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Re: Is Cyplyta a reasonably strong antipsychotic?

Posted by SLS on February 22, 2023, at 20:11:20

In reply to Re: Is Cyplyta a reasonably strong antipsychotic?, posted by undopaminergic on February 22, 2023, at 3:22:43

> > > Do you find that your psychotic symptoms start to come back if you lower the dose? Do you notice a difference if you forget a dose?
> >
> > Not exactly, but I can't sleep if I lower the dose. However, I haven't done it in a long time.
> >
> > The forgotten dose usually leads to not being able to sleep.
> >
> >
> Not being able to sleep is a problem, for sure, but in my opinion it is not best remediated with antipsychotics. Can you try cyproheptadine (Periactin)? It is both an antihistamine (histamine H1-receptor antagonist) and a serotonin 5-HT2A receptor antagonist. If that doesn't work, and the dopamine antagonism turns out essential, try augmenting with a low dose of a more selective dopamine antagonist (than olanzapine and quetiapine) like haloperidol; in this situation, I would avoid sulpiride and amisulpride, as they can have stimulant effects. There are also other agents that can help with sleep, such as clonidine and Xyrem. And what about the Z-drugs ((es)zopiclone, zolpidem, zaleplon)?
> -undopaminergic

What about Seroquel (quetiapine) 25-50 mg h.s.? If the only property of Seroquel necessary to improve sleep is antihistaminergic, I guess we can exclude that from consideration. Are there any other properties of Seroquel that contribute to improving sleep?

Doxepin and amitriptyline are often used. However, unlike the other TCAs, trimipramine has no amine reuptake inhibition. It is also the only TCA that improves sleep architecture. I tried it once to treat depression. I don't remember it having any hypnotic effects. I react badly to mirtazapine. It makes my depression much worse. For some people, low dosages work very well to help with sleep. Unfortunately, treating their patients with mirtazapine for depression is almost always a wasted opportunity by psychiatrists who should know better. In my estimation, the actual effective dosage range for mirtazapine when treating depression is 45-90 mg/day.


From the monograph:

Recommended Dose and Dosage Adjustment:

Initial treatment
NTP-MIRTAZAPINE OD TABLETS should be administered as a single dose preferably in the
evening prior to sleep. The recommended initial dose is 15 mg daily. In clinical trials, patients
generally received doses of mirtazapine in the range of 15-45 mg/day.


The following dosages of mirtazapine are more likely to dramatically improve the quality of one's life than lower dosages.

60 mg/day
75 mg/day
90 mg/day


This might help:

- 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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