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Re: Adding Parnate and prazosin. sigismund

Posted by SLS on January 15, 2012, at 7:50:41

In reply to Re: Adding Parnate and prazosin. SLS, posted by sigismund on January 15, 2012, at 1:50:47

> I would like deeper sleep and more of it. I have been thinking of trimipramine, guanfacine, nefazodone and prazosin (possibly acamprosate as well) as things which may be useful.

Those are all some pretty brainy choices. I'm sure you'll find something that is a good match for you.

> If they make me feel better in the day, that would be a bonus.

Trimipramine would be a logical choice if depression is mixed-up in your condition somehow. Prazosin might smooth out disturbed sleep, but I don't know if it helps to sleep deeper. If PTSD is in there somewhere, it might be a good choice. Nefazodone is a worthy choice for improving sleep architecture. My concern with nefazodone is that this effect cannot be sustained beyond a few weeks as reported by the second study appearing below. They might be wrong, though. I found another study that made no mention of diminishing effect after 8 weeks.

- Scott


Neuropsychopharmacology. 1994 Apr;10(2):123-7.
The effects of nefazodone on sleep architecture in depression.

Armitage R, Rush AJ, Trivedi M, Cain J, Roffwarg HP.

University of Texas Southwestern Medical Center, Dallas 75235-9070.

A polysomnographic study was conducted on 10 outpatients with major depression at baseline and during 4 to 8 weeks of open-trial treatment with nefazodone (400 to 600 mg/day). All 10 patients were treatment responders as evidenced by at least 50% reduction from baseline scores on the Hamilton Depression Rating Scale. Nefazodone was associated with significantly decreased wake and movement time and increased minutes and percentage of stage 2 sleep at the expense of light stage 1 sleep. Nefazodone did not increase rapid-eye-movement (REM) latency and it did not suppress REM sleep. In fact, a trend toward increased REM in the second REM period was observed, although decreased REM in the third REM period was also noted. In summary, nefazodone, an effective antidepressant, decreases arousals and wakefulness during sleep and reduces light non-REM sleep. This agent does not appear to suppress REM sleep or prolong REM latency in patients who respond to treatment.

[PubMed - indexed for MEDLINE]


Br J Psychiatry. 2002 Jun;180:528-35.
Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression.
Hicks JA, Argyropoulos SV, Rich AS, Nash JR, Bell CJ, Edwards C, Nutt DJ, Wilson SJ.

Psychopharmacology Unit, University of Bristol, UK.

Sleep effects of antidepressants are important clinically and for elucidating mechanism of action: selective serotonin reuptake inhibitors disturb sleep and 5-HT(2) receptor-blocking compounds may enhance sleep quality.

To compare the objective and subjective effects on sleep of paroxetine and nefazodone in patients with moderate to severe depression.

Forty patients with depression were randomised to take paroxetine 20-40 mg/day or nefazodone 400-600 mg/day for 8 weeks. Objective and subjective quality of sleep and depression measures were assessed throughout.

Nefazodone significantly increased objective sleep efficiency and total sleep time, and improved subjective sleep on days 3 and 10. Paroxetine decreased sleep efficiency early in treatment and some sleep disruption remained at week 8. Paroxetine but not nefazodone produced marked suppression of rapid eye movement (REM) sleep.

Nefazodone improves sleep in early treatment compared with paroxetine in patients with moderate to severe depression. These effects are seen within the first 2 weeks of treatment and diminish thereafter.

[PubMed - indexed for MEDLINE]

Free full text


J Clin Psychopharmacol. 1997 Jun;17(3):161-8.
A multicenter, double-blind comparison of the effects of nefazodone and fluoxetine on sleep architecture and quality of sleep in depressed outpatients.
Armitage R, Yonkers K, Cole D, Rush AJ.

University of Texas Southwestern Medical Center, Depart. of Psychiatry 75235-9070, USA.

This study was an 8-week, randomized, double-blind, parallel-group investigation that compared the effects of nefazodone and fluoxetine on sleep architecture and on clinician- and patient-rated sleep measures in 43 outpatients with moderate to severe, nonpsychotic major depressive disorder and insomnia. Twenty-two patients received nefazodone 200 mg daily for 1 week, followed by 400 mg daily for 7 weeks. Twenty-one patients received fluoxetine 20 mg daily. Dosage increases (to 500 mg/day for nefazodone and 40 mg/day for fluoxetine) were available after day 29, depending on clinician judgement. Sleep parameters were measured during baseline phase, while patients were unmeasured and symptomatic, and at weeks 2, 4, and 8 of treatment. Nefazodone and fluoxetine were equally effective as antidepressants. However, compared with baseline, nefazodone increased sleep efficiency and reduced the number of awakenings and percent awake and movement time, whereas fluoxetine increased the number of awakenings and did not significantly alter sleep efficiency or percent awake and movement time. Although fluoxetine increased stage 1 sleep and rapid eye movement (REM) latency and reduced total percent REM sleep, nefazodone increased REM sleep, decreased REM latency, and did not alter stage 1 sleep. Differences between treatment groups, based on change from baseline, revealed greater sleep efficiency, fewer awakenings, less percent awake and movement time, less percent stage 1 and more REM sleep, and shorter REM latency for nefazodone compared with fluoxetine. Significantly greater improvement in clinician- and patient-rated sleep disturbance was found with nefazodone compared with fluoxetine. Nefazodone was associated with better sleep quality.

[PubMed - indexed for MEDLINE]

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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