Psycho-Babble Medication Thread 1121637

Shown: posts 1 to 19 of 19. This is the beginning of the thread.

 

clomipramine insomnia - does it ever go away?

Posted by TriedEveryMedication on January 25, 2023, at 5:15:30

tried a single 25mg capsule at bed time, it kept me up all night and even though I didn't take any more, it kept me up the next night too.

does this get better? or should i dose in the morning?

 

Re: clomipramine insomnia - does it ever go away? TriedEveryMedication

Posted by SLS on January 25, 2023, at 8:24:31

In reply to clomipramine insomnia - does it ever go away?, posted by TriedEveryMedication on January 25, 2023, at 5:15:30

> tried a single 25mg capsule at bed time, it kept me up all night and even though I didn't take any more, it kept me up the next night too.

I don't like using you as an example of my pet peeves with how the Psycho-Babble mentality has reduced your chances of getting well, but I will.

When your life depends on the successful treatment of a seemingly intractable illness, why would you stop taking a drug just because it kept you awake one night after the very first dose? Did you fall to the ground writhing in pain? For God's sake - for *your* sake, *go back* to following your doctor's instructions. Adhere to the fundamentals of clinical psychophadrmacology that have proven effective for decades. Even if the insomnnia doesn't resolve by itself, then treat the insomnia. You don't have a better choice if this stuff has the potential to work.

Try to tolerate startup side effects. If the side effects persist, even after an antidepressant response, deal with it. Don't give up just for one night's sleep disturbance.

Insomnia. Deal with it.

Clomipramine might diminish your sex drive. Deal with it. Clomipramine might prevent you from achieving orgasms. Deal with it. If you have really "TriedEveryMedication", why the heck are you being so picayune about side effects, many of which mitigate or disappear altogether?

I couldn't sleep for almost two weeks when I first began treatment with Parnate and desipramine - which produced a robust response (Six months beginning in June of 1987). Two weeks. Had I decided to quit taking those two drugs after my first day of insomnia, I would never have achieved remission back then. The only reason treatment was discontinued is because a delusional mania emerged after six months of a stable remission. After I finally found another doctor willing to treat me with the exact same combination of drugs, I never again responded to it.

That's another lesson to be had. It applies to "pulsing" antidepressants or adjuncts - taking the same or similar drug treatments multiple times: "Antidepressant discontinuation-induced treatment refractoriness". If you are chronically TRD, you are probably a *lifer* of a successful treatment.

Nardil gave me persistent (partial) insomnia, dizziness, and fainting, especially at the beginning of treatment. It made me sit on the toilet for 30-45 minutes just to achieve micturition (urination). It was scary. I didn't want to go to the hospital to be catheterized. It was worth the 45 minutes. I took bethanechol (Urecholine) to be mitigate this side effect. I believe it is a pro-cholinergic. I had no intention of stopping treatment.


> does this get better? or should i dose in the morning?

It might not make any difference when you take it, but you can take it all at once in the morning to see what happens. It is certainly worth a try before remediating the insomnia with medication.


- Scott

I didn't have any insomnia at all with clomipramine (Anafranil). It did diminish my sex drive. The side effects were a hybrid of TCA and SSRI Otherwise, it felt I

 

Re: clomipramine insomnia - does it ever go away?

Posted by Christ_empowered on January 26, 2023, at 13:25:38

In reply to Re: clomipramine insomnia - does it ever go away? TriedEveryMedication, posted by SLS on January 25, 2023, at 8:24:31

hi :-)

I'm into Orthomolecular, a supplement protocol for the mentally ill initially developed by Dr.Abram Hoffer in 50s Canada. and...

Hoffer was a fan of clomimpramine. he was a psychiatrist, and he usually used vitamins with meds, occasionally with shock treatments in the mix.

I just thought I'd mention that because apparently clomimpramine is under appreciated in depressive disorders...at least here in the US, the emphsis is all on ocd. moving on...

can your doctor prescribe short term, as needed sedatives? gabapentin, ambien, restoril...something. if you've been on z drugs already and the insomnia is intense, then I'd think restoril might be the way to go...just a personal, random opinion, obviously.

I consulted The Google, and it appears that as with many antidepressants, 'this too shall pass...' if one can make it that far. obviously, that doesn't go for emerging aggression, psychosis, mania, etc.

please ask about some short term as needed sleepin pills. :-)

 

Re: clomipramine insomnia - does it ever go away? TriedEveryMedication

Posted by SLS on January 26, 2023, at 19:17:32

In reply to clomipramine insomnia - does it ever go away?, posted by TriedEveryMedication on January 25, 2023, at 5:15:30

Hi.

Another pet peeve of mine about doctors...

Too many doctors don't prepare you for the side effects that are likely to appear and how they would be handled.

Did your doctor describe to you what are the most common and the most dangerous side effects of clomipramine? If not, would it have helped if your doctor told you to expect insomnia as a possible side effect, and how it would be handled?

Of course, this argues in favor of having an experienced doctor manage your treatment.


- Scott

 

Re: clomipramine insomnia - does it ever go away? SLS

Posted by TriedEveryMedication on January 26, 2023, at 19:34:33

In reply to Re: clomipramine insomnia - does it ever go away? TriedEveryMedication, posted by SLS on January 26, 2023, at 19:17:32

> Hi.
>
> Another pet peeve of mine about doctors...
>
> Too many doctors don't prepare you for the side effects that are likely to appear and how they would be handled.
>
> Did your doctor describe to you what are the most common and the most dangerous side effects of clomipramine? If not, would it have helped if your doctor told you to expect insomnia as a possible side effect, and how it would be handled?
>
> Of course, this argues in favor of having an experienced doctor manage your treatment.
>
>
> - Scott


Well, no - he told me it would be sedating. I've had experience with other TCAs so I thought I knew what the side effects might be (dry mouth, constipation etc). I should have known - many of the drugs that are sedating for most people don't sedate me at all. Like Mirtazapine - keeps me awake.

I can tolerate most side effects. Insomnia wrecks me though. And I can't really do any thing about it because things like Z-drugs make my depression far far worse so I have to avoid those.

 

Re: clomipramine insomnia - does it ever go away? TriedEveryMedication

Posted by undopaminergic on January 27, 2023, at 9:53:32

In reply to Re: clomipramine insomnia - does it ever go away? SLS, posted by TriedEveryMedication on January 26, 2023, at 19:34:33

>
> I can tolerate most side effects. Insomnia wrecks me though. And I can't really do any thing about it because things like Z-drugs make my depression far far worse so I have to avoid those.
>

What about alprazolam? There is some evidence that it has antidepressant effects.

How do you react to antihistamines? Or melatonin?

-undopaminergic

 

Re: clomipramine insomnia - does it ever go away? TriedEveryMedication

Posted by SLS on January 27, 2023, at 13:46:49

In reply to Re: clomipramine insomnia - does it ever go away? SLS, posted by TriedEveryMedication on January 26, 2023, at 19:34:33

Hi.

I wrote a long response to you, but it disappeared into the ether.

> Well, no - he told me it would be sedating. I've had experience with other TCAs so I thought I knew what the side effects might be (dry mouth, constipation etc). I should have known - many of the drugs that are sedating for most people don't sedate me at all. Like Mirtazapine - keeps me awake.

You have a weird brain. In actuality, all brains are weird. Your reaction to drugs that are supposed to be sedating or hypnotic keep you awake. I guess you would considerate them paradoxical reactions that are idiosyncratic to your brain specifically. However, I'm sure that, at some point in the future, your reactions to these drugs will be used to help choose effective treatments. In 1983, after becoming familiar with the medical literature that existed at that time, I came to the conclusion that I was born 50 years too early.

I am very glad that your treatment is being guided by a doctor. I hope they are receptive and take your thoughts into consideration. You might know more than your doctor about the neurobiology of depression, but he most likely knows better than you as to which treatments yield positive results based on your symptomatology and your reactions to different treatments along the way. There are a growing number of brain tissue stimulating devices. Elecro-convulsive therapy (ECT); repetitive transcranial magnetic stimulation (rTMS); magnetic seizure therapy (MST); MRI-guided TMS; vagus nerve stimulation (VNS); deep brain stimulation (DBS); Stanford accelerated intelligent neuromodulation therapy (SAINT); transcranial direct current stimulation (tDCS)...

https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies

I had written a bunch of stuff to you about hope and uncertainty. Uncertainty is your best friend. Uncertainty allows for hope. Uncertainty has kept me alive for 40 years. I could never say to myself with certainty that I would never be successfully treated. Therein lied my reason to hope. Certainty might have made suicide very easy for me. Baron Shopsin, MD was one of the doctors I saw in the 1980s. He was a giant among the first cohort of psychopharmacologists. I respected him and genuinely liked him. However he did something to me that was cruel and of no clinical value. He asked me, "If God came down and told you that you would never get well, what would you do?" In other words, he assaulted me with certainty. I was left sitting in my chair speechless and motionless. I was unable to process the hopelessness to be found in such certainty. I tried to smother the predictable thoughts from surfacing. I knew that in this hypothetical scenario, suicide was inevitable. I would most likely choose death if God were to tell me that I would live the rest of my days struggling in the painful altered state of consciousness that is depression.

This was suppose to renew your sense of hope had you lost it. I hope it doesn't have the opposite effect.

By the way, how do you react to amphetamine and methylphenidate? Perhaps you react to these stimulants as if they were calming rather than stimulating.


- Scott


 

Re: clomipramine insomnia - does it ever go away? undopaminergic

Posted by SLS on January 27, 2023, at 13:59:01

In reply to Re: clomipramine insomnia - does it ever go away? TriedEveryMedication, posted by undopaminergic on January 27, 2023, at 9:53:32

> >
> > I can tolerate most side effects. Insomnia wrecks me though. And I can't really do any thing about it because things like Z-drugs make my depression far far worse so I have to avoid those.
> >
>
> What about alprazolam? There is some evidence that it has antidepressant effects.
>
> How do you react to antihistamines? Or melatonin?
>
> -undopaminergic
>

You are good, UD.

When I was being treated at the Columbia outpatient research program for depression, alprazolam was actually being studied for its antidepressant properties. Of all the benzodiazepines, I think alprazolam is the best of the bunch to treat anxiety. It feels like you are floating on a cloud. I felt very relaxed. None of the others felt that way to me. However, it is also the benzo most likely to become addicted to.


- Scott

 

Re: clomipramine insomnia - does it ever go away? SLS

Posted by TriedEveryMedication on January 27, 2023, at 16:53:20

In reply to Re: clomipramine insomnia - does it ever go away? TriedEveryMedication, posted by SLS on January 27, 2023, at 13:46:49

> Hi.
>
> I wrote a long response to you, but it disappeared into the ether.

> You have a weird brain. In actuality, all brains are weird. Your reaction to drugs that are supposed to be sedating or hypnotic keep you awake. I guess you would considerate them paradoxical reactions that are idiosyncratic to your brain specifically. However, I'm sure that, at some point in the future, your reactions to these drugs will be used to help choose effective treatments. In 1983, after becoming familiar with the medical literature that existed at that time, I came to the conclusion that I was born 50 years too early.
>
> I am very glad that your treatment is being guided by a doctor. I hope they are receptive and take your thoughts into consideration. You might know more than your doctor about the neurobiology of depression, but he most likely knows better than you as to which treatments yield positive results based on your symptomatology and your reactions to different treatments along the way. There are a growing number of brain tissue stimulating devices. Elecro-convulsive therapy (ECT); repetitive transcranial magnetic stimulation (rTMS); magnetic seizure therapy (MST); MRI-guided TMS; vagus nerve stimulation (VNS); deep brain stimulation (DBS); Stanford accelerated intelligent neuromodulation therapy (SAINT); transcranial direct current stimulation (tDCS)...
>
> https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies
>
> I had written a bunch of stuff to you about hope and uncertainty. Uncertainty is your best friend. Uncertainty allows for hope. Uncertainty has kept me alive for 40 years. I could never say to myself with certainty that I would never be successfully treated. Therein lied my reason to hope. Certainty might have made suicide very easy for me. Baron Shopsin, MD was one of the doctors I saw in the 1980s. He was a giant among the first cohort of psychopharmacologists. I respected him and genuinely liked him. However he did something to me that was cruel and of no clinical value. He asked me, "If God came down and told you that you would never get well, what would you do?" In other words, he assaulted me with certainty. I was left sitting in my chair speechless and motionless. I was unable to process the hopelessness to be found in such certainty. I tried to smother the predictable thoughts from surfacing. I knew that in this hypothetical scenario, suicide was inevitable. I would most likely choose death if God were to tell me that I would live the rest of my days struggling in the painful altered state of consciousness that is depression.
>
> This was suppose to renew your sense of hope had you lost it. I hope it doesn't have the opposite effect.
>
> By the way, how do you react to amphetamine and methylphenidate? Perhaps you react to these stimulants as if they were calming rather than stimulating.
>
>
> - Scott
>
>

Hi Scott,
Thank you for your reply. Your words about hope and uncertainty are very true. Yes, it does renew my sense of hope - thank you. I've been going through a rough time with middle age regrets pounding me, I need all the hope I can get! Funny you mentioned rTMS - I tried a full course of that a few years ago without success. I'm keeping my eye on SAINT, though.

I actually react pretty well to adderall. Lowish doses sometimes makes me a bit drowsy.

 

Re: clomipramine insomnia - does it ever go away? undopaminergic

Posted by TriedEveryMedication on January 27, 2023, at 16:56:02

In reply to Re: clomipramine insomnia - does it ever go away? TriedEveryMedication, posted by undopaminergic on January 27, 2023, at 9:53:32


> What about alprazolam? There is some evidence that it has antidepressant effects.
>
> How do you react to antihistamines? Or melatonin?
>
> -undopaminergic
>

It's funny, antihistamines like hydroxyzine do not put me to sleep. They used to, but it seems like I have a permanent tolerance to them now. I've noticed nothing with melatonin. I'll ask my doc about alprazolam. Thank you

 

Re: clomipramine insomnia - does it ever go away? TriedEveryMedication

Posted by SLS on January 28, 2023, at 10:44:13

In reply to Re: clomipramine insomnia - does it ever go away? SLS, posted by TriedEveryMedication on January 27, 2023, at 16:53:20

Hi, Again.

(That's an odd first name).


> > Hi.
> >
> > I wrote a long response to you, but it disappeared into the ether.
> >
> > You have a weird brain. In actuality, all brains are weird. Your reaction to drugs that are supposed to be sedating or hypnotic keep you awake. I guess you would considerate them paradoxical reactions that are idiosyncratic to your brain specifically. However, I'm sure that, at some point in the future, your reactions to these drugs will be used to help choose effective treatments. In 1983, after becoming familiar with the medical literature that existed at that time, I came to the conclusion that I was born 50 years too early.
> >
> > I am very glad that your treatment is being guided by a doctor. I hope they are receptive and take your thoughts into consideration. You might know more than your doctor about the neurobiology of depression, but he most likely knows better than you as to which treatments yield positive results based on your symptomatology and your reactions to different treatments along the way. There are a growing number of brain tissue stimulating devices. Elecro-convulsive therapy (ECT); repetitive transcranial magnetic stimulation (rTMS); magnetic seizure therapy (MST); MRI-guided TMS; vagus nerve stimulation (VNS); deep brain stimulation (DBS); Stanford accelerated intelligent neuromodulation therapy (SAINT); transcranial direct current stimulation (tDCS)...
> >
> > https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies
> >
> > I had written a bunch of stuff to you about hope and uncertainty. Uncertainty is your best friend. Uncertainty allows for hope. Uncertainty has kept me alive for 40 years. I could never say to myself with certainty that I would never be successfully treated. Therein lied my reason to hope. Certainty might have made suicide very easy for me. Baron Shopsin, MD was one of the doctors I saw in the 1980s. He was a giant among the first cohort of psychopharmacologists. I respected him and genuinely liked him. However he did something to me that was cruel and of no clinical value. He asked me, "If God came down and told you that you would never get well, what would you do?" In other words, he assaulted me with certainty. I was left sitting in my chair speechless and motionless. I was unable to process the hopelessness to be found in such certainty. I tried to smother the predictable thoughts from surfacing. I knew that in this hypothetical scenario, suicide was inevitable. I would most likely choose death if God were to tell me that I would live the rest of my days struggling in the painful altered state of consciousness that is depression.
> >
> > This was suppose to renew your sense of hope had you lost it. I hope it doesn't have the opposite effect.
> >
> > By the way, how do you react to amphetamine and methylphenidate? Perhaps you react to these stimulants as if they were calming rather than stimulating.


> Hi Scott,
> Thank you for your reply. Your words about hope and uncertainty are very true. Yes, it does renew my sense of hope - thank you. I've been going through a rough time with middle age regrets pounding me, I need all the hope I can get! Funny you mentioned rTMS - I tried a full course of that a few years ago without success. I'm keeping my eye on SAINT, though.


> I actually react pretty well to adderall. Lowish doses sometimes makes me a bit drowsy.


That's an example of how using one's reactions to a given medication can suggest what the reactions will be to other medications.

Simplistic scenario: You reacted to normally sedating drugs by becoming activated. Perhaps the converse is also true. Perhaps this "paradoxical" reaction indicates that taking amphetamine, which normally produces activation, produces sedation in you.


- Scott


 

Re: clomipramine insomnia - does it ever go away? TriedEveryMedication

Posted by SLS on January 28, 2023, at 11:28:14

In reply to Re: clomipramine insomnia - does it ever go away? undopaminergic, posted by TriedEveryMedication on January 27, 2023, at 16:56:02

>
> > What about alprazolam? There is some evidence that it has antidepressant effects.
> >
> > How do you react to antihistamines? Or melatonin?
> >
> > -undopaminergic
> >
>
> It's funny, antihistamines like hydroxyzine do not put me to sleep. They used to, but it seems like I have a permanent tolerance to them now. I've noticed nothing with melatonin. I'll ask my doc about alprazolam. Thank you

1. If the problem you are addressing is severe anxiety, then alprazolam is a good choice. If, however, your anxiety is no worse than moderate, lorazepam (Ativan) might be a better choice. It is rather neutral with respect to mood, and allows for clearer thinking. Clonazepam is sometimes used. If the anxiety is provoked by social situations, Nardil is probably the most effective medication. However, it comes with risks for which one must follow dietetic and drug restrictions. Paroxetine (Paxil) is usually the SSRI best suited to treating chronic anxiety, including Generalized Anxiety Disorder (GAD).

2. If insomnia is the problem you are addressing, there are several medications that would probably give favorable results.

zolpidem (Ambien) - Z-drug
lorazepam (Ativan) - benzodiazepine
temazepam (Restoril) - benzodiazepine
clonazepam (Klonopin) - benzodiazepine
quetiapine (Seroquel) - antipsychotic
mirtazepine (Remeron) - antidepressant
doxepin (Sinequan) - antidepressant (TCA) - Extremely antihistaminergic
amitriptyline (Elavil) - antidepressant (TCA)
trimipramine (Surmontil) - antidepressant (TCA)
prazosin (Minipress) - Specific for PTSD nightmares.

I prefer Z-drugs. If you ever need to discontinue Ambien, you can do so abruptly without having typical benzodiazepine withdrawal reactions. Insomnia can be a withdrawal reaction. For me, I had only partial insomnia as a withdrawal reaction to Ambien discontinuation. This might not be true of everyone. Zolpidem and triazolam (Halcion) are good for initial-insomnia while temazepam is good for sleep-maintenance. Many people like low-dosage quetiapine for both types of insomnia.

About melatonin:

1. Melatonin can make depression somewhat worse.

2. The optimum timing of melantonin dosing varies between individuals. Most people find that 1 hour before bedtime works well. Yet, there are people who sleep much better when melatonin is given in the afternoon.

3. Herbal teas. Valerian is mentioned often. Chamomile, lemon grass, and eleuthero are others with reputations as being sleep-aids.


- Scott

 

Correction regarding Herbal Teas

Posted by SLS on January 28, 2023, at 11:33:42

In reply to Re: clomipramine insomnia - does it ever go away? TriedEveryMedication, posted by SLS on January 28, 2023, at 11:28:14

Herbal Teas were not meant to be listed under melatonin. Herbal Teas should be considered separately.


> About melatonin:
>
> 1. Melatonin can make depression somewhat worse.
>
> 2. The optimum timing of melantonin dosing varies between individuals. Most people find that 1 hour before bedtime works well. Yet, there are people who sleep much better when melatonin is given in the afternoon.


Herbal teas. Valerian is mentioned often. Chamomile, lemon grass, and eleuthero are others with reputations as being sleep-aids.


- Scott

 

Re: clomipramine insomnia - does it ever go away? SLS

Posted by undopaminergic on January 29, 2023, at 2:36:37

In reply to Re: clomipramine insomnia - does it ever go away? TriedEveryMedication, posted by SLS on January 28, 2023, at 10:44:13

>
> Simplistic scenario: You reacted to normally sedating drugs by becoming activated. Perhaps the converse is also true. Perhaps this "paradoxical" reaction indicates that taking amphetamine, which normally produces activation, produces sedation in you.
>

I saw someone claim that sleep on Dexedrine is of superior quality.

I got extremely calm when I took my first dose of phenylethylamine (PEA) under selegiline treatment.

It is often claimed that people with ADHD have a paradoxical calming reaction to stimulants. That was true of PEA for me, but not methylphenidate or other dopamine reuptake inhibitors.

-undopaminergic

 

Re: clomipramine insomnia - does it ever go away? SLS

Posted by undopaminergic on January 29, 2023, at 4:21:26

In reply to Re: clomipramine insomnia - does it ever go away? TriedEveryMedication, posted by SLS on January 28, 2023, at 11:28:14

>
> 2. If insomnia is the problem you are addressing, there are several medications that would probably give favorable results.
>
> zolpidem (Ambien) - Z-drug
> lorazepam (Ativan) - benzodiazepine
> temazepam (Restoril) - benzodiazepine
> clonazepam (Klonopin) - benzodiazepine
> quetiapine (Seroquel) - antipsychotic
> mirtazepine (Remeron) - antidepressant
> doxepin (Sinequan) - antidepressant (TCA) - Extremely antihistaminergic
> amitriptyline (Elavil) - antidepressant (TCA)
> trimipramine (Surmontil) - antidepressant (TCA)
> prazosin (Minipress) - Specific for PTSD nightmares.
>

What about cyproheptadine (Periactin)? It's an antihistamine but also blocks serotonin 5-HT2A, which may improve sleep quality.

> I prefer Z-drugs. If you ever need to discontinue Ambien, you can do so abruptly without having typical benzodiazepine withdrawal reactions. Insomnia can be a withdrawal reaction. For me, I had only partial insomnia as a withdrawal reaction to Ambien discontinuation. This might not be true of everyone. Zolpidem and triazolam (Halcion) are good for initial-insomnia while temazepam is good for sleep-maintenance. Many people like low-dosage quetiapine for both types of insomnia.
>

Midazolam (Dormicum) is another short-acting benzodiazepine suitable for sleep initiation, but it seems to be available (as Versed) only for injection in the US.

> About melatonin:
>
> 1. Melatonin can make depression somewhat worse.
>

Yet there is an antidepressant (agomelatine -- Valdoxan) that is a melatonin agonist.

> 2. The optimum timing of melantonin dosing varies between individuals. Most people find that 1 hour before bedtime works well. Yet, there are people who sleep much better when melatonin is given in the afternoon.
>

Dose is also important. There are people who insist that 300 mcg (micrograms) is better than higher doses.

> 3. Herbal teas. Valerian is mentioned often. Chamomile, lemon grass, and eleuthero are others with reputations as being sleep-aids.
>

Eleutherococcus is also called Siberian Ginseng.

I got angry from Valerian. It was very unusual in how it started and in its qualities. But it has only happened once.

-undopaminergic

 

Re: clomipramine insomnia - does it ever go away?

Posted by SLS on January 29, 2023, at 7:17:48

In reply to Re: clomipramine insomnia - does it ever go away? SLS, posted by undopaminergic on January 29, 2023, at 2:36:37

Hi.

> > Simplistic scenario: You reacted to normally sedating drugs by becoming activated. Perhaps the converse is also true. Perhaps this "paradoxical" reaction indicates that taking amphetamine, which normally produces activation, produces sedation in you.

> I saw someone claim that sleep on Dexedrine is of superior quality.

I don't remember R-amphetamine keeping me awake. 20 mg/day I think?

> I got extremely calm when I took my first dose of phenylethylamine (PEA) under selegiline treatment.
>
> It is often claimed that people with ADHD have a paradoxical calming reaction to stimulants. That was true of PEA for me, but not methylphenidate or other dopamine reuptake inhibitors.

You might be too young, but do you remember a drug called nomifensine (Merital)? It was developed and sold by Hoechst-Roussel. It was probably the strongest DA reuptake inhibitor that made it to the US market as an antidepressant. I think it was stronger than amineptine (sold in France and later withdrawn). Some people achieved remission with nomifensine who responded to nothing else. I did. But, as usual, the improvement (nearly full remission) that I experienced disappeared in 3-4 days. Unfortunately, for those who relied upon nomifensine to return to a normal life, nomifensine was withdrawn from the market worldwide. These people were forced to drop out of life again. In the United states, it was available for only 3 years (1982-1985). There were a few reports of nomifensine being associated with hemolytic anemia. Some people had also developed antibodies to the drug and caused immunohemolytic anemia. Otherwise, I think it would have made a good treatment for TRD.

Amineptine, a dopamine reuptake inhibitor, represents one of my pet peeves regarding the availability of effective drugs that are safe when used properly. With amineptine, its withdrawal had nothing to do with efficacy or safety. I get angry whenever I think about it. The International Olympic Committee (IOC) banned amineptine as a performance-enhancing stimulant. That's it. That was enough for France to mandate its removal from the market.

Fentanyl (opioid): I am outraged about this one. I'm sure fentanyl (Duragesic) is soon to be withdrawn by the FDA as a response to public outcry. I'm very sorry that it kills people whose stash of heroin contains fentanyl, which is a much cheaper substance and easily acquired from the overseas black market. Fentanyl is an *essential* addition to the pharmacopeia. It is the most potent analgesic approved for marketing. It is the only drug capable of easing the excruciating pain of late-stage cancer. Ask a wife whose husband has terminal cancer if fentanyl should be made illegal.

Amineptine? Banned by the IOC as a performance enhancer? That it? What about amphetamine and anabolic steroids? Why didn't France make all of those drugs illegal, too?

If the FDA were to withdraw every drug that is abused for purposes other than medical, should the FDA make all of them illegal? Gee. What about acetaminophen (Tylenol)? Taking too much will kill. It causes fulminate liver failure in overdose. Should this substance be made illegal? I am outraged.

Fentanyl isn't the problem. Criminals are.


- Scott

 

Re: clomipramine insomnia - does it ever go away? undopaminergic

Posted by SLS on January 29, 2023, at 8:21:04

In reply to Re: clomipramine insomnia - does it ever go away? SLS, posted by undopaminergic on January 29, 2023, at 4:21:26

> >
> > 2. If insomnia is the problem you are addressing, there are several medications that would probably give favorable results.
> >
> > zolpidem (Ambien) - Z-drug
> > lorazepam (Ativan) - benzodiazepine
> > temazepam (Restoril) - benzodiazepine
> > clonazepam (Klonopin) - benzodiazepine
> > quetiapine (Seroquel) - antipsychotic
> > mirtazepine (Remeron) - antidepressant
> > doxepin (Sinequan) - antidepressant (TCA) - Extremely antihistaminergic
> > amitriptyline (Elavil) - antidepressant (TCA)
> > trimipramine (Surmontil) - antidepressant (TCA)
> > prazosin (Minipress) - Specific for PTSD nightmares.
> >


> What about cyproheptadine (Periactin)? It's an antihistamine but also blocks serotonin 5-HT2A, which may improve sleep quality.


Sleep architecture?

I think it is important to acknowledge the possibility that cyproheptadine does things other than block histamine receptors. We tend to pigeon-hole things in order to make sense of the world. Lamotrigine was pigeon-holed as an anticonvulsant before it was found serendipitously to exert antidepressant effects. I was a patient at the NIH in 1992-1993 when the seizure disorders unit reported to the biological psychiatry unit that a bunch of people who were taking lamotrigine for epilepsy reported an improvement in their comorbid depressive disorder.


> > I prefer Z-drugs. If you ever need to discontinue Ambien, you can do so abruptly without having typical benzodiazepine withdrawal reactions. Insomnia can be a withdrawal reaction. For me, I had only partial insomnia as a withdrawal reaction to Ambien discontinuation. This might not be true of everyone. Zolpidem and triazolam (Halcion) are good for initial-insomnia while temazepam is good for sleep-maintenance. Many people like low-dosage quetiapine for both types of insomnia.


> Midazolam (Dormicum) is another short-acting benzodiazepine suitable for sleep initiation, but it seems to be available (as Versed) only for injection in the US.


Ah. I had no idea that midazolam good for sleep-initiation. Isn't midazolam used as an adjunct in general anesthesia?


> > About melatonin:
> >
> > 1. Melatonin can make depression somewhat worse.


> Yet there is an antidepressant (agomelatine -- Valdoxan) that is a melatonin agonist.


Yes. What else does it do?

That's the question one should always ask, especially when other pharmacological properties of a drug have yet to be discovered.


> > 2. The optimum timing of melantonin dosing varies between individuals. Most people find that 1 hour before bedtime works well. Yet, there are people who sleep much better when melatonin is given in the afternoon.


> Dose is also important. There are people who insist that 300 mcg (micrograms) is better than higher doses.


I insist that lithium displays a similar clinical trait. For me, 300 mg/day is magic. At 450 mg/day, I very quickly relapse. Lithium has been reported to have a biphasic effect on glutamate release. You commented on this, noting that this bimodal pharmacological property displays a dosage-response curve regarding glutamate release, but can yield conflicting clinical results depending on the study being examined.


> > 3. Herbal teas. Valerian is mentioned often. Chamomile, lemon grass, and eleuthero are others with reputations as being sleep-aids.

> Eleutherococcus is also called Siberian Ginseng.


I wish I had your memory. I am still having trouble with mine. My guess is that the impairment of short-term memory associated with depression is one of the last things to resolve. I had a few bilateral ECT treatments in the 1990s, so this must be taken into consideration. However, I doubt that there are any residual memory deficits produced by ECT for me. We'll see.


> I got angry from Valerian. It was very unusual in how it started and in its qualities. But it has only happened once.


I hate that there are so many differences in the way people respond to a given treatment. Trying to generalize and predict one's reactions to specific drugs is a fool's errand. It is frustrating and makes me feel impotent. We are all trying to help each other in the face of inconsistency and paradox. Dammit.


- Scott


 

Re: clomipramine insomnia - does it ever go away? SLS

Posted by undopaminergic on January 29, 2023, at 9:54:29

In reply to Re: clomipramine insomnia - does it ever go away? undopaminergic, posted by SLS on January 29, 2023, at 8:21:04

> > >
> > > 2. If insomnia is the problem you are addressing, there are several medications that would probably give favorable results.
> > >
> > > zolpidem (Ambien) - Z-drug
> > > lorazepam (Ativan) - benzodiazepine
> > > temazepam (Restoril) - benzodiazepine
> > > clonazepam (Klonopin) - benzodiazepine
> > > quetiapine (Seroquel) - antipsychotic
> > > mirtazepine (Remeron) - antidepressant
> > > doxepin (Sinequan) - antidepressant (TCA) - Extremely antihistaminergic
> > > amitriptyline (Elavil) - antidepressant (TCA)
> > > trimipramine (Surmontil) - antidepressant (TCA)
> > > prazosin (Minipress) - Specific for PTSD nightmares.
> > >
>
>
> > What about cyproheptadine (Periactin)? It's an antihistamine but also blocks serotonin 5-HT2A, which may improve sleep quality.
>
>
> Sleep architecture?

Yes, something about slow wave or deep sleep last time I checked (but I did not go into depth).

> I think it is important to acknowledge the possibility that cyproheptadine does things other than block histamine receptors.
>

There is no question that it does. It can be used as an antidote to serotonin syndrome. Then again, even chlorpromazine seems to work for this purpose.

> We tend to pigeon-hole things in order to make sense of the world. Lamotrigine was pigeon-holed as an anticonvulsant before it was found serendipitously to exert antidepressant effects. I was a patient at the NIH in 1992-1993 when the seizure disorders unit reported to the biological psychiatry unit that a bunch of people who were taking lamotrigine for epilepsy reported an improvement in their comorbid depressive disorder.
>

Many anticonvulsants have found additional indications, though usually inofficially. But I think sometimes there is an unfounded belief that *any* anticonvulsant should work as a mood stabiliser.

> > Midazolam (Dormicum) is another short-acting benzodiazepine suitable for sleep initiation, but it seems to be available (as Versed) only for injection in the US.
>
>
> Ah. I had no idea that midazolam good for sleep-initiation. Isn't midazolam used as an adjunct in general anesthesia?
>

Yes, and other purposes where a sedative-hypnotic is useful.

> > > About melatonin:
> > >
> > > 1. Melatonin can make depression somewhat worse.
>
>
> > Yet there is an antidepressant (agomelatine -- Valdoxan) that is a melatonin agonist.
>
>
> Yes. What else does it do?

It is known to block serotonin 5-HT2C receptors, yielding a dopaminergic effect. But its half-life is only about 2 hours, so I'm not sure how useful this property is in practice.

> That's the question one should always ask, especially when other pharmacological properties of a drug have yet to be discovered.
>

Few, if any, compounds are tested for an exhaustive list of targets. Moreover, not all receptors and sites are even known yet.

> > Dose is also important. There are people who insist that 300 mcg (micrograms) is better than higher doses.
>
>
> I insist that lithium displays a similar clinical trait. For me, 300 mg/day is magic. At 450 mg/day, I very quickly relapse. Lithium has been reported to have a biphasic effect on glutamate release. You commented on this, noting that this bimodal pharmacological property displays a dosage-response curve regarding glutamate release, but can yield conflicting clinical results depending on the study being examined.
>

So there is some other study (beyond the one I cited) pertaining to this effect?

> > > 3. Herbal teas. Valerian is mentioned often. Chamomile, lemon grass, and eleuthero are others with reputations as being sleep-aids.
>
>
> > Eleutherococcus is also called Siberian Ginseng.
>
>
> I wish I had your memory.

I think my memory is at its best when it comes to drugs. Contrast that with mathematics: often I have to determine the result of 3+4 by counting "5, 6, 7".

> I am still having trouble with mine. My guess is that the impairment of short-term memory associated with depression is one of the last things to resolve. I had a few bilateral ECT treatments in the 1990s, so this must be taken into consideration. However, I doubt that there are any residual memory deficits produced by ECT for me. We'll see.
>

What memory performance is considered "normal" or "good", and how is it measured? There are some answers to that, I'm sure, and it is a science in itself, but the point I'm hinting at is that almost everyone seems to think their memory isn't good enough.

> > I got angry from Valerian. It was very unusual in how it started and in its qualities. But it has only happened once.
>
>
> I hate that there are so many differences in the way people respond to a given treatment. Trying to generalize and predict one's reactions to specific drugs is a fool's errand. It is frustrating and makes me feel impotent. We are all trying to help each other in the face of inconsistency and paradox. Dammit.
>

Yes.

-undopaminergic

 

Re: clomipramine insomnia - does it ever go away? undopaminergic

Posted by SLS on January 29, 2023, at 10:10:29

In reply to Re: clomipramine insomnia - does it ever go away? SLS, posted by undopaminergic on January 29, 2023, at 9:54:29

Hi.

> > I insist that lithium displays a similar clinical trait. For me, 300 mg/day is magic. At 450 mg/day, I very quickly relapse. Lithium has been reported to have a biphasic effect on glutamate release. You commented on this, noting that this bimodal pharmacological property displays a dosage-response curve regarding glutamate release, but can yield conflicting clinical results depending on the study being examined.


> So there is some other study (beyond the one I cited) pertaining to this effect?

Yes - and it was a clinical study of how people reacted to low-dosage versus high-doage lithium. I have been racking my brain trying to locate it again.


> > > > 3. Herbal teas. Valerian is mentioned often. Chamomile, lemon grass, and eleuthero are others with reputations as being sleep-aids.


> > > Eleutherococcus is also called Siberian Ginseng.

> > I wish I had your memory.


> I think my memory is at its best when it comes to drugs. Contrast that with mathematics: often I have to determine the result of 3+4 by counting "5, 6, 7".


I know this arithmetic deficit well.


> > I am still having trouble with mine. My guess is that the impairment of short-term memory associated with depression is one of the last things to resolve. I had a few bilateral ECT treatments in the 1990s, so this must be taken into consideration. However, I doubt that there are any residual memory deficits produced by ECT for me. We'll see.


> What memory performance is considered "normal" or "good", and how is it measured? There are some answers to that, I'm sure, and it is a science in itself, but the point I'm hinting at is that almost everyone seems to think their memory isn't good enough.


I agree. Also, as people age, short-term memory deteriorates.


> > > I got angry from Valerian. It was very unusual in how it started and in its qualities. But it has only happened once.


> > I hate that there are so many differences in the way people respond to a given treatment. Trying to generalize and predict one's reactions to specific drugs is a fool's errand. It is frustrating and makes me feel impotent. We are all trying to help each other in the face of inconsistency and paradox. Dammit.


> Yes.
>
> -undopaminergic


- Scott


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