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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 flipsactown on May 16, 2004, at 3:52:36
Yesterday, was my 5th week on Nardil currently 60mg daily. At first I did not mind the insomnia as long as my depression was in check, an besides, all the extra time I had on my hands, I was able to put to productive use. I started taking OTC benadryl when I was desperate for some sleep which worked for a couple of weeks but did not give me continuous sleep. I begged my outgoing pdoc for an rx to help me sleep and he prescribed Seroquel. Took Seroquel the night before my new pdoc's appointment but was disappointed in that I got maybe 2hr sleep. My new pd doc rxs Ambien as I told him I was only getting a couple hours sleep. I have only been taking Ambien for 4 days, but this sleep deprivation is taken its toll on my depression and I would hate to stop Nardil because of sleep deprivation. My new pdoc is actually admitting he knows little about MAOI's and will do some research to see if there are other meds I can safely take with Nardil such as Trazodone.
I hope Scott SLS is doing better!
FST
Posted by harryp on May 16, 2004, at 5:26:51
In reply to NARDIL INSOMNIA NEED HELP!!, posted by flipsactown on May 16, 2004, at 3:52:36
Hi!
I'm glad your doc is doing research. All the MAOI literature that I have seen specifically recommends Trazadone for MAOI induced insomnia. I can attest that it works extremely well. When I started 25-50mg Trazadone + 1mg lorazapan "night anxiety" at night I started sleeping better than I had in a long time.
I think you will have good results with it.
Posted by Sad Panda on May 16, 2004, at 10:48:55
In reply to NARDIL INSOMNIA NEED HELP!!, posted by flipsactown on May 16, 2004, at 3:52:36
> Yesterday, was my 5th week on Nardil currently 60mg daily. At first I did not mind the insomnia as long as my depression was in check, an besides, all the extra time I had on my hands, I was able to put to productive use. I started taking OTC benadryl when I was desperate for some sleep which worked for a couple of weeks but did not give me continuous sleep. I begged my outgoing pdoc for an rx to help me sleep and he prescribed Seroquel. Took Seroquel the night before my new pdoc's appointment but was disappointed in that I got maybe 2hr sleep. My new pd doc rxs Ambien as I told him I was only getting a couple hours sleep. I have only been taking Ambien for 4 days, but this sleep deprivation is taken its toll on my depression and I would hate to stop Nardil because of sleep deprivation. My new pdoc is actually admitting he knows little about MAOI's and will do some research to see if there are other meds I can safely take with Nardil such as Trazodone.
>
> I hope Scott SLS is doing better!
> FST
>
>Hi FST,
I assume Remeron was a failure? Trimipramine is another one you could ask for, it is a TCA that has no 5-HT or NE reuptake capabilities, it's a little weaker than Doxepin for H1 blockade & it is stronger than all other AD's for 5-HT2A blockade, I think it comes in a generic variety too now.
Cheers,
Panda.
Posted by SLS on May 16, 2004, at 11:46:05
In reply to Re: NARDIL INSOMNIA NEED HELP!! » flipsactown, posted by Sad Panda on May 16, 2004, at 10:48:55
> Trimipramine is another one you could ask for, it is a TCA that has no 5-HT or NE reuptake capabilities,
Panda - Wow. That is a very, very interesting suggestion. Very.
> I think it comes in a generic variety too now.
As of a year ago, trimipramine was available in the US only as the branded product, Surmontil. It is very expensive for a tricyclic. Odyssey Pharmaceuticals serves as the sole distributor. They do have a patient assistance program, but I don't know how good it is.
http://www.needymeds.com/programs/odyssey.html
Odyssey seems to have made a business of taking on drugs that have a limited market and for which there is only one manufacturer. They basically corner the market and charge whatever the market will bear.
FST - If Nardil is working for you, the insomnia should be treated aggressively. There is no reason why it could not be managed successfully with the drugs that are currently available.
- Scott
Posted by King Vultan on May 16, 2004, at 11:53:35
In reply to NARDIL INSOMNIA NEED HELP!!, posted by flipsactown on May 16, 2004, at 3:52:36
In "Psychotropic Drugs", they recommend:
A first-choice drug for sleep onset insomnia is triazolam (Halcion).
A first-choice drug for sleep maintenance insomnia is temazepam (Restoril).
A first-choice drug for early-morning awakening is flurazepam (Dalmane, Somnol), which induces sleep of long duration.
Scott (SLS) recently gave some sleep recommendations to me and mentioned that Halcion is powerful but doesn't allow some people to sleep the whole night. In that respect, it appears to me to have some similarities to Ambien, which also has a short half life and is more useful for people who have trouble falling asleep to begin with. He also mentioned having some luck with Restoril and Ativan (lorazepam) for maintaining sleep.
I've been on Nardil since March 1 and on 90 mg/day for three weeks now, and the 2 x 25 mg/night of diphenhydramine (Benadryl) is working well enough for me to get by. It actually seems to be working a little better lately, so maybe the insomnia is dissipating somewhat. I still wake up at least two or three times a night, though, and can't seem to get much more than about six hours of sleep in any event. However, I've seen the opinion expressed that one characteristic of MAOIs is that they reduce the need for sleep, and perhaps there is something to that.
Todd
Posted by flipsactown on May 16, 2004, at 20:36:29
In reply to Re: NARDIL INSOMNIA NEED HELP!! » flipsactown, posted by Sad Panda on May 16, 2004, at 10:48:55
>
> I assume Remeron was a failure? Trimipramine is another one you could ask for, it is a TCA that has no 5-HT or NE reuptake capabilities, it's a little weaker than Doxepin for H1 blockade & it is stronger than all other AD's for 5-HT2A blockade, I think it comes in a generic variety too now.
>
I have never used Remeron by itself. I have used it in combo with Prozac, Wellbutrin, Lamictal and Lithium.Although Nardil seems to be lifting my depression, I don't know how much longer I can stay with it, especially if I don't get more than 2 continuous hours sleep and will have to abandon it and probably go back to something like Lexapro or anything but an MAOI since it appears that Kaiser pdocs are not comfortable rxing anything but the newer ADs. I am tired of researching MAOI's and sharing the info with my pdoc only to be told that Kaiser goes strictly by their PDR'S which apparently does not endorse MAOIs.
Although my new pdoc seems more receptive to MAOIs and even promised to do some researching on his own and may even rx Trazodone or any other SAFE Rx, I will believe it when I see it.
I think I will give Ambien another week before I decide if I will stay with Nardil since Nardil appears to be lifting my depression. I will keep Trimipramine in mind if I decide to quit Nardil. Thanks for the info.
FST
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Posted by flipsactown on May 16, 2004, at 20:55:14
In reply to Re: NARDIL INSOMNIA NEED HELP!!, posted by King Vultan on May 16, 2004, at 11:53:35
> A first-choice drug for sleep onset insomnia is triazolam (Halcion).
>
> A first-choice drug for sleep maintenance insomnia is temazepam (Restoril).
>
> A first-choice drug for early-morning awakening is flurazepam (Dalmane, Somnol), which induces sleep of long duration.
>
> Scott (SLS) recently gave some sleep recommendations to me and mentioned that Halcion is powerful but doesn't allow some people to sleep the whole night. In that respect, it appears to me to have some similarities to Ambien, which also has a short half life and is more useful for people who have trouble falling asleep to begin with. He also mentioned having some luck with Restoril and Ativan (lorazepam) for maintaining sleep.Will keep these meds in mind. Thanks.
>
> I've been on Nardil since March 1 and on 90 mg/day for three weeks now, and the 2 x 25 mg/night of diphenhydramine (Benadryl) is working well enough for me to get by.I also take OTC Benadryl and it seems to work just as well as the Rxd Ambien.
> It actually seems to be working a little better lately, so maybe the insomnia is dissipating somewhat.I surely hope so.
> I still wake up at least two or three times a night, though, and can't seem to get much more than about six hours of sleep in any event.
It is the same with me, but I am lucky to get 3 or 4 hours total sleep.
> However, I've seen the opinion expressed that one characteristic of MAOIs is that they reduce the need for sleep, and perhaps there is something to that.
I think this is true. However, with me the sleep deprivation will eventually increase my depression and actually counter Nardil's AD effectiveness.
Thanks for the info.
FST
>
Posted by flipsactown on May 16, 2004, at 21:09:22
In reply to Re: NARDIL INSOMNIA NEED HELP!!, posted by SLS on May 16, 2004, at 11:46:05
> > Trimipramine is another one you could ask for, it is a TCA that has no 5-HT or NE reuptake capabilities,
Will keep this in mind should I decide on quitting Nardil.
> As of a year ago, trimipramine was available in the US only as the branded product, Surmontil. It is very expensive for a tricyclic. Odyssey Pharmaceuticals serves as the sole distributor. They do have a patient assistance program, but I don't know how good it is.Since I belong to Kaiser, it probably is not in their formulary of covered drugs but can be added by my pdoc but I surely doubt my pdoc would be willing to Rx anything out of the ordinary.
>
>
> FST - If Nardil is working for you, the insomnia should be treated aggressively.
I agree with you 100%.> There is no reason why it could not be managed successfully with the drugs that are currently available.
There is, if you belong to Kaiser. Thanks for the great info. You're the man, Scott! Glad to see you back in your usual informative form.
FST
Posted by ace on May 16, 2004, at 21:51:49
In reply to NARDIL INSOMNIA NEED HELP!!, posted by flipsactown on May 16, 2004, at 3:52:36
> Yesterday, was my 5th week on Nardil currently 60mg daily. At first I did not mind the insomnia as long as my depression was in check, an besides, all the extra time I had on my hands, I was able to put to productive use. I started taking OTC benadryl when I was desperate for some sleep which worked for a couple of weeks but did not give me continuous sleep. I begged my outgoing pdoc for an rx to help me sleep and he prescribed Seroquel. Took Seroquel the night before my new pdoc's appointment but was disappointed in that I got maybe 2hr sleep. My new pd doc rxs Ambien as I told him I was only getting a couple hours sleep. I have only been taking Ambien for 4 days, but this sleep deprivation is taken its toll on my depression and I would hate to stop Nardil because of sleep deprivation. My new pdoc is actually admitting he knows little about MAOI's and will do some research to see if there are other meds I can safely take with Nardil such as Trazodone.
>
> I hope Scott SLS is doing better!
> FSTI would recommend Nitrazepam 5-10mg, Remeron 15mg, adding a sedating TCA, or melatonin. Even Clonidine, or Valium.
Don't stop Nardil because of this...there are plenty of sleep aids you can use.
Ace.
Posted by Tepiaca on May 17, 2004, at 0:29:00
In reply to NARDIL INSOMNIA NEED HELP!!, posted by flipsactown on May 16, 2004, at 3:52:36
heyy how you doing
dont leat the insomnia makes you quit NardilI also was suffering from insomnia problems when I reached the dose of 60mg .
Now Im on 45 and I still need help aiders.
I was on klonopin for sleeping at first but I did not work . Then I changed to Ambien and worked only for a month .
I took again one little dose of klonopin in the noon just because a couple of interview jobs and I found that day that klonopin started to work.
I dont understand how this happened
But I have a good sleep nowGood luck !!
Posted by flipsactown on May 17, 2004, at 2:04:13
In reply to Re: NARDIL INSOMNIA NEED HELP!! » flipsactown, posted by Tepiaca on May 17, 2004, at 0:29:00
Thanks for the words of encouragement. This morning I took only 2 tabs instead of 3 and was able to sleep 3 straight hours. Yes! I could not believe it. However, I was up to 4 tabs (60mg) and was as depression free as when I first started taking an AD which was Prozac. That is saying a lot because at that time Prozac saved my life and I was basically on Prozac for the majority of the 13 years that I have been on ADs.
But, I also noticed my depression has returned as I decreased my dosage from 4 to 3 and now 2. I may stay at 2 for awhile and catch up on some sleep, because the sleep deprivation I have been experiencing the last 5 weeks, has made me irritable and depressed which defeats the purpose of taking an AD.
FST
> heyy how you doing
> dont leat the insomnia makes you quit Nardil
>
> I also was suffering from insomnia problems when I reached the dose of 60mg .
> Now Im on 45 and I still need help aiders.
> I was on klonopin for sleeping at first but I did not work . Then I changed to Ambien and worked only for a month .
> I took again one little dose of klonopin in the noon just because a couple of interview jobs and I found that day that klonopin started to work.
> I dont understand how this happened
> But I have a good sleep now
>
> Good luck !!
Posted by Sad Panda on May 17, 2004, at 2:07:18
In reply to Re: NARDIL INSOMNIA NEED HELP!! » Sad Panda, posted by flipsactown on May 16, 2004, at 20:36:29
Hi FST,
When I said Remeron, I meant in combination with Nardil. I thought you had tried Remeron for sleep while you were taking Nardil.
Remeron, Trimipramine & Doxepin are heavily sedating AD's that can be used for sleep & safely combined Nardil. They are all potent H1 blockers(infinitely stronger than Benadryl) & 5-HT2A blockers(all equal or more potent than Trzodone or Serzone). I like Remeron because it has 5-HT3 blocking which is great for nausea but Doxepin is dirt cheap ($10 for 60 tablets) & easier to dose.
Cheers,
Panda.
>
>
> >
> > I assume Remeron was a failure? Trimipramine is another one you could ask for, it is a TCA that has no 5-HT or NE reuptake capabilities, it's a little weaker than Doxepin for H1 blockade & it is stronger than all other AD's for 5-HT2A blockade, I think it comes in a generic variety too now.
> >
> I have never used Remeron by itself. I have used it in combo with Prozac, Wellbutrin, Lamictal and Lithium.
>
> Although Nardil seems to be lifting my depression, I don't know how much longer I can stay with it, especially if I don't get more than 2 continuous hours sleep and will have to abandon it and probably go back to something like Lexapro or anything but an MAOI since it appears that Kaiser pdocs are not comfortable rxing anything but the newer ADs. I am tired of researching MAOI's and sharing the info with my pdoc only to be told that Kaiser goes strictly by their PDR'S which apparently does not endorse MAOIs.
>
> Although my new pdoc seems more receptive to MAOIs and even promised to do some researching on his own and may even rx Trazodone or any other SAFE Rx, I will believe it when I see it.
>
> I think I will give Ambien another week before I decide if I will stay with Nardil since Nardil appears to be lifting my depression. I will keep Trimipramine in mind if I decide to quit Nardil. Thanks for the info.
>
> FST
> >
> >
> >
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> >
> >
> >
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Posted by flipsactown on May 17, 2004, at 2:58:46
In reply to Re: NARDIL INSOMNIA NEED HELP!! » flipsactown, posted by ace on May 16, 2004, at 21:51:49
> I would recommend Nitrazepam 5-10mg, Remeron 15mg, adding a sedating TCA, or melatonin. Even Clonidine, or Valium.
Thanks, I will keep these meds in mind, but I am finding out that Kaiser pdocs seem to be overly conservation, especially when it comes to MAOIs. However, my new pdoc I saw last Wednesday, although admitting he did not Rx MAOIs, promised to research Nardil, and MAOIs in general and that if the Ambien did not give me adequate sleep, that he will consider Trazodone and other meds that he finds SAFE to use with MAOIs. Since he mentioned that he relies on their current PDR, I am not holding my breath that he will recommend anything out of the ordinary such as Trazodone or Remeron which are listed as meds to be avoided while taking Nardil. It appears the US has not updated their PDR in quite awhile regarding MAOIs, or if they ever will, because of the stigma associated with it. This is a shame as it appears that the newer ADs eventually poop out with long term use. I don't know if MAOIs have the same poop out factor, but even if did, I feel that in my case, Nardil has helped with my depression. Now the insomnia SE, I feel, can be defeated if only my pdoc's would not be so rigid with their PDR.
I will continue with Nardil as long as I can and hope that my new pdoc will be more helpful than the last, especially when it comes to Rxing other meds with Nardil.
FST
Posted by flipsactown on May 17, 2004, at 3:17:37
In reply to Re: NARDIL INSOMNIA NEED HELP!! » flipsactown, posted by Sad Panda on May 17, 2004, at 2:07:18
> When I said Remeron, I meant in combination with Nardil. I thought you had tried Remeron for sleep while you were taking Nardil.Yes, I did but for only one night. I actually tried it before Ace. I did get some sleep with Remeron but woke up with a slight headache, but the main reason I did not continue was that I gained over 40 lbs on Remeron in a period of 6 months. I may try Rem again if my new pdoc decides not to Rx Trazodone with or without his knowledge because as you know in the US, at least in my case, Remeron is listed as being contraindicated and if my new pdoc follows the their PDR to the letter, he will not Rx Remeron either. Anyway, I still have a full bottle from my previous pdoc.
> Remeron, Trimipramine & Doxepin are heavily sedating AD's that can be used for sleep & safely combined Nardil. They are all potent H1 blockers(infinitely stronger than Benadryl) & 5-HT2A blockers(all equal or more potent than Trzodone or Serzone). I like Remeron because it has 5-HT3 blocking which is great for nausea but Doxepin is dirt cheap ($10 for 60 tablets) & easier to dose.
>
I agree with you but I am at the mercy of my new pdoc. Thanks for the info.
>
FST
This is the end of the thread.
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