Psycho-Babble Medication Thread 367805

Shown: posts 1 to 19 of 19. This is the beginning of the thread.

 

nortriptyline + celexa (+ trazodone?) for ocd ibs

Posted by yeltom on July 19, 2004, at 14:09:24

I take celexa (40-60 mg) plus trazodone (50 mg) at night for OCD, anxiety, and depression, and recently have had bad IBS (irritable bowel syndrome-alternating diarreah/constipation). The gastroenterologist I saw recommended a low dose of a tricyclic antidepressant. After talking with my psychiatrist, I settled on nortriptyline, thinking that it might be a good way to augment the celexa (which I need) as well as stop the IBS. The idea was to substitute the nortriptyline for the trazodone. I'm just wondering what experiences people have had with this combination. I am having a hard time making the transition. I seem to have become dependent on trazodone to get to sleep. 10 mg of nortriptylene didn't seem to be enough for the IBS (though maybe I didn't give it enough time), but 20 mg seems to leave me with a headache and dizziness in the morning and still doesn't really help me sleep the way trazodone does. (Plus, rather than fixing the ibs, it just seems to change it from diarreah-predominant to constipation-predominant.) Is there anything theoretically wrong with mixing trazodone and nortrip? Seems to make my headache and dizziness worse. Maybe I should try 10 mg or nortrip plus 25 mg of trazodone. Is 10 mg of nortrip enough (in theory) to significantly augment celexa? I could see that being the case with prozac (because of significant p450 enzyme inhibition), but not so much with celexa. Any and all responses appreciated.

 

Re: nortriptyline + celexa (+ trazodone?) for ocd ibs

Posted by King Vultan on July 19, 2004, at 17:45:03

In reply to nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by yeltom on July 19, 2004, at 14:09:24

Nortriptyline is not as powerful a sleep aid as trazodone and has a much longer half life, such that you are probably going to be feeling more of the effects the next day--my reference shows a half life of 18-44 hours for nortriptyline and only 4-9 hours for trazodone. I also found nortriptyline to induce constipation, this at higher dosages than what you are taking, however (50 to 75 mg/day). This is not an uncommon side effect of tricyclic antidepressants, even ones that are low in anticholinergic effects as nortriptyline is.

The trazodone isn't actually a med that you can become dependent upon like a benzodiazepine sleep aid (Halcion, for instance), but it may be that with all that's going on, you need something as powerful as trazodone to get you to sleep. I know very little about IBS, but from what I can gather, I think the reasoning to use nortriptyline in this situation was sound. Unfortunately, even with good planning, things often don't work out as one hopes in endeavors where there is a psychiatric component. All I can suggest is to reconvene with your doctor(s).

I am ignorant in this area, but is there any chance the Celexa could be part of the IBS? I ask because of a friend of mine takes Paxil and suffers from this, but he has a multitude of other problems that may be factors also.

Todd

 

Re: nortriptyline + celexa (+ trazodone?) for ocd ibs

Posted by cpallen79 on July 19, 2004, at 18:19:24

In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by King Vultan on July 19, 2004, at 17:45:03

Hello, I also have been blessed with IBS... what a fun thing. I'm wondering if perhaps another SSRI might help instead of the Celexa... One you may want to watch otu for is Zoloft as it tends to aggravate IBS, at least initially.
Something wierd I noticed is that trazodone seems to aggravate my IBS a bit, but I enjoy that it helps me sleep, hence I keep it in my arsenal. Maybe try another SSRi for gut regulation instead of Celexa. Another option is an antispasmodic like Bentyl or Levsin
Best,
Chris


> Nortriptyline is not as powerful a sleep aid as trazodone and has a much longer half life, such that you are probably going to be feeling more of the effects the next day--my reference shows a half life of 18-44 hours for nortriptyline and only 4-9 hours for trazodone. I also found nortriptyline to induce constipation, this at higher dosages than what you are taking, however (50 to 75 mg/day). This is not an uncommon side effect of tricyclic antidepressants, even ones that are low in anticholinergic effects as nortriptyline is.
>
> The trazodone isn't actually a med that you can become dependent upon like a benzodiazepine sleep aid (Halcion, for instance), but it may be that with all that's going on, you need something as powerful as trazodone to get you to sleep. I know very little about IBS, but from what I can gather, I think the reasoning to use nortriptyline in this situation was sound. Unfortunately, even with good planning, things often don't work out as one hopes in endeavors where there is a psychiatric component. All I can suggest is to reconvene with your doctor(s).
>
> I am ignorant in this area, but is there any chance the Celexa could be part of the IBS? I ask because of a friend of mine takes Paxil and suffers from this, but he has a multitude of other problems that may be factors also.
>
> Todd

 

Re: nortriptyline + celexa (+ trazodone?) for ocd ibs

Posted by yeltom on July 19, 2004, at 21:24:51

In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by King Vultan on July 19, 2004, at 17:45:03

Thanks for the thoughtful response. Are you a doctor? SSRIs have been known to cause diarreah (and I've never been able to take Zoloft for that reason), so it would make sense that it might trigger or affect IBS in some way. Couldn't the presence of Celexa and hence inhibition of p450 enzyme (albeit minimal compared to other SSRIs) cause nortriptyline to cause side effects (as well as benefits) at lower doses than usual? Would there be anything wrong in theory with combining a small amount of trazodone (say, 25 mg) with the nortriptyline? Thanks


> Nortriptyline is not as powerful a sleep aid as trazodone and has a much longer half life, such that you are probably going to be feeling more of the effects the next day--my reference shows a half life of 18-44 hours for nortriptyline and only 4-9 hours for trazodone. I also found nortriptyline to induce constipation, this at higher dosages than what you are taking, however (50 to 75 mg/day). This is not an uncommon side effect of tricyclic antidepressants, even ones that are low in anticholinergic effects as nortriptyline is.
>
> The trazodone isn't actually a med that you can become dependent upon like a benzodiazepine sleep aid (Halcion, for instance), but it may be that with all that's going on, you need something as powerful as trazodone to get you to sleep. I know very little about IBS, but from what I can gather, I think the reasoning to use nortriptyline in this situation was sound. Unfortunately, even with good planning, things often don't work out as one hopes in endeavors where there is a psychiatric component. All I can suggest is to reconvene with your doctor(s).
>
> I am ignorant in this area, but is there any chance the Celexa could be part of the IBS? I ask because of a friend of mine takes Paxil and suffers from this, but he has a multitude of other problems that may be factors also.
>
> Todd

 

Re: nortriptyline + celexa (+ trazodone?) for ocd ibs

Posted by yeltom on July 19, 2004, at 21:29:26

In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by cpallen79 on July 19, 2004, at 18:19:24

What sort of IBS do you have? In what way does trazodone make it worse? I've tried levsin and robinul, but they have their own annoying side effects, so I figured if I'm going to have to deal with side effects, I might as well take something that fits in with my psychiatric goals. Hence the tricyclic idea. Thanks

> Hello, I also have been blessed with IBS... what a fun thing. I'm wondering if perhaps another SSRI might help instead of the Celexa... One you may want to watch otu for is Zoloft as it tends to aggravate IBS, at least initially.
> Something wierd I noticed is that trazodone seems to aggravate my IBS a bit, but I enjoy that it helps me sleep, hence I keep it in my arsenal. Maybe try another SSRi for gut regulation instead of Celexa. Another option is an antispasmodic like Bentyl or Levsin
> Best,
> Chris
>
>
> > Nortriptyline is not as powerful a sleep aid as trazodone and has a much longer half life, such that you are probably going to be feeling more of the effects the next day--my reference shows a half life of 18-44 hours for nortriptyline and only 4-9 hours for trazodone. I also found nortriptyline to induce constipation, this at higher dosages than what you are taking, however (50 to 75 mg/day). This is not an uncommon side effect of tricyclic antidepressants, even ones that are low in anticholinergic effects as nortriptyline is.
> >
> > The trazodone isn't actually a med that you can become dependent upon like a benzodiazepine sleep aid (Halcion, for instance), but it may be that with all that's going on, you need something as powerful as trazodone to get you to sleep. I know very little about IBS, but from what I can gather, I think the reasoning to use nortriptyline in this situation was sound. Unfortunately, even with good planning, things often don't work out as one hopes in endeavors where there is a psychiatric component. All I can suggest is to reconvene with your doctor(s).
> >
> > I am ignorant in this area, but is there any chance the Celexa could be part of the IBS? I ask because of a friend of mine takes Paxil and suffers from this, but he has a multitude of other problems that may be factors also.
> >
> > Todd
>
>

 

Re: nortriptyline + celexa (+ trazodone?) for ocd ibs yeltom

Posted by King Vultan on July 19, 2004, at 22:54:34

In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by yeltom on July 19, 2004, at 21:24:51

> Thanks for the thoughtful response. Are you a doctor? SSRIs have been known to cause diarreah (and I've never been able to take Zoloft for that reason), so it would make sense that it might trigger or affect IBS in some way. Couldn't the presence of Celexa and hence inhibition of p450 enzyme (albeit minimal compared to other SSRIs) cause nortriptyline to cause side effects (as well as benefits) at lower doses than usual? Would there be anything wrong in theory with combining a small amount of trazodone (say, 25 mg) with the nortriptyline? Thanks
>

No, I'm not a doctor, but I do know a small amount about antidepressants, some from my own research, and some from taking them--I think I've tried around ten. The CYP-450 issues in this case are minimal IMO; although, I think it's good you are aware of the potential for problems they can sometimes cause. The 2D6 enzyme is the notorious one, and Celexa has only a weak inhibitory effect on this particular enzyme. As for adding trazodone, my references have conflicting data on whether trazodone is a 2D6 inhibitor, but regardless, 10 mg of nortriptyline is such a low dosage that it seems unlikely IMO in this situation to create an unsafe situation. However, don't take my word for it; you should absolutely consult your doctor on any change in medication.

As for the diarrhea, I have noticed this myself on Zoloft at least two separate times when I've started taking it again, but mine always went away within one day. Zoloft does seem to be one of the more notorious ones for causing this particular problem, and I believe that Remeron may have the ability to block this or at least mitigate it. Also, I asked my pdoc once about trimipramine (Surmontil) for sleep, and he indicated that he used it especially for people with gastrointestinal problems. I don't know if this includes IBS or not.

Todd

 

Re: nortriptyline + celexa (+ trazodone?) for ocd ibs yeltom

Posted by Sad Panda on July 20, 2004, at 7:58:09

In reply to nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by yeltom on July 19, 2004, at 14:09:24

> I take celexa (40-60 mg) plus trazodone (50 mg) at night for OCD, anxiety, and depression, and recently have had bad IBS (irritable bowel syndrome-alternating diarreah/constipation). The gastroenterologist I saw recommended a low dose of a tricyclic antidepressant. After talking with my psychiatrist, I settled on nortriptyline, thinking that it might be a good way to augment the celexa (which I need) as well as stop the IBS. The idea was to substitute the nortriptyline for the trazodone. I'm just wondering what experiences people have had with this combination. I am having a hard time making the transition. I seem to have become dependent on trazodone to get to sleep. 10 mg of nortriptylene didn't seem to be enough for the IBS (though maybe I didn't give it enough time), but 20 mg seems to leave me with a headache and dizziness in the morning and still doesn't really help me sleep the way trazodone does. (Plus, rather than fixing the ibs, it just seems to change it from diarreah-predominant to constipation-predominant.) Is there anything theoretically wrong with mixing trazodone and nortrip? Seems to make my headache and dizziness worse. Maybe I should try 10 mg or nortrip plus 25 mg of trazodone. Is 10 mg of nortrip enough (in theory) to significantly augment celexa? I could see that being the case with prozac (because of significant p450 enzyme inhibition), but not so much with celexa. Any and all responses appreciated.
>
>

Most TCA's are strongly antimuscarinic which produces constipation & they also block 5-HT2A(like Trazodone) which produces a good nights sleep & smoothes out a lot of the problems caused by SSRI's. To replace 50mg of Trazodone you will need roughly 75mg of Nortriptyline which may be too stimulating or you might like it. If you only want sedation, then 25mg of Amitriptyline would make a better swap for 50mg of Traz.

The only thing that can smooth over both diarrhoea & constipation is fiber. :)

Cheers,
Panda.

 

Re: nortriptyline + celexa (+ trazodone?) for ocd ibs

Posted by zeugma on July 20, 2004, at 12:00:27

In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs yeltom, posted by Sad Panda on July 20, 2004, at 7:58:09

Nortriptyline has no sedative effect below 50 mg. Bear in mind though that I was taking the nortriptyline alone. It is unlikely that Celexa would cause a dramatic rise in nortriptyline concentrations. However there is a lot of variation in intrinsic 2D6 activity due to genetic factors. I am a normal-to-fast metabolizer of nortriptyline, and 100 mg nortriptyline sends me to sleep in the range of 3-4 hours. 75 mg sent to sleep in about 6 hours. This is very far from what I understand about the sedative effect of trazodone, although in both cases patients are instructed to take at 'bedtime.' Of course, this is only my experience.

Nortriptyline tends to be constipating. This side effect may diminish in time (it did for me) or it may not. The symptomology that I found nortriptyline most useful for in terms of IBS was upper GI tract pain and nausea. I found it to have analgesic and antinauseant effects at 20 mg.

If you are interested in a combination sleep aid/IBS remedy, low dose amitriptyline might be more of what you're looking for. If you decide instead to stick with the nortrip, you should get a blood plasma level taken of nortriptyline once you get in the 50 mg range. This will help your doctor optimize the dose and ensure that levels are neither too high or too low.

 

Re: nortriptyline + celexa (+ trazodone?) for ocd ibs zeugma

Posted by yeltom on July 20, 2004, at 12:10:07

In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by zeugma on July 20, 2004, at 12:00:27

I have noticed a sedative effect at 10 mg; it's just not enough to consistently put me to sleep. At this point, the question is whether I'm going to take 10 or 20 mg. 50 mg seems out of the question. I have a hard time getting out of bed in the morning with 20 mg, and when I do, I have a dull headache and dizziness. I'm worried about all the side effects of amitriptyline, and I'm very used to trazodone. That's why I'm wondering whether mixing trazodone with nortip would be a bad idea.

> Nortriptyline has no sedative effect below 50 mg. Bear in mind though that I was taking the nortriptyline alone. It is unlikely that Celexa would cause a dramatic rise in nortriptyline concentrations. However there is a lot of variation in intrinsic 2D6 activity due to genetic factors. I am a normal-to-fast metabolizer of nortriptyline, and 100 mg nortriptyline sends me to sleep in the range of 3-4 hours. 75 mg sent to sleep in about 6 hours. This is very far from what I understand about the sedative effect of trazodone, although in both cases patients are instructed to take at 'bedtime.' Of course, this is only my experience.
>
> Nortriptyline tends to be constipating. This side effect may diminish in time (it did for me) or it may not. The symptomology that I found nortriptyline most useful for in terms of IBS was upper GI tract pain and nausea. I found it to have analgesic and antinauseant effects at 20 mg.
>
> If you are interested in a combination sleep aid/IBS remedy, low dose amitriptyline might be more of what you're looking for. If you decide instead to stick with the nortrip, you should get a blood plasma level taken of nortriptyline once you get in the 50 mg range. This will help your doctor optimize the dose and ensure that levels are neither too high or too low.
>
>

 

nortriptyline to augment Celexa (or other ssri)

Posted by yeltom on July 20, 2004, at 12:21:10

In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by zeugma on July 20, 2004, at 12:00:27

Thanks for your responses, everyone, but what I'm really looking for is people who have had experience using low-dose nortriptyline with Celexa.

 

Surmontil/trimipramine for sleep, ibs King Vultan

Posted by yeltom on July 20, 2004, at 16:08:26

In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs yeltom, posted by King Vultan on July 19, 2004, at 22:54:34

Surmontil/trimipramine looks interesting. Seems to work primarily on norepinephrine, like desipramine, so it would theoretically be good to augment/balance an ssri. But unlike desipramine, it's sedating. Yet it has a relatively short half-life, so it might give less of a hangover than amitriptyline. And instead of inhibiting REM sleep, like most antidepressants, it appears to increase it, which might be good, especially since celexa inhibits it. Does this reasoning make sense? I wonder why it's particularly good for gastrointestinal problems? Anyone have any experience with this?

> > Thanks for the thoughtful response. Are you a doctor? SSRIs have been known to cause diarreah (and I've never been able to take Zoloft for that reason), so it would make sense that it might trigger or affect IBS in some way. Couldn't the presence of Celexa and hence inhibition of p450 enzyme (albeit minimal compared to other SSRIs) cause nortriptyline to cause side effects (as well as benefits) at lower doses than usual? Would there be anything wrong in theory with combining a small amount of trazodone (say, 25 mg) with the nortriptyline? Thanks
> >
>
>
> No, I'm not a doctor, but I do know a small amount about antidepressants, some from my own research, and some from taking them--I think I've tried around ten. The CYP-450 issues in this case are minimal IMO; although, I think it's good you are aware of the potential for problems they can sometimes cause. The 2D6 enzyme is the notorious one, and Celexa has only a weak inhibitory effect on this particular enzyme. As for adding trazodone, my references have conflicting data on whether trazodone is a 2D6 inhibitor, but regardless, 10 mg of nortriptyline is such a low dosage that it seems unlikely IMO in this situation to create an unsafe situation. However, don't take my word for it; you should absolutely consult your doctor on any change in medication.
>
> As for the diarrhea, I have noticed this myself on Zoloft at least two separate times when I've started taking it again, but mine always went away within one day. Zoloft does seem to be one of the more notorious ones for causing this particular problem, and I believe that Remeron may have the ability to block this or at least mitigate it. Also, I asked my pdoc once about trimipramine (Surmontil) for sleep, and he indicated that he used it especially for people with gastrointestinal problems. I don't know if this includes IBS or not.
>
> Todd
>
>

 

Re: Surmontil/trimipramine for sleep, ibs yeltom

Posted by Larry Hoover on July 20, 2004, at 16:58:00

In reply to Surmontil/trimipramine for sleep, ibs King Vultan, posted by yeltom on July 20, 2004, at 16:08:26

> Surmontil/trimipramine looks interesting. Seems to work primarily on norepinephrine, like desipramine, so it would theoretically be good to augment/balance an ssri.

I'm taking it right now, with Zoloft.

> But unlike desipramine, it's sedating. Yet it has a relatively short half-life, so it might give less of a hangover than amitriptyline. And instead of inhibiting REM sleep, like most antidepressants, it appears to increase it, which might be good, especially since celexa inhibits it. Does this reasoning make sense? I wonder why it's particularly good for gastrointestinal problems? Anyone have any experience with this?

Trimipramine was found to be useful in the treatment of IBS, over twenty years ago, particularly the type not including constipation. I'm not sure why, though. Here's a blurb on the sleep effects:

Eur Arch Psychiatry Clin Neurosci. 1996;246(5):235-9.

Trimipramine: a challenge to current concepts on antidepressives.

Berger M, Gastpar M.

Klinikum, Albert-Ludwigs-Universitat, Freiburg, Germany.

Although it is chemically a classical tricyclic antidepressant agent, trimipramine shows atypical pharmacological properties. Its well-documented antidepressant action cannot be explained by noradrenaline or serotonin reuptake inhibition or by a down-regulation of beta-adrenoceptors. Furthermore, its receptor affinity profile resembles more that of clozapine, a neuroleptic drug, than that of tricyclic antidepressants. Trimipramine does not reduce, but rather increases, rapid eye movement sleep. It stimulates nocturnal prolactin secretion and inhibits nocturnal cortisol secretion and may act at the level of the hypothalamus on corticotropin-releasing hormone secretion. Trimipramine is of particular value in depressed patients with insomnia, and it has been shown to be effective in the therapy of primary insomnia. As the pharmacological profile indicates, and an open clinical study has shown, trimipramine might also be active as an antipsychotic. The drug is both a tool for increasing our understanding of depression and a potential therapy for several psychiatric disorders.

Lar

 

Re: Surmontil/trimipramine for sleep, ibs Larry Hoover

Posted by yeltom on July 20, 2004, at 17:53:40

In reply to Re: Surmontil/trimipramine for sleep, ibs yeltom, posted by Larry Hoover on July 20, 2004, at 16:58:00

Thanks for respoding. I actually had already read that abstract. How much are you taking? Are you taking it for sleep, ibs, to augment the zoloft? How is it working? How bad are the side effects? Let me know, will you. Thanks

> > Surmontil/trimipramine looks interesting. Seems to work primarily on norepinephrine, like desipramine, so it would theoretically be good to augment/balance an ssri.
>
> I'm taking it right now, with Zoloft.
>
> > But unlike desipramine, it's sedating. Yet it has a relatively short half-life, so it might give less of a hangover than amitriptyline. And instead of inhibiting REM sleep, like most antidepressants, it appears to increase it, which might be good, especially since celexa inhibits it. Does this reasoning make sense? I wonder why it's particularly good for gastrointestinal problems? Anyone have any experience with this?
>
> Trimipramine was found to be useful in the treatment of IBS, over twenty years ago, particularly the type not including constipation. I'm not sure why, though. Here's a blurb on the sleep effects:
>
> Eur Arch Psychiatry Clin Neurosci. 1996;246(5):235-9.
>
> Trimipramine: a challenge to current concepts on antidepressives.
>
> Berger M, Gastpar M.
>
> Klinikum, Albert-Ludwigs-Universitat, Freiburg, Germany.
>
> Although it is chemically a classical tricyclic antidepressant agent, trimipramine shows atypical pharmacological properties. Its well-documented antidepressant action cannot be explained by noradrenaline or serotonin reuptake inhibition or by a down-regulation of beta-adrenoceptors. Furthermore, its receptor affinity profile resembles more that of clozapine, a neuroleptic drug, than that of tricyclic antidepressants. Trimipramine does not reduce, but rather increases, rapid eye movement sleep. It stimulates nocturnal prolactin secretion and inhibits nocturnal cortisol secretion and may act at the level of the hypothalamus on corticotropin-releasing hormone secretion. Trimipramine is of particular value in depressed patients with insomnia, and it has been shown to be effective in the therapy of primary insomnia. As the pharmacological profile indicates, and an open clinical study has shown, trimipramine might also be active as an antipsychotic. The drug is both a tool for increasing our understanding of depression and a potential therapy for several psychiatric disorders.
>
> Lar

 

trimipramine and norepinephrine Larry Hoover

Posted by yeltom on July 20, 2004, at 18:14:48

In reply to Re: Surmontil/trimipramine for sleep, ibs yeltom, posted by Larry Hoover on July 20, 2004, at 16:58:00

As I said, I read that abstract that said that trimipramine's antidepressant effects cannot be attributed to NE reuptake inhibition, but other sources say that it does affect NE. What's the truth? If it does affect NE, wouldn't the expectation be that it has energizing qualities in addtion to the sedating ones? Have you noticed any energizing effects?

> > Surmontil/trimipramine looks interesting. Seems to work primarily on norepinephrine, like desipramine, so it would theoretically be good to augment/balance an ssri.
>
> I'm taking it right now, with Zoloft.
>
> > But unlike desipramine, it's sedating. Yet it has a relatively short half-life, so it might give less of a hangover than amitriptyline. And instead of inhibiting REM sleep, like most antidepressants, it appears to increase it, which might be good, especially since celexa inhibits it. Does this reasoning make sense? I wonder why it's particularly good for gastrointestinal problems? Anyone have any experience with this?
>
> Trimipramine was found to be useful in the treatment of IBS, over twenty years ago, particularly the type not including constipation. I'm not sure why, though. Here's a blurb on the sleep effects:
>
> Eur Arch Psychiatry Clin Neurosci. 1996;246(5):235-9.
>
> Trimipramine: a challenge to current concepts on antidepressives.
>
> Berger M, Gastpar M.
>
> Klinikum, Albert-Ludwigs-Universitat, Freiburg, Germany.
>
> Although it is chemically a classical tricyclic antidepressant agent, trimipramine shows atypical pharmacological properties. Its well-documented antidepressant action cannot be explained by noradrenaline or serotonin reuptake inhibition or by a down-regulation of beta-adrenoceptors. Furthermore, its receptor affinity profile resembles more that of clozapine, a neuroleptic drug, than that of tricyclic antidepressants. Trimipramine does not reduce, but rather increases, rapid eye movement sleep. It stimulates nocturnal prolactin secretion and inhibits nocturnal cortisol secretion and may act at the level of the hypothalamus on corticotropin-releasing hormone secretion. Trimipramine is of particular value in depressed patients with insomnia, and it has been shown to be effective in the therapy of primary insomnia. As the pharmacological profile indicates, and an open clinical study has shown, trimipramine might also be active as an antipsychotic. The drug is both a tool for increasing our understanding of depression and a potential therapy for several psychiatric disorders.
>
> Lar

 

Re: Surmontil/trimipramine for sleep, ibs yeltom

Posted by Larry Hoover on July 20, 2004, at 19:42:55

In reply to Re: Surmontil/trimipramine for sleep, ibs Larry Hoover, posted by yeltom on July 20, 2004, at 17:53:40

> Thanks for respoding. I actually had already read that abstract. How much are you taking?

25 mg, one hour before sleep.

> Are you taking it for sleep, ibs, to augment the zoloft?

The intent was to help with insomnia, which Zoloft made worse. I didn't know about the IBS link until today, and though I have IBS, I don't think my dose is large enough to affect that. Zoloft, initially, and at each dose increase, provoked extraordinary diarrhea that lasted days. My IBS med, Dicetel, fixed that problem up.

> How is it working?

It helps initiation of sleep. I also use 30 mg temazepam. The effect of the trimipramine seems to be diminishing over time. I expect I'll have to increase the dose. For primary insomnia, the dose is 100 mg, so I've got a ways to go, yet.

> How bad are the side effects?

Bit of dry mouth, but that passed after a week or so. Also, tended to sleep without moving for extended periods, and waking crampy. That passed, too.

> Let me know, will you. Thanks

You're welcome.

 

Re: trimipramine and norepinephrine yeltom

Posted by Larry Hoover on July 20, 2004, at 19:45:19

In reply to trimipramine and norepinephrine Larry Hoover, posted by yeltom on July 20, 2004, at 18:14:48

> As I said, I read that abstract that said that trimipramine's antidepressant effects cannot be attributed to NE reuptake inhibition, but other sources say that it does affect NE. What's the truth? If it does affect NE, wouldn't the expectation be that it has energizing qualities in addtion to the sedating ones? Have you noticed any energizing effects?

It's such an old and generally disregarded med, that I've never found complete pharmacokinetic and binding affinity data. Most often, you'll just get some generic description of the effects of tricyclics. I haven't noticed any energizing effect. I take it and it makes me sleepy. But my dose is far below the therapeutic antidepressant dose.

Lar

 

Re: Surmontil/trimipramine for sleep, ibs Larry Hoover

Posted by yeltom on July 20, 2004, at 22:43:58

In reply to Re: Surmontil/trimipramine for sleep, ibs yeltom, posted by Larry Hoover on July 20, 2004, at 19:42:55

I couldn't take zoloft for that reason. Actually, when used for IBS, tricyclics are generally effective at very low doses. Amitriptyline has been successful at doses as low as 2.5 mg (not a misprint), so 25 mg might be plenty. You might be able to give up the Dictel or use less of it. What is Dictel?

> > Thanks for respoding. I actually had already read that abstract. How much are you taking?
>
> 25 mg, one hour before sleep.
>
> > Are you taking it for sleep, ibs, to augment the zoloft?
>
> The intent was to help with insomnia, which Zoloft made worse. I didn't know about the IBS link until today, and though I have IBS, I don't think my dose is large enough to affect that. Zoloft, initially, and at each dose increase, provoked extraordinary diarrhea that lasted days. My IBS med, Dicetel, fixed that problem up.
>
> > How is it working?
>
> It helps initiation of sleep. I also use 30 mg temazepam. The effect of the trimipramine seems to be diminishing over time. I expect I'll have to increase the dose. For primary insomnia, the dose is 100 mg, so I've got a ways to go, yet.
>
> > How bad are the side effects?
>
> Bit of dry mouth, but that passed after a week or so. Also, tended to sleep without moving for extended periods, and waking crampy. That passed, too.
>
> > Let me know, will you. Thanks
>
> You're welcome.
>

 

Re: Surmontil/trimipramine for sleep, ibs yeltom

Posted by Larry Hoover on July 21, 2004, at 11:26:11

In reply to Re: Surmontil/trimipramine for sleep, ibs Larry Hoover, posted by yeltom on July 20, 2004, at 22:43:58

> I couldn't take zoloft for that reason. Actually, when used for IBS, tricyclics are generally effective at very low doses. Amitriptyline has been successful at doses as low as 2.5 mg (not a misprint), so 25 mg might be plenty. You might be able to give up the Dictel or use less of it. What is Dictel?

Well, that dose does not counteract the Zoloft, in any case. I can't say I've had an IBS attack lately, either. It's harder to notice the absence of something, I think.

Dicetel is pinaverium bromide, which is a quaternary ammonium compound that specifically blocks intestinal calcium channels. I get it for free, via a compassionate drug policy.

Lar

 

Re: nortriptyline + celexa (+ trazodone?) for ocd ibs yeltom

Posted by cpallen79 on July 21, 2004, at 20:39:16

In reply to Re: nortriptyline + celexa (+ trazodone?) for ocd ibs, posted by yeltom on July 19, 2004, at 21:29:26

Howdy! In answer to your question, not a doc, jsut a man obsessed with feelin good, so I tend to watch otu for side effects of meds (even my PDOC is impressed- at least i think LOL). I have IBS D these days- used to get plugged up to all hell as a kid, now its painful cramping which can easily induce panic in me. I've noticed that since I started Trazodone that I feel more cramping and pain... then again I have a very active imagination, hence I wouldn't be surprised if it was just me. I've foudn ssris can be helpful, and have considered a tiny dab of a tca as well, who knows though. I'll keep you posted on what I do.
Cheers
Chris


> What sort of IBS do you have? In what way does trazodone make it worse? I've tried levsin and robinul, but they have their own annoying side effects, so I figured if I'm going to have to deal with side effects, I might as well take something that fits in with my psychiatric goals. Hence the tricyclic idea. Thanks
>
> > Hello, I also have been blessed with IBS... what a fun thing. I'm wondering if perhaps another SSRI might help instead of the Celexa... One you may want to watch otu for is Zoloft as it tends to aggravate IBS, at least initially.
> > Something wierd I noticed is that trazodone seems to aggravate my IBS a bit, but I enjoy that it helps me sleep, hence I keep it in my arsenal. Maybe try another SSRi for gut regulation instead of Celexa. Another option is an antispasmodic like Bentyl or Levsin
> > Best,
> > Chris
> >
> >
> > > Nortriptyline is not as powerful a sleep aid as trazodone and has a much longer half life, such that you are probably going to be feeling more of the effects the next day--my reference shows a half life of 18-44 hours for nortriptyline and only 4-9 hours for trazodone. I also found nortriptyline to induce constipation, this at higher dosages than what you are taking, however (50 to 75 mg/day). This is not an uncommon side effect of tricyclic antidepressants, even ones that are low in anticholinergic effects as nortriptyline is.
> > >
> > > The trazodone isn't actually a med that you can become dependent upon like a benzodiazepine sleep aid (Halcion, for instance), but it may be that with all that's going on, you need something as powerful as trazodone to get you to sleep. I know very little about IBS, but from what I can gather, I think the reasoning to use nortriptyline in this situation was sound. Unfortunately, even with good planning, things often don't work out as one hopes in endeavors where there is a psychiatric component. All I can suggest is to reconvene with your doctor(s).
> > >
> > > I am ignorant in this area, but is there any chance the Celexa could be part of the IBS? I ask because of a friend of mine takes Paxil and suffers from this, but he has a multitude of other problems that may be factors also.
> > >
> > > Todd
> >
> >
>
>


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