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Re: clomipramine insomnia - does it ever go away? SLS

Posted by undopaminergic on January 29, 2023, at 9:54:29

In reply to Re: clomipramine insomnia - does it ever go away? undopaminergic, posted by SLS on January 29, 2023, at 8:21:04

> > >
> > > 2. If insomnia is the problem you are addressing, there are several medications that would probably give favorable results.
> > >
> > > zolpidem (Ambien) - Z-drug
> > > lorazepam (Ativan) - benzodiazepine
> > > temazepam (Restoril) - benzodiazepine
> > > clonazepam (Klonopin) - benzodiazepine
> > > quetiapine (Seroquel) - antipsychotic
> > > mirtazepine (Remeron) - antidepressant
> > > doxepin (Sinequan) - antidepressant (TCA) - Extremely antihistaminergic
> > > amitriptyline (Elavil) - antidepressant (TCA)
> > > trimipramine (Surmontil) - antidepressant (TCA)
> > > prazosin (Minipress) - Specific for PTSD nightmares.
> > >
>
>
> > What about cyproheptadine (Periactin)? It's an antihistamine but also blocks serotonin 5-HT2A, which may improve sleep quality.
>
>
> Sleep architecture?

Yes, something about slow wave or deep sleep last time I checked (but I did not go into depth).

> I think it is important to acknowledge the possibility that cyproheptadine does things other than block histamine receptors.
>

There is no question that it does. It can be used as an antidote to serotonin syndrome. Then again, even chlorpromazine seems to work for this purpose.

> We tend to pigeon-hole things in order to make sense of the world. Lamotrigine was pigeon-holed as an anticonvulsant before it was found serendipitously to exert antidepressant effects. I was a patient at the NIH in 1992-1993 when the seizure disorders unit reported to the biological psychiatry unit that a bunch of people who were taking lamotrigine for epilepsy reported an improvement in their comorbid depressive disorder.
>

Many anticonvulsants have found additional indications, though usually inofficially. But I think sometimes there is an unfounded belief that *any* anticonvulsant should work as a mood stabiliser.

> > Midazolam (Dormicum) is another short-acting benzodiazepine suitable for sleep initiation, but it seems to be available (as Versed) only for injection in the US.
>
>
> Ah. I had no idea that midazolam good for sleep-initiation. Isn't midazolam used as an adjunct in general anesthesia?
>

Yes, and other purposes where a sedative-hypnotic is useful.

> > > About melatonin:
> > >
> > > 1. Melatonin can make depression somewhat worse.
>
>
> > Yet there is an antidepressant (agomelatine -- Valdoxan) that is a melatonin agonist.
>
>
> Yes. What else does it do?

It is known to block serotonin 5-HT2C receptors, yielding a dopaminergic effect. But its half-life is only about 2 hours, so I'm not sure how useful this property is in practice.

> That's the question one should always ask, especially when other pharmacological properties of a drug have yet to be discovered.
>

Few, if any, compounds are tested for an exhaustive list of targets. Moreover, not all receptors and sites are even known yet.

> > Dose is also important. There are people who insist that 300 mcg (micrograms) is better than higher doses.
>
>
> I insist that lithium displays a similar clinical trait. For me, 300 mg/day is magic. At 450 mg/day, I very quickly relapse. Lithium has been reported to have a biphasic effect on glutamate release. You commented on this, noting that this bimodal pharmacological property displays a dosage-response curve regarding glutamate release, but can yield conflicting clinical results depending on the study being examined.
>

So there is some other study (beyond the one I cited) pertaining to this effect?

> > > 3. Herbal teas. Valerian is mentioned often. Chamomile, lemon grass, and eleuthero are others with reputations as being sleep-aids.
>
>
> > Eleutherococcus is also called Siberian Ginseng.
>
>
> I wish I had your memory.

I think my memory is at its best when it comes to drugs. Contrast that with mathematics: often I have to determine the result of 3+4 by counting "5, 6, 7".

> I am still having trouble with mine. My guess is that the impairment of short-term memory associated with depression is one of the last things to resolve. I had a few bilateral ECT treatments in the 1990s, so this must be taken into consideration. However, I doubt that there are any residual memory deficits produced by ECT for me. We'll see.
>

What memory performance is considered "normal" or "good", and how is it measured? There are some answers to that, I'm sure, and it is a science in itself, but the point I'm hinting at is that almost everyone seems to think their memory isn't good enough.

> > I got angry from Valerian. It was very unusual in how it started and in its qualities. But it has only happened once.
>
>
> I hate that there are so many differences in the way people respond to a given treatment. Trying to generalize and predict one's reactions to specific drugs is a fool's errand. It is frustrating and makes me feel impotent. We are all trying to help each other in the face of inconsistency and paradox. Dammit.
>

Yes.

-undopaminergic


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poster:undopaminergic thread:1121637
URL: http://www.dr-bob.org/babble/20230117/msgs/1121686.html