also had some other side effects that I couldn't live with, such as speech blockage, memory impairment and urinary retention (I was able to cope with the urinary retention with Bethanechol). Those symptoms weren't too bad on desipramine, but on anything like imipramine or amitriptyline, they were severe. I also had some other physical symptoms that weren't as serious, but I was bothered by them. These included edema (especially facial edema), constipation, and excessive sweating and thirst. Oddly enough, the WORST side effects I ever experienced were from maprotiline, which, like so many "newer generation" drugs, turned out to be worse than those from the previous "generation."
Thanks for asking about my sleep. Well, lately, once I finally go to sleep, my sleep has been ok. It's that darn phase shift that I struggle with. I do think that when I'm able to exercise earlier in the day, I tend to go to bed a tiny bit earier that night. I remember reading that vigorous exercise can suppress melatonin for about 12-13 hours, so perhaps that's what's happening with me.
By the way, I did end up trying melatonin. On the first night, I took 1 mg, which was much too much. A couple of nights later, I tried 0.3 mg. That was a bit better, but even that small amount caused some worsening of my depression. It felt more like an exacerbation of the physical symptoms of my depression, but those physical symptoms can, in turn, color (or discolor) everything else for the rest of day, so I've abadoned that project for now.
I always enjoy reading your posts.
Posted by Larry Hoover on April 14, 2005, at 21:34:18
In reply to Re: sleep study question » Larry Hoover, posted by Sarah T. on April 14, 2005, at 19:12:46
> Hi Larry. Thanks for your reply. Wow! You woke up 27 times during the study??!! I wonder whether that happens regularly or whether the many awakenings might have been due to the discomfort of sleeping in an unfamiliar place with all those electrodes and wires getting in the way.
No, I'm sure it was happening regularly, and was the explanation for my feeling non-restored every morning. It amazed me that this was not some sort of critical finding. The sleep doctor said that I had nothing to treat! He was also an *sshole. He said, three times, three different ways "Sorry, we don't do magic here. Nope. No magic." Right. Like I drove three hours to spend three hours getting hooked up and briefed and interviewed, and got all this paste glued in my hair ("don't worry, it'll wash out"....but meanwhile I have to drive home with globs of goo like horns coming out of my scalp), in the misguided notion that I might find some magic. Harrumppfff.
> Am I correct in understanding that you did take melatonin on the night of the sleep study? Why?
I was taking it regularly, then. I didn't want to change anything I normally did.
> If you don't take it regularly, why did you take it the night of the study?
Sorry if I was confusing. I was taking it regularly then. I stopped when I went on the zopiclone (after the sleep study, he did at least suggest an alternative med).
> How much did you take? Did you take regular or sustained release?
Regular form, dose approx. 1.5 mg.
> You said that you are now trying Zoplicone. Is that also known as "Sonata" or is it "Ambien"?
It's called Imovane. Not available in US, I think. Canada, Britain, Europe have it. Not US.
That new sleep med that was just announced in US (Lunesta, eszopiclone) is one enantiomer of zopiclone. It wasn't worth getting the racemic zopiclone past the FDA, so they did the same thing as they did with Celexa to create Lexapro. Only the s-enantiomer, rather than a mixture of r- and s-.
Lar
Posted by Sarah T. on April 14, 2005, at 23:30:35
In reply to Re: sleep study question » Sarah T., posted by Larry Hoover on April 14, 2005, at 21:34:18
> > > The sleep doctor said that I had nothing to treat! He was also an *sshole.
>>> Lar
>Ah, yes. Quite a few of my doctors have been of the *sshole persuasion. I think that's one reason I haven't dragged myself in for a sleep study yet. I'm just so sick and tired of expending lots of energy, time and money on these medical workups, only to walk away, hundreds or thousands of dollars poorer, and none the wiser. Most of what I've learned about what ails me and the purported treatments, I've learned from this board and from my own reading. Was the doctor who ran your sleep study the chairman of a department? I've had the worst experiences with physicians who are also administrators.
Posted by Sarah T. on April 14, 2005, at 23:33:41
In reply to Re: Melatonin etc. » Sarah T., posted by KaraS on April 10, 2005, at 17:06:57
Kara, before you tried doxepin, did you ever try Surmontil/trimipramine? In looking through the archives, I see that a few doxepin-takers also tried Surmontil, and vice-versa.
Posted by KaraS on April 15, 2005, at 13:46:00
In reply to Re: Melatonin etc. » KaraS, posted by Sarah T. on April 14, 2005, at 19:43:59
> Hi Kara,
>
> Thanks for your reply. I've been wondering whether you have noticed an improvement in your depressive symptoms while on doxepin? I understand that your improved sleep could, in and of itself, ameliorate your depression, but if it's possible to separate out the effects of that, do you think that low dose of doxepin is helping in other ways, besides sleep?
I'm only taking 25 mg. but it has definitely had an antidepressant effect - even at that low dosage. I am not completely anhedonic anymore. I can enjoy a tv show, a movie and even music again.
> I was interested to hear about your response to nortriptyline. Did you ever take imipramine? If so, how did that compare with nortriptyline, for you? For me, the TCA's, which I haven't taken in years, were significantly better for mood improvement than anything that's come out in the past 10-15 years (ssri's, Wellbutrin, Strattera, etc., etc), but I had severe cardiovascular effects on the TCA's. I would wake up with resting heart rates of >100 bpm. Before I even got out of bed, my heart rate was often around 105-106. That is absolutely unacceptable. I also had some other side effects that I couldn't live with, such as speech blockage, memory impairment and urinary retention (I was able to cope with the urinary retention with Bethanechol). Those symptoms weren't too bad on desipramine, but on anything like imipramine or amitriptyline, they were severe. I also had some other physical symptoms that weren't as serious, but I was bothered by them. These included edema (especially facial edema), constipation, and excessive sweating and thirst. Oddly enough, the WORST side effects I ever experienced were from maprotiline, which, like so many "newer generation" drugs, turned out to be worse than those from the previous "generation."I've never taken imipramine but I've taken desipramine and it gave me tachycardia. Since imipramine metabolizes to desipramine I'm pretty certain I wouldn't be able to tolerate it. The only reason I haven't increased the doxepin (which is obviously helping) is because of the side effects. I no longer worry about the cardio effects however, since I'm no longer getting palpitations and my EKG (ECG?) was fine.
> Thanks for asking about my sleep. Well, lately, once I finally go to sleep, my sleep has been ok. It's that darn phase shift that I struggle with. I do think that when I'm able to exercise earlier in the day, I tend to go to bed a tiny bit earier that night. I remember reading that vigorous exercise can suppress melatonin for about 12-13 hours, so perhaps that's what's happening with me.Sorry to hear you're still struggling with insomnia. I'm still trying to deal with the delayed sleep phase as well. The doxepin helps me sleep but I still don't want to go to bed at night until later and later each day. Vigorous exercise is good for so many things if you have the time and can make yourself do it.
> By the way, I did end up trying melatonin. On the first night, I took 1 mg, which was much too much. A couple of nights later, I tried 0.3 mg. That was a bit better, but even that small amount caused some worsening of my depression. It felt more like an exacerbation of the physical symptoms of my depression, but those physical symptoms can, in turn, color (or discolor) everything else for the rest of day, so I've abadoned that project for now.Definitely sounds like melatonin isn't for you. It was worth the try though.
> I always enjoy reading your posts.
Thanks. Same here.
Kara
Posted by KaraS on April 15, 2005, at 13:48:54
In reply to KaraS, another question for you, posted by Sarah T. on April 14, 2005, at 23:33:41
> Kara, before you tried doxepin, did you ever try Surmontil/trimipramine? In looking through the archives, I see that a few doxepin-takers also tried Surmontil, and vice-versa.
No, I haven't but I'm curious about it and have it on my list of things to try for 2 reasons. It has some slight dopaminergic activity and it mixes the best with MAOIs so it would probably be the safest TCA to mix with selegiline. Have you ever tried it? Are you thinking of it in terms of being your main AD or to take a small dose for sleep and/or anxiety purposes?
K
Posted by Sarah T. on April 15, 2005, at 18:54:09
In reply to Re: KaraS, another question for you » Sarah T., posted by KaraS on April 15, 2005, at 13:48:54
> > Kara, before you tried doxepin, did you ever try Surmontil/trimipramine?
> Have you ever tried it? Are you thinking of it in terms of being your main AD or to take a small dose for sleep and/or anxiety purposes? > K
I was thinking of taking a small dose for sleep and/anxiety, in the same way you're taking doxepin. I'm not currently taking anything else except for trying lots of different alternative remedies; however, I am thinking of either doxepin or surmontil for the near future, and I wonder which would be better for combining with other medicines. I'm almost 100% certain that I wouldn't be able to go above 25mg on the Doxepin/surmontil because of side effects, so I expect that I'd want to try to combine it with something else. Are you waiting for the selegiline patch? I'm interested to try it, when -- or should I say "if" -- it's ever released, but I'm concerned that I'll react to it the same way I reacted to Adderall. Those levorotatory isomers of the amphetamines do not agree with me, but maybe the transdermal route will be better for us.
Posted by Sarah T. on April 15, 2005, at 19:01:10
In reply to Re: Melatonin etc. » Sarah T., posted by KaraS on April 15, 2005, at 13:46:00
> >> I'm only taking 25 mg. but it has definitely had an antidepressant effect - even at that low dosage. I am not completely anhedonic anymore. I can enjoy a tv show, a movie and even music again.> > >
It's so good to hear that even 25 mg is helping your depression. I guess I should just bite the bullet and try doxepin or Surmontil. I'm afraid I won't be able to get out of bed, though. I have enough difficulty getting up even without a sedating medicine.
Posted by KaraS on April 15, 2005, at 19:38:24
In reply to Re: KaraS, another question for you » KaraS, posted by Sarah T. on April 15, 2005, at 18:54:09
> > > Kara, before you tried doxepin, did you ever try Surmontil/trimipramine?
>
> > Have you ever tried it? Are you thinking of it in terms of being your main AD or to take a small dose for sleep and/or anxiety purposes? > K
>
>
> I was thinking of taking a small dose for sleep and/anxiety, in the same way you're taking doxepin. I'm not currently taking anything else except for trying lots of different alternative remedies; however, I am thinking of either doxepin or surmontil for the near future, and I wonder which would be better for combining with other medicines. I'm almost 100% certain that I wouldn't be able to go above 25mg on the Doxepin/surmontil because of side effects, so I expect that I'd want to try to combine it with something else. Are you waiting for the selegiline patch? I'm interested to try it, when -- or should I say "if" -- it's ever released, but I'm concerned that I'll react to it the same way I reacted to Adderall. Those levorotatory isomers of the amphetamines do not agree with me, but maybe the transdermal route will be better for us.
I think you're right that Surmontil is fairly easily mixed with other meds. I don't think you have anything to lose by trying either of these two drugs at low doses. The one advantage that doxepin has over Surmontil is that it is less anticholinergic. I'm very afraid of anything that's going to dumb me down at all. (I'm not feeling terribly sharp these days to begin with!)
I was thinking in terms of mixing Surmontil (or doxepin?) with selegiline + DLPA. I had been waiting for the Ensam patch but since I had the anxiety meltdown a couple of months ago, I'm afraid I wouldn't be able to tolerate the patch unless I'm able to combine it with something very anxiolytic. (Initially when I tried selegiline it made me sleepy but after the third or fourth day, it still made me feel tired initially but started producing more of a stimulant type effect about 8-9 hours after I took it.) But maybe you're right, maybe the transdermal delivery system will reduce the side effects and make it easier to tolerate for both of us. Then maybe they'll make a lot of psych meds in patch form and life will get much easier for many of us. (I'm trying to think positively, can you tell?)Kara
Posted by KaraS on April 15, 2005, at 19:41:37
In reply to Re: Melatonin etc. » KaraS, posted by Sarah T. on April 15, 2005, at 19:01:10
> > >> I'm only taking 25 mg. but it has definitely had an antidepressant effect - even at that low dosage. I am not completely anhedonic anymore. I can enjoy a tv show, a movie and even music again.> > >
>
> It's so good to hear that even 25 mg is helping your depression. I guess I should just bite the bullet and try doxepin or Surmontil. I'm afraid I won't be able to get out of bed, though. I have enough difficulty getting up even without a sedating medicine.
You can always stop it if you find that it's making things worse. Wait until your body has adjusted to the medication before judging it though. I still struggle to get out of bed but at least I've had restorative sleep before I face the struggle!
Posted by Sarah T. on April 16, 2005, at 23:16:18
In reply to Re: KaraS, another question for you » Sarah T., posted by KaraS on April 15, 2005, at 19:38:24
KS: > > > > > I think you're right that Surmontil is fairly easily mixed with other meds. I don't think you have anything to lose by trying either of these two drugs at low doses. The one advantage that doxepin has over Surmontil is that it is less anticholinergic. I'm very afraid of anything that's going to dumb me down at all. (I'm not feeling terribly sharp these days to begin with!) >
ST: Thanks for letting me know that Doxepin is less anticholinergic than Surmontil. I do remember seeing one of those charts rating various meds according to their adverse effects, but I haven't seen the chart in a while. I'll have to do a search on it.
KS:>> I was thinking in terms of mixing Surmontil (or doxepin?) with selegiline + DLPA. I had been waiting for the Ensam patch but since I had the anxiety meltdown a couple of months ago, I'm afraid I wouldn't be able to tolerate the patch unless I'm able to combine it with something very anxiolytic. (Initially when I tried selegiline it made me sleepy but after the third or fourth day, it still made me feel tired initially but started producing more of a stimulant type effect about 8-9 hours after I took it.) But maybe you're right, maybe the transdermal delivery system will reduce the side effects and make it easier to tolerate for both of us. Then maybe they'll make a lot of psych meds in patch form and life will get much easier for many of us. (I'm trying to think positively, can you tell?) > Kara >
ST: I wonder why you got tired from the Selegiline at first. How many milligrams did you take? When you felt the stimulant effect 8-9 hours later, perhaps it was one or more of those metabolites kicking in. I am curious about your initial fatigue on what is supposedly a stimulating medicine. One reason for my interest is that, when I developed tolerance to Dexedrine, that tolerance manifested primarily as fatigue (sometimes extreme) and, at times, a zombie-like affect. I assumed that my presynaptic receptors had become overly efficient at dopamine reuptake. Initially, my doctor told me to take more, but that was the worst thing to do! I became completely immobilized when I increased the daily dose, or if I took too many milligrams at once, or if I took one dose too close to the next one.
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