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Re: clomipramine insomnia - does it ever go away? undopaminergic

Posted by SLS on January 29, 2023, at 8:21:04

In reply to Re: clomipramine insomnia - does it ever go away? SLS, posted by undopaminergic on January 29, 2023, at 4:21:26

> >
> > 2. If insomnia is the problem you are addressing, there are several medications that would probably give favorable results.
> >
> > zolpidem (Ambien) - Z-drug
> > lorazepam (Ativan) - benzodiazepine
> > temazepam (Restoril) - benzodiazepine
> > clonazepam (Klonopin) - benzodiazepine
> > quetiapine (Seroquel) - antipsychotic
> > mirtazepine (Remeron) - antidepressant
> > doxepin (Sinequan) - antidepressant (TCA) - Extremely antihistaminergic
> > amitriptyline (Elavil) - antidepressant (TCA)
> > trimipramine (Surmontil) - antidepressant (TCA)
> > prazosin (Minipress) - Specific for PTSD nightmares.
> >


> What about cyproheptadine (Periactin)? It's an antihistamine but also blocks serotonin 5-HT2A, which may improve sleep quality.


Sleep architecture?

I think it is important to acknowledge the possibility that cyproheptadine does things other than block histamine receptors. We tend to pigeon-hole things in order to make sense of the world. Lamotrigine was pigeon-holed as an anticonvulsant before it was found serendipitously to exert antidepressant effects. I was a patient at the NIH in 1992-1993 when the seizure disorders unit reported to the biological psychiatry unit that a bunch of people who were taking lamotrigine for epilepsy reported an improvement in their comorbid depressive disorder.


> > I prefer Z-drugs. If you ever need to discontinue Ambien, you can do so abruptly without having typical benzodiazepine withdrawal reactions. Insomnia can be a withdrawal reaction. For me, I had only partial insomnia as a withdrawal reaction to Ambien discontinuation. This might not be true of everyone. Zolpidem and triazolam (Halcion) are good for initial-insomnia while temazepam is good for sleep-maintenance. Many people like low-dosage quetiapine for both types of insomnia.


> Midazolam (Dormicum) is another short-acting benzodiazepine suitable for sleep initiation, but it seems to be available (as Versed) only for injection in the US.


Ah. I had no idea that midazolam good for sleep-initiation. Isn't midazolam used as an adjunct in general anesthesia?


> > About melatonin:
> >
> > 1. Melatonin can make depression somewhat worse.


> Yet there is an antidepressant (agomelatine -- Valdoxan) that is a melatonin agonist.


Yes. What else does it do?

That's the question one should always ask, especially when other pharmacological properties of a drug have yet to be discovered.


> > 2. The optimum timing of melantonin dosing varies between individuals. Most people find that 1 hour before bedtime works well. Yet, there are people who sleep much better when melatonin is given in the afternoon.


> Dose is also important. There are people who insist that 300 mcg (micrograms) is better than higher doses.


I insist that lithium displays a similar clinical trait. For me, 300 mg/day is magic. At 450 mg/day, I very quickly relapse. Lithium has been reported to have a biphasic effect on glutamate release. You commented on this, noting that this bimodal pharmacological property displays a dosage-response curve regarding glutamate release, but can yield conflicting clinical results depending on the study being examined.


> > 3. Herbal teas. Valerian is mentioned often. Chamomile, lemon grass, and eleuthero are others with reputations as being sleep-aids.

> Eleutherococcus is also called Siberian Ginseng.


I wish I had your memory. I am still having trouble with mine. My guess is that the impairment of short-term memory associated with depression is one of the last things to resolve. I had a few bilateral ECT treatments in the 1990s, so this must be taken into consideration. However, I doubt that there are any residual memory deficits produced by ECT for me. We'll see.


> I got angry from Valerian. It was very unusual in how it started and in its qualities. But it has only happened once.


I hate that there are so many differences in the way people respond to a given treatment. Trying to generalize and predict one's reactions to specific drugs is a fool's errand. It is frustrating and makes me feel impotent. We are all trying to help each other in the face of inconsistency and paradox. Dammit.


- Scott



Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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poster:SLS thread:1121637
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