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Re: Can Klonopin induce Depression/cognitive problems? » utopizen

Posted by zeugma on October 14, 2004, at 5:04:11

In reply to Re: Can Klonopin induce Depression/cognitive problems?, posted by utopizen on October 12, 2004, at 19:48:02

> My sleep doc (I have a benign case of sleep apnea) is a pulmnologist at Beth Israel in Boston, and leads the research on ADD+Sleep disorder coorelations. He says he finds good success with Provigil + Strattera COMBINED.

I don't doubt that at all. I have taken Strattera and Provigil indiviually, and gotten good results as far as ADD and narcolepsy are concerned. Unfortunately, I cannot tolerate their side effects. I did my best with them. But they are not benign drugs for me at all.>

> Maybe you should try Adderall, and if that doesn't work, Desoxyn is the favorite of sleep docs. But no matter what you take, maximize your antidepressant/antipsychotic or whatever regimen you take, because mood is the biggest factor in helping you feel more awake, regardless of your sleep disorder.

Well, nortriptyline actually has a therapeutic window, meaning that if your plasma levels rise above a certain point, the effectiveness as an AD is lost. It is not a question of side effects worsening, as it is with drugs with a flat dose-response curve, like the SSRI's. The effect is simply lost. As it is, I take 100 mg/day, and the Ritalin I take raises my plasma levels slightly. Nortriptyline strikes a balance between energizing (noradrenergic) and sedating (antihistaminic) effects for me, which has cleared up my chronically stuffy nose, among other things, and I found it to be a far less fatiguing med than Strattera. I seriously doubt that cymbalta would be more energizing or effective than nortriptyline, and given the difficulties I have tolerating meds, I don't even know that I would tolerate it. TCA's tend to be easier on the GI tract than the newer AD's, and I have a pretty severe case of IBS, which nortriptyline at least partially relieves. By the way, the analgesic properties of Cymbalta are shared by the TCA's, which appears to be related to their noradrenergic mechanisms.
>
> I hope you've gotten a sleep study, to rule out apnea. I have a very benign case, but get a BiPAP machine anyway.

well, i know I don't snore, which I thought was pathognomic of apnea. Anyway, the nature of the sleep problems I experience seem to indicate narcolepsy: I get sensations of intense dreaming on falling asleep, and I wake immediately after (two minutes, let's say, have elapsed on the clock). They are unmistakably REM episodes since they often include 'false awakenings' which I don't believe occur during any other stage of sleep.
>
> You SHOULD explore Cymbalta, because it really does help so many with energy and motivation and you might notice an effect in 1-2 weeks with peek effect in just 4 weeks. You're on a very low-tech drug, and I think you should at least try adding Cymbalta to the mix.
>
Low-tech, yes, but we are talking about molecules, not vacuum cleaners. Nortriptyline and related drugs are 'dirty' and this means that statistically people are more likely to have adverse effects during carefully controlled eight-week trials. But some tolerate the older drugs better. This is probably due to the complex interplay between the drugs and a host of genetic factors.

> Don't rely on stimulants alone to pull you through. Switching or uping their doses does help, but not forever. Trust me. Been there, done that.

my therapist told me that inattentive ADD responds less robustly to stimulants. Unfortunately, I know this already. Sleep hygiene, careful adherence to dosing schedule, and diet seem to be ways of optimizing response.

-z


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