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Re: Insomnia, Vivid dreams, reboxetine & efexor

Posted by Elizabeth on March 17, 1999, at 22:11:42

In reply to Re: Insomnia, Vivid dreams, reboxetine & efexor, posted by Nick on March 14, 1999, at 13:44:13

Hi Nick. I'd suggest clonidine, then. It's often used for children with ADHD, along with Ritalin, to help them sleep (also helps with "frustration tolerance" problems). I'm not sure how I feel about using a cardiovascular drug on kids, but it should be fine for adults. Check interactions with the antidepressants of course. It might be especially good for anxious, labile patients. The minimum dose strength is 0.1mg; I'd start there but don't hesitate to increase to 0.3mg or possibly more (not sure what the maximum is). Side effects are usually mild, may cause a little dry mouth and orthostatic hypotension.

A tricyclic might work, but it has the risk of excessive side effects. I notice you're in the UK: is lofepramine a sedating drug? That would be my first choice if it is (and indeed, I often wish we had it here in the States). Well, anyway, if lofepramine isn't sedating, imipramine or nortriptyline would be fine. A good conservative dose to start on would be 25mg, increase as necessary (within safe limits of course :-) ).

Another thing I've heard of to block vivid dreams or nightmares is valproate, a fairly large dose (start with 500mg and titrate up) taken at bedtime. If you Brits have gabapentin, that's another sedating anticonvulsant with fewer side effects that might work as well.

Any of these can be taken an hour or so before bedtime.

Hope this helps.





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