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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Shes_InItForTheMoney on March 12, 2012, at 23:04:18
Hello...
I just started clonidine (Catapress) for my anxiety caused by my mood swings, and in particular, to help me get a good night's sleep. I work shift work, so my sleeping schedule is all outta wack.
Now I have been on psych meds for over 20 years, and I honestly can say I have (been lucky) to try most conventional and unconventional meds.
I have read of clonidine's action on cortisol reduction, and my doc mentioned how well this med works in about 80 percent of his patients (sorry I don't know the n=) and it has been not only the best sleep aid, but general anxiety reducer I have EVER taken. After my shot at all meds out there (available in Canada) I have come to the conclusion that there are a few meds that I combine that control most of my BP2 (w/ Major Depression and Anxiety). I take .5mg of clonidine at bedtime, and .2mg during the day. Even if it makes me a bit woozy and fatigued sometimes, it REALLY seems to take the suckerpunch out of my Effexor dose, and tame some of the SRI's I am on.
Now I wanted to know, is clonidine is an alpha 1 agonist? Scott, you have been on Minipress, which I understand is an alpha 2 agonist? I am getting amazing benefits (knock on wood) from clonidine, as it seems to shut down the hyper-cortisol state I get into with dysphoric mania and major anxiety. My benzos don't even work nearly as good. I seem to be able to prevent the usual side-effects of clonidine like major depression and fatigue, as it seems to balance out my antidepressants.
And I just started Effexor augmentation, and had been suddendly, after a good period, started having SI, suicidal ideation. But once we increased to clonidine, that changed..but am still scared from it since it has been years since I had SI. I was thinking of maybe switching to Nortriptyline, but there are warnings about the fact one is an alpha agonist, the other an alpha antagonist. (I hope I have my homework straight..lol)
So, should I give the Notriptyline a shot? I appreciate your and everyone's input. I am asking you in particular because of you being on Minipress. Thanks kindly,
Jay
Posted by SLS on March 13, 2012, at 0:57:13
In reply to SLS (Scott), anybody,,Clonidine (triggers), posted by Shes_InItForTheMoney on March 12, 2012, at 23:04:18
Hi Jay.
I just wanted to let you know that I saw your post. However, it is 1:37 am, and I should probably try to get back to sleep.
Clonidine = pre-synaptic NE alpha-2 agonist.
Prazosin = post-synaptic NE alpha-1a/b/d antagonist.Both drugs reduce NE activity. However, they act on opposite sides of the synapse. I was thinking that combining the two drugs would work particularly well for PTSD. I guess this would also improve sleep. Prazosin is not depressogenic as far as I know. Clonidine is depressogenic, but not for everyone. There is also propranalol to reduce sympathetic tone. It works well for some people to reduce the autonomic effects of anxiety. It is clonidine, however, that reduces cortisol release the most.
Gosh. I couldn't help myself.
- Scott
Posted by SLS on March 13, 2012, at 5:58:17
In reply to SLS (Scott), anybody,,Clonidine (triggers), posted by Shes_InItForTheMoney on March 12, 2012, at 23:04:18
> Hello...
Hello...
I am so very happy that clonidine is having such a broad therapeutic effect to improve sleep and daytime anxiety.
> So, should I give the Notriptyline a shot?
First of all, nortriptyline blocks NE alpha-1a receptors peripherally in the arteries. This can cause some dizziness via a reduction of blood pressure, particularly upon standing (orthostatic hypotension). You will have to see for yourself how dizzy you get from taking both clonidine and nortriptyline. I take Parnate, nortriptyline, and prazosin, each known to have hypotension as side effects. My static blood pressure is normal. Only occasionally do I get dizzy anymore.
I doubt nortriptyline would act to antagonize the the desired psychotropic actions of clonidine. The brain contains a special NE receptor, designated alpha-1d. It is located in parts of the brain suspected to be involved with depression and anxiety. I am not aware of the NE alpha-1a receptor having psychotropic effect. Ed_UK might know. Each drug interacts with totally different NE receptors. Both drugs tend to reduce NE activity, so they are not antagonistic in this respect. Just know that a minority of people are activated by nortriptyline and other tricyclic drugs. However, nortriptyline is less so than desipramine.
It is not unusual to experience somnolence for the first few days with nortriptyline. Therefore, it makes sense to start at a low dosage. Dosage increases thereafter can be more aggressive. Unlike desipramine, nortriptyline blocks serotonin 5-HT2a receptors, and gives this drug some anxiety-reducing properties as well as pro-dopaminergic cognitive enhancing effects along circuits located in the PFC area of the brain.
I kind of rambled here. I'm too lazy to correct for redundancy. Please ask more questions if you feel the need.
- Scott
Posted by Phillipa on March 13, 2012, at 10:10:02
In reply to Re: SLS (Scott), anybody,,Clonidine (triggers) » Shes_InItForTheMoney, posted by SLS on March 13, 2012, at 5:58:17
Off topic just looking at babble you went to bed after lam and are now up? Isn't that much too little sleep? I always need at least 9hours. How do you manage to do this? Phillipa
Posted by SLS on March 13, 2012, at 14:14:16
In reply to Re: SLS (Scott), anybody,,Clonidine (triggers) » SLS, posted by Phillipa on March 13, 2012, at 10:10:02
> Off topic just looking at babble you went to bed after lam and are now up? Isn't that much too little sleep? I always need at least 9hours. How do you manage to do this? Phillipa
My sleep is very much disturbed at this point. I need more than I am getting, but I experience frequent awakenings during the night and sometimes can't fall back to sleep. However, this insomnia might not be such a bad thing. It might be an indicator that my system is recovering its responsivity to the Parnate + TCA combination. When I was younger and still naive to this treatment, it produced total insomnia in me. I had to take two BZDs to sleep. I welcome drug-induced insomnia. It has always been a good sign for me.
- Scott
Posted by g_g_g_unit on March 14, 2012, at 7:14:11
In reply to Re: SLS (Scott), anybody,,Clonidine (triggers) » Phillipa, posted by SLS on March 13, 2012, at 14:14:16
> My sleep is very much disturbed at this point. I need more than I am getting, but I experience frequent awakenings during the night and sometimes can't fall back to sleep. However, this insomnia might not be such a bad thing. It might be an indicator that my system is recovering its responsivity to the Parnate + TCA combination. When I was younger and still naive to this treatment, it produced total insomnia in me. I had to take two BZDs to sleep. I welcome drug-induced insomnia. It has always been a good sign for me.
Hmm, well I'll try to take the fact that I'm barely sleeping a wink on Parnate in good stead then :)
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