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Re: Help, I can't sleep, No seroquel » linkadge

Posted by SLS on January 17, 2007, at 6:45:51

In reply to Re: Help, I can't sleep, No seroquel » SLS, posted by linkadge on January 16, 2007, at 20:29:34

> I might mention it at a the next doctors apt.
>
> Have you ever taken trimipramine? Perhaps not as strong an AD.


Yes. I tried trimipramine. Although I didn't see a hint of a response to it (I'll double-check my notes), I would not discourage you from trying it. It might be the ideal drug for you to test the waters of TCA. Perhaps you can then move on to nortriptyline if trimipramine is without effect. You know, of course, the potential of trimipramine to enhance sleep architecture, so there are multiple reasons for you to try that first. I can't attest to the subjective experience of HR and palpitations with trimipramine. My body has become so accomodated to the effects of tricyclics, I am a poor judge of it.

TCA and elevated HR is a package deal. It does mitigate over time, but it is likely to remain elevated relative to your unmedicated baseline. I have not yet been given enough reason to be afraid of this as a long-term condition. Maybe you can research this further to help settle your mind or unsettle mine. :-)

Consider the TCA thing a 4-6 week experiment if you are uncomfortable with a long-term commitment. The outcome might provide you with some important information about your psychobiology. With nortriptyline, I recommend starting at 25mg at night and working up to 75mg as your initial target dosage. If after 3 weeks you don't respond, then I would raise the dosage to 100mg and go another 3 weeks and/or assay your blood level. Although the therapeutic range is supposed to be 50-150 ng/ml, I would opt for adjusting the dosage to reach towards the upper limit. You know, of course, that unlike the other TCAs, nortriptyline has a dosage window of efficacy. If you take too much, you can lose the therapeutic effect. Most people respond to 75-100mg

It is my hope that you respond favorably (perhaps for the first time) to one of the TCAs and become accommodated to the CV side effects. In order for you to become comfortable with living long-term with an elevated HR, you will probably want to do some research into the consequences of doing so. Remember, though, that although TCAs are labelled "cardiotoxic", they may not be cardiotoxic at therapeutic dosages. I believe that it is an infrequent event that conduction abnormalities should appear.

See if the crap works first. You have plenty of time to decide how long you think it is safe to live with. Since you are a "virgin", the sensations of elevated HR and palpitations will be significant early in treatment, but they will most likely disappear with time.

TCA responders:

Melancholic mood and thoughts.
Insomnia
Early morning awakenings
Morning worst time
Lack of appetite - low body weight
Agitation


- Scott

 

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URL: http://www.dr-bob.org/babble/20070113/msgs/723112.html