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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Christia on December 26, 2011, at 13:58:08
Hello,
I am not sure anyone can help, but I'm gonna try!
Background: The only meds I have ever responded to are parnate (pooped out), effexor, and cymbalta. Savella, all SSRis, remeron, etc. failed.
I recently started EmSam. The bottom line is that my depression is slowly worsening on it. However, my body feels so much better on it than on cymbalta.
Here is my laymans take on why.
While cymbalta helps with depression, its likely interfering with late stage sleep as shown in a sleep study. Hence my cognition, my pain levels, and my overall sense of calm are much better while not taking it. On cymbalta I am in real pain upon awakening. While it helps with depression, the med makes me feel like I drank coffee and alcohol togethersuper tired and jumpy.
Still, I do not want to be depressed.
So, if cymbalta is the way to go, given that I have to take it at night because its sedating, is there something I can add that will make stage 3 and 4 sleep possible without further affecting my ability to function during the day?
Or, is there something I can do to boost the EmSam? Are any new meds on the horizon?
Thanks in advance for any tips!
Posted by SLS on December 26, 2011, at 17:04:39
In reply to deep sleep, antidepressants, posted by Christia on December 26, 2011, at 13:58:08
Trimipramine (Surmontil) is a tricyclic antidepressant that improves stages 3 and 4 sleep along with increasing REM latency. It can be combined with other antidepressants.
I didn't like the way Cymbalta affected me. I always felt fatigued.
- Scott
Posted by Christia on December 29, 2011, at 22:41:02
In reply to Re: deep sleep, antidepressants, posted by SLS on December 26, 2011, at 17:04:39
Thanks! Somehow I missed this response.
You might have felt fatigued for the same reason I did--lack of good sleep!I wish there were some tests that showed what we would respond to. Savella did not work for me, and I am still confused as to why, if effexor and cymbalta did (with great fatigue) but SSRIs did not. I thought I just needed some NE but evidently there's more to it than that. Again, thanks.
> Trimipramine (Surmontil) is a tricyclic antidepressant that improves stages 3 and 4 sleep along with increasing REM latency. It can be combined with other antidepressants.
>
> I didn't like the way Cymbalta affected me. I always felt fatigued.
>
>
> - Scott
Posted by sigismund on December 31, 2011, at 4:30:17
In reply to Re: deep sleep, antidepressants, posted by SLS on December 26, 2011, at 17:04:39
Mirtazepine felt brilliant for sleep, and then terrible until the afternoon when it worse off.
I loved the depth of sleep it gave me.
I wonder if Surmontil would be as good?
I didn't think much of low dose doxepin. Would Surmontil be like that?
Posted by SLS on December 31, 2011, at 7:45:26
In reply to Re: deep sleep, antidepressants, posted by sigismund on December 31, 2011, at 4:30:17
> Mirtazepine felt brilliant for sleep, and then terrible until the afternoon when it worse off.
>
> I loved the depth of sleep it gave me.
>
> I wonder if Surmontil would be as good?
>
> I didn't think much of low dose doxepin. Would Surmontil be like that?
Not necessarily. I don't think Surmontil (trimipramine) is a histamine H1 blocker like doxepin is. I tried Surmontil once. I didn't experience any hangover effects. I found the drug to be relatively clean.
- Scott
Posted by SLS on December 31, 2011, at 13:53:59
In reply to Re: deep sleep, antidepressants, posted by sigismund on December 31, 2011, at 4:30:17
> Not necessarily. I don't think Surmontil (trimipramine) is a histamine H1 blocker like doxepin is.
Well, after a little snooping, I discovered that Surmontil is indeed antihistaminic. Still, it might be worth a try.
> I tried Surmontil once. I didn't experience any hangover effects. I found the drug to be relatively clean.
- Scott
Posted by SLS on January 1, 2012, at 6:14:43
In reply to Re: deep sleep, antidepressants » sigismund, posted by SLS on December 31, 2011, at 7:45:26
> > Mirtazepine felt brilliant for sleep, and then terrible until the afternoon when it worse off.
> >
> > I loved the depth of sleep it gave me.
> >
> > I wonder if Surmontil would be as good?
I forgot to mention that Surmontil is the only TCA that actually improves sleep-architecture.Nefazodone might be an interesting drug to research regarding sleep quality.
- Scott
Posted by sigismund on January 1, 2012, at 11:59:30
In reply to Re: deep sleep, antidepressants » SLS, posted by SLS on January 1, 2012, at 6:14:43
>I forgot to mention that Surmontil is the only TCA that actually improves sleep-architecture.
That is what interested me.
I read on askapatient or somewhere that it was very anticholinergic. I would have to keep the dose really low.
Posted by SLS on January 1, 2012, at 12:07:52
In reply to Re: deep sleep, antidepressants » SLS, posted by sigismund on January 1, 2012, at 11:59:30
> >I forgot to mention that Surmontil is the only TCA that actually improves sleep-architecture.
>
> That is what interested me.
>
> I read on askapatient or somewhere that it was very anticholinergic. I would have to keep the dose really low.I don't recall the anticholinergic side-effects. However, I have become more tolerant of them over time. Surmontil is not a well-studied drug. I looked on the PDSP database, but anticholinergic properties were not tested for.
- Scott
Posted by g_g_g_unit on January 7, 2012, at 4:12:19
In reply to deep sleep, antidepressants, posted by Christia on December 26, 2011, at 13:58:08
>On cymbalta I am in real pain upon awakening. >While it helps with depression, the med makes me >feel like I drank coffee and alcohol together super >tired and jumpy.
That's how I've been feeling upon waking with Lexapro. Sleeping in helps, but then I just feel stoned the rest of the day.
Posted by LostBoyinNCReturns on March 17, 2012, at 10:11:07
In reply to deep sleep, antidepressants, posted by Christia on December 26, 2011, at 13:58:08
Hi,
As someone who is former TRD, I have credibility on this subject. I would say if you have failed adequate dosage of the stronger meds like Parnate and Cymbalta and others, the odds of any AD helping your depression all that much are low.
I would begin looking at an altogether different avenue to get you out of what sounds like TRD. Have you been to a sleep medicine doctor yet and gotten thoroughly screened for sleep apnea? Even mild sleep apnea can make depression worse or even create depression.
I would get cozy with a good sleep medicine physician who accepts whatever type of insurance you have. Also, many people have to buy their CPAP gear out of pocket, which is expensive but it is worth it as you might get well enough to get a job...I assume taking such strong meds as you are taking you are unemployed?
Other "different avenues" include: ECT, a different kind of mood disorder such as bipolar which ADs usually worsen instead of help, endocrine deficiencies (thyroid being the most common, testosterone common in middle aged and older males), simple anemia and iron deficiency (many GPs no longer bother to treat or even diagnose unless the anemia is severe.
All sorts of things can cause TRD.
Finally, a bad life environment can create a situation where you will not get better no matter what you do. Unfortunately, with the possible exception of ECT, none of these meds really work all that great if you environment totally sucks. Severe financial stressors, chronic unemployment, obesity and poor overall health, negative family members, abusive relationships can all combine to create a "living hell" sort of environment that just perpetrates TRD.
Solution? Fix your negative environment. Dump negative family members. Dump abusive relationships, if unemployed get a part time job or maybe even volunteer somewhere, if under severe financial stress such as credit card debt or other debt consider something fast and dirty such as bankruptcy.
Even a bad geographic location, where the area is economically depressed and educational opportunities are low, can contribute to TRD.
Usually it will take a two pronged approach to TRD, a strong biological one plus improving your "life situation" to something more positive.
Also, chronic depression can gradually slide you into a negative life environment. This happened to me and it took me a move to another city to recognize it had happened to me. I now am aware of the critical need for a positive environment and stress management for TRD to be successfully treated.
Eric
This is the end of the thread.
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