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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by TriedEveryMedication on March 30, 2020, at 12:09:05
Hi,
Hope everyone is holding up ok during this situation.Desipramine has been the only thing that ever worked for me for being able to focus on tasks and for being able to get things done.
I find that Insomnia with it is horrendous, though. It wasn't always the case. I used to be able to take my dose and sleep through the night maybe 6 hours and jump out of bed ready to go.
The past few times I've been on it, I will wake up at 1 or 2 am and stay away until 6am and then crash again.
I've tried various meds to combat the insomnia and most of them kind of kill the cognitive and attentional benefits of the desipramine. Prazosin maybe worked the best but I still don't get a good night's sleep. hypnotics and trazodone somewhat mess up the benefits of the desipramine.
Without any meds I sleep pretty well.
Any ideas? Any other meds to try instead of desipramine? (I've gone through many other tricyclics and straterra - no luck)
Posted by Lamdage22 on March 30, 2020, at 12:20:07
In reply to Dealing with insomnia with desipramine, posted by TriedEveryMedication on March 30, 2020, at 12:09:05
Which ones? Have you tried trazodone?
> I've tried various meds to combat the insomnia and most of them kind of kill the cognitive and attentional benefits of the desipramine.
Posted by Lamdage22 on March 30, 2020, at 13:09:02
In reply to Re: Dealing with insomnia with desipramine, posted by Lamdage22 on March 30, 2020, at 12:20:07
I don't know if Trazodone is safe with Desipramine though.
Posted by linkadge on March 30, 2020, at 16:04:48
In reply to Dealing with insomnia with desipramine, posted by TriedEveryMedication on March 30, 2020, at 12:09:05
Hmm. Some possibilities include:
- cyproheptadine
- clonidine
- amitriptyline, doxepin, trimipramine
- mirtazapine
- gabapentin / pregabalin
- magnesium
- seroquelLinkadge
Posted by linkadge on March 30, 2020, at 16:06:23
In reply to Dealing with insomnia with desipramine, posted by TriedEveryMedication on March 30, 2020, at 12:09:05
clonidine might be worth a shot, if you haven't tried it already. By itself, it can improve concentration and might provide a temporary reprieve from the noradrenergic action reducing insomnia.
Linkadge
Posted by TriedEveryMedication on March 31, 2020, at 0:10:33
In reply to Re: Dealing with insomnia with desipramine, posted by Lamdage22 on March 30, 2020, at 13:09:02
> I don't know if Trazodone is safe with Desipramine though.
I've combined them. It seems to kill the beneficial effect of the desip, though. The amount of desipramine that's efficacious for me is 10-25mg, a very low dose.
Posted by TriedEveryMedication on March 31, 2020, at 0:12:13
In reply to Re: Dealing with insomnia with desipramine, posted by linkadge on March 30, 2020, at 16:06:23
> clonidine might be worth a shot, if you haven't tried it already. By itself, it can improve concentration and might provide a temporary reprieve from the noradrenergic action reducing insomnia.
>
> LinkadgeI don't think I've tried this. Would it be much different than prazosin?
Clonidine at night with the desipramine, right?
Posted by Lamdage22 on March 31, 2020, at 2:47:36
In reply to Re: Dealing with insomnia with desipramine, posted by linkadge on March 30, 2020, at 16:04:48
Do you have sexual side effects with Desipramine? Sry for the offtopic. Thanks.
Posted by TriedEveryMedication on March 31, 2020, at 2:56:01
In reply to Re: Dealing with insomnia with desipramine, posted by Lamdage22 on March 31, 2020, at 2:47:36
> Do you have sexual side effects with Desipramine? Sry for the offtopic. Thanks.
>
>Not really so much. urinary hesitancy, that's about it down there.
Posted by undopaminergic on March 31, 2020, at 3:01:30
In reply to Dealing with insomnia with desipramine, posted by TriedEveryMedication on March 30, 2020, at 12:09:05
Hi,
What about staying up till you're tired enough to fall asleep easily? That's the method I try to practise, especially when I'm on stimulants -- so maybe it works with desipramine too.
-undopaminergic
Posted by Lamdage22 on March 31, 2020, at 3:06:36
In reply to Re: Dealing with insomnia with desipramine, posted by TriedEveryMedication on March 31, 2020, at 0:10:33
Cool. I wonder if I should ask for Desipramine. I am a low dose responder with Trazodone and Venlafaxine.
Posted by linkadge on March 31, 2020, at 10:47:06
In reply to Re: Dealing with insomnia with desipramine, posted by TriedEveryMedication on March 31, 2020, at 0:12:13
Yeah, clonidine can be used off label for anxiety and sometimes insomnia. You might check your blood pressure on the desipramine. If it's on the high side, this might be more of a case for something like clonidine.
Clonidine activates a receptor (alpha-2) that puts the break on norepinephrine release. It is often used in combination with stimulants (for ADHD) to enhance the effect and offset some of the anxiety / side effects.
Linkadge
Posted by TriedEveryMedication on March 31, 2020, at 13:17:12
In reply to Re: Dealing with insomnia with desipramine, posted by undopaminergic on March 31, 2020, at 3:01:30
> Hi,
>
> What about staying up till you're tired enough to fall asleep easily? That's the method I try to practise, especially when I'm on stimulants -- so maybe it works with desipramine too.
>
> -undopaminergicIt's rather insidious. I'll fall asleep easily, say around 10pm. but then I'll be wide await around 1 or 2am. I suppose I could try to stay away until 2am, but at that point I suspect I wouldn't be able to fall asleep.
Posted by rjlockhart37 on March 31, 2020, at 22:05:48
In reply to Dealing with insomnia with desipramine, posted by TriedEveryMedication on March 30, 2020, at 12:09:05
desipramine is TCA that hits norepinephrine, it is alertness, and attentive, vigilant. But that also, is one the reasons why your having insomnia, norepinephrine at night. You could try a beta blocker at night such propranolol, or a mild sedative. You talk to you doctor about it. But im saying i know desipramine, it is good for depression and activation, but it also can cause too much norepinephrine. It's like taking wellbutrin before you go to sleep, insomnia. I would try a beta blocker, they block epinephrine and norepinephrine, so you have none when you went to sleep.
Posted by undopaminergic on April 1, 2020, at 2:42:12
In reply to Re: Dealing with insomnia with desipramine » undopaminergic, posted by TriedEveryMedication on March 31, 2020, at 13:17:12
> > Hi,
> >
> > What about staying up till you're tired enough to fall asleep easily? That's the method I try to practise, especially when I'm on stimulants -- so maybe it works with desipramine too.
> >
> > -undopaminergic
>
> It's rather insidious. I'll fall asleep easily, say around 10pm. but then I'll be wide await around 1 or 2am. I suppose I could try to stay away until 2am, but at that point I suspect I wouldn't be able to fall asleep.
>What about getting up and doing something when you wake up? Maybe you'll get tired again, or maybe you will stay awake for the day, but either way is better than lying awake in bed for hours.
-undopaminergic
Posted by SLS on April 10, 2020, at 18:31:30
In reply to Re: Dealing with insomnia with desipramine » TriedEveryMedication, posted by linkadge on March 31, 2020, at 10:47:06
> Yeah, clonidine can be used off label for anxiety and sometimes insomnia. You might check your blood pressure on the desipramine. If it's on the high side, this might be more of a case for something like clonidine.
>
> Clonidine activates a receptor (alpha-2) that puts the break on norepinephrine release. It is often used in combination with stimulants (for ADHD) to enhance the effect and offset some of the anxiety / side effects.
>
> LinkadgeFor many people, clonidine produces profound depression. I guess that's not surprising given its action on NE alpha-2 receptors. My grandmother, who had never experienced depression before, became very depressed immediately upon starting clonidine. It resolved upon discontinuation.
- Scott
Posted by linkadge on April 11, 2020, at 16:19:22
In reply to Re: Dealing with insomnia with desipramine, posted by SLS on April 10, 2020, at 18:31:30
>For many people, clonidine produces profound
>depression.I don't know if that's universal. In animal models, at least, alpha-2 agonists can reverse stress induced depression (perhaps were the receptors become desensitized leading to excessive catecholamine release).
https://www.sciencedirect.com/science/article/abs/pii/0028390886902327
Posted by undopaminergic on April 12, 2020, at 5:19:44
In reply to Re: Dealing with insomnia with desipramine » SLS, posted by linkadge on April 11, 2020, at 16:19:22
> >For many people, clonidine produces profound
> >depression.
>
> I don't know if that's universal. In animal models, at least, alpha-2 agonists can reverse stress induced depression (perhaps were the receptors become desensitized leading to excessive catecholamine release).
>Also, not all alpha2-adrenoceptors are presynaptic.
-undopaminergic
This is the end of the thread.
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