Posted by fachad on June 16, 2002, at 20:42:41
In reply to Re:Doxepin for Scalp Pain, etc » Chloe, posted by Ritch on June 16, 2002, at 11:33:39
>I wouldn't worry too much about increasing it. TCA's have very long half-lives (I wish its half-life would have been 6-8hrs!). Your blood levels are continuing to increase just by taking the same dose every nite. I would wait until you had been on 20mg for two full weeks before bumping it further.
Just a quick note on TCAs for conditions other than depression. I think the steady-state plasma concentration notions are more applicable when you are treating a major depressive episode than when you are treating other conditions.
With my wife's IBS, she felt relief within 1 hour of the first ami dose! More relief from the abdominal pain and cramping than she was getting from Percocet, Valium, and atropine.
Even now if she has a flare-up of IBS, she can take an additional 25mg or 50 ami on top of her regular 150mg and it gives immediate relief.
Also with insomnia, you can get relief from the first TCA dose, and it works just as well if you only take it 2 or 3 nights a week PRN.
This is totally unlike depression where you have to achieve and then maintain steady plasma concentrations for weeks before relief becomes apparent.
It seems like a very significant difference to me.
> > > Hi Chloe,
> > >
> > > So *that's* what that is! Got a question for you. You said it started when you were taking Neurontin+lithium. Had you ever been on lithium before without being combined with the Neurontin? I just wonder if the Neurontin might have precipitated it.
> >
> > No, I was on lithium for years in the '80's. Neurontin wasn't "born" yet! I never remember Li being drying back then...I had really thick long hair, and never had any problems with scalp or hair. I DO know that neurontin for me, is *extremely* drying. When I started it, I felt everything dry up. My mouth, my *female parts*, my skin. My body doesn't make ANY natural oils. Hence the 1 tbs FSO and 2000 mgs Evening primrose oil. That has helped some...
> > Whenever I increase the dose of N, I get increased burning of the skin and scalp for about a week. Then it seems to settle down. But then several weeks will go by, and I will run my hand thru my hair, and it will feel so brittle and dry. And I condition the hell out of it too...So I do think N was probably the culprit. But now my body is just so dried out and weary from daily meds. Because any new med or dosage change seems to start the scalp burn now...
>
> That's interesting. I notice that in the wintertime I can't take more than 100mg of Neurontin at night or I wake up with extremely dry throat and I have to drink a lot of water for the dryness and soreness to fade away. I read somebody else post about that a few weeks ago. However, N. seemed to *add* oil to my facial skin-bizarre! I think it tinkers with collagens or something. Depakote works fine for hypomania and temper, BUT, if I try to stop the Neurontin (I am still just at 100mg tid), my depression worsens, and I feel "tweaky". It definitely helps social anxiety. I have kept everything the same and just reduced Neurontin and I clearly felt worse. I hope that if pregabalin gets out on the market it will work just as good or better, with fewer sfx. Maybe it won't have this dryness thing.
>
>
> >
> >
> > >It's a good thing you have nailed it. It helps when it has a *name*!
> >
> > Yes, thanks to Fachad's diligent research. I wish the derm doc had just come out and said it was that. Rather than saying I don't have a rash, this something I need to bring up with my psychiatrist. GEEZ, I felt like a hypochondriac or I was faking the pain. It was rather uncomfortable, though brief!
>
> Yes, I hate polypharmacy because of those kinds of problems. You go and see a GP, or an internist about something and if they don't think you are a hypochrondriac, they don't want to get involved with trying to figure it out-because they are afraid it is just a sfx of all of the psych meds you are taking! That's why I would like to get rid of the N. and the Klonopin, but they both clearly help.
>
> >
> > >You are also very lucky you don't mind heavy-hitting sedative meds. The first psych meds I was prescribed (all at once, too), was lithium 900mg/day + doxepin 75mg/bedtime + amitripytline 25mg/bedtime + chlordiazepoxide 10mg/bedtime.
> >
> > Just curious, why would you take amitrip and doxepin? Was there a reason for that one? That is alot of meds! You must have felt awful! Or at least not (hypo)manic!
>
> When I first seen a shrink-it wasn't somebody hauling my ass in for an evaluation. I was in a nasty agitated mixed-state (not psychotic-but probably getting there), and sleeping about 2 hours every nite and getting paranoid while the depression was deepening along with very intense anxiety. I wanted relief NOW! The ami. and chlord. were just for two weeks until my sleep normalized and my anxiety level dropped off. Then I was just on 75mg doxepin and 900mg/LI. Amazingly, I managed to go to work everyday.
>
> >
> > >Needless to say my first night's sleep on that was rather, well.. heavy to say the least. Doxepin is weird in that you get whalloped pretty good when you start a given dose (say 25mg at bedtime). But, after a few weeks the daytime sedation does wear away quite a bit. I can't believe it was possible, but I was up to 150mg/day for a few weeks and actually worked around dangerous machinery! I don't think I could hack that now!
> >
> > So far, I really like Doxepin, at my low dose of 20 mg. I will probably need to raise it, but I am going to try another night at 20 to give my scalp time to adjust, and let the blood level go up. Maybe 20 will be all I need, but I doubt it.
> > I have less orthostatic hypotension, less thump, thump, cardiac changes, less constipation, but oddly some heartburn. That ami is powerful in slowing down the gut! I am also glad to report, that *so far* I am not noticing a withdrawal or rebound of anxiety when I wake up on Doxepin. With ami, the alarm would go off, and perhaps startle me, and my heart would pound and race, though I am half asleep. And then I would be in a frantic nasty mood from the moment I was awakened, throughout the entire day.
> > With Dox, the last two mornings, I have awoken with dreams I can't remember, and I am glad and have some desire to get out of bed. My fear was that anxiety would creep in with dox's short 6-8 hour half-life. But today was so even, and I have been calm. Did this "calmness" wear off with the sedation in your experience with dox? Did you notice any rebound anxiety during the day?
>
> I wouldn't worry too much about increasing it. TCA's have very long half-lives (I wish its half-life would have been 6-8hrs!). Your blood levels are continuing to increase just by taking the same dose every nite. I would wait until you had been on 20mg for two full weeks before bumping it further. As far as the racing heartbeat when waking-I had that on doxepin, but only at the higher doses. It was really bad at 150mg/day. It was there at 75mg/day, too. However, at 25mg/day it went away. So, I stayed at that dose for a few years. The daytime sedation-you will adjust to that.
>
> >
> > >I had to give up the imipramine trial. It just screwed up my sleep so badly. I was evidently not sleeping soundly, and it was triggering the early morning awakenings. Since I stopped it my sleep has improved steadily. But, I still feel the depression during the day.
> >
> > Maybe imiprimine is just not a good TCA for you. I realized that Trimip. gave me a pradoxical effect. I had anxiety, insomnia, shakes, oh and EPS. It was very unpleasant. Didn't nortrip work well pretty for you?
>
> If, I ever take another TCA, nortriptyline would be the only one. It was easily the most tolerable one (at lower doses anyhow). It was good for anxiety and attention. It didn't disrupt my sleep as much as the imipramine. But, I don't like the cardio-toxicity potential, and I do a lot of work outside in the heat, and imipramine and to a lesser extent nortrip. aggravated chest pain if overexerting.
>
> >
> > >It looks like I am going to start a smidge of Effexor starting Monday (to be my sole AD-no more Celexa, etc.). Just 12.5mg first thing in the morning, and then let it wash out later on so it (hopefully) won't wreck my sleep. I got hypomanic and irritable on it before, but that was related to steroids I was taking. Also, I wasn't on Depakote at the time but subtherapeutic lithium instead. So, this will be the Effexor irritability challenge (to see if the Depakote will keep a lid on it).
> >
> > Gee, I really hope you trial of effexor goes well. Perhaps with the protection from dep. it will be a more positive experience this time. Dep. is definitely better for the short fuse/irritability stuff. So you are no longer on a stimulant? I guess I have lost track a bit.
> > Shifting meds can really mess up my head. Usually I feel pretty on top of things. But I can't remember anything lately. I keep telling myself to write things down, but I forget everything looking for a damn piece of paper!
>
> Well, the problem with stimulants is the too short half-life (of most of them anyhow), and they don't have the capacity to really reduce any type of anxiety I have (except some elements of social anxiety with dexedrine), other than that I could tolerate them fairly well without cycling, which I found odd.
>
> >
> > Let us know how the Effexor goes. I hope it helps your sleep troubles, too...I'll keep my fingers crossed for you
> > Chloe
>
> We'll see. Without any AD my sleeping is better but is starting to lengthen. I am starting to sleep more than 8 hrs (bad sign), and I am still yawning during the day and fairly listless, but my mood isn't that bad.
>
> take care,
>
> Mitch
poster:fachad
thread:108844
URL: http://www.dr-bob.org/babble/20020609/msgs/110100.html