67 replies to this topic

[Atropy]

I need to start seriously looking at anti-depressants.I had a turning point recently that showed me that I need them.I am done with trying to micro manage things with vitamins and nootropics,it seems there's no effective safe and natural stack that can replace the positive effects of anti-depressants.

If there was a safe powerful serotonin precursor I would use it. I need to start living life and stop surviving by a single thread all the time,as I have been doing my whole life.

I have a mentality of always trying to get out of my comfort zone,but without effective medication it's hard to recover.

My view of anti-depressants is that I should be without them,and be mentally healthy using natural ,healthy measures.So I tried experimenting with nootropics in the hope that they could replace anti-depressants.But I have come to the conclusion that they usually only work well if you are mentally healthy.

I have depression and social anxiety,general anxiety too(last one kinda self diagnosed).


Current situation-Last 7 months to now.
I have been on imipramine for around 5-6 years.I felt its effects from the very first day,even tho my shrink said that was not possible.Extreme tiredness and uplifted mood.

I am currently on 75mg imipramine which is too low for me.I was on a bare minimum of 100mg and did not want to increase beacuse I already had side effects which were heart pounding when exercising and lowered ability to achieve orgasm,low libido and low blood pressure(that cant be good longterm).I was able to get an orgasm but usually it was painful.

I dropped my dosage of Imipramine because I had a really good reaction to DLPA.At first it was euphoria,but it shifted to irritability.I still dropped the imipramine to 75mg thinking tinkering with the dosage of DLPA would help.

I got some brain zaps which I endured for a while,which are gone now.

Shortly after I tried Piracetam in dosages of 800mg-3.2g per day I think,which changed things for the better.

It made me feel depressed when alone,but much more social in public.
It allowed me to push my endurance beyond my regular abilities.

However,brain fog started after almost 2 months.So I slowly stopped it,and I realised I had symptoms of adrenal fatigue.The symptoms are lowered mood,long time to recover from workouts,insomnia,especially after a workout.Jiagulan helps with mood,ashwagandda and more recently Relora helps with cortisol,I think.

From my bro science.I would think that I stressed my already stressed HPA axis with the Piracetam. I think that my anti-depressant was supporting the HPA axis and when I dropped my dosage of imipramine,I compromised the HPA axis.

I have previously had problems with insomnia in general but especially after a cardio and endurance taxing work-out.These are signs of high cortisol,I think?

This also makes me think that I have had adrenal fatigue symptoms for a long time,since I am not a fast recoverer from workouts.

But because the symptoms of Adrenal fatigue and depression are so similar,and affect the same parts of the body,its complicated and I wouldn't know for sure.
I scored moderate on the adrenal fatigue stress index.

In general my concentration is terrible and I take a while to learn things.

History
I have tried Zoloft around a decade ago ,which gave me hypomania.My psychiatrist thus diagnosed me with Bipolar 2.I think he might have been onto something.He then added lamictal to it.I think the hypo mania stopped but I stopped the treatment plan because at the time I was severely addicted to Pot and could not stop,I was self medicating.Plus the hypomania encourage me to not stop,so I stopped the medication as I didn't want to imagine the side effects of these chemicals combined.(hypochondria)

My psychiatrist is more like the refill prescription,make small talk and see you later guy.
So I have to be informed before I make any suggestions to my psychiatrist.

Success
My greatest drug side effect free success was when I started meditating.It helped me clear my mind of all that subliminal trash talk.

THe only problem is that It takes tremendous discipline to start and continue doing on a continual basis.If I was somehow forced to do this somehow it would hep abit.But I have never been able to start again. since under a decade ago.

Also,self help CTB helped abit ,if only I could be consistent.
The impramine helps but not as much at this dosage.Its barely holding me together at this dosage I guess.
Background
To give you an idea of my life,I have never had a girlfriend,and I'm 30.
I have never had any real friends or deep meaningful relationships with people.I have never been able to function on that level.
I have always been introverted ,and I still need alot of time by myself.

I am stressed very easily.I dwell on trivial things that other people barely acknowledge.I make mountains out of molehills.
I have a hard time making even small decisions.I overanalize things and its hard for me not to do so.
I have allot of work to do but it seems impossible without meds.

My stack is:
75mg imipramine
tyrosine 500mg morning
Tryptophan 1.5mg with p5p night
Relora- 1 now foods relora divided between 2 per day.Cortisol lowering A.F
Jiagulan-1 a day A.F
Aswagandha -between a half and a whole pill a day,helps with cortisol A.F-Himalaya
L-theanine 200mg
Taurine 1 gram

I cycle some of the above,excluding imipramine.

Vitamins
Pantothetic acid-500mg divided by 2 per day.
pantethine-300mg divided by 2
Chromium polinicolinate 100 RDA
3 grams sodium ascorbate(vitamin c for adrenal fatigue)
multi basics multi 1
half a b-complex
Vitamin D3-k2
glucosomine
Cissus(occasional)
2 fish oil pills
2 iodine pills(Thyroid)
60 gram whey isolate
zinc pico/mag citrate

Options
I have seen that many people have enjoyed the Side-effect free Tianeptine.I have also seen that Bupropion(Wellbutrin) has also helped many people.

My question is,which of these 2 are for me?
Tianeptine is considered a nootropic stimulant so it may not be good for my condition.This was my first preference tho,but I fear it may exacerbate my A.F.

So I am thinking maby I should consider Bupropion?Afobazole an option?

The option of going back to increasing the dosage of imipramine seems like a last resort since I haven't really delved into trying the newer anti-depressants,with lower side effects.

I layed it all out there so,shoot a reply if you can.Thanks for your help.

Edited by Atropy, 18 October 2013 - 02:38 PM.

[nowayout]

Tianeptine supposedly improves HPA abnormalities. You can look up the studies on pubmed. I don't know if it is safe with imipramine though.

Wellbutrin would probably be bad if you have insomnia. It can be anxiogenic also, while tianeptine is supposedly anxiolytic.

[jadamgo]

I'm assuming by AF you mean Atrial Fibrillation? The only antidepressants you should be worried about are the old-fashioned MAOIs phenelzine and tranylcypromine. If you're going to use them, you would need to have your heart condition monitored and you couldn't eat tyramine-containing foods. Also, you wouldn't want to use T3 hormone supplementation unless your T3 levels were already low. It can be a very effective treatment, but it's not necessarily appropriate for heart patients.

Tianeptine and bupropion shouldn't cause any problems for AF. Neither should the other atypicals, or the SSRIs, SNRIs, tricyclics, or lithium.

You could also look into bright light therapy. If you're concerned about spending a bunch of money on a good lightbox, you could give it a trial run first of spending an hour in the sunlight every morning for a week, and see if you feel better. If so, you ought to get a lightbox.

If CBT self-help was effective, but only when you stuck with it, then CBT from an actual therapist would probably be very effective since it doesn't require as much self-starting and discipline.

[Atropy]

Sorry,I mean't Adrenal fatigue=AF.Also,if it does make a difference in the clinical treatment,the anxiety and depression was probablya result of childhood and teenage physical and mental abuse.It is also definitely partly genetic.

Ill check the studies on Pubmed,and investigate the Lightbox experiment.Ill try and muster up the motivation for the CBT.

[peacenik]

hands down tianeptine.. i have somewhat similar situation as yours and tianeptine has definitely provided relief. PM me and i can forward you a US source.

[riloal]

I read in the net, that tianeptine lowers cortisol, so it wouldn,t be good for Adrenal fatigue.

[nupi]

Adrenal fatigue is not even a recognized diagnosis so I would not be too worried about that..

[nowayout]

Adrenal fatigue is not even a recognized diagnosis so I would not be too worried about that..

Agreed.

[Tom_]

Adrenal fatigue doesn't exist. 50% of severe depressive disorders are accompanied by increased cortisol levels (not suppressible by a DST) many others have sub-clinically high levels seen by swab or ff cortisol tests. You're problems are clearly not related to decreased cortisol output.

The sups and vits clearly (not surprisingly haven't done much/anything) so drop them.

If anxiety is a major problem I wouldn't suggest Bupropion. I don't like Tianeptine mostly because of its lack of high quality research (plenty of studies but mostly of low quality).

You could continue with Imipramine and combine it with Bupropion, T3 or Lithium.

Or you could discontinue Imipramine and start Moclobemide if its available in your area. It has a side effect profile comparable to SSRIs, doesn't cause weight gain or sexual dysfunction.

You could swap to another Tricyclic that is more stimulating like Lofepramine or Nortriptyline - both of which show similar efficacy and reduced side effect profiles.

Mirtazapine is pretty sedating but this can be managed by taking it at night and the sedative effects tend to reduce over time. This can be combined with a more activating antidepressant and combined with an SNRI is more effective than a full MAOI for depression while having a much milder side effect profile.

[jadamgo]

Sorry,I mean't Adrenal fatigue=AF.Also,if it does make a difference in the clinical treatment,the anxiety and depression was probablya result of childhood and teenage physical and mental abuse.It is also definitely partly genetic.

Ill check the studies on Pubmed,and investigate the Lightbox experiment.Ill try and muster up the motivation for the CBT.

CBT or another empirically supported therapy would probably be very helpful. Pills can help in recovery from trauma, but cognitive restructuring, behavior modification, and emotional healing are the cornerstones of recovery. Undoing the biological damage is only half the solution.

[Tom_]

I'm not sure if I would go as far to say they are the cornerstones of recovery. They are certainly VERY important but pharmacotherapy plays as much a part in most disorders (not all) as does psychotherapy.

I agree with Jadamgo that it is vital to a full remission you use evidenced based therapy. Although maybe something slightly more analytically and insite oriented to start with would be more useful, taking into account history and chronicity? Group IPT? Followed by group CBT or DBT like therapy? Jadamgo what do you think?

Of course this will depend on availability. If only 1:1 is available is not a big deal.

[Atropy]

I appreciate your responses guys,that's what I needed to hear,specific recommendations.I agree with alot of what you say.

Relora has has a powerful effect on me,to make me heavy and tired.But it has tolerance.
Ashwagahanda and Jiagulan work abit for mood.The best out of all of the supps were probably L-Theanine and Trypto.
So not really effective for me.

I think Im gonna look for the medication first,because any kind of CBT other than self CBT needs far more moticvation.I have had years of counselling and I have kind of lost my faith in counsellors,psychologists and psychiatrists.

I too think the problem is high cortisol.

I want to try the easiest solutions first,so that means the T3 or Lithium first.

1) What is T3?Is it T3 supplementation for the thyroid,I know nothing about T3,please elaborate,maby leave a brand name.

2)What dosage of Lithium would you recommend,is Lithium Orotate what I'm looking for,or will any Lithium do?

Moclobomide seems interesting too,I will find out if it is available,or even if it will be prescribed.

But let me experiment with the Lithium Immediately.

Tianeptine is the easiest thing I can get.

Switching classes of Imipramine,maby,if I do hopefully those other Tricyclics won't leave me mentally and physically slow.

[Tom_]

The treatment for resistant depression (which you just meet criteria for (failure of two antidepressants from separate classes - Sertraline and Imipramine) is medication combined with psychotherapy (the right kind by someone who knows what they are doing and in your case hopefully in a group). One or the other might help but its pretty clear in your case they need to be combined.

Lithium orotate is a load of crap, no research base, I mean two small studies (not for depression) compared to 100s for real Lithium and no safety or dosing guideline has been established. Lithium carbonate (and citrate but rarely used and much poorer research base) is the only approved drug. The doses will be lower than those used in Bi-polar (normally 300mg TID), the side effects are often unpleasant (weight gain being often a lot), it requires regular plasma monitoring bla bla bla. If it needs to be used then it does but exhaust the easier safer options first. I've just had a massive rant about it but on the other hand it is one of the two best argumentation agents for MDD with massive improvements often seen.

T3 or triiodothyronine - the thyroid hormone is the other one of the two best argumentation agents. It seems to have fallen out of favor of late for no discernible reason. Its as effective as Lithium agumentation. The majority of its research is based on combination with TCA therapy but is effective alongside any antidepressant. Its side effects are typically mild, it requires monitoring for hyperthyroidism although this is rare. If you insist on augmentation before swapping to another AD then this is the one to go for.

You can also trial an atypical antipsychotic alongside Imipramine. Amisulpride or Aripiprazole would be my recommendations. They are both very effective for depression. Amisulpride in low doses actually out did Imiprmaine. Aripiprazole is the lowest side effect AAP and has a novel mechanism of action. AAPs have been extenively studied as augmentation agents and are the next best option to Lithium/T3.

There are combination options, to help efficacy and fatigue. Imipramine is a very potent SRI so adding in SSRI like drugs aren't the best idea nor will they be stimulating. It is however a fairly weak NRI so you could combine with it with Bupropion (although further anticholinergic side effects makes me thing bad idea), reboxetine which is a pure NRI although its possible its not as effective as an AD as PUBLISHED research shows. Atomoxetine failed to show efficacy as an antidepressant but it will improve energy, concerntration and the like.

Any TCA you use apart from protriptyline is more likely than not to cause sedation. Protriptyline's uses are pretty much limited to narcolepsy and ADHD and is awful for the old meat pump. You might get lucky with something like Lofepramine or Nortriptyline but I doubt it based on the fact that the Imipramine (which metabolizes into despiramine - a very potent NRI and one of the most activating) causes you so much sedation.

When someone fails a Tricylic typically they have failed a list of other antidepressants. Normal treatment algorithms recommend either you try 1 more TCA and then/or swap to an MAOI - Moclobomide is safer, comes with no restrictions and appears to be as effective in no refractory cases of depression as full MAOIs (only in refractory illness do full MAOIs seem to be more effective than any other class (those that have failed 5 antidepressants from at least three classes and typically 2-3 augmentation strategies).

I maintain the best option is to swap to Moclobremide, evaluate effiacy and then consider a swap agumentation or swap (you can reduce the dose to 25mg between day 4-7 from 75mg) and then a wash out period of a week is required (you can get away with 5 days) before you start Moclobremide at 150mg a day for three days before titrating 300mg (normal minium dose).

OR

swap to Mirtazapine, drop to 50mg and then 25mg over 3-4 days and then start mirtazapine at 15 or 30mg and continue the Imipramine for four more days (those four days are may be severely sedating). You can then continue this for four weeks and increase the dose as you like to 45mg and decide if its an effective AD by itself (it is a sedating one) or after two weeks you can iniate an SNRI (Duloxetine or Malicinipran). (Malinicpran is a potent NRI and potent but slightly less so SRI). The Mirtazapine having serotoninergic antagonist effects will reduce a lot of the side effects of Malicinipran (which you may have experienced on Imipramine as well - nausea, sexual dsyfunction, dizziness etc) while the Malicinipran will be more activating during the day (Mirtazapine is sedating so good sleep and then activation). weight gain from the Mirtazapine will be countered by weight loss by the Malicinipran and in general less side effects (of course there still will be some, maybe a fair few (but likely better than Imipramine), consitpation is almost granted but this can be managed). Or you could try one or the other by themselves. Malinicpran can be exchanged for Venlafaxine, Desvenlafaxine or Duloxetine but all of them are less activating then Malinicpran - all have similar side effect profiles and effiacy.
This is a variant of calafornian rocket fuel (traditonally venlafaxine and Mirtazapine) which has shown to be more effective than a full MAOI multiple times (although only just).

If you swap TCAs Amitryptyline while even more sedating is the gold standard of antidepressants and is the only study I'm aware of that has ever produced a 100% response rate (combined with Lithium and at a high dose) - it was a small study and is NOT representive of its really effiacy which is lower. MAOIs are more effective but that comes closest.
OR
Noratyptayline

[hani]

How does Moclobremide properties as anxiolytic compare to SSRIs? And it doesn't have the risk of making him hypomanic?

[Tom_]

There is a risk of hypomania induced by any antidepressant therapy but Moclobremide doesn't show more risk factors than any other AD (although its possible SSRI's and SNRI's show a slightly higher rate on hypo/mania). Furthermore at the time he was smoking a lot of pot (I think) and this could have confounded factors but SSRI induced mania is not enough for a diagnosis of bi-polar 2 unless the episode was pushing full mania and/or proglonged or followed by other episodes not drug induced. It is enough to suggest a bi-polar spectrum disorder so an atypical antipsychotic MIGHT improve efficacy of an AD. Because of that fact I did nearly suggest Trimipramine but its the MOST sedating AD.

Its not been extensively studied in anxiety disorders (it shows very good efficacy for agitated depression) failed to match irreversible MAOIs for soical anxiety but clearly separated from placebo and was effective for panic disorder. Its not got much research for other anxiety disorders but one would expect it would.

[Atropy]

Thanks allot.I see I have a few options.I tried to do some more research on these AD's,but I've been extremely unproductive lately.I can't get things done.It took me forever to even reply.

I like the idea of trying Moclobemide if its a long term solution,if it will be prescribed.My biggest anxiety is that it won't be prescribed.I want to find the right med for me.

I still like the idea of a so called side effect free anti-depressant/nootropic,Tianeptine.

I know that there's no way I will be functional while tapering down the medication and especially during the washout period.It's not going to be pretty.I need to be functional,during the washout period especially,there's no doubt.

Would it be okay to use Tianeptine while tapering down the Imipramine?If it works then great.
Would Tianeptine pose a problem if combined with Moclobemide or Imipramine, short-term?

I'm gonna dig into the research on these AD's as soon as I can.

I

[penisbreath]

I didn't wanna start a new Tianeptine thread, since there seem to be a couple active at the moment, but does anyone know if it's contraindicated in fatigue conditions where the HPA-axis might be suppressed, like atypical depression? I tried it a few years ago for a couple of weeks and recall feeling more anxious and stressed out, but was probably on some supplements that were unknowingly making me worse as well

[Tom_]

Atypical depression has raised HPA axis activity, not as severe as melancholic depression but raised all the same.

I've done a bit of research on Tianeptine today. I've decided to withdraw my comment about it being useless and totally unevidenced. I've decided its a valid option. However I can assure you the research shows it is NOT side effect free. It has a damn sight less side effects than TCA's like Imipramine and it might even be a little less than SSRIs but it still has significant side effects.

If you get prescribed Moclobremide you will have to spend a week free of all antidepressants (any monoaminergic drug in fact) before you start. Realistically its not a massive concern but it isn't worth the risk of a Serotonin toxidrome.

There isn't any point using an antidepressant short term. It will take two weeks before it starts to work.

If you do get Moclobremide prescribed then you can do the swap quickly.

Day 1: Drop to 50mg Imipramine
Day 4: Drop to 25mg Imipramine
Day 8: Stop Imipramine

(You will have about two weeks of withdrawal symptoms if you are susepctable to them)

Day 15: start 150mg Moclobremide (you could start at 300mg but because of the speed you not leaving two weeks 150mg is a better idea).
Day 18: increase to 300mg Moclobremide
Wait six weeks, if there is no effect or only a partial response increase to 600mg. If there is no effect after another six weeks then its time to swap to another drug. If there is some you can increase to 750-900mg (off license dose) or add in an adjunct - Mirtazapine would be a good choice, so would Bupropion or Trazadone.

If you can't get hold of Moclobremide starting Mirtazapine is a good choice. It is sedating but certainly no more than Imipramine and you can add in energizing adjuncts if you need it. It will also allow you to cross taper.

Day 1: Imipramine 50mg
Day 3: Imipramine 25mg and start Mirtazapine at 30mg
Day 8: Stop Imipramine.
Wait 6 weeks as above and then decide where to go.

[Atropy]

Thanks for your thorough reply Tom_.

Yes,I will probably have withdrawal symptoms,if I know myself.

I have about 3 months where I have to be more productive and stable than usual starting from now.Even right now I am not able to function properly cognitively.So,this is a time where I can't really afford to do the 1 week washout period,and the period of weaning and introducing Moclobremide.People will totally know that there is something off with me.

The thing about me is,I have felt the effects of Imipramine and Zoloft from the very first dosage.I am 90% sure it was not a placebo effect,even thought my doc said it was not possible to experience immediate effects.
One time I was given sugar pills by an acupuncturist for anxiety,it didn't do a dam thing.He told me afterwards that it was sugar pills,I was not surprised.

So this immediate effect that I get from meds may hold true to all Ad's..

Are you 100% sure it's not recommended to use Tianeptine for the weaning of Imipramine and the washout period before Mocrobremide and possibly during the introduction of Mocrobremide?

I have some thoughts,are they viable?

1) My other option is to try Tianeptine with Imipramine,just for these 3 months that I have things to do.Then afterwards,do the change to the longer-term Moclobremide,when I am in a more stable place.

2) Or I can just increase the dosage of the imipramine back to 100mg and then further to 125mg for 3 months and endure the side effects(more nausea,palpitations,low blood pressure,dizzyness).

3) Or finally,I could just switch to Mitarzapine soon.This will allow me to skip the washout period.

I don't like 2,I dont need all those side effects,only to reduce the dosage after a few months.I don't like 3 as I won't know if Moclobremide would have been better the first time.I like 1 the best as it seems like a safer shorter term solution.

What do you think?

[Atropy]

I have received Moclobemide.I have been on a 5 day taper.Today is my first day not taking any anti-depressants.I had ridiculous insomnia lastnight and tonight.
I will have had one day off from imipramine and then I will try 150mg of Moclobemide.

I did the taper even though my shrink said that it was not necessary,I just had to substitute it in place of the imipramine but not take them together.

I was gonna take 2 days of no medications but I can't take the insomnia anymore.Been taking a some vitamins/adaptogens/mushrooms/400mg piracetam to survive these few days.

I have also been incredibly short and unable to take shit from people,much more pronounced than usual.Feels like I am walking a thin line,so to speak,and I am finding it hard to concentrate or be productive.

I am reminded of my insomnia that I had before medications.I have also read many reports that Moclobemide causes insomnia,so I may have to ask my shrink if I can add the Mitazapine with it.

Insomnia or unrestful sleep has always been an issue for me.I can't really control my sleep well.

Edited by Atropy, 07 November 2013 - 06:21 PM.

[Atropy]

I tried one dosage of 150 mg and there was a definite,although subtle effect of mood stabiliization. I was definitely less agressive. I stopped taking my tyrosine now,which I think is the cause of it.I took the medication at 2am and then 2am the next morning again.My insomnia is too bad to go on with just this one dosage a day.

I am going to increase to 300mg a day now,my question is that is it better to divide it by 2,one at night and one in the morning or just take both in the morning?

What can I take directly for insomnia as the tryptophan and melatonin is not as effective.I need to sleep.The lack of sleep is not from the Moclobemide,but from the lack of imipramine.

[Tom_]

Why the fuck were you taking Moclobremide at 2am?!

300mg a day is a good dose, keep it at that for six weeks. Sleep hygiene, strict and rigid is how you are going to get to sleep, not drugs. I wish drugs would do any good but in the short term they might just about get you off, in the long term they will either poop-out or continue to make your sleep bareable. Remission from depression and good sleep hygiene will normalize your sleep.

Moclobremide is typically taken twice daily. I'd suggest one on awakening and one around 3pm. If you must, a short course of benzos or z-drugs will help with sleep COMBINED WITH RELIGIOUS SLEEP HYGIENE...with a light box if need be. You can try ramlton if you like but finding the right dose is hit and miss, anywhere between 2 and 64mg seems to be about right.

[Atropy]

Why the fuck were you taking Moclobremide at 2am?!

Because it was the last of all of my supplements I took to try and sleep,I was desperate.This insomnia is something else,really strong.Im just awake and I feel like I may be losing it.


For dam sure I need something in the meantime to make me sleep.The medication is working it seems,I feel very stimulated and able to concentrate,and I am very aware of it,I feel super productive.My brain zaps are getting stronger,doesnt bother me.Im just happy I have a good reaction to the meds.Thats just my very early evaluation.


Only shit part is I haven't slept properly and I am taxing myself,last night was 2 hours sleep.

What I am thinking
1-I think I'm going to go to a doc and see if I can get that thing you prescribed,what was it ,Remlton?What is the the correct spelling of that medication?

2-Also,I'm thinking of doing a pineal gland detox(decalcify),but it seems expensive. Main ingredient is organic blue ice skate fish oil,containing factor x.You will probably shit on this idea.

3-I am contemplating buying a Phillips Go lite,unless you can recommend a better/cheaper product?There is also a product called the Nightwave that I have my eye on.

Edited by Atropy, 11 November 2013 - 07:51 PM.

[Tom_]

You know I'm going to shit on idea 2. Its pointless and stupid.

Benzo's are the way to go here.

[Atropy]

I see,allright. Im assuming after the 6 week trial,if Moclobemide is effective,I can maby add in the trazadone,correct?That would help with sleep?

[deeptrance]

Given that benzos have a rapid tolerance issue and create a dependence that can result in a rebound of insomnia and anxiety upon withdrawal, I think it would be more cautious to try something weaker unless you're in an insomnia "crisis" that needs drastic action.

Oleamide helps many people with sleep, for example, but you'd mainly want to use it for times when you wake up in the middle of the night because it is fairly short acting.

Baicalin is useful for some people, it works as a GABA-A modulator.

You could try adding more adaptogens, which is something that has helped me on a number of levels including improved sleep. Rhodiola, schisandra, eleuthero... timed according to how they affect you. Rhodiola is a bit stimulating for me so I take it in the morning. Always be sure to use standardized extracts of all herbs, from reputable sources, unless unavailable or unwarranted.

Valerian is less of a dumbing agent than benzos and I've found it to exhibit no tolerance factor, though I'm probably dependent on it.

Prescription med alternatives which can be purchased without a scrip if you need to go that route, include gabapentin and clonidine. I won't go into discussing these, there's plenty of info available on them all over the web. I take gabapentin for a partial seizure disorder and I reserve a dose for nights when I awaken a couple hours after falling asleep. Very helpful.

I've been using tianeptine for a few weeks and I love it, but I've read many reports of it losing its efficacy after a few months. Then again, that can happen with any psych medication. I'm in a support group where I hear lots of stories about meds, some of them involving the failure of a drug which had previously been effective. Then the inevitable search for a replacement ensues...

[Atropy]

Yeah,that response is abit surprising,I don't know much,but when I hear benzo's,I don't ever read furthur,also Phenibut or oxycotin are things I would not consider unless other avenues have been considered.

Yes,I thought about valerian,californian poppy,Huperzine A.Valerian may probably be more effective short term,but I read that it interacts with Moclobemide,Im not too sure how strong the interaction is or could be,just google info.

Tryptophan may work a little.I would definitely try 5htp at this point,but not with Moclobemide.

I have survived on under 3 hours sleep for 60 hours,also,had less sleep the days before.My Adrenals are back to taking a thrashing.

But I did find an otc sleeping pill work great for one night,next night not as great.

Ashwaghanda,Relora worked well but very quickly lost effectiveness.Maca,makes me angry.Gotta wait long before it works again,it does nothing at the moment.
Deeptrance,I will check out these meds,at the top of my list tho is probably Trazadone,providing it will be prescribed .

Moclobemide is definitely more stimulating than imipramine.I like it,only problem is the insomnia side effect,lets see if it passes.Hopefully it will with the theraputic benefits remaining.

[Tom_]

There is nothing wrong with Trazadone at below 150mg and it can be an effective hypnotic at those doses. Mirtazapine can also be used and since its completely devoid of SSRI behavior any dose can be used safely. Taking the Moclobremide IN THE MORNING upon awakening will of course help as well.

There is a reason I don't suggest adaptogens. There efficacy is not shown and far from guarantied, they carry more risk than Benzo's simply because nobody knows how they work. Tolerance can be a major factor in there use as well. Long-term use of Z-drugs (I let them fall under Benzo's) is typically safe and while withdrawal symptoms might be present often dose escalation beyond prescription guidelines aren't needed - I would be a bad example of that, I can take 15mg of zopiclone to little effect.

Benzo's are the standard for short term sleep problems and they have antidepressant qualities of their own. Clonzapam, Temazepam and Z-drugs are the most useful.

[Atropy]

Is diphenhydramine safe for long periods of time for sleep,its the only otc thing that works?

[nowayout]

Is diphenhydramine safe for long periods of time for sleep,its the only otc thing that works?

It is probably safer than Z-drugs or benzos, and probably as safe as or safer than antihistaminic antidepressants such as mirtazapine.

Edited by nowayout, 14 November 2013 - 04:24 PM.