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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by linkadge on August 12, 2017, at 18:50:22
I stopped my meds 2 days ago (very low doses of Effexor, lithium and amitriptyline) to try and get my sleep under control.
I just keep staying up later and later. The amitriptyline puts me to sleep for about an hour, and then I'm wide awake for another 2 or so. I don't fall asleep fully till about 2-3 in the morning.
When my sleep gets f'd up, I find the meds are essentially useless.
To focus exclusively on sleep, I'm taking
1) melatonin time release 5mg
2) cyrpoheptadine 1-5mg
3) lorazepamThat's it. I slept very well last night with this. I did wake up somewhat depressed.
If I sleep normally for a week, I can reassess my state and think about what to do next.
Linkadge
Posted by SLS on August 12, 2017, at 20:24:57
In reply to Med washout to focus on sleep, posted by linkadge on August 12, 2017, at 18:50:22
> I stopped my meds 2 days ago (very low doses of Effexor, lithium and amitriptyline) to try and get my sleep under control.
>
> I just keep staying up later and later. The amitriptyline puts me to sleep for about an hour, and then I'm wide awake for another 2 or so. I don't fall asleep fully till about 2-3 in the morning.
>
> When my sleep gets f'd up, I find the meds are essentially useless.
>
> To focus exclusively on sleep, I'm taking
>
> 1) melatonin time release 5mg
> 2) cyrpoheptadine 1-5mg
> 3) lorazepam
>
> That's it. I slept very well last night with this. I did wake up somewhat depressed.
>
> If I sleep normally for a week, I can reassess my state and think about what to do next.Good luck, Linkadge.
It might be worth considering that depression can be a temporary result of getting lots of sleep after a period of sleep-deprivation. I hope you feel better tomorrow.
- Scott
Posted by Lamdage22 on August 14, 2017, at 11:00:28
In reply to Re: Med washout to focus on sleep, posted by SLS on August 12, 2017, at 20:24:57
If you experience withdrawal symptoms you can reintroduce a small dose and titrate down from that.
I dont know what dosage you have been on but its better to be careful with psychiatric meds.
When i reduce meds (which i do all the time) i cut 5-10% of the previous dosage every 4-6 weeks.
Posted by linkadge on August 14, 2017, at 17:07:04
In reply to Re: Med washout to focus on sleep, posted by Lamdage22 on August 14, 2017, at 11:00:28
When my sleep starts to get messed up, the meds just don't work anyway.
So far, so good. I got 3 great nights of sleep (with just melatonin, cyproheptadine and lorazepam only). It also broke the cycle of staying up later and later and short sleep duration. On day 3 though, symptoms of depression are slowly returning (mainly anxiety and anhedonia).
I'm starting a low dose of Effexor again, and perhaps remeron. I am seeing the doctor next week. We switched from remeron to amitriptyline (mainly because the remeron was causing too much daytime sedation). It seems to be better (for me) for sleep than amitriptyline, but I don't like the way I feel the next day.
Suprisingly, the amitriptyline is causing little sedation and is significantly more activating than remeron. One possibility is that I have some degree of bipolarity and that amitriptyline is pushing me too far.I have noticed in the past that amitriptyline is a much stronger antidepressant than remeron. Remeron felt more like a mood stabilizer / antipsychotic than antidepressant.
Linkadge
Posted by SLS on August 14, 2017, at 21:20:15
In reply to Re: Med washout to focus on sleep, posted by linkadge on August 14, 2017, at 17:07:04
> I have noticed in the past that amitriptyline is a much stronger antidepressant than remeron. Remeron felt more like a mood stabilizer / antipsychotic than antidepressant.
Most people don't take Remeron at dosages that are high enough to produce robust antidepressant effects. Dosages for depression should really be 45-90 mg/day. Keeping it in this range often produces less sedation and perhaps less weight-gain.
- Scott
Posted by linkadge on August 15, 2017, at 14:57:41
In reply to Re: Med washout to focus on sleep, posted by SLS on August 14, 2017, at 21:20:15
Hi Scott,
You may be right. However, the only additional effect which would become pronounced at higher doses would be the alpha-2 effect. I think the 5-ht2 receptors would become saturated at much lower doses.
From reading patient experiences, mirtazapine seems to loose its effect as an antidepressant sooner than other drugs, although it may work faster.
Amitriptyline has more targets (i.e. reuptake inhibition, trk agonism, anti-muscarinic effects, ion channel effects).
On a scale for likelihood to induce mania, I would put mirtazapine on the lower end, and the TCA's on the higher end.
But that's just my 2 cents.
Linkadge
Posted by linkadge on August 15, 2017, at 14:59:08
In reply to Re: Med washout to focus on sleep, posted by SLS on August 14, 2017, at 21:20:15
Just to add, I think anticholinergics can delay the sleep cycle, whereas cholinergic can advance it
Linkadge
Posted by phidippus on November 25, 2017, at 11:56:01
In reply to Med washout to focus on sleep, posted by linkadge on August 12, 2017, at 18:50:22
I doubt any of the medications you were taking were causing sleep problems. Insomnia usually stems from the illnesses you suffer and getting them under control contributes greatly to sleep quality. If I were to choose a medication from those you're taking, I would say it was the Effexor. Lithium and amytryptaline both promote sleep. Of the medications you took to sleep, only lorazepam seems helpful. Melatonin has not been shown to be an effective sleep promoting agent and Cyproheptadine has no indications for sleep.
Eric
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