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Thread: Imipramine, have I made the right choice?

  1. #41
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by Dazzlar13 View Post
    I'm hoping they'll do something along those lines, I mean to be honest other than the imipramine I'm on exactly what they prescribed, it's the doctors who won't prescribe the mood stabilizer the psychiatrist prescribed.
    That is 'brave' of them. Have you referred this back to the psychiatrist?

    I have had some addiction issues in the past but I have really struggled to come off the diazepam for over a year now.
    Now is not the time to try again, but once the new med regime is working it really needs to be tackled. The trick is to formulate a plan and to stick to it. I'm not a Heather Ashton fan, imho she is a very flawed character pushing some dubious ideologies, but the method set out in her manual is as good a plan as any. I wouldn't take on board anything else claimed on that site. Much of it is male bovine manure based on ignorance, often wilful ignorance, plus more than a little zealotry.
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  2. #42
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    Re: Imipramine, have I made the right choice?

    Yes, they have referred me back, I'm not sure how long it will be till I get to see them.

    I am familiar with the Ashton method, I have the book "Back to life" it's going to be a challenge as I'm taking zopiclone as well. Stupid as I know it is it is mind you. I do plan on tackling it, I'd like the help of professionals but the drug services where I live are mainly focused on opiates..


    Hopefully my sleep and anxiety improve as they've both been pretty bad since I had the dosage increased. I assume this is normal?

    Thanks for all your advice, it's been really helpful.
    Last edited by Dazzlar13; 29-07-20 at 19:16.

  3. #43
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by Dazzlar13 View Post
    I am familiar with the Ashton method, I have the book "Back to life" it's going to be a challenge as I'm taking zopiclone as well. Stupid as I know it is it is mind you. I do plan on tackling it, I'd like the help of professionals but the drug services where I live are mainly focused on opiates..
    One that understands the particular issues with BZDs could be a big help, but I'd be wary about those without considerable experience. The problem is there are two issues that need handling with BZD withdrawal, the effects of the med and the issues arising from the anxiety disorder. It needs a delicate touch, not the bull-in-gate approach often used with opiates, etc.

    Hopefully my sleep and anxiety improve as they've both been pretty bad since I had the dosage increased. I assume this is normal?
    Unfortunately, yes for both. Serotonin isn't the 'feel good' neurotransmitter of popular myth, anything but as you've discovered (neurotransmitters don't actually have an intrinsic attribute, their action is determined by the receptors they bind too). The increased serotonin activity should begin to drop a couple of weeks after the last dose increase and the heightened anxiety will then usually begin to diminish. The extra serotonin is probably also responsible for the insomnia and imipramine isn't usually sedating enough to override this. Like the anxiety it should diminish after a week, or two as serotonin synthesis and expression drops back to baseline, and below. If it become a problem in the meantime then maybe try an over the counter antihistamine like diphenhydramine found in Nytol tablets and liquid. If that isn't strong enough then ask your doctors for something. A small dose of mirtazapine should do the trick, but their computer may flag a risk of serotonin syndrome. It will be wrong, but you might have trouble convincing them of this because there is so much BS about it even in MHRA, NHS and FDA literature despite the best efforts of syndrome researchers like Ken Gillman and Ian Whyte.
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  4. #44
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    Re: Imipramine, have I made the right choice?

    Thanks for the advice. I had been ok sleeping and the anxiety had calmed down. But I had a tough night last night.
    I am going to wait untill everything has settled before I try to withdraw.

    I did speak to my doctor last week and they are asking me to speak to them in a two weeks to see how I'm doing. I've not been great but I'd like to give the imipramine a bit longer to work. They did mention paroxetine which is the only SSRI I haven't tried. They said it helps some people who can't sleep because of anxiety, could this potentially be a good shout? Citalopram used to work like a charm for me but I've been off and on it too much I think. Same as I jave with sertraline or have I been off and on SSRI for so long (about 10 years) that none will work?

  5. #45
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by Dazzlar13 View Post
    I did speak to my doctor last week and they are asking me to speak to them in a two weeks to see how I'm doing. I've not been great but I'd like to give the imipramine a bit longer to work.
    Given your med history (see below) and the fact you're taking diazepam which inhibits the way ADs work it will likely take any AD longer than usual to kick-in so I'd be planning to give imipramine a good 12 weeks at 150mg to prove itself before drawing any conclusions.

    They did mention paroxetine which is the only SSRI I haven't tried. They said it helps some people who can't sleep because of anxiety, could this potentially be a good shout?
    Paroxetine has no intrinsic sedative properties and insomnia is one of the most common SSRI side-effects so... That said, if it works well then you sleep patterns are likely to be more settled. But it's too early to be contemplating a med change, imho.

    Citalopram used to work like a charm for me but I've been off and on it too much I think. Same as I jave with sertraline or have I been off and on SSRI for so long (about 10 years) that none will work?
    There is growing evidence antidepressants may become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control, or not working at all. They may also produce more severe, and/or different, initial side-effects. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC, 2018; Amsterdam JD, 2009; Leykin Y, 2007; Paholpak S, 2002).

    In light of this I suggest you give serious thought to remaining permanently on imipramine, or whatever AD next works well for you. It was a conclusion I reached after having to go back onto ADs for the third time because restarting them was such a pain in the butt (and elsewhere). I've been on a TCA pretty much continually for nearly 30 years now and my brain hasn't turned to mush yet. As a bonus there is good evidence that TCAs and SSRIs can reduce the risk of Alzheimer's dementia and the blood thinning properties of SSRIs and other serotoninergic ADs may also reduce heart attack and ischaemic stroke risk, although they may increase that of the much less common haemorrhagic stroke a little.
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  6. #46
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    Re: Imipramine, have I made the right choice?

    Hi panic down under. Thank you for the detailed reply. I plan on giving imipramine a bit more time. I am struggling really bad with my sleep at the moment and sleeping well is something I have massive obsession with. I will be sticking with whatever works well for me permanently I think. I wish I could go back to the time when all I was taking was citalopram and a joint at night ( I started benzos to get off smoke Ng a joint to help me sleep, most stupid decision I've ever made) and was getting 8 hours sleep and holding down a full time job. I feel like I'm losing the fight with my diazepam and zopiclone at the moment.

  7. #47
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by Dazzlar13 View Post
    I am struggling really bad with my sleep at the moment and sleeping well is something I have massive obsession with.
    SSRI induced insomnia is a very common initial side-effects. Talk to your GP as it is treatable.

    I wish I could go back to the time when all I was taking was citalopram and a joint at night ( I started benzos to get off smoke Ng a joint to help me sleep, most stupid decision I've ever made)
    That was jumping from the frying pan into the fire. The THC in cannabis inhibits hippocampi neurogenesis. Just as with alcohol and BZDs cannabis gives the illusion of reducing anxiety while triggering, or reinforcing the very brain changes which produces it and depression. Cannabidiol (CBD) inhibits the deleterious effects of THC, but most of the cannabis sold these days has been selectively breed to maximize THC and lower CBD levels.

    and was getting 8 hours sleep and holding down a full time job. I feel like I'm losing the fight with my diazepam and zopiclone at the moment.
    Neither is a good sleeping med as tolerance to their sedating effect builds quickly, often within as little as a couple of weeks. I think their only value to you atm is in preventing withdrawal symptoms. Trazodone and mirtazapine are better bets, though even they need to be taken with caution.
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  8. #48
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    Re: Imipramine, have I made the right choice?

    Hello again Panic down under. I ended up having to speak to a doctor as I was struggling with the sleep issues caused by the imipramine and I asked if they would give me a low dose of mirtazapine or increase my dosage of promazine. They eventually talked me into tapering on paroxetine, they originally wanted to put me on venlaflaxine which I turned down flat. I feel that with me staring imipramine around 6 months ago that I gave it a fair shot. I find it odd that I've slept great already since I've started it and imipramine gave me insomnia and made my anxiety worse, like they both behaved the exact opposite side effects wise than you would expect.

    My main worries now are that I'll return to having no sex drive, emotional blunting and teeth grinding in my sleep.

  9. #49
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    Re: Imipramine, have I made the right choice?

    Quote Originally Posted by Dazzlar13 View Post
    They eventually talked me into tapering on paroxetine, they originally wanted to put me on venlaflaxine which I turned down flat. I feel that with me staring imipramine around 6 months ago that I gave it a fair shot.
    But you've only been on 150mg for 3? weeks which is lot long enough to know if it will work and which probably accounts for the increased insomnia.

    I find it odd that I've slept great already since I've started it
    How long have you been taking paroxetine?

    Given your history with SSRIs hopefully they'll be willing to prescribe up to the maximum 60mg immediate-release/75mg slow-release for at least 12 weeks should it be necessary.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  10. #50
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    Re: Imipramine, have I made the right choice?

    I know what you mean but I have been struggling with insomnia for around 12 weeks on and off. I felt like I was experiencing a caffeine high all the time.

    I don't think they'll have an issue with the dosage tbh. They had me on 60mg of duloxetine a bit back and I personally felt it was too high a dosage, it turned me into an a-sexual apathetic mess. So hopefully it doesn't come to that.

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