Psycho-Babble Medication Thread 1005781

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Re: Adding Parnate and prazosin. SLS

Posted by sigismund on January 14, 2012, at 1:39:48

In reply to Re: Adding Parnate and prazosin. Phillipa, posted by SLS on January 13, 2012, at 21:13:25

Scott, can you write more about what you think the effect of the prazosin on the way you feel is?

 

Re: Adding Parnate and prazosin. sigismund

Posted by SLS on January 14, 2012, at 7:20:25

In reply to Re: Adding Parnate and prazosin. SLS, posted by sigismund on January 14, 2012, at 1:39:48

> Scott, can you write more about what you think the effect of the prazosin on the way you feel is?


To me, the addition of prazosin felt like a powerful and clean antidepressant. I gained mental energy and clarity. I was smarter. I enjoyed things more and was more social. My self-confidence increased. I was less apt to sigh or become breathless. Music sounds better. Food tastes better.

Right now, I seem to be in a lull. The antidepressant response has faded somewhat. It is still early in treatment, though. I began responding only two weeks ago. For me, two weeks is a long time.

What exactly are the features or symptoms of your condition that you would like to see successfully treated?


- Scott

 

Re: Adding Parnate and prazosin. SLS

Posted by Phillipa on January 14, 2012, at 19:47:46

In reply to Re: Adding Parnate and prazosin. Phillipa, posted by SLS on January 13, 2012, at 21:13:25

Scott I can join you in being bored. So I'm doing well? Phillipa

 

Re: Adding Parnate and prazosin. SLS

Posted by sigismund on January 15, 2012, at 1:50:47

In reply to Re: Adding Parnate and prazosin. sigismund, posted by SLS on January 14, 2012, at 7:20:25

>prazosin felt like a powerful and clean antidepressant. I gained mental energy and clarity. I was smarter. I enjoyed things more and was more social. My self-confidence increased. I was less apt to sigh or become breathless. Music sounds better. Food tastes better.

That would be unexpected for me. Very interesting.

>What exactly are the features or symptoms of your condition that you would like to see successfully treated?

I would like deeper sleep and more of it. I have been thinking of trimipramine, guanfacine, nefazodone and prazosin (possibly acamprosate as well) as things which may be useful. If they make me feel better in the day, that would be a bonus

 

Re: Adding Parnate and prazosin. sigismund

Posted by SLS on January 15, 2012, at 7:50:41

In reply to Re: Adding Parnate and prazosin. SLS, posted by sigismund on January 15, 2012, at 1:50:47

> I would like deeper sleep and more of it. I have been thinking of trimipramine, guanfacine, nefazodone and prazosin (possibly acamprosate as well) as things which may be useful.

Those are all some pretty brainy choices. I'm sure you'll find something that is a good match for you.

> If they make me feel better in the day, that would be a bonus.

Trimipramine would be a logical choice if depression is mixed-up in your condition somehow. Prazosin might smooth out disturbed sleep, but I don't know if it helps to sleep deeper. If PTSD is in there somewhere, it might be a good choice. Nefazodone is a worthy choice for improving sleep architecture. My concern with nefazodone is that this effect cannot be sustained beyond a few weeks as reported by the second study appearing below. They might be wrong, though. I found another study that made no mention of diminishing effect after 8 weeks.


- Scott

-----------------------------------------


Neuropsychopharmacology. 1994 Apr;10(2):123-7.
The effects of nefazodone on sleep architecture in depression.

Armitage R, Rush AJ, Trivedi M, Cain J, Roffwarg HP.

University of Texas Southwestern Medical Center, Dallas 75235-9070.
Abstract

A polysomnographic study was conducted on 10 outpatients with major depression at baseline and during 4 to 8 weeks of open-trial treatment with nefazodone (400 to 600 mg/day). All 10 patients were treatment responders as evidenced by at least 50% reduction from baseline scores on the Hamilton Depression Rating Scale. Nefazodone was associated with significantly decreased wake and movement time and increased minutes and percentage of stage 2 sleep at the expense of light stage 1 sleep. Nefazodone did not increase rapid-eye-movement (REM) latency and it did not suppress REM sleep. In fact, a trend toward increased REM in the second REM period was observed, although decreased REM in the third REM period was also noted. In summary, nefazodone, an effective antidepressant, decreases arousals and wakefulness during sleep and reduces light non-REM sleep. This agent does not appear to suppress REM sleep or prolong REM latency in patients who respond to treatment.

PMID:
8024673
[PubMed - indexed for MEDLINE]


-----------------------------------------------------

Br J Psychiatry. 2002 Jun;180:528-35.
Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression.
Hicks JA, Argyropoulos SV, Rich AS, Nash JR, Bell CJ, Edwards C, Nutt DJ, Wilson SJ.
Source

Psychopharmacology Unit, University of Bristol, UK.
Abstract
BACKGROUND:

Sleep effects of antidepressants are important clinically and for elucidating mechanism of action: selective serotonin reuptake inhibitors disturb sleep and 5-HT(2) receptor-blocking compounds may enhance sleep quality.
AIMS:

To compare the objective and subjective effects on sleep of paroxetine and nefazodone in patients with moderate to severe depression.
METHOD:

Forty patients with depression were randomised to take paroxetine 20-40 mg/day or nefazodone 400-600 mg/day for 8 weeks. Objective and subjective quality of sleep and depression measures were assessed throughout.
RESULTS:

Nefazodone significantly increased objective sleep efficiency and total sleep time, and improved subjective sleep on days 3 and 10. Paroxetine decreased sleep efficiency early in treatment and some sleep disruption remained at week 8. Paroxetine but not nefazodone produced marked suppression of rapid eye movement (REM) sleep.
CONCLUSIONS:

Nefazodone improves sleep in early treatment compared with paroxetine in patients with moderate to severe depression. These effects are seen within the first 2 weeks of treatment and diminish thereafter.

PMID:
12042232
[PubMed - indexed for MEDLINE]

Free full text


--------------------------------------------------


J Clin Psychopharmacol. 1997 Jun;17(3):161-8.
A multicenter, double-blind comparison of the effects of nefazodone and fluoxetine on sleep architecture and quality of sleep in depressed outpatients.
Armitage R, Yonkers K, Cole D, Rush AJ.
Source

University of Texas Southwestern Medical Center, Depart. of Psychiatry 75235-9070, USA. armitage@utsw.swmed.edu
Abstract

This study was an 8-week, randomized, double-blind, parallel-group investigation that compared the effects of nefazodone and fluoxetine on sleep architecture and on clinician- and patient-rated sleep measures in 43 outpatients with moderate to severe, nonpsychotic major depressive disorder and insomnia. Twenty-two patients received nefazodone 200 mg daily for 1 week, followed by 400 mg daily for 7 weeks. Twenty-one patients received fluoxetine 20 mg daily. Dosage increases (to 500 mg/day for nefazodone and 40 mg/day for fluoxetine) were available after day 29, depending on clinician judgement. Sleep parameters were measured during baseline phase, while patients were unmeasured and symptomatic, and at weeks 2, 4, and 8 of treatment. Nefazodone and fluoxetine were equally effective as antidepressants. However, compared with baseline, nefazodone increased sleep efficiency and reduced the number of awakenings and percent awake and movement time, whereas fluoxetine increased the number of awakenings and did not significantly alter sleep efficiency or percent awake and movement time. Although fluoxetine increased stage 1 sleep and rapid eye movement (REM) latency and reduced total percent REM sleep, nefazodone increased REM sleep, decreased REM latency, and did not alter stage 1 sleep. Differences between treatment groups, based on change from baseline, revealed greater sleep efficiency, fewer awakenings, less percent awake and movement time, less percent stage 1 and more REM sleep, and shorter REM latency for nefazodone compared with fluoxetine. Significantly greater improvement in clinician- and patient-rated sleep disturbance was found with nefazodone compared with fluoxetine. Nefazodone was associated with better sleep quality.

PMID:
9169959
[PubMed - indexed for MEDLINE]

 

Re: Adding Parnate and prazosin. SLS

Posted by sigismund on January 15, 2012, at 11:57:22

In reply to Re: Adding Parnate and prazosin. sigismund, posted by SLS on January 15, 2012, at 7:50:41

Thanks Scott for the references.

Whatever I get I will be using the lowest possible dose

 

Re: Adding Parnate and prazosin. sigismund

Posted by SLS on January 16, 2012, at 6:35:40

In reply to Re: Adding Parnate and prazosin. SLS, posted by sigismund on January 15, 2012, at 11:57:22

> Thanks Scott for the references.
>
> Whatever I get I will be using the lowest possible dose


Good luck.

If you are chronically sleep-deprived, you might be very surprised by how differently you will feel once you make up the sleep-debt.


- Scott

 

Re: Adding Parnate and prazosin.

Posted by SLS on January 16, 2012, at 6:44:52

In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56

I experienced a lull in my response to treatment. It lasted for about a week. I had been greatly disappointed by this. I came to believe that my improvement had plateaued and was fading.

I am doing significantly better today. Something must still be working. I am more hopeful that my progress will continue and result in a robust antidepressant response. I guess I should expect that the course of improvement will not be linear, and that I should expect occasional lulls.

- Scott

 

Re: Adding Parnate and prazosin. SLS

Posted by sigismund on January 17, 2012, at 16:18:02

In reply to Re: Adding Parnate and prazosin., posted by SLS on January 16, 2012, at 6:44:52

It would have been interesting for you to have tried Prazosin in the past to see what it did on its own.

 

Re: Adding Parnate and prazosin. sigismund

Posted by SLS on January 17, 2012, at 17:20:27

In reply to Re: Adding Parnate and prazosin. SLS, posted by sigismund on January 17, 2012, at 16:18:02

> It would have been interesting for you to have tried Prazosin in the past to see what it did on its own.

Yes. It might have saved me from carrying around an extra 50 pounds.

I hope you receive benefit from one of the treatments you select. I am finding that 6 mg/day of prazosin is producing a certain amount of sleepiness during the day, which I don't like. I have been taking 2 mg t.i.d. At some point, I will try to reduce the dosage.


- Scott

 

Re: Adding Parnate and prazosin. SLS

Posted by Phillipa on January 17, 2012, at 20:47:52

In reply to Re: Adding Parnate and prazosin. sigismund, posted by SLS on January 17, 2012, at 17:20:27

Scott don't "rock the boat" so to speak as it's working. Phillipa

 

Re: Adding Parnate and prazosin. SLS

Posted by sigismund on January 18, 2012, at 2:48:09

In reply to Re: Adding Parnate and prazosin. sigismund, posted by SLS on January 17, 2012, at 17:20:27

My shrink is more sceptical than me. I told him trimipramine improved sleep architecture. He looked at me as if to say 'If you believe that, you'll believe anything'. That might be why I said 'I read it on Wikipedia'. So I didn't have the heart to mention the other 3 things, not to speak of the more adventurous and interesting pharmaceutical approaches (GHB for sleep, amphetamine for daytime use), although I did mention Serzone which he told me is no longer available here.

 

Re: Adding Parnate and prazosin. Phillipa

Posted by SLS on January 18, 2012, at 7:15:46

In reply to Re: Adding Parnate and prazosin. SLS, posted by Phillipa on January 17, 2012, at 20:47:52

> Scott don't "rock the boat" so to speak as it's working. Phillipa

That's good advice. It's just that I'm not getting anything done, and I sleep too much during the day.

If you do my laundry...


- Scott

 

Re: Adding Parnate and prazosin. sigismund

Posted by SLS on January 18, 2012, at 7:17:29

In reply to Re: Adding Parnate and prazosin. SLS, posted by sigismund on January 18, 2012, at 2:48:09

> My shrink is more sceptical than me. I told him trimipramine improved sleep architecture. He looked at me as if to say 'If you believe that, you'll believe anything'. That might be why I said 'I read it on Wikipedia'. So I didn't have the heart to mention the other 3 things, not to speak of the more adventurous and interesting pharmaceutical approaches (GHB for sleep, amphetamine for daytime use), although I did mention Serzone which he told me is no longer available here.

Frustrating, to say the least.


- Scott

 

Re: Adding Parnate and prazosin. SLS

Posted by Phillipa on January 18, 2012, at 18:50:56

In reply to Re: Adding Parnate and prazosin. Phillipa, posted by SLS on January 18, 2012, at 7:15:46

Scott you are tireder than I thought. Laundry? What's that? Easier to wear, throw away and buy new. Wishful thinking. Phillipa

 

Re: Adding Parnate and prazosin.

Posted by creepy on January 26, 2012, at 1:42:11

In reply to Re: Adding Parnate and prazosin. sigismund, posted by SLS on January 18, 2012, at 7:17:29

Ive had bad results making suggestions to pdocs, and Ive tried it in many different ways as suggested by my therapist. They seem to perceive it as some sort of challenge or control issue. All I want is to get better faster and not go through another failed trial that jeopardizes my employment with sick days, cognitive fog and irritability.
Ive found its better to just say 'well a relative does better on this'.
It sucks, but Ive found more often than not you screw up the relationship with the doc making any sort of suggestions. Counter-transference? dunno.

 

Re: Adding Parnate and prazosin.

Posted by SLS on January 27, 2012, at 19:17:06

In reply to Re: Adding Parnate and prazosin., posted by creepy on January 26, 2012, at 1:42:11

I am having trouble remaining optimistic with my taking prazosin. I don't see a trend towards further improvement. I feel like I have arrived at a plateau. Maybe things will be different a week from now.


- Scott

 

Re: Adding Parnate and prazosin. SLS

Posted by Phillipa on January 27, 2012, at 20:58:00

In reply to Re: Adding Parnate and prazosin., posted by SLS on January 27, 2012, at 19:17:06

Scott how improved are you at this point? Talked with your doc? Remember even in weight loss plateus happen. Phillipa

 

Re: Adding Parnate and prazosin.

Posted by papillon2 on January 28, 2012, at 2:40:42

In reply to Re: Adding Parnate and prazosin., posted by creepy on January 26, 2012, at 1:42:11

> Ive found its better to just say 'well a relative does better on this'.

I'm having trouble finding the research paper/study, but I did read that a good indicator of how an individual will respond to a psychiatric medication (level of inprovement, side effects) is how a relative, especially a first degree relative, has responded.

 

Re: Adding Parnate and prazosin. papillon2

Posted by SLS on January 28, 2012, at 5:20:34

In reply to Re: Adding Parnate and prazosin., posted by papillon2 on January 28, 2012, at 2:40:42

> > Ive found its better to just say 'well a relative does better on this'.
>
> I'm having trouble finding the research paper/study, but I did read that a good indicator of how an individual will respond to a psychiatric medication (level of inprovement, side effects) is how a relative, especially a first degree relative, has responded.

This has been observed for many years. It sure beats blinded trial-and-error.


- Scott

 

Re: Adding Parnate and prazosin. Phillipa

Posted by SLS on January 28, 2012, at 5:31:11

In reply to Re: Adding Parnate and prazosin. SLS, posted by Phillipa on January 27, 2012, at 20:58:00

> Scott how improved are you at this point? Talked with your doc? Remember even in weight loss plateus happen.

Yes. However, I can't say that I am any better now than I was for the first two weeks that I took prazosin. I just don't see a trend towards improvement right now.

One thing nice - I was able to read two entire Scientific American articles and comprehend them. I haven't had that kind of mental focus in over ten years. For now, I am using that improvement as a source of hope.

I have an appointment to see my doctor in two weeks. That will allow more time to see where this thing is headed. Maybe he'll increase the prazosin. Postural hypotension dizziness is only an intermittent problem.

Today, I am feeling about 25% improved. I'm pretty sure that I could go back to work at 50%.


- Scott

 

Re: Adding Parnate and prazosin. SLS

Posted by Phillipa on January 28, 2012, at 18:35:59

In reply to Re: Adding Parnate and prazosin. Phillipa, posted by SLS on January 28, 2012, at 5:31:11

Scott is this the best response since the first parnate response? What GAF do you feel you would receive? If your doc uses them? Phillipa

 

Re: Adding Parnate and prazosin. SLS

Posted by sigismund on January 28, 2012, at 19:27:24

In reply to Re: Adding Parnate and prazosin. Phillipa, posted by SLS on January 28, 2012, at 5:31:11

Scott, can you explain something for me?

The ADs you have taken have increased NE (so to speak) and the prazosin blocks it (or something like that).

It just seems back the front, if you see what I mean.

 

Re: Adding Parnate and prazosin. sigismund

Posted by Phillipa on January 28, 2012, at 21:04:29

In reply to Re: Adding Parnate and prazosin. SLS, posted by sigismund on January 28, 2012, at 19:27:24

Sigi are you saying that the combo of two are normalizing Scotts brain back to what it was before MDD? PJx

 

Re: Adding Parnate and prazosin. sigismund

Posted by SLS on January 29, 2012, at 6:41:52

In reply to Re: Adding Parnate and prazosin. SLS, posted by sigismund on January 28, 2012, at 19:27:24

> Scott, can you explain something for me?

Probably not, but I'll try.

> The ADs you have taken have increased NE (so to speak) and the prazosin blocks it (or something like that).

Yes. Prazosin blocks NE alpha-1 receptors.

> It just seems back the front, if you see what I mean.

Yes. That's why I don't pay too much attention to theories anymore when it comes to choosing drugs for treatment. Theories are sometimes valuable to include drugs for consideration, but not for their exclusion.

I offered my doctor one possible explanation in an email I sent him:

"It occurred to me that prazosin might quiet those neurons that are observed to be hyperactive in cingulate cortex (Brodmann areas 24, 25) in indviduals with MDD. If so, it would effectively mimic DBS."

This is really nothing more than a wild guess for which I have little evidence to support. However, NE alpha-1 receptors do exist in the regions I specified.


- Scott


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