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Dr. Bob is Robert Hsiung, MD,
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Posted by katekite on May 31, 2002, at 21:34:11
In reply to Trimipramine for Sleep » Angel Girl, posted by fachad on May 28, 2002, at 9:48:24
Thanks fachad... I am really interested to hear further info on this and about other alternatives to benzos.... I've now been on klonopin for 9 months and it has really screwed up my sleep. But... try to get off and have rebound insomnia.
The dopamine antagonism has me concerned though, esp residual coding probs next am, etc as I need all my dopamine during the day.
have also been looking at clonidine, used in little kids with ADD to make them sleep, wonder if any adults use it.
kate
Posted by fachad on June 1, 2002, at 15:16:45
In reply to Re: Trimipramine for Sleep(fachad), posted by johnj on May 31, 2002, at 18:13:07
JohnJ,
I do not have any anxiety. My problem is the opposite - I don't even feel anxious when really bad things are happening or are about to happen.
Someday I think apathy disorders will be recognized as the polar opposite of anxiety disorders, in the same way as mania is the polar opposite of depression.
So I can't say if trimipramine helps with anxiety, because I don't have any. I will say that it does not aggrivate my apathy and lethargy as much as Ativan.
Comparing the next day effects of Trimip vs. Ativan, trimip makes me feel a little more sleepy first thing in the morning, but fine the rest of the day. Ativan makes me feel apathetic, lethartic, and a little down for the whole rest of the next day.
As always, YMMV.
> HI,
> I read the articles you attached with much interest. I suffer from depression with quite a bit of anxiety. Which comes first is still a mystery, but I have a feeling anxiety plays a big role and then my sleep becomes disturbed and depression follows. Has trimipramine helped with anxiety? How sedated are you the following morning? I read the one study that said there was decreased coding ability(I assume this means cognitive impairment?). What have been your experiences? Thanks
> Johnj
Posted by fachad on June 1, 2002, at 15:30:12
In reply to Re: Trimipramine for Sleep » fachad, posted by katekite on May 31, 2002, at 21:34:11
Were you put on benzos for sleep or anxiety or both? I've heard that for anxiety, benzos are really the best treatment - much better than SSRIs or other alternatives.
For sleep, from an objective standpoint (PSG and EEG), trimipramine is the best med period. I experience better sleep subjectively also, but that will vary from person to person.
The dopamine antagonism of trimpramine is really minimal - much less than the weakest APs. It only looks significant when compared to other ADs, which have little to no DA antagonism.
As far as coding ability, or general cognitive ability, my experience is that trimipramine is far less of problem than Ativan.
Ativan hits me pretty hard the whole next day, both in terms of cognitive impairment and in terms of making me feel a little melancholy.
The trimipramine grogginess dissipates much quicker for me than the Ativan lethargy and melancholy.
Just so you know, my Ativan doses were 1 mg or 2 mg and my trimipramne doses are approx 12.5 mg or 25 mg.
To get 12.5 mg I dump the powder from a 25 mg capsule into a tall glass of water, stir, then drink half the glass. 25mg is the smallest capsule they make, and 12.5 mg does the job for me with less residual effects than 25 mg.
I considered clonadine, but it can cause depression and it can cause rebound high blood pressure when it wears off in the morning. I don't want to introduce any new problems, I already have my lifetime allotment...
> Thanks fachad... I am really interested to hear further info on this and about other alternatives to benzos.... I've now been on klonopin for 9 months and it has really screwed up my sleep. But... try to get off and have rebound insomnia.
>
> The dopamine antagonism has me concerned though, esp residual coding probs next am, etc as I need all my dopamine during the day.
>
> have also been looking at clonidine, used in little kids with ADD to make them sleep, wonder if any adults use it.
>
> kate
Posted by katekite on June 1, 2002, at 20:33:45
In reply to Trimipramine for Sleep - DA, coding, clonidine,etc » katekite, posted by fachad on June 1, 2002, at 15:30:12
thanks. The klonopin was originally for anxiety. But it turned out that was a misdiagnosis as what I actually have is more a 'mental restlessness and overwhelmed behind feeling' of ADD... which disappears on ADD meds. Since starting ADD meds I have found I do experience anxiety occasionally but not to the point of needing medication for it or it interupting sleep -- just finally know what anxiety is versus what I always thought was anxiety.
My sleep problems seem to be a result of being wound up and thinking in circles taking forever to go to sleep, also waking frequently and too early (like when come up to start a new sleep cycle will wake at slightest sound and not go back to sleep).
I'll look into trimipramine, it sounds like its worth a shot.
Thanks again,
kate
Posted by Cece on June 1, 2002, at 20:39:29
In reply to Trimipramine for Sleep » Angel Girl, posted by fachad on May 28, 2002, at 9:48:24
Thanks for all the info on Trimipramine. I have taken it for about a year, replacing Nortiptyline. I like it better than Nort- I feel like I sleep more normally, less like a 'log'. I didn't know that it was so atypical- very interesting.
I just skimmed the articles, catching what I could. I'm wondering if you know what these terms mean: "reduced coding ability" (referred to re morning-after effects, and "latent REM'?
Thanks,
Cece
Posted by Cece on June 1, 2002, at 21:07:02
In reply to Trimipramine for Sleep - DA, coding, clonidine,etc » katekite, posted by fachad on June 1, 2002, at 15:30:12
Fachad-
I see that you already answered my question about "coding".
I take 25mg Trimipramine at night. I do have a slow time waking up in the morning, but always have to some extent. And as you say, any grogginess wears off very fast. I have no anti-cholinergic side effects.
I take other meds too, and am weaning off of benzos. I was taking 1.25 mg/day of xanax (for about 3 years), with .75 of it at night. I've cut down to .5 at night and already feel less overall cognitive problems. I'm going to continue going down and hope to get off it entirely. I've taken .125mg- that is 1/4 of the smallest tab made, a real chopping chore- of klonopin at night for a long time (about 10 years). I'm going to wean off that also. I'd like to get all benzos out of my regime. I find that Neurontin is a better calming med for me.
I've recently been trying out thyroid supplement therapy- moving from the low end of normal to the high end. That is doing wonders for my overall alertness and energy, and for waking up in the morning. I used to be able to sleep through 3 alarm clocks, and sometimes used 976-WAKE as a last resort! Now, my alarm clocks get me out of bed pretty easily. And I don't feel overly activated.
I do have a bad habit of staying up too late, which obviously doesn't help- I'm working on that. I get obsessed with whatever I'm doing and have a hard time telling myself to set it aside for another day. I find that Trimipramine is somewhat subtle in "inducing" sleep, at least at the low dose I take. It doesn't knock me out, I have to cooperate with it.
Cece
Posted by omega man on June 1, 2002, at 22:42:48
In reply to Unable to sleep yet again!, posted by Angel Girl on May 27, 2002, at 2:13:35
i got a new drug called zopiclone..in Uk..it hits really heavy...with less groginess the next day than stuff that usually does that..
Posted by fachad on June 1, 2002, at 22:59:10
In reply to Re: Trimipramine for Sleep- P.S. » fachad, posted by Cece on June 1, 2002, at 21:07:02
Cece,
Have you gained weight from your 25 mg/day? I gained from only 5 or 10 mg/day of doxepin, but so far, after a month, I have not gained from trimip.
Also regarding sleep induction, Ambien is really superior for that. It just wears off too fast and is useless for sleep maintanence. I found trimp becasue of frustration with Ambien short effects.
I frequently take 5 mg of Ambien with my trimip, the Ambien puts me out FAST, and the trimip keeps me asleep. Plus, each med reduces the dosage needs of the other.
> Fachad-
>
> I see that you already answered my question about "coding".
>
> I take 25mg Trimipramine at night. I do have a slow time waking up in the morning, but always have to some extent. And as you say, any grogginess wears off very fast. I have no anti-cholinergic side effects.
>
> I take other meds too, and am weaning off of benzos. I was taking 1.25 mg/day of xanax (for about 3 years), with .75 of it at night. I've cut down to .5 at night and already feel less overall cognitive problems. I'm going to continue going down and hope to get off it entirely. I've taken .125mg- that is 1/4 of the smallest tab made, a real chopping chore- of klonopin at night for a long time (about 10 years). I'm going to wean off that also. I'd like to get all benzos out of my regime. I find that Neurontin is a better calming med for me.
>
> I've recently been trying out thyroid supplement therapy- moving from the low end of normal to the high end. That is doing wonders for my overall alertness and energy, and for waking up in the morning. I used to be able to sleep through 3 alarm clocks, and sometimes used 976-WAKE as a last resort! Now, my alarm clocks get me out of bed pretty easily. And I don't feel overly activated.
>
> I do have a bad habit of staying up too late, which obviously doesn't help- I'm working on that. I get obsessed with whatever I'm doing and have a hard time telling myself to set it aside for another day. I find that Trimipramine is somewhat subtle in "inducing" sleep, at least at the low dose I take. It doesn't knock me out, I have to cooperate with it.
>
> Cece
Posted by johnj on June 2, 2002, at 0:47:47
In reply to Re: Trimipramine for Sleep- P.S. » fachad, posted by Cece on June 1, 2002, at 21:07:02
HI,
I currently take nortryptline 50 mg, and have tried to switch, due to nort. causing things to get screwed up when I excercise. How did you make the switch from one TCA to another? Do you excercise? Did you find norty to have negative effects when you did excercise? My doc tried to switch me to imipramine, but after going up 20 mg the side effects, dry mouth, and some jitterness were too much. I take tranzene, a benzo, for anxiety and that is a big problem with my depression. Thanks
Johnj
Posted by Cece on June 2, 2002, at 23:54:41
In reply to Re: Trimipramine (CECE) Nortryptline question, posted by johnj on June 2, 2002, at 0:47:47
John-
My pdoc had me switch Trim for the Nort directly- no phasing- and it was just fine. I was taking the lowest cap of Nort (forget exactly now how much- maybe 25mg).
I don't officially exercise, but am very active and garden a lot. I don't recall any particular problem from the Nort. But if I went up any higher on my dosage I got very nasty dry mouth.
Cece
Posted by johnj on June 3, 2002, at 8:08:15
In reply to Re: Trimipramine (CECE) Nortryptline question » johnj, posted by Cece on June 2, 2002, at 23:54:41
Hi,
Do you have a lot of anxiety with your depression? I take is that is why you take xanax and klonopin. Have you found the trimipramine helpful with depression also? Thanks
Johnj
Posted by johnj on June 3, 2002, at 13:59:36
In reply to Trimipramine - Wt. Gain and Sleep Induction » Cece, posted by fachad on June 1, 2002, at 22:59:10
Hi,
This has been a great thread and I was wondering how you found all that info on trimipramine? I am looking to get off nortryptline since it causes some problems when I excercise, and wonder if trimipramine might be better. I worked outside yesterday and felt like crap in the evening and woke up early so today is not very good. I need the help with sleep that is for sure.
I think the benzo helps my anxiety, but it can possibly lead to some depression problems so I want to limit my benzo dose.One of the articles stated the following:
<Based on experience using trimipramine, a profile of 'ideal' patient characteristics has been built up. Finally, the use of trimipramine in selected patient populations is reviewed.> Do you have any idea how I can find this information?Was the article posted just an abstract?
You seem to know how to get your hands on some quality info and any pointers would be appreciated. Thanks, and I hope your sleep is better.
Johnj
Posted by Cece on June 4, 2002, at 13:46:26
In reply to Trimipramine - Wt. Gain and Sleep Induction » Cece, posted by fachad on June 1, 2002, at 22:59:10
Fachad-
I don't think that I've gained weight on the trimipramine, but (see previous posts, I think on this thread), I have gained weight sine I went off Topomax.
The Depakote that I take does contribute to weight gain, even though I only take 250mg/day. But I think that that is a permanent med for me- in the past when I've experimented with going off it entirely I have had relapses into terrible moods- getting up on the wrong side of bed style.
I also take Lamictal which for some people seems to cause weight gain. Again, I'm not sure if that's true for me- I don't think so.
I'm hoping that over time the Thyroid will change my metabolism. I've always had to fight with my weight- never a skinny person.
Thanks for the info about the Ambien. I'm actually falling asleep fine these days, but will keep the info in mind. Also, I'm trying to simplify my med regime as much as possible, so hate to think of adding yet another pill. I'm already running my own little pharmacy here and it's a lot of work.
Cece
Posted by Cece on June 4, 2002, at 13:59:04
In reply to One more question (CECE) , posted by johnj on June 3, 2002, at 8:08:15
John-
I have had my share of anxiety, but it's not a constant for me. In the past, I was very anxious. I would characterize my current tendencies more toward franticness.
I started taking xanax, because I took it before I had a MRI (I'm prone to claustrophobia). I felt really good the next day and told my previous pdoc. So, I started taking a little. Then he went to a conference where xanax was discussed as having AD properties, and it became a regular med for me. In retrospect, I'm not so sure that it was necessary except maybe PRN, and probably not such a good idea. I think that he was a little too casual about it.
Klonopin, in a tiny dose, was my first med, prescribed before I started 'real' treatment, for anxiety. It helped, and has stayed in my mix for over 10 years. Since it also has some anti-convulsive properties, it seemed like maybe a good idea. But, I'm not so sure that it's necessary, either (I only take .125mg/day).
My current pdoc thinks that it is a good idea for me to try taking the benzos out- very slowly of course. I do have some cognitive slowing, and they are the most likely culprit. The other meds I take may treat my anxiety just fine.
Cece
Posted by Cece on June 4, 2002, at 14:02:13
In reply to Re: Trimipramine - (fachad), posted by johnj on June 3, 2002, at 13:59:36
Actually, it wasn't I who found all that good info- check the previous posts. I've gotten a lot of new and good info from this thread myself.
Cece
Posted by johnj on June 4, 2002, at 14:56:01
In reply to Re: Trimipramine - (fachad) » johnj, posted by Cece on June 4, 2002, at 14:02:13
Can you tell me what this medication is for? It sounds like we have some similiarties since I take norty. and a benzo(tranzene). Have you ever tried lithium? Thank you
johnj
Posted by Cece on June 4, 2002, at 16:40:33
In reply to Re: Neurotin - (CECE), posted by johnj on June 4, 2002, at 14:56:01
John-
I tried lithium some time ago- couldn't handle the side effects and it didn't seem to work well anyway. My main mood stabilizer now is Lamictal which is working out to be a very good med for me. The Neurontin balances well with it, for me- the Lamictal is an activating MS and has AD effects as well. The Neurontin is calming and gives me a sense of well-being. It also helps my fibromyalgia.
I began Nortriptyline as an AD and to help sleep (I had problems with the quality of my sleep, not being able to fall in to the deep level that is restorative). My current pdoc switched me to the Trim. and I sleep well and get less morning grog than with Nort. Since good sleep is important (probably the key) to treating fibromyalgia, it helps that too. I really can't tell how much AD effect I get off it- too many meds, and I've been on a TCA for so many years. Nort certainly wasn't enough of an AD for me, at least at the very low dose that I could handle (side effects).
I am BPII with much history of depression. I am doing well now- almost normal ups and downs, but still with a lower than normal tolerance for stress.
Cece
Posted by fachad on June 4, 2002, at 19:12:19
In reply to Re: Trimipramine - (fachad), posted by johnj on June 3, 2002, at 13:59:36
I searched a medline database for hypnotics.
I was turned off by benzodiazapines after I found out that they mess up sleep architecture and prevent deep stage 4 sleep.
I had thought there was little difference between the tertiary TCAs (amitriptyline, doxepin, imipramine, trimipramine) except for degrees of H1 blockade (drowsiness) and ACH blockade (dry mouth, etc). But then I found all these articles on trimipramine and how it was unique in structure, lack of reuptake, and beneficial effects on sleep architecture.
I would expect it to have some effect on anxiety, but I don't really know.
> Hi,
>
> This has been a great thread and I was wondering how you found all that info on trimipramine? I am looking to get off nortryptline since it causes some problems when I excercise, and wonder if trimipramine might be better. I worked outside yesterday and felt like crap in the evening and woke up early so today is not very good. I need the help with sleep that is for sure.
> I think the benzo helps my anxiety, but it can possibly lead to some depression problems so I want to limit my benzo dose.
>
> One of the articles stated the following:
> <Based on experience using trimipramine, a profile of 'ideal' patient characteristics has been built up. Finally, the use of trimipramine in selected patient populations is reviewed.> Do you have any idea how I can find this information?Was the article posted just an abstract?
> You seem to know how to get your hands on some quality info and any pointers would be appreciated. Thanks, and I hope your sleep is better.
> Johnj
Posted by johnj on June 4, 2002, at 21:05:51
In reply to Re: Trimipramine - (fachad) » johnj, posted by fachad on June 4, 2002, at 19:12:19
Hi again:
I am a little knew with the lingo so I wondered if you could explain "reuptake" to me. Do you mean trimipramine doesn't affect seratonin very much? Thanks
Johnj
Posted by fachad on June 5, 2002, at 9:58:05
In reply to Re: Trimipramine - (fachad) one more question, posted by johnj on June 4, 2002, at 21:05:51
There are (at least) two known ways a drug can interact with a neurotransmitter/receptor system.
It can inhibit reuptake. This means that when the nerve fires by releasing the neurotransmitter, the transmitter is not sucked back up into the nerve. This makes its effects longer. SSRIs like Prozac, Paxil, etc. inhibit the reuptake of serotonin without effects on norephenepherine or dopamine.
The second major way a drug can interact with a nerve is by blocking its receptor site. This has the opposite effect. Even if the nerve fires and releases it's neurotransmitter, and even if that neurotransmitter stays in the synapse longer, it will have reduced effects because the receptor is blocked.
Most antidepressants were believed to work thru inhibiting reuptake of NE or 5HT or both. Side effects are often caused by blockade.
Trimipramine does not inhibit reuptake of NE or 5HT to any significant degree. It does have blockade properties at H1 histamine receptors, ACH cholenergic receptors (dry mouth) and others.
But as to how it relieves depression, it is not known. It has been shown to be as effective as the drugs that inhibit reuptake.
It may be the lack of reuptake properties that explains why it uniquely enhances sleep.
> Hi again:
> I am a little knew with the lingo so I wondered if you could explain "reuptake" to me. Do you mean trimipramine doesn't affect serotonin very much? Thanks
> Johnj
Posted by katekite on June 8, 2002, at 10:19:52
In reply to Re: Trimipramine - Reuptake and Blockade » johnj, posted by fachad on June 5, 2002, at 9:58:05
Saw my pdoc on Thursday and asked for trimipramine. Am having endrocrine testing done soon and so he said no: trimipramine decreases cortisol and increases prolactin.
Maybe after testing is all done. I really need to sleep well and I have a hunch trimipramine would do it.
Came away instead with ambien and vistoril (the name sounds like it ought to keep you up to see the vistas). Ambien is like sonata for me except lasts 5 hrs instead of 3.5. It also, at least on the first try seems to have less of a drugged feeling the following day. Vistoril is just hydroxyzine a sedating anti-histamine and that is weak weak weak, but not as drying out as benadryl and I did actually sleep for 7 hrs last night with it so I can't say it doesn't work, it just didn't have much kick to it.
I'll be trying to rotate ambien sonata benadryl and hydroxyzine to avoid becoming dependent on sonata or ambien (which are enough like benzos to have at least some dependency potential, despite all the advertising that says they aren't benzos.)
kate
Posted by Chloe on June 9, 2002, at 19:46:45
In reply to didn't get trimipramine, boo hoo., posted by katekite on June 8, 2002, at 10:19:52
Hi Kate,
Sorry you have to endure those tests. Just wanted to tell you that I got trimip 25 mgs. I have taken it the last two nights and have had awful sleep. I am used to amitriptyline, and trimip doesn't seem to touch me. YMMV. I was awake all last night :(. I hope you have a better time with it. Please let us know...I think I am wierd!Take care,
Chloe
Posted by hildi on August 16, 2003, at 16:45:21
In reply to Re: Trimipramine for Sleep - DA, coding, clonidine,etc » fachad, posted by katekite on June 1, 2002, at 20:33:45
Hi Katekite- ADD is what they finally diagnosed you with? (I have talked with you before-this is so new and different a diagnosis) What are you taking for the ADD??
Hildi> thanks. The klonopin was originally for anxiety. But it turned out that was a misdiagnosis as what I actually have is more a 'mental restlessness and overwhelmed behind feeling' of ADD... which disappears on ADD meds. Since starting ADD meds I have found I do experience anxiety occasionally but not to the point of needing medication for it or it interupting sleep -- just finally know what anxiety is versus what I always thought was anxiety.
>
> My sleep problems seem to be a result of being wound up and thinking in circles taking forever to go to sleep, also waking frequently and too early (like when come up to start a new sleep cycle will wake at slightest sound and not go back to sleep).
>
> I'll look into trimipramine, it sounds like its worth a shot.
>
> Thanks again,
>
> kate
Posted by BekkaH on August 16, 2003, at 23:44:06
In reply to Re: Trimipramine for Sleep - DA, coding, clonidine,etc » katekite, posted by hildi on August 16, 2003, at 16:45:21
Hi Hildi,
Unfortunately, I haven't seen KateKite here in a long time. She always had a lot to say and I wish she'd return.
Bekka
Posted by hildi on August 18, 2003, at 18:10:27
In reply to Hildi, I haven't seen KateKite , posted by BekkaH on August 16, 2003, at 23:44:06
Hi Bekka. Thanks for responding. I didn't look at the date of katekite's posting, if I had I would have noticed that this was an old post.
This was the first time in a long that I visited Psychobabble myself. But, earlier I had noticed that I hadn't seen posts from her, which seemed odd and sad because she always wrote a lot and had good things to say.
I hope she is well.
HildiHi Hildi,
>
> Unfortunately, I haven't seen KateKite here in a long time. She always had a lot to say and I wish she'd return.
>
> Bekka
This is the end of the thread.
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