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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by paul on April 21, 2000, at 23:42:19
a friend of mine's lifelong sleep problem-falling asleep and staying there-was completely solved by serzone. i like what s does, but i haven't had the sleep-luck he's had. is there another a.d. out there -NOT paxil or zoloft-that might be worth trying? i'm trying to put as little of this junk into my life as possible so i'm looking for that miracle a.d. any help tearfully acknowledged.
pcl
Posted by KarenB on April 22, 2000, at 0:56:38
In reply to most sedating a-d's, posted by paul on April 21, 2000, at 23:42:19
> a friend of mine's lifelong sleep problem-falling asleep and staying there-was completely solved by serzone. i like what s does, but i haven't had the sleep-luck he's had. is there another a.d. out there -NOT paxil or zoloft-that might be worth trying? i'm trying to put as little of this junk into my life as possible so i'm looking for that miracle a.d. any help tearfully acknowledged.
> pclPaul,
Nortriptyline, or brand name "Pamelor," is sedating and put me right to sleep when taken 30-45 min. before bedtime. Sedation is NOT what I need, however and so I went off it. Others, though, have had great success. It is not an SSRI like Paxil or Zoloft - it's an older tricyclic. Dry mouth and constipation are some side effects, if you can put up with that (ugh.). If you want more info, "bob" uses it as his primary AD and it apparently is working for him.
Karen
Posted by bob on April 22, 2000, at 2:37:15
In reply to Re: most sedating a-d's, posted by KarenB on April 22, 2000, at 0:56:38
Hi Paul,
All the time I've been on nortriptyline, it hasn't been so sedating that it's put me to sleep ... well, only when I jumped from 75mg (augmenting zoloft) to 150mg (dumped zoloft and made it my main AD). I'd fall asleep if I stood still for 30 seconds, right there on my feet. That only lasted a week or so. I've never had much in terms of side-effects (thank goodness!) from nortrip at all. As always, your mileage may vary. Given your aversion to SSRIs (zoloft and paxil), a TCA like nortrip might work better for you anyway. Disturbed sleep can be a symptom of depression (as opposed to wanting to sleep all the time), so if you find a med that's a better match for you that may take care of the problem as much as hoping for a desired side effect.
There are other meds you can take to address the sleeplessness itself, too. I'm sure others will chime in once they realize sedation is what you WANT, not what you want to avoid. For me, the one med that knocked me out consistently was perphenazine, an antipsychotic med I was taking tiny amounts of to help with side effects from wellbutrin. Neuroleptic meds like that are not necessarily things you want to take long term. While rare at the level I was on, they can have some nasty permanent side effects (Tardive Dyskinesia, to be precise).
cheers,
bob[then again, seeing as its 3:30 AM, maybe I'm not the one to be offering advice on getting to sleep!]
Posted by JohnL on April 22, 2000, at 5:49:59
In reply to most sedating a-d's, posted by paul on April 21, 2000, at 23:42:19
> a friend of mine's lifelong sleep problem-falling asleep and staying there-was completely solved by serzone. i like what s does, but i haven't had the sleep-luck he's had. is there another a.d. out there -NOT paxil or zoloft-that might be worth trying? i'm trying to put as little of this junk into my life as possible so i'm looking for that miracle a.d. any help tearfully acknowledged.
> pclYou might consider one of several choices.
Remeron 7.5mg (half the minimum dose) is absolutely great for sleep. At this dose, there is no carryover into the next day after the morning's first coffee. I've tried all diffferent doses of Remeron, and a lot of different drugs, over the past year, and nothing for me is better for sleep than 7.5mgRemeron.Some people like Trazodone. It's an earlier ancestor of Serzone. Personally I hated it. Actually worsened sleep, nightmares, headaches. Yuck.
A tricyclic like Nortriptyline or Amitriptyline or Imipramine. But even at small doses you will likely have bothersome dry mouth and constipation, or other discouraging side effects. These are great meds, but one must be able to endure certain given side effects.
This might surprise you, but something good for both sleep and depression is available over the counter...St Johnswort. No kidding. Some people--like me--really do respond nicely to SJW. And believe me, I've tried just about ALL the prescripts out there over the years. I mention SJW because there are controlled scientific sleep studies on it that have shown how it influences brain waves and improves sleep architecture. On the other hand, I have heard a few cases of SJW insomnia. We're all different. But due to the ease and the inexpense, I think it's certainly worth trying for about 2 or 3 weeks. It takes longer than most drugs to build up in the body. So disregard the first week. Look for benefits in week two or week three. If nothing by then, move on to something else.
Another natural for sleep and depression is 5HTP, the precursor ingredient for the body's production of serotonin.
In your shoes, knowing what I know and being able to reflect back on dozens of trials and combinations, I would suggest the following options for immediate trial:
Remeron 7.5mg alone, an hour before bed.
Remeron 7.5mg an hour before bed, with SJW during the day (stick with brands Movana, Nature's Way Perika, Kira, or Ricola). Dosage could range from 2 to 3 pills a day, depending on how you respond. Maximum is 9 pills a day. Take the last dose before late afternoon. I think you might find that having some SJW in your system improves sleep structure. It isn't sedating, and it won't cause you to fall asleep (the Remeron will do that), but once you are asleep the quality of that sleep will be high quality. I noticed sleep benefits by my second day.
Either of the above with 5HTP added is a third option.These options I think stand a real good chance of improving your sleep, improving your depression, and satisfying your preference to avoid as much medication in your body as possible. They certainly aren't the only options, but they fit the description of what you are looking for. JohnL
Posted by dove on April 22, 2000, at 11:35:44
In reply to Re: most sedating a-d's, posted by JohnL on April 22, 2000, at 5:49:59
The three meds I have found that enhance sleep the best are Melatonin, Amitriptyline (Elavil), and Nefazodone (Serzone).
Melatonin can and will add to depressive symptoms, but it can easily help falling asleep and remaining asleep. Which can be such a boon that some will see a brightening of mood and not have to visit other sedating script meds.
Amitriptyline (Elavil) really works well for improved sleep. It can help even in small dosages, such as 25-50 mgs. With initiation some will find dry mouth, constipation, dizziness, but these effects quickly left for me, after two weeks. I have found myself a little foggy in the morning after upping the dosage the night before, but I have quickly adapted to the symptoms which, once again, quickly disappear.
Nefazodone (Serzone) has been an incredible plus for my quality of sleep. I take Serzone with Amitriptyline, the largest dosage of the day taken before bed. It enables me to shut off my mind and relax, which is the major cause for most of my sleep problems.
The SSRI's, (prozac, zoloft) don't seem to help with sleep problems at all, actually they seem to make them worse for many people. St. John's Wort made my sleep considerably worse, and wouldn't readily recommend it from my personal experience.
The three meds I described are the only ones I have ever found that helped me, but as you can see from this board, Your Mileage May Vary.
Best of luck to you!
dove
Posted by saint james on April 22, 2000, at 11:39:02
In reply to most sedating a-d's, posted by paul on April 21, 2000, at 23:42:19
The most sedating TCA is Doxipin. It might be better to try the improved TCA, Remeron, first as it has no histine or colonrergic effects, however
Doxipin is very cheap and Remeron is brand.
sleep well,james
Posted by allisonm on April 22, 2000, at 13:19:03
In reply to most sedating a-d's, posted by paul on April 21, 2000, at 23:42:19
If you try Remeron, though, start it on a Friday night or on a night when you don't have to be anywhere for a couple of days. It may well make you sleep through most of next day. That's what it did to me.
Posted by JohnB on April 22, 2000, at 19:35:20
In reply to Re: most sedating a-d's, posted by saint james on April 22, 2000, at 11:39:02
doxipin is sedating but it's effects will carryover into the next day.
Posted by paul on April 22, 2000, at 23:36:56
In reply to Re: most sedating a-d's, posted by JohnL on April 22, 2000, at 5:49:59
john-
i've tried amitryptiline. i'd rather nail my head to the floor. and as for 5-htp-the stuff is total crap and i'm not the only one who feels this way. is remeron an a.d.? the serzone i'm on now helps w/depression but doesnt seem to do anything for sleep even though i take the full day's dose-300 mg-@ bedtime.
my ex-shrink always warned me to stay away from sjw since i'm on serzone but he's recently been reported to the appropriate authorities for professional misconduct so whatever he said in the past is FERTILIZER now. i'll talk to my new shreenk and see what he sez. i tried trazodone too but things were SOOOOOOO fuggedup then that evaluating it fairly is impossible. the zoloft just pooped out and so did the paxil-awa turning me into a total blimp-and ending in a WONDERFUL withdrawal experience that landed me in the ER thanks to the idiot g.p. that never bothered to educate me on any of the warnings relative to the trash. like so many classic cases, it stopped working and i stopped taking it. THEN i got up close and personal with the gaping maw of HELL itself.
tx for the indepth reply
pcl
Posted by paul on April 22, 2000, at 23:43:05
In reply to Re: most sedating a-d's, posted by dove on April 22, 2000, at 11:35:44
i would do a lot more research into melatonin before taking it at all. of the many problems with the stuff bioactivity is primary. i doubt you know just what you're getting unless its pharmacy-grade and i don't even know if that exists. a friend of mine who used to be quite a prominent shrink read me the riot act when i told him i was using it. i wish i could substantiate what he said but i no longer have his email. suffice it to say it was enough to get me to NEVER mess with the stuff again.
tx
pcl
Posted by paul on April 22, 2000, at 23:49:14
In reply to Re: most sedating a-d's, posted by saint james on April 22, 2000, at 11:39:02
thanks to everyone who took the time to write! it's a treat to answer substantive discourse instead of the worthless SCHNIVE i've encountered elsewhere.
tx
pcl
Posted by bob on April 23, 2000, at 0:56:30
In reply to Re: most sedating a-d's, posted by paul on April 22, 2000, at 23:36:56
> paxil-awa turning me into a total blimp-and ending in a WONDERFUL withdrawal experience ... i got up close and personal with the gaping maw of HELL itself.
LOL! What a great description! Given the prevalence lately of paxil withdrawal posts, it's sooooooooo tempting to start a "tell us your favorite paxil withdrawal nightmare story ... and embellish as much as you'd like, please" thread ... but seriously, one of the great things about Babbleland is that we DON'T get that alarmist about anything here -- it's a disservice to those who it helps ... some of whom are Babblelanders who have actually admitted to it, too!
Geez, it's tempting, tho ...
bob[ps to noa -- don't go telling folks about my "henny penny" withdrawal symptoms, now! ;^) ]
Posted by ChrisK on April 23, 2000, at 6:40:01
In reply to Re: most sedating a-d's, posted by paul on April 22, 2000, at 23:43:05
One other possibilty is Zyprexa. It has good AD qualities and sleep is very enhanced. It does bring on the weight gain though. I take it with Nortriptyline at night and have no sleep problems. It might be worth looking into.
Posted by allisonm on April 23, 2000, at 16:05:03
In reply to Re: most sedating a-d's, posted by paul on April 22, 2000, at 23:36:56
> is remeron an a.d.?
Yes.
Go here: http://www.rxlist.com/cgi/generic/mirtaz.htm
REMERON® (mirtazapine) Tablets are an antidepressant for oral administration. Mirtazapine has a tetracyclic chemical structure
unrelated to selective serotonin reuptake inhibitors, tricyclics or monoamine oxidase inhibitors (MAOI). Mirtazapine belongs to the
piperazino-azepine group of compounds.The mechanism of action of REMERON® (mirtazapine) Tablets, as with other antidepressants, is unknown.
Evidence gathered in preclinical studies suggests that mirtazapine enhances central noradrenergic and serotonergic activity. These studies
have shown that mirtazapine acts as an antagonist at central presynaptic a2 adrenergic inhibitory autoreceptors and heteroreceptors, an
action that is postulated to result in an increase in central noradrenergic and serotonergic activity.Mirtazapine is a potent antagonist of 5-HT2 and 5-HT3 receptors. Mirtazapine has no significant affinity for the 5-HT1A and 5-HT1B
receptors. Mirtazapine is a potent antagonist of histamine (Hi) receptors, a property that may explain its prominent sedative effects.Mirtazapine is a moderate peripheral a1 adrenergic antagonist, a property that may explain the occasional orthostatic hypotension
reported in association with its use.Mirtazapine is a moderate antagonist at muscarinic receptors, a property that may explain the relatively low incidence of anticholinergic
side effects associated with its use.It is designated 1,2,3,4,10,14b-hexahydro-2-methylpyrazino[2,1-a] pyrido [2,3-c] benzazepine
and has the empirical formula of C17H19N3. Its molecular weight is 265.36.
Posted by Brandon on April 23, 2000, at 0:18:02
In reply to Re: most sedating a-d's, posted by JohnL on April 22, 2000, at 5:49:59
>
> This might surprise you, but something good for both sleep and depression is available over the counter...St Johnswort. No kidding. Some people--like me--really do respond nicely to SJW. And believe me, I've tried just about ALL the prescripts out there over the years. I mention SJW because there are controlled scientific sleep studies on it that have shown how it influences brain waves and improves sleep architecture. On the other hand, I have heard a few cases of SJW insomnia. We're all different. But due to the ease and the inexpense, I think it's certainly worth trying for about 2 or 3 weeks. It takes longer than most drugs to build up in the body. So disregard the first week. Look for benefits in week two or week three. If nothing by then, move on to something else.I completely and wholeheartedly agree with JohnL on this one. While SJW had little benefit for me in the one MDD I experienced for my dysthimic moods it has been wonderful. I take Movana brand SJW and it elevates my mood very smoothly and my sleep is wonderful. I always feel very well rested in the mornings. I take a full 900mg. (3tabs) at night before bed. I have found that of all the brands I have tried Movana has the most pronounced effect on me. I'm not sure if this is do to some kind of placebo effect or to the compound itself. What I do know is that sleep is great and in the mornings I am alert and refreshed and ready for the day!
This is the end of the thread.
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