- Joined
- Apr 4, 2006
- Messages
- 14,513
I have been having a fuck of a hard time sleeping lately even though i am on 6mg's of clonazepam a day, 150mg's of morphine or if i run out of my script early 18 to 54mg's of IV hydromorphone and 300-400mg's of quetiapine all taken at night. My sleep is completely fucked up and not really restful at all. My doctor thought that a tricyclic might help and i have been on amitriptyline before with good results. I found it to be the best sleep aid i have ever taken and it's the only anti-depressant i have taken besides bupropion that worked and didn't drive me manic.
I have been on 100mg's of amitriptyline and 300mg's of bupropion before but not while i have been on quetiapine. I take lamotrigine, quetiapine and bupropion to control my bipolar disorder but even when i am not manic sleep is difficult. Zopiclone only works for a maximum of 3 days before i have to take a break for atleast another 3 days. My doctor is wary of adding a hypnotic benzo like temazepam or nitrazepam to the mix as i am already on clonazepam and combine that with the morphine and quetiapine and it's no wonder he is wary of adding another benzo.
I am thinking of either trying amitriptyline or doxepin. I have heard that doxepin is so sedating that it makes amitriptyline look like a amphetamine by comparison and that is saying alot . I don't want to have to go off the bupropion as it does help my bipolar depression alot and it also helps my seasonal affective disorder that nails me every winter. I know amitriptyline is basically a SNRI with heavy anti-cholinergic side effects and doxepin is basically a norepinephrine reuptake inhibitor with strong anti-histaminic and anti-cholinergic side effects. Bupropion is a norepinephrine and dopamine reuptake inhibitor. Bupropion is also a potent cyp2d6 inhibitor which is the liver enzyme that is needed to metabolize amitriptyline but the bupropion didn't seem to have a negative effect on how the amitriptyline worked the last time i was on this combo.
I would like to get peoples opinions on how good or bad of a idea it would be to add a tricyclic to this mix. My mood has been good lately so i really don't want to fuck it up by adding another drug to the mix but the insomnia is killing me. Would adding 2 drugs that are norepinephrine reuptake inhibitors increase the risk of mania? I'm just sorta at a loss here as on one hand i don't want to set off rapid cycling or anything but as the same time i need some fucking sleep
Any help or advise would be much appreciated.
I have been on 100mg's of amitriptyline and 300mg's of bupropion before but not while i have been on quetiapine. I take lamotrigine, quetiapine and bupropion to control my bipolar disorder but even when i am not manic sleep is difficult. Zopiclone only works for a maximum of 3 days before i have to take a break for atleast another 3 days. My doctor is wary of adding a hypnotic benzo like temazepam or nitrazepam to the mix as i am already on clonazepam and combine that with the morphine and quetiapine and it's no wonder he is wary of adding another benzo.
I am thinking of either trying amitriptyline or doxepin. I have heard that doxepin is so sedating that it makes amitriptyline look like a amphetamine by comparison and that is saying alot . I don't want to have to go off the bupropion as it does help my bipolar depression alot and it also helps my seasonal affective disorder that nails me every winter. I know amitriptyline is basically a SNRI with heavy anti-cholinergic side effects and doxepin is basically a norepinephrine reuptake inhibitor with strong anti-histaminic and anti-cholinergic side effects. Bupropion is a norepinephrine and dopamine reuptake inhibitor. Bupropion is also a potent cyp2d6 inhibitor which is the liver enzyme that is needed to metabolize amitriptyline but the bupropion didn't seem to have a negative effect on how the amitriptyline worked the last time i was on this combo.
I would like to get peoples opinions on how good or bad of a idea it would be to add a tricyclic to this mix. My mood has been good lately so i really don't want to fuck it up by adding another drug to the mix but the insomnia is killing me. Would adding 2 drugs that are norepinephrine reuptake inhibitors increase the risk of mania? I'm just sorta at a loss here as on one hand i don't want to set off rapid cycling or anything but as the same time i need some fucking sleep
Any help or advise would be much appreciated.