Mirtazapine Alternative - Insomnia

[Alonza_Domnik]

Thanks for sharing such useful information, Nice information has been given.The post seems to be very informative one. When i was suffering from insomnia problem my friend suggested me to go for hypnosis treatment. It took a hypnosis treatment from thoughtsbecomereality after co-operating with i was completely cured. They gave a good advise.

[DavidS]

I, too, am very much in favour of therapy, be it hypnosis, NLP, self-hypnosis, relaxation training, rather than drugs. It does require some training, though, some time and trouble, and often some expenditure.

My wife says I usually go to sleep in less than 30 seconds, and when working I usually have a nap at lunchtime.

[johnep]

I think the post smells like a spammer trying to allay our suspicions.
johnep

[DavidS]

I think the post smells like a spammer trying to allay our suspicions.
johnep

I wondered about that too, John: the IP address is from india and the link is to a hypnotherapy practice in London. But they aren't known to the spam sites, so I suspect its a well-meaning friend -- or a telephone client, another possibility!

A good hypnotist could get lots of recommendations if he wasn't ethical, lol. Look into my eyes look into my eyes etc etc.

I'll check the spam sites again in a day or so and see if I'm wrong then.

OK?? - views please

[CJH86]

......on the topic (and without wanting to start a new thread) i have a drug query. I have just been started on amitryptyline by my GP for my long-term insomnia alongside CBT (after trying allsorts- promethazine, mirtazepine, benzodiazepines and most recently rather hefty doses of zopiclone) My query is that i had a very bad reaction to a SSRI several years ago and subsequently another bad reaction to a different SSRI. Naturally im not sure whether taking this is a good idea as i was under the opinion amitryptyline works on 5-HT uptake aswell as NA so in theory there is similarities in action (although my gp tells me it doesnt!)......any thoughts on this?

[johnep]

Amitryptyline belongs to a class of meds related to promethazine so as you presumably did not have a bad reaction, then seems logical.
Dose varies from 10mg upto 150mg. Helps you to get back to sleep after waking up during the night. Also used extensively at lower dose for nerve pain.
johnep

[Nik]

Yes amitriptyline can block both NA and 5-HT uptake, but is not really selective for either one.Clomipramine is more selective for blocking 5-HT uptake, whereas most other TCA's such as imipramine are selective for NA. Important thing to note is that a lot of active metabolites of TCA's such as nortriptyline from amitriptyline and desmethylimipramine from imipramine are a lot more selective for NA. Rang and Dale's Pharmacology has a useful table and diagram of affinities of certain TCA's for NA and 5-HT uptake if you get the chance to look it up.

[bobbin]

Yes amitriptyline can block both NA and 5-HT uptake, but is not really selective for either one.Clomipramine is more selective for blocking 5-HT uptake, whereas most other TCA's such as imipramine are selective for NA. Important thing to note is that a lot of active metabolites of TCA's such as nortriptyline from amitriptyline and desmethylimipramine from imipramine are a lot more selective for NA. Rang and Dale's Pharmacology has a useful table and diagram of affinities of certain TCA's for NA and 5-HT uptake if you get the chance to look it up.

Imipramine itself is believed to block the reuptake of both serotonin and noradrenaline, it isn't selective for NA. DMI, as you say, is very selective for NA. Lofepramine is also metabolised to DMI.

[Nik]

Imipramine itself is believed to block the reuptake of both serotonin and noradrenaline, it isn't selective for NA.

Yep sorry that's what I meant

[bobbin]

......on the topic (and without wanting to start a new thread) i have a drug query. I have just been started on amitryptyline by my GP for my long-term insomnia alongside CBT (after trying allsorts- promethazine, mirtazepine, benzodiazepines and most recently rather hefty doses of zopiclone) My query is that i had a very bad reaction to a SSRI several years ago and subsequently another bad reaction to a different SSRI. Naturally im not sure whether taking this is a good idea as i was under the opinion amitryptyline works on 5-HT uptake aswell as NA so in theory there is similarities in action (although my gp tells me it doesnt!)......any thoughts on this?

Hi there,

What was your reaction to the SSRIs?

Amitriptyline is very different to the SSRIs in terms of side effects. A low doses, its effect on 5-HT uptake is weak. It is a potent antihistamine, which probably accounts for much of its sleep inducing effect. It also blocks numerous other receptors eg. 5-HT(2), alpha-1 and mucarinic receptors. Blockage of these receptors can cause a multitude of side effects but may also actually reduce other side effects eg. blocking 5-HT(2) receptors may attenuate certain 'SSRI-like' side effects.

One of the main problems with using amitriptyline as a sleep aid is that it often causes substantial daytime drowsiness and fatigue. Nevertheless, many people use 10-50mg at night to help sleep or neuropathic pain. High doses are generally reserved for severe depression, although amitriptyline is less often prescribed for depression thesedays because of its toxicity in overdose and due to the fact that high doses may not be well-tolerated. On the other hand, patients who do not respond well to SSRIs can often experience relief with tricyclics.

In the United States, there is an increasing tendency to use very low doses of quetiapine (Seroquel) from severe chronic insomnia eg. 25mg in the evening. Although it can be effective, it isn't much used in the UK for this purpose, except in patients who also suffer from psychiatric disorders as well.

Bobbin