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Re: perversely caught between insomnia and fatigue » zeugma

Posted by Ktemene on August 12, 2004, at 23:04:09

In reply to Re: perversely caught between insomnia and fatigue, posted by zeugma on August 11, 2004, at 16:51:38

Hi Zeugma,

I was hoping that the Ritalin would not give you the horrible insomnia that you were getting with Provigil. Of course you have only had one or two nights experience with Ritalin's effects by now. But I was wondering how it was going? Any improvements?

Ktemene

> Hi, thanks to all for your helpful suggestions.
>
> I have a torturous concatenation of problems, but 10 mg Ritalin LA had me much more calm than 100 mg Provigil. of course I don't know yet how it's going to affect my sleep.
>
> Racer, YES, the Provigil crash! it is absolutely horrendous. I did wonder what would happen if I split the Provigil dosage, or took an extra 25 or 50 mg mid afternoon. I will keep that in mind if the Ritalin doesn't work out. But it seems, from today's trial, that Ritalin does a much better job of making me feel cognitively normal, as well as lowering the fatigue level. It could be that my ADD is so severe that maintaining any kind of sustained attention results in exhaustion, and the Ritalin kept my nerves at a much lower pitch as I did my tasks. And so far no sign of that afternoon crash, although I do feel tired.
>
> Panda, I'll consider CMI if and when my depression returns. Playing around with Provigil and Ritalin is enough tweaking for the moment. Clomipramine is my preference over adding Lexapro to nortriptyline, but I don't feel absolute about that: the advantage of lexapro would be the ability to add, say, 2.5 mg to my existing regimen and seeing what happens. But that's looking ahead a little.
>
> KV, I know the MAOI's are powerful REM suppressors. I metabolize TCA's quickly, so nortriptyline's REM-suppressant effect wears off by the afternoon, and I understand that would not be a problem with an MAOI. I think a nortriptyline-Ritalin combination would be similar to Parnate, theoretically at least. I think Ritalin, because of its stronger NE properties, has been shown to be more effective than provigil in suppressing cataplexy, although many narcoleptics need TCA's too. Also, as you point out, MAOI's tend to induce insomnia. Benzos are out as sleep aids for me, as Klonopin can actually induce cataplexy. I don't know if the other benzos are as problematic in this regard, but my current dose of nortriptyline (100 mg) has resulted in an complete suppression of dreaming at night and I'm quite happy with that.
>
> Thanks to all, and I will keep you updated,
>
> z


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poster:Ktemene thread:376220
URL: http://www.dr-bob.org/babble/20040811/msgs/377043.html