Posted by SLS on March 21, 2018, at 10:41:37
In reply to Re: insomnia on Nortrip! Help me block the NE SLS » SLS, posted by porkpiehat on March 20, 2018, at 14:20:25
Hi, Porkpiehat.
I'll need to think about this for a bit. My initial thoughts are to explore Abilify and Saphris. Abilify is a partial 5-HT1a agonist and D2/3 partial agonist, whereas Saphris is a 5-HT1a, 5-HT7 and is D2 receptor antagonist. Both drugs are 5-HT2a antagonists. Both drugs have antidepressant activity. Neither drug influences NE directly. Abilify causes weight gain generally. Saphris does not.
To the best of my recollection...
Abilify:
D2 partial agonist
D3 partial agonist
5-HT1a partial agonist
5-HT2a antagonistSaphris:
D2 antagonist
5-HT1a antagonist
5-HT7 antagonist
5-HT2a antagonist
I read not too long ago that amitriptyline was okay with MAOI. I used it in combination with Nardil 45 mg/day. I cannot predict how it would have affected me if the Nardil dosage was higher.I'll give more thought to this.
- Scott
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> > > Nortiptyline is proving a good add on to Marplan in terms of mood and anxiety, but the NE in my brain makes it impossible to sleep! I don't feel stimulated, but I am so hyperfocused my brain can't wander off into sleep.
> > >
> > > I'm hoping that something can help block the NE in the central nervous symptom...I was thinking prazosin or propranolol but I think they work peripherally.
> > >
> > > SLS if you're out there your pharmacological wisdom might help!
> > >
> > > please and thank you!
> >
> > Total insomnia?
> >
> > Insomnia can be a good predictor of a positive response. I'm not sure that I would try to block NE. It might be precisely the NE effect that is responsible for your feeling better.
> >
> > You can try adjusting the nortriptyline dosage downwards as was suggested by Ed_UK. However, if you lose the improvement, you will probably need to maintain a higher dosage. In this event, you can add sleep aids - hopefully on a temporary basis. The insomnia might resolve on its own. If all else fails, you can switch from nortriptyline to amitriptyline. Amitriptyline tends to be soporific, so I doubt sleep would be a problem. Unfortunately, anticholinergic side effects are pronounced. You cannot take imipramine or clomipramine in combination with Marplan because of the risk of serotonin syndrome.
> >
> > A few ideas:
> >
> > 1. Ambien for problems with sleep initiation.
> > 2. Ativan or Restoril for problems with sleep maintenance.
> > 3. Seroquel at low dosages.
> >
> > Stay away from trazodone. It is unpredictable and is capable of producing serotonin syndrome when combined with a MAOI.
> >
> > No caffeine! You might want to give things a few more days before making a move.
> >
> > I'm guessing that you are close to finding a treatment that works well for you.
> >
> >
> > - Scott
> >
> >
>
> thanks for your thoughts, Scott. Long story short(ish) ...Trazodone was the only effective thing for sleep first on parnate and now on Marplan. But I found It was impossible to wake up in the morning, and I was finding increased agitation (slight paranoia, seething irritability) that i remembered from past times I took trazodone for sleep.
>
> On a whim I stopped the trazodone and so much changed. irritability gone: nagging feeling that I'm in trouble and need to explain everything I am doing, gone; waking up feeling "blah" about everything. sex drive returned
>
> surprisingly my compulsive drinking smoking and fishing stopped too. My cravings for booze and obsessive focus on fishing/avoiding friends was bad enough I asked my parents and pdoc for help.
>
> Unfortunately within a week of stopping trazodone my concentration and social anxiety started to worsen, and my mind would start to spiral into suicidal plans. My sleep on doxylamine and ativan and gabapentin was "ok." Serotonin side effects such as night sweats and GI problems from the Marplan were back and embarrassing; my voice also became too tight for me to speak confidently.
>
> So I started Nortriptyline (reluctantly) hoping that the 5th2 inhibtion would address the anxiety concentration and physical symptoms. Like every NRI i've taken I knew it would ruin my sleep. NRI's also typically put me into a bored, zoned, detached place. That happened last night and the lack of connection spun me into a sense of hopelessness/depression.
>
> That is why I don't want NE reuptake inhibition on top of the increased NE from the MAOI. More often than not my issues with anger, paranoia, and nervousness, are solved with a beta blocker...so again, NE seems counterintuitive.
>
> I'm guessing the irritability, detachment, and obsessive focus (plus the beneficial ability to foucs) on the trazodone came from 5ht1a agonism, as buspar, viibryd, seroquel, etc. gave me the similar experience. If I could take a pure 5ht2 antagonist I would.
>
> It makes me wonder how well Marplan was handling my symptoms given that I seem to stumble when I change my sleep meds or lamictal brand.
>
> questions: Trazodone has negligable SERT activity below 100mgs and is frequently used for MAOI sleep issues...Doesn't Amitriptyline have more SERT activity? I think I would have trouble selling my doctor on it...
> What are the nasty side effects like?
>
> Wouldn't I end up with the same NE issues as Ami metabolizes into Nort?
>
> thanks for reading this is as condense a description as I could manage.
Some 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:1097503
URL: http://www.dr-bob.org/babble/20180212/msgs/1097544.html