![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by PAT on October 10, 1999, at 8:20:29
I am moderately depressed/w anxiety and can't sleep. Tried Serzone, helped at one time but then got off it. Since then I have tried to go back on with no luck. I become agitated, less people friendly. (Could be lack of sleep). I have also tried remeron (15 mg or 7.5 mg) which made sedated and restless, didn't wear off until late the next day. Didn't sleep that well on it. Same thing with Trazodone. I get the benefit of sedation without restful sleep. Any suggestions or info/experiences on TCA's for sleep or anything else would be helpful.
Posted by Bob on October 10, 1999, at 8:27:34
In reply to TCA's and sleep, posted by PAT on October 10, 1999, at 8:20:29
Go read the melatonin thread above.
Before meds, I tried it and it really worked well, but I wound up with headaches from it as well. The thread above, tho, talks about its sublingual form (which I didn't know about) and how this can be a much better way to take it, since a lower dose is needed.
(and here I am, really antsy to try it again because of those headaches and because I'm on five meds [3 psychotropes, 2 for side effect relief] as it is ... see what I mean folks -- I can dish out the whup'ass at work, I can even take it and sling it right back, but I'm jello at home ... sheesh!)
Bob
Posted by JohnL on October 10, 1999, at 10:00:56
In reply to TCA's and sleep, posted by PAT on October 10, 1999, at 8:20:29
> I am moderately depressed/w anxiety and can't sleep. Tried Serzone, helped at one time but then got off it. Since then I have tried to go back on with no luck. I become agitated, less people friendly. (Could be lack of sleep). I have also tried remeron (15 mg or 7.5 mg) which made sedated and restless, didn't wear off until late the next day. Didn't sleep that well on it. Same thing with Trazodone. I get the benefit of sedation without restful sleep. Any suggestions or info/experiences on TCA's for sleep or anything else would be helpful.
Hi Pat. Most all TCAs are fairly sedating, with the exception of Vivactil (Protrityline). The secondary TCAs such as Nortriptyline and Desiprimine are usually more tolerable than others.
I too have some experience with Trazodone, Remeron, Serzone. I tried low dose of the TCA Nortriptyline with Zoloft for a month. The Zoloft was so bad for sex I had to give it up. The ONLY time I've ever felt total euthymia was with the addition of Nortriptyline, and since that whole cocktail was abandoned (intolerable sex probs, not sure if Zoloft and/or Nortrip, probably just the Zoloft) for trials of other things, I may actually return to Nortriptyline with my Prozac if the current Naltrexone disappoints. To make a long story short, the best sleep of my life was with the TCA Nortriptyline. The sedation during the day does indeed lessen with time, unlike Remeron or Serzone or Trazodone which seemed to cause drowsiness for me that dragged on month after month.
I think a TCA would be a fine choice for sleep. But you'll probably need your doc's intuition to choose the right one. I like Nortriptyline for sleep. Not sure, but I think the most sedating is Clomipramine. Be prepared to wait out some daytime sedation for a month or two. Depends mostly on what dose you take. Sometimes all it takes is a little in late afternoon or dinner. Just food for thought. Sleep on it. :)
Posted by Pat on October 10, 1999, at 11:55:02
In reply to Re: TCA's and sleep, posted by JohnL on October 10, 1999, at 10:00:56
> > I am moderately depressed/w anxiety and can't sleep. Tried Serzone, helped at one time but then got off it. Since then I have tried to go back on with no luck. I become agitated, less people friendly. (Could be lack of sleep). I have also tried remeron (15 mg or 7.5 mg) which made sedated and restless, didn't wear off until late the next day. Didn't sleep that well on it. Same thing with Trazodone. I get the benefit of sedation without restful sleep. Any suggestions or info/experiences on TCA's for sleep or anything else would be helpful.
>
> Hi Pat. Most all TCAs are fairly sedating, with the exception of Vivactil (Protrityline). The secondary TCAs such as Nortriptyline and Desiprimine are usually more tolerable than others.
>
> I too have some experience with Trazodone, Remeron, Serzone. I tried low dose of the TCA Nortriptyline with Zoloft for a month. The Zoloft was so bad for sex I had to give it up. The ONLY time I've ever felt total euthymia was with the addition of Nortriptyline, and since that whole cocktail was abandoned (intolerable sex probs, not sure if Zoloft and/or Nortrip, probably just the Zoloft) for trials of other things, I may actually return to Nortriptyline with my Prozac if the current Naltrexone disappoints. To make a long story short, the best sleep of my life was with the TCA Nortriptyline. The sedation during the day does indeed lessen with time, unlike Remeron or Serzone or Trazodone which seemed to cause drowsiness for me that dragged on month after month.
>
> I think a TCA would be a fine choice for sleep. But you'll probably need your doc's intuition to choose the right one. I like Nortriptyline for sleep. Not sure, but I think the most sedating is Clomipramine. Be prepared to wait out some daytime sedation for a month or two. Depends mostly on what dose you take. Sometimes all it takes is a little in late afternoon or dinner. Just food for thought. Sleep on it. :)John L, Thanks for the info. Would there be any side effects that you can think of with small doses of PAMELOR?????
Posted by JohnL on October 10, 1999, at 15:33:04
In reply to Re: TCA's and sleep, posted by Pat on October 10, 1999, at 11:55:02
> Would there be any side effects that you can think of with small doses of PAMELOR?????I believe the smallest dose is a 10mg capsule. Next size up is 25mg. Full dose is usually 25mg 3 to 4 times daily. I slept fine on 25mg in late afternoon. You know how Trazodone or Remeron kick in real fast and knock you out? Pamelor is more subtle, takes more time.
At 25mg I remember early side effects were blurry vision, daytime sedation, slight confusion, trembly, dry mouth, strange taste, hangover feeling in AM. But they were all mild, not as bad as it sounds. Very similar to serzone actually. After a few weeks, the side effects that persisted were dry mouth, strange taste. Slept great. I actually got to liking that strange taste. Side effects overall were probably more pronounced for me because was also taking Zoloft.
There may be a better choice though. Pamelor is the only one I've tried. Some TCAs lengthen REM sleep, some shorten it. I've read info about that somewhere, wish I could remember where. Somewhere out there in cyberspace is info on TCAs and their effects on REM sleep. In any case, you will likely have some side effects even at low doses, most probably dry mouth.
Posted by saint james on October 10, 1999, at 19:58:38
In reply to Re: TCA's and sleep, posted by JohnL on October 10, 1999, at 15:33:04
Pamelor is the only one I've tried. Some TCAs lengthen REM sleep, some shorten it. I've read info about that somewhere, wish I could remember where. Somewhere out there in cyberspace is info on TCAs and their effects on REM sleep. In any case, you will likely have some side effects even at low doses, most probably dry mouth.
James here....
Correct, in general most AD's that sedate, esp the TCA's, seem to make people dream more and improve the quality of sleep. Benzo's don't have this effect, tend to change sleep cycles so you sleep, but really don't get the best sleep, just more quanity. In judgeing sleep we tend to be more worried about quanity, but the real issue is
good sleep. Good sleep is when you feel rested when you wake up.I took Doxipin for years, as it is the most sedating TCA. Very anti-colinergic, excellext for my allergies. The allergist and dermatologist use Doxipin often for allergic conditions. Start at 25 mgs, no higher, lest you want to sleep 24/7. In general, you should try it, or any sedating AD used for sleep, for 1 month because you can't really tell at first if it is too sedating. Everyone finds these meds very sedating at first, but it is a mistake to quit b4 one month. Once you get used to a med, adjust dose to whatever gives good sleep (i.e. you feel rested in the AM)
At first if a dose is making you a total zommbe after a few days, consider halfing the dose.I had to take 75 mgs of Doxipin to sleep and grew tired of the sexual side effects so I moved on to Remeron, 15 mgs. I found it had less daytime sedation, and worked quicker. TCA's took 1-2 hrs but Remeron takes 30 mins. no sexual side effects.
In general to AM sedation is pretty strong on either, till you get up and start moving, then it goes away. Remeron to me has less daytime sedation than TCA's.
james
Posted by Jane (janey girl) on October 10, 1999, at 22:50:11
In reply to Re: TCA's and sleep, posted by saint james on October 10, 1999, at 19:58:38
Pat,
Sorry to hear about your sleep problems. Chronic
insomniac here myself.I was started on trazodone nearly two years ago.
Original script was for 75 mg at bedtime, although
with changing of AD meds and further sleep problems,
I'm up to 300 - 375 mg at night. YES, YES, YES,
I know, it's a dose to slug a horse.Good luck and sweet dreams.
Jane
Posted by Sean on October 11, 1999, at 11:37:29
In reply to TCA's and sleep, posted by PAT on October 10, 1999, at 8:20:29
> I am moderately depressed/w anxiety and can't sleep. Tried Serzone, helped at one time but then got off it. Since then I have tried to go back on with no luck. I become agitated, less people friendly. (Could be lack of sleep). I have also tried remeron (15 mg or 7.5 mg) which made sedated and restless, didn't wear off until late the next day. Didn't sleep that well on it. Same thing with Trazodone. I get the benefit of sedation without restful sleep. Any suggestions or info/experiences on TCA's for sleep or anything else would be helpful.
I had good luck with amitriptyline. I believe it
is considered the most sedating of the TCA's. It
was also a good anxiolytic and antidepressant for
me. Had to stop because of side effects unfortunately
(heart related, congenital) but would otherwise
still be taking it...
Posted by Elizabeth on October 12, 1999, at 1:54:29
In reply to Re: TCA's and sleep, posted by saint james on October 10, 1999, at 19:58:38
I think what you want is enhanced slow-wave sleep, not REM sleep. (REM enhancers, such as the cholinesterase inhibitors used for Alzheimer's disease, tend to cause insomnia and broken sleep, though not always.) However, if you are concerned about your sleep architecture and not simply about getting more sleep, you probably want to see a sleep specialist.
Pretty much all TCAs suppress REM sleep and enhance SWS because they are anticholinergic and increase norepinephrine. They're often used for narcolepsy (protriptyline and amitriptyline in particular) for this reason.
The most sedating TCAs, which increase sleep continuity quite a lot, are amitriptyline (Elavil) and doxepin (Sinequan). Doxepin has fewer peripheral side effects.
If these are too sedating, imipramine (Tofranil) and clomipramine (Anafranil) are probably next, followed by nortriptyline (Pamelor). Nortriptyline has fewer side effects and may be the best choice if it is sedating enough. It's a good compromise if you want sedation but can do with minimal dry mouth, constipation, etc.
Protriptyline especially, and also desipramine, may be very activating and aren't likely to be good sleep aids.
Posted by dove on October 12, 1999, at 9:56:47
In reply to Re: TCA's and sleep, posted by Elizabeth on October 12, 1999, at 1:54:29
Amitriptyline (Elavil) works well for me, take it an hour before bed. When you first start taking one of the sedating TCA's the effect will seem pretty grand but your body will soon tolerate the sedation and that is the time to up the dosage to achieve the maintanence dosage. The dry-mouth and other "less-liquid-in-the-body" side-effects lessen fairly quickly and become tolerable.
Side note: I am taking a CNS Stimulant now and had to lower my Amitriptyline due to increased side-effects and my sleep has truly suffered. I am taking that sublingual (melt under the tongue) Melatonin and that seems to be making up for the lowered TCA dosage beautifully.
~dove
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.