Posted by SLS on March 21, 2016, at 12:24:39
In reply to Re: Tricyclics and bipolar depression » linkadge, posted by B2chica on March 21, 2016, at 9:42:45
As I mentioned above, you may very well have a unipolar depression with psychomotor agitation that resembles the melancholic subtype. People with this kind of depression usually feel worse in the morning and experience more early morning awakenings. If this is indeed the case, a tricyclic antidepressant would be a good choice. I would choose nortriptyline. It is not usually activating and has mild anticholinergic side effects compared to amitriptyline. Amitriptyline is better for insomnia, though.
If you are bipolar and will ultimately respond to a TCA, I would avoid those drugs that are serotonin reuptake inhibitors. The TCAs that are not SRIs include desipramine, nortriptyline, and trimipramine. Linkadge's suggestion of using doxepin is an interesting one. It tends to promote sleep and reduce anxiety. It is strongly antihistaminic. However, doxepin is not quite as effective for depression as are the other TCAs in my opinion. Still, it might work for you. Interestingly, trimipramine improves sleep architecture in depression, but I don't know how well it works for severe insomnia. I tried trimipramine and found it to be very tolerable. I think you are going to need to have a conversation with your doctor about trying a TCA either with or without adding Zyprexa, even if only temporarily.
If you find amitriptyline to be effective for depression but intolerable, you can move to nortriptyline and perhaps employ Linkadge's strategy to combine cyproheptadine (Periactin) with melatonin for insomnia.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1087318
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