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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by g_g_g_unit on October 22, 2013, at 23:36:44
I know Mirtazapine is supposed to improve akathisia, but I've been feeling very overstimulated on just 15mg at night, particularly once the sedation wears off. I'm not sure how to distinguish between 'overstimulation' and akathisia, but I feel very restless, shakey, slightly agitated and can't focus.
Since I'm only using it for sleep, should I try lowering the dose? Or do these side-effects pass?
Posted by gadchik on October 23, 2013, at 17:35:52
In reply to akathisia on mirtazapine, posted by g_g_g_unit on October 22, 2013, at 23:36:44
I had to stay @ 7.5mg & even lower. I loved it for sleep. Was an easy drug to take, for me, but couldn't tolerate 15mg
Posted by doxogenic boy on October 24, 2013, at 10:34:13
In reply to akathisia on mirtazapine, posted by g_g_g_unit on October 22, 2013, at 23:36:44
> I know Mirtazapine is supposed to improve akathisia, but I've been feeling very overstimulated on just 15mg at night, particularly once the sedation wears off. I'm not sure how to distinguish between 'overstimulation' and akathisia, but I feel very restless, shakey, slightly agitated and can't focus.
>
> Since I'm only using it for sleep, should I try lowering the dose? Or do these side-effects pass?I think 7,5 mg mirtazapine is worth trying.
- doxogenic
Posted by g_g_g_unit on October 24, 2013, at 22:37:48
In reply to Re: akathisia on mirtazapine » g_g_g_unit, posted by doxogenic boy on October 24, 2013, at 10:34:13
Thanks .. I've lowered it to 7.5mg, and now 3mg, but still have akathisia all day (due to the long-ish half-life, I guess). If I go without it, I get no sleep. Toxic cr*p.
Posted by SLS on October 25, 2013, at 0:27:48
In reply to akathisia on mirtazapine, posted by g_g_g_unit on October 22, 2013, at 23:36:44
> I know Mirtazapine is supposed to improve akathisia, but I've been feeling very overstimulated on just 15mg at night, particularly once the sedation wears off. I'm not sure how to distinguish between 'overstimulation' and akathisia, but I feel very restless, shakey, slightly agitated and can't focus.
That doesn't sound like akathisia to me. You might be sensitive to pro-norepinephrine drugs.
What about using small doses (25-50 mg) of Seroquel for sleep?
- Scott
Posted by g_g_g_unit on October 25, 2013, at 0:46:02
In reply to Re: akathisia on mirtazapine » g_g_g_unit, posted by SLS on October 25, 2013, at 0:27:48
> That doesn't sound like akathisia to me. You might be sensitive to pro-norepinephrine drugs.Scott, how do you distinguish between the two? I do feel a lot of inner tension and discomfort, and am having trouble with activities like watching TV etc.
>
> What about using small doses (25-50 mg) of Seroquel for sleep?
>Seroquel gives me genuine akathisia in even tiny doses (12.5mg). I might just washout from the Mirtazapine and try it again at a very low dose (1-3mg).
Posted by doxogenic boy on October 25, 2013, at 2:57:51
In reply to Re: akathisia on mirtazapine, posted by g_g_g_unit on October 24, 2013, at 22:37:48
> Thanks .. I've lowered it to 7.5mg, and now 3mg, but still have akathisia all day (due to the long-ish half-life, I guess). If I go without it, I get no sleep. Toxic cr*p.
Maybe you will be better at 3 mg if you wait some days. If you doesn't - have you tried trimipramine for sleep? I use 100 mg.
- doxogenic
Posted by SLS on October 25, 2013, at 7:45:38
In reply to Re: akathisia on mirtazapine » g_g_g_unit, posted by doxogenic boy on October 25, 2013, at 2:57:51
> have you tried trimipramine for sleep? I use 100 mg.
You are reading my mind!
- Scott
Posted by g_g_g_unit on October 25, 2013, at 9:54:38
In reply to Re: akathisia on mirtazapine » g_g_g_unit, posted by doxogenic boy on October 25, 2013, at 2:57:51
> > Thanks .. I've lowered it to 7.5mg, and now 3mg, but still have akathisia all day (due to the long-ish half-life, I guess). If I go without it, I get no sleep. Toxic cr*p.
>
> Maybe you will be better at 3 mg if you wait some days. If you doesn't - have you tried trimipramine for sleep? I use 100 mg.
>Sorry, I was just in a bad mood because it's my birthday weekend and now I have to opt for zero sleep tonight; I didn't think Remeron would mess me up this badly.
I haven't tried trimipramine, but I'll put it on the list - thanks!
Posted by doxogenic boy on October 26, 2013, at 8:49:10
In reply to Re: akathisia on mirtazapine » doxogenic boy, posted by SLS on October 25, 2013, at 7:45:38
> > have you tried trimipramine for sleep? I use 100 mg.
>
> You are reading my mind!That was a nice compliment! Does trimipramine work for sleep for Parnate users, and is the combo safe? What about Parnate + trimipramine + quetiapine?
- doxogenic
Posted by doxogenic boy on October 26, 2013, at 8:55:54
In reply to Re: akathisia on mirtazapine » doxogenic boy, posted by g_g_g_unit on October 25, 2013, at 9:54:38
I hope the mirtazapine side effects will subside soon. Good luck!
- doxogenic
Posted by SLS on October 28, 2013, at 7:25:24
In reply to Re: akathisia on mirtazapine » SLS, posted by doxogenic boy on October 26, 2013, at 8:49:10
> > > have you tried trimipramine for sleep?
I took trimipramine for a few months in an attempt to treat depression. I can't say that it helped with insomnia, as my baseline depression presents with hypersomnia. I took it in the morning. It did not make me feel at all sleepy or sedated.
> > You are reading my mind!
> That was a nice compliment! Does trimipramine work for sleep for Parnate users, and is the combo safe?The combination is safe, and might act synergistically with Parnate to produce a more robust antidepressant response. You will just have to experiment with trimipramine to see if it addresses your needs.
Can you list the sleep-promoting (hypnotic) drugs that you have tried so far?
> What about Parnate + trimipramine + quetiapine?That sounds like an excellent strategy to help with both depression and insomnia. Trimipramine might not increase the time spent asleep, but quetiapine should. Trimipramine will, however, increase the quality of sleep by extending the time spent in slow-wave (delta-wave) sleep.
- Scott
Posted by doxogenic boy on October 28, 2013, at 8:30:23
In reply to Re: akathisia on mirtazapine » doxogenic boy, posted by SLS on October 28, 2013, at 7:25:24
> > > > have you tried trimipramine for sleep?
>
> I took trimipramine for a few months in an attempt to treat depression. I can't say that it helped with insomnia, as my baseline depression presents with hypersomnia. I took it in the morning. It did not make me feel at all sleepy or sedated.Thanks for your response.
The first time I took trimipramine, I think it was 10 mg, I slept for 20 hours. I waked up a lot of times, but had no problems falling asleep again. It was only the first time it had this powerful effect on my sleep, but I think it still have some effect.I also use quetiapine and agomelatine (and three other meds), could it be that trimipramine+quetiapine+agomelatine work synergistically for more and better sleep? My insomnia is definitely cured - I sleep for 11-12 hours when my sleep isn't interrupted by an alarm clock, and I feel good and not tired at daytime with so much sleep.
> > > You are reading my mind!
>
> > That was a nice compliment! Does trimipramine work for sleep for Parnate users, and is the combo safe?
>
> The combination is safe, and might act synergistically with Parnate to produce a more robust antidepressant response. You will just have to experiment with trimipramine to see if it addresses your needs.Thank you for this information. I am satisfied with my current meds (see my signature) that have worked for 4 years, but it is good to know that there is an option I haven't tried if they ever should stop working. When I am depressed, I always has insomnia too.
> Can you list the sleep-promoting (hypnotic) drugs that you have tried so far?
oxazepam
flunitrazepam
zopiclone
zolpidem
clonazepam
chlorpromazine
levomepromazine
quetiapine
chloral hydrate
alimemazine
mianserin
trazodone
mirtazapine
trimipramine
Xyrem
(I got Xyrem for depression, but it didn't work.)Here is my medication history 1994 - 2009:
http://www.dr-bob.org/babble/20090826/msgs/914853.html> > What about Parnate + trimipramine + quetiapine?
>
> That sounds like an excellent strategy to help with both depression and insomnia. Trimipramine might not increase the time spent asleep, but quetiapine should. Trimipramine will, however, increase the quality of sleep by extending the time spent in slow-wave (delta-wave) sleep.I have "periodic limb movements during sleep",
http://www.sleepfoundation.org/article/sleep-related-problems/periodic-limb-movements-sleep
it showed on polysomnography in an overnight stay in a sleep laboratory, but I was medication-free when that was done in 2005. Does trimipramine work for that sleep disorder too?And do quetiapine add any risk of interactions to a Parnate+trimipramine combo?
- doxogenic
Posted by ed_uk2010 on October 28, 2013, at 17:48:56
In reply to Re: akathisia on mirtazapine » doxogenic boy, posted by SLS on October 28, 2013, at 7:25:24
Hi Scott,
For me, alpha-2 antagonism appears to be bad news. Ultra low-dose mirtaz is sedating but unremarkable. 30mg or more causes a very uncomfortable restless/distressed feeling. Vile! Interestingly, I have an unusual reaction to the alpha-2 agonist clonidine. After a brief period of drowsiness, it leads to increased emotional intensity - which can either be good... ...or bad.
ed
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