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2 hours ago, Britton777 said:

I have tried doxepin and it wired me, but I don’t think I’ve tried trimipramine. I’ll have to look it up. I’m not very good with the medication lingo, so why is tramipramine different? Is it different from other TCA’s? 

I’ve tried elavil, anafrinil and doxepin. All wired me. 

I’m worried about mania/agitation with rixulti too. 

That's what I figured you would say about doxepin if you had tried it. Then trimipramine may do the same thing... it's mightily antihistaminergic and sufficiently anticholinergic too. But those other properties are what distinguish it from other TCAs (the 5-HT2A and presynaptic D2 antagonism) and that it actually enhances sleep architecture (most other if not all other TCAs actually deteriorate sleep architecture).

The chances of Rexulti causing mania/agitation are far, far lower than its chemical counterpart, Abilify. I assure you that you need not worry about trying it. If you do have a paradoxical reaction from it, that means that your pdoc can gauge better what not to give you in the future.

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A great site to learn correct, up-to-date, information about MAOIs is PsychoTropical Research at https://psychotropical.info/  . At the site, you can also get the modern "MAOI diet" (up-to-date with current practices in commercial food preparation -- versus the ancient lists you see elsewhere that were created 75 years ago). 

The site is the creation of Dr. Ken Gillman, who is an expert in SSRI syndrome, with many journal articles published in quality peer-reviewed medical journals.

I'm currently on Emsam. I'm a fan of MAOIs.  Emsam has a much better side effect profile than any SSRI I was on -- as the side effects I have on Emsam are essentially none (did have some insomnia at first, but even that has resolved). Emsam is outrageously expensive now. When I first started taking it, it was $400 for 30 patches. Now is $2000. Outrageous.  Tranylcypromine and phenelzine should be much cheaper.

 

 

 

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12 hours ago, Kodos said:

A great site to learn correct, up-to-date, information about MAOIs is PsychoTropical Research at https://psychotropical.info/  . At the site, you can also get the modern "MAOI diet" (up-to-date with current practices in commercial food preparation -- versus the ancient lists you see elsewhere that were created 75 years ago). 

The site is the creation of Dr. Ken Gillman, who is an expert in SSRI syndrome, with many journal articles published in quality peer-reviewed medical journals.

I'm currently on Emsam. I'm a fan of MAOIs.  Emsam has a much better side effect profile than any SSRI I was on -- as the side effects I have on Emsam are essentially none (did have some insomnia at first, but even that has resolved). Emsam is outrageously expensive now. When I first started taking it, it was $400 for 30 patches. Now is $2000. Outrageous.  Tranylcypromine and phenelzine should be much cheaper.

 

 

 

Thanks Kodos. I will look at that site.

I’m not sure if you read through this thread, but wondering if you think an MAOI could help me. Main symptoms are anxiety, derealization, OCD, brain fog, insomnia and depression. Nothing has helped me. I have never fired an MAOI. 

I’m coming off a bad experience with rixulti yesterday. I had the worst panic all day yesterday, all night and this morning. 

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16 hours ago, mikl_pls said:

That's what I figured you would say about doxepin if you had tried it. Then trimipramine may do the same thing... it's mightily antihistaminergic and sufficiently anticholinergic too. But those other properties are what distinguish it from other TCAs (the 5-HT2A and presynaptic D2 antagonism) and that it actually enhances sleep architecture (most other if not all other TCAs actually deteriorate sleep architecture).

The chances of Rexulti causing mania/agitation are far, far lower than its chemical counterpart, Abilify. I assure you that you need not worry about trying it. If you do have a paradoxical reaction from it, that means that your pdoc can gauge better what not to give you in the future.

I did have a bad reaction to the rixulti ?. I was in a heavy state of derealization. Anxiety and panic all day yesterday and all through the night. Didn’t sleep. I’m still feeling the effects now. Pretty scary. My body is so agitated I can keep still. I have knots in my stomach and my head feels very heavy and weird. I feel detached from my body. 

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17 hours ago, Iceberg said:

 

 

17 hours ago, Iceberg said:

I couldn't say about the paradoxical becuase is individual and your case is quite unique. Halcion is a bit different because it is very potent but also very fast acting. This is good for sleep induction but not necessarily maintaince which might mean it's not a total match for you...I just said it cuz I had good luck after other benzos failed. Idk that it's "taboo" or blacklisted by docs, but it's not super common...my personal thought: 

1) it's older and only used for sleep so I just think it's not on many docs radar

2) potent short acting benzos can build tolerance and dependance fast... Possibly faster than other options like Z-drugs... so it's not necessarily a first line option 

3) I think after several benzos fail for sleep docs sometimes write off the whole class

Thanks iceberg. When you say you failed on other benzos, what did fail mean for you? 

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20 minutes ago, Britton777 said:

 

Thanks iceberg. When you say you failed on other benzos, what did fail mean for you? 

In this sense I mean didn't help me sleep...some work for other stuff but most didn't help sleep much, especially if trying for a PRN basis 

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4 minutes ago, Britton777 said:

Thank you! Have you ever been paradoxical to benzodiazepines? 

Not significantly, no. Ativan doesn't play nice with me at higher doses I get restless and somewhat irritable, I think it's just the way it sedates me. Of course it's a skewed sample because I was in bad shape most times it happend... But I wouldn't really call it paradoxical 

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5 hours ago, Britton777 said:

I did have a bad reaction to the rixulti ?. I was in a heavy state of derealization. Anxiety and panic all day yesterday and all through the night. Didn’t sleep. I’m still feeling the effects now. Pretty scary. My body is so agitated I can keep still. I have knots in my stomach and my head feels very heavy and weird. I feel detached from my body. 

I'm very sorry that happened. :( Part of that sounds a little like akathisia, but the rest of it sounds like a paradoxical reaction.

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12 minutes ago, mikl_pls said:

I'm very sorry that happened. :( Part of that sounds a little like akathisia, but the rest of it sounds like a paradoxical reaction.

Not sure where to go from here. I’m so scared and feeling hopeless. I’m nit sure I will ever find a medication to help me. 

Do you mind reminding me, are you on an MAOI? 

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1 hour ago, Britton777 said:

Not sure where to go from here. I’m so scared and feeling hopeless. I’m nit sure I will ever find a medication to help me. 

Do you mind reminding me, are you on an MAOI? 

I'm no longer on one anymore, my pdoc took me off of it. I was on Parnate, but I have been on Parnate, Marplan, and Emsam.

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23 minutes ago, Britton777 said:

Did the MAOI’s help you? Did you take them for depression? Why did you come off of them? TIA 

They helped me moderately so, I had to have adjunctive agents to help them help me. Yes, I was taking them primarily for depression. I had to come off them because my pdoc refused to elevate the dosage as she believed them to be dangerous (which is totally untrue), so I just said to hell with it and moved on to something else.

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