Sedating SSRI?

[Isaiah2017]

I wonder whether there´s an SSRI antidepressant also effective for sedation. From my short little search, it seems sedating ADs (Mirtazapine, Doxepine, Trazadone etc.) rather belong to other classes instead of SSRI.

[tryp]

SSRIs are really idiosyncratic for that - there's none that will really do that in the way that the ones you mentioned will. 

Generally speaking, fluvoxamine tends to be the most sedating. The citaloprams (citalopram and escitalopram) are also on the calming side. Fluoxetine tends to be more stimulating, and sertraline as well to some extent.  Not sure about paroxetine. 

Edited July 30, 2017 by tryp

[mikl_pls]

Paroxetine is also regarded as more sedating, though I have no personal experience with it. I remember when taking escitalopram in high school I was constantly falling asleep in class, and it made me so apathetic about everything that my room went to ultra-hell (super messy and cluttered!!! It was beyond ridiculous...). Citalopram has a relatively high affinity for the H1 histamine receptor compared to the other SSRIs, and thus is likely to be more sedating than the other SSRIs. Fluvoxamine was definitely sedating for me, so much so that I couldn't function in school and had to come off of it.

Trazodone becomes a serotonin reuptake inhibitor in larger doses like 300 mg, but due to its extremely sedating nature, it's usually not well tolerated when taken during the day at such high doses. They make an extended release trazodone called Oleptro which comes in 150 mg and 300 mg, which can be split and taken as high as 375 mg and is taken at bedtime, but it's still brand-name only and I've not been able to locate a copay coupon... so it's bound to be expensive.

I took doxepin for insomnia, and while it was extremely sedating, it wouldn't start working until after I woke up the next day, so I would lay in bed and sleep all day the day after I took it.

Remeron is supposed to be even more sedating than doxepin, but for me that was not the case (maybe because of my dosage—low doses, 7.5-15 mg, are more sedating, but higher doses, 30-45 mg, are not, and can even be stimulating. I was on 30 mg.) The antidepressant effects tend not to kick in until 30 mg for most people, but some people's depression improves in the lower doses secondary to improving their sleep and anxiety.

[Iceberg]

I kno someone who got knocked the hell out with lexapro but I don't think that's super common. I know doc's that will go up to 600 on trazodone. At 300 it was actually helpful more so than SSRIs for my depression. Remeron didn't sedate me either so I doubled it up with traz. Which I really wouldn't recommend. A few of the TCAs are sedating. Why specifically do you need the sedation? 

[mikl_pls]

12 minutes ago, Iceberg said:

I know doc's that will go up to 600 on trazodone.

That dosage is usually reserved for inpatients, with 400 mg being the max for outpatients, but I know that some pdocs prescribe inpatient doses for outpatients of certain meds.

6 hours ago, Isaiah2017 said:

I wonder whether there´s an SSRI antidepressant also effective for sedation.

1

13 minutes ago, Iceberg said:

A few of the TCAs are sedating. Why specifically do you need the sedation? 

Why are you looking for specifically a SSRI? As @Iceberg pointed out, some of the tricyclics are sedating, so you might look into those (like doxepin, amitriptyline, imipramine, and clomipramine in lower doses but supposedly becomes a bit stimulating in higher doses; even nortriptyline can be sedating in lower doses). Amoxapine, a tetracyclic, can also be somewhat sedating in lower doses.

 

[BrianOCD]

Seems to be really user specific.

For some Effexor is activating, and I've heard others say it makes them want to sleep.

Nature of drugs.

[Iceberg]

Oh yeah...amoxapine. I always forget about that one

[mikl_pls]

4 hours ago, Iceberg said:

Oh yeah...amoxapine. I always forget about that one

It's a neat medicine what with having both antidepressant and atypical antipsychotic properties in one medicine. For some reason, my pdoc is under the impression that 100 mg is a high dose, but it's meant to be taken in the 200-400 mg range for outpatients for depression. I've experimented with increasing the dosage on my own (I know, not a good idea...), and I was really impressed with the rapid onset of action of it. If I ever end up having to switch antidepressants, I may end up switching to this one and begging my pdoc to give me a higher dose than she has prescribed me before.

[Iceberg]

Some docs are conservative about "high" doses of the heavy duty meds that have antipsychotic properties. I had a doc say that 100 of Thorazine. Was a "huge" dose before 

[mikl_pls]

2 minutes ago, Iceberg said:

Some docs are conservative about "high" doses of the heavy duty meds that have antipsychotic properties. I had a doc say that 100 of Thorazine. Was a "huge" dose before 

My pdoc is conservative with just about anything she considers a "high" dose, especially stimulants... She regards Ritalin 30 mg as a high dose, yet she also regards Dexedrine 30 mg to be an extremely high dose. She used to prescribe it for me, but now she flat out won't prescribe it to me anymore, but she hesitantly prescribed me Adderall 60 mg which has Dexedrine 45 mg in it... *sigh* I still love her though. She has helped me out a lot.

[Iceberg]

Adderall 60 is the max for me too

[mikl_pls]

6 minutes ago, Iceberg said:

Adderall 60 is the max for me too

She has prescribed me up to 90 mg Adderall before (which has 67.5 mg Dexedrine... more than twice 30 mg...), which helped tremendously with my hypersomnia and ADHD, but I still felt I needed a higher dose. Then my insurance company changed the quantity limit of Adderall XR from 2/day to 1/day and I can no longer take 60 mg/day Adderall XR without a PA, and her office suuuuuuuucks at getting PAs through.

Sorry to derail the subject of this post though.

Edited July 31, 2017 by mikl_pls

[Catwoman]

On 31-7-2017 at 2:28 AM, BrianOCD said:

Seems to be really user specific.

For some Effexor is activating, and I've heard others say it makes them want to sleep.

Nature of drugs.

I think so too.

I never felt sedated or groggy on fluvoxamine (Luvox). Escitalopram (Lexapro) made me feel less motivated and a little sluggish, but never sedated. 
Sertraline (Zoloft) is said to be activating and can cause sleep problems (even insomnia) But apart from the restless legs (which I had will al three SSRI's) I'm sleeping fine. 

Edited August 1, 2017 by Catwoman

[mikl_pls]

3 hours ago, Catwoman said:

Sertraline (Zoloft) is said to be activating and can cause sleep problems (even insomnia) But apart from the restless legs (which I had will al three SSRI's) I'm sleeping fine.

Prozac, too, but I also seem to be sleeping fine, especially since I re-started taking a stimulant. I also slept just fine on the supposedly stimulating SNRIs Effexor, Cymbalta, and Pristiq. I don't want to think about Fetzima, that was a bad experience... lol.

[Isaiah2017]

On 31.7.2017 at 1:08 AM, mikl_pls said:

That dosage is usually reserved for inpatients, with 400 mg being the max for outpatients, but I know that some pdocs prescribe inpatient doses for outpatients of certain meds.

Why are you looking for specifically a SSRI? As @Iceberg pointed out, some of the tricyclics are sedating, so you might look into those (like doxepin, amitriptyline, imipramine, and clomipramine in lower doses but supposedly becomes a bit stimulating in higher doses; even nortriptyline can be sedating in lower doses). Amoxapine, a tetracyclic, can also be somewhat sedating in lower doses.

 

I´ve a strange history with antidepressants, they cause me a range of symptoms like extreme inner restlessness (have lost my sense of humour completely despite being known for it amongst my relatives and friends), akathisia, tremors, heart palpitations, extreme bright light sensitivity, confusion, concentration issues, memory issues and strange psychological symptoms (insomnia, anxiety and spells of severe depression) resulting from food and medicines or supplements intolerances. Been on Mirtazapine for two years, these symptoms kicked in from the 7th or the 8th month. Although Mirtazapine isn´t a tricyclic, but other tricyclic like Trimipramin (immediate issues) and now Opipramol (had provided a 4-5 day relief before all the symptoms reappeared suddenly) have caused exactly the same issues. So I was exploring the possibility of tricyclic or even tetracyclic antidepressants having these possible side-effects on people with a weak immune system (I certainly have one).

 

I find the mention of Trazadone interesting. Does that medicine work differently tricyclic and tetracyclic antidepressants? I wonder whether that might work for me. @Iceberg I was specifically enquiring about an SSRI because it´s advertised that they don´t have too many side-effects. However, since none of them quite works as a sedative, they may not work for me because sleep has been an issue for me since seven years.

I´m really interested in the mechanism of action of Trazadone, and how different it is to tricyclics and tetracyclics. Any information is welcome.

[mikl_pls]

54 minutes ago, Isaiah2017 said:

I´ve a strange history with antidepressants, they cause me a range of symptoms like extreme inner restlessness (have lost my sense of humour completely despite being known for it amongst my relatives and friends), akathisia, tremors, heart palpitations, extreme bright light sensitivity, confusion, concentration issues, memory issues and strange psychological symptoms (insomnia, anxiety and spells of severe depression) resulting from food and medicines or supplements intolerances. Been on Mirtazapine for two years, these symptoms kicked in from the 7th or the 8th month. Although Mirtazapine isn´t a tricyclic, but other tricyclic like Trimipramin (immediate issues) and now Opipramol (had provided a 4-5 day relief before all the symptoms reappeared suddenly) have caused exactly the same issues.

The inner restlessness, akathisia, tremors, heart palpitations, concentration issues, insomnia, and anxiety are common to SSRIs and SNRIs—it's mechanism of action is increased serotonergic neurotransmission. I don't know about the extreme bright light sensitivity, confusion, or memory issues though... Some of that could be serotonin-mediated as well. But the severe depression resulting from taking an antidepressant screams bipolar to me; however, I'm not a professional or pdoc or anything. Mirtazapine is supposed to be very calming and sedating, yet you experienced all these symptoms with it after several months? That's confounding. Trimipramine surprises me as well as it doesn't have that much monoamine reuptake inhibition but acts more like an antipsychotic, and opipramol (which I hadn't heard of until now) acts mostly as a sigma receptor agonist and doesn't have any monoamine reuptake inhibition at all, so that one is a complete enigma to me. Have you been screened for bipolar, or has your doc/pdoc explored the possibility of bipolar with you? Even bipolar type II?

1 hour ago, Isaiah2017 said:

So I was exploring the possibility of tricyclic or even tetracyclic antidepressants having these possible side-effects on people with a weak immune system (I certainly have one).

I wouldn't be able to contribute any information for you about this. I don't have a particularly strong immune system, but I don't have a weak immune system either (at least that's what I think...) What's the link between immune system strength and reaction to antidepressants?

1 hour ago, Isaiah2017 said:

I find the mention of Trazadone interesting. Does that medicine work differently tricyclic and tetracyclic antidepressants? I wonder whether that might work for me.

In low doses, trazodone is primarily a sedative, mostly acting as a 5-HT_2A antagonist which causes dopamine release in certain parts of the brain and causes an anxiolytic response and even a hypnotic response. It is unrelated to the tricyclics and tetracyclics. At higher doses, it recruits more receptor binding, like 5-HT_2C antagonism, H1 receptor antagonism, and SERT inhibition, making it a moderately weak serotonin reuptake inhibitor. (That happens around 300 mg I think.) If you've reacted the way you did to any of the other antidepressants the way you did that had monoamine reuptake or 5-HT_2A/2C antagonism (trimipramine), I think there's a high possibility you might no react to it favorably, but that's my uneducated guess. The only way to really know is to try it out!

I would say you could try a sedating antipsychotic, but they have considerable 5-HT_2A/2C antagonism. The only thing I can think of would be to try a sedating anticonvulsant/mood stabilizer, like Depakote/Depakene, Tegretol, Trileptal, maybe Topamax (sedating for some), maybe Zonegran (sedating for some), or heck, even Mysoline or phenobarbital if none of those produce good results or don't work... I'm about 87.5% kidding on those last two...

You could also try one of these anticonvulsants or one of the atypical antipsychotics in conjunction with one of the antidepressants to see if it alleviates those symptoms.

I do hope you can find something that works for you that doesn't give you bad side effects.