Quick question

[SEANML]

Nope they do not cover any other then a(waiting for one now) Psychologist. My sleep dr is being of help on the side. As he use to be a phycologist

He meant long term at the dosing I am at (vyvanse 70mg,mirtazapine 30mg olanzapine 25mg trazadon (now 50mg) and a melatonin 10 mg. Plus I drink a crap load of coffee. He said this amount of medication is not good.

I checked over your ana answer, I just didn't understand it on how it shows amitriptyline is not ana/RF maker. Sorry my brain injury makes reading large documents hard. Thanks for all your effort thought, you must have read it and understood it . You have alot of knowledge and resources

[panic_down_under]

Nope they do not cover any other then a(waiting for one now) Psychologist. My sleep dr is being of help on the side. As he use to be a phycologist

A psychologist should be able to help you with cognitive and/or behavioural, or mindfulness therapy techniques.

He meant long term at the dosing I am at (vyvanse 70mg,mirtazapine 30mg olanzapine 25mg trazadon (now 50mg) and a melatonin 10 mg. Plus I drink a crap load of coffee.

Woo!! Back up the truck! You are on the maximum dose of a very potent stimulant, lisdexamfetamine (Vyvanse), and drink "crap loads of coffee". No wonder you can't sleep despite taking huge amounts of several sedating meds!

I suggest you get a second opinion about your medication regime, if possible. At the very least stop drinking coffee!

I checked over your ana answer, I just didn't understand it on how it shows amitriptyline is not ana/RF maker.

The side-effect listing for antinuclear antibodies (ANA) seems to rest on the single case noted in the patient information sheet I linked (PDF, p 14) in which a patient also had pulmonary fibrosis of the lung. Both high ANA and RF are a very common side-effect of pulmonary fibrosis with about 30% having one, or both, but as far as I can tell there have been no other reports in the medical literature associating ANA and RF with amitriptyline. OTOH, there are many studies reporting, or recommending amitriptyline be prescribed for pain relief for patients with ANA and RF.

I've done further research on ziprasadone and it is a more potent SRI than I thought which likely makes it problematic with clomipramine, and possibly imipramine too. It depends on the dose.

[SEANML]

So the reason ana rf was in the side effects is due to a person having lung issues no other people had the ana,rf? If I understand you correct.

Only reason I'm changing my meds is to solve the insane food cravings. Makes me a fat monster. I cant resist I've tried. I sleep amazing other then that. The drugs I'm on have made me hungry always. And 30 min after I take them I raid the nuts and olive oil. No other food satisfy it.

So ziprasidone would not be good with those 2 meds? I am trying to get comfy with amitriptyline now. Just to be honest it really constipated me. I got the constipated IBS version. I will only be changing mirtazipine and olanzapine 1 month at a time. Not sure wich one yet as I'm scared I wont sleep. I need sleeper alternatives.

All I know is something triggered me to have OCD, anxiety again 6 months ago. Before that I was fine other then some sleep difficulties. I dono the culprit.

The high dose vyvanse is to counteract the food cravings from my sleep med. I was on 60mg ritalin in the past with less stimulants affect, but my hunger was too much. I take them also to help with my fatigue. I will make a slow attempt on my coffee starting tomorrow though. All I know is in my past I slept better with ritalin but I need off all these hunger meds. I dono which one caused it. Mirtazapine and olanzapine are only a year of use. I want off food cravings drugs so I can go back on my ritalin. Atleast with ritalin you can take off days. 24/7 stimulated is rough. No days of rest. I make sure to have my last cup 6 hours before sleep atleast. Part of me wonders if the vyvanse trigger my old disorders to re surface?

Do you know if there is other sleeping meds other the tcas,benzos and sleeping pills. Was gonna ask my sleep dr the same question. To my understanding I'm on the most powerful combo but cant take hunger. It's the only effect I get. Wish I never had to change.

Hey! What about taking ziprasadone and olanzapine instead of mirtazapine? In theory that could work couldnt it?

[panic_down_under]

So the reason ana rf was in the side effects is due to a person having lung issues no other people had the ana,rf? If I understand you correct.

Yes. I can't say with 100% certainty that amitriptyline wasn't responsible for the immune dysfunction, but if there is only one known case linking the med to the dysfunctions and it also had another factor, the lung fibrosis, which is known to cause ana and/or rf in 30% of cases then Occam's razor says it would be the most likely culprit, not the med.

So ziprasidone would not be good with those 2 meds?

It depends on the dose. It is something your GP needs to work out.

I am trying to get comfy with amitriptyline now. Just to be honest it really constipated me. I got the constipated IBS version.

Most of the TCAs can cause constipation (and dry mouth). It is usually less severe with clomipramine and imipramine than amitriptyline. Eating lots of fibre and ensuring you're well hydrated will help, I also found sprinkling a tablespoon of crushed linseed, aka flax seed, on the morning cornflakes help too.

All I know is something triggered me to have OCD, anxiety again 6 months ago. Before that I was fine other then some sleep difficulties. I dono the culprit.

...The high dose vyvanse is to counteract the food cravings from my sleep med.

...Part of me wonders if the vyvanse trigger my old disorders to re surface?

So you take meds to help you sleep then a stimulant to ease the food cravings from the sedatives which forces you to take higher doses and/or more sedatives? Does that sound reasonable to you?

Did the OCD and anxiety start soon after you began taking lisdexamfetamine? If so, it could well be the trigger. Taking a stimulant with an anxiety disorder is often problematic.

I was on 60mg ritalin in the past with less stimulants affect, but my hunger was too much.

...All I know is in my past I slept better with ritalin but I need off all these hunger meds.

Did you need fewer sedatives, or lower doses of them when you were on methylphenidate (Ritalin)?

I dono which one caused it. Mirtazapine and olanzapine are only a year of use. I want off food cravings drugs so I can go back on my ritalin

Mirtazapine is almost certainly the one causing most of the food cravings.

Do you know if there is other sleeping meds other the tcas,benzos and sleeping pills.

Doxepin perhaps. It is about as sedating as mirtazapine, but usually doesn't produce food cravings to the same severity. It depends on whether it is still available in Canada. It still is here in Oz, but Lesley - WiseMonkey - posted a while ago that it had been taken off the NZ market. TCA prices have also increased lately. Not sure if the two are linked.

What about taking ziprasadone and olanzapine instead of mirtazapine? In theory that could work couldnt it?

Taking two antipsychotics is not a good idea, and even less so just for sedation. I'm not a fan of antipsychotics for anything other than the illnesses they are made for.

[SEANML]

Ritalin only took mirtazapine and 10-20 mg olanzapine now I need 25mg. I can concentrate better though now. There is a chance that I will try ritalin again but that's not going to be a concern until I get the sleep drugs figured out (Ritalin wasn't as powerful for the good side effects, and I was still quite tired on 6 of them. But I like that my weekends I could avoid taking any and just relax. But first the hunger has to be solved because its intense without vyvanse. So mental problems came 1 or 2 months after vyvanse was started.
Ritalin took the heavy sedation as well. But less mental issues. Had them but less intense. Also less coffee.

I know vyvanse lasts longer and is more intense for my ADHD and energy levels. It most likely has contributed to the sleep. But I need new meds before I can even think of touching it. Only imaprimine seemed safe but you say it wont sedate . What do you take if I may ask?

Oops I may have asked my dr for the wrong thing. Which on prescribes meds? Only that one is covered

Anti-psychotics never caused me an issue other then bed and seroquel caused that Seborrheic dermatitis and possibly un controllable hunger. That's why I'd prefer them. Amitriptyline and the other tcas scare me for the side effects. Less with anti psychotics, been on them for years.

I need a med that's not a tca but helps with sleep with less hunger. In my opion TCAs seem to have some scary side effects compared to the drugs im aware of,

Is there any sedatives that are not a TCA? Any other suggestions? I will be asking my dr that question.Id take imaprimine if it was a sedative,amitrip still frightens me sadly. Gotta be other non tcas out there. I just cant touch hypnotics, too dangerous in all my drs opinions

[panic_down_under]

So mental problems came 1 or 2 months after vyvanse was started.

Which may be significant. You need to tell your doctor this.

Only imaprimine seemed safe but you say it wont sedate . What do you take if I may ask?

A TCA that isn't available in Canada, dosulepin, aka dothiepin, (Prothiaden).

Amitriptyline and the other tcas scare me for the side effects. Less with anti psychotics, been on them for years.

See, that's the problem. You've been on antipsychotics for years so are comfortable with them and fear TCAs because they are something new. You have also become fixated on side-effects which you will almost certainly never experience, but your mind can't let go. Had you been on TCAs for years and now been asked to take antipsychotics you'd be just as scared of their side-effects...and with more justification.

In my opion TCAs seem to have some scary side effects compared to the drugs im aware of,

Only in your imagination. I would not take the two antipsychotics except if I had schizophrenia or maybe bipolar depression. Nor am I a fan of mirtazapine.

Id take imaprimine if it was a sedative,

Hoping for a med which solves two different issues is often futile. It is almost always better to take the best med for each problem than one med which does neither task well.

[SEANML]

In your opinion what med would you suggest for sleep and then a med for ocd/anxiety.

Olanzapine did work but seems it's no longer as potent. Just wish I could overcome my amitriptyline fears and tcas in general. Just shoot if I got rheumatoid I'd be so depressed .
I'm terrified of auto immune and cancer.

Is amitriptyline my only best bet for sleep? I feel either raise olanzapine or add another anti phycotic with olanzapine and then take mirtazipine away.
Your version is add amitriptyline and take away mirtazipine? Then I'd constantly wonder if I was getting ANA. By the sounds of it imaprimine is useless in your eyes?

[panic_down_under]

In your opinion what med would you suggest for sleep and then a med for ocd/anxiety.

Try doxepin if you can get it for sleep instead of mirtazapine, and clomipramine or imipramine for OCD, or amitriptyline if insomnia is still an issue.

Just shoot if I got rheumatoid I'd be so depressed .
I'm terrified of auto immune and cancer.

Then isn't it fortunate that this not a real issue with any of the TCAs under discussion, only a problem created by your mind.

I feel either raise olanzapine or add another anti phycotic with olanzapine and then take mirtazipine away.

Taking two antipsychotics would be seriously nutz, imo.

Your version is add amitriptyline and take away mirtazipine?

No, my 'version' is take what will likely be the more effective meds for OCD, clomipramine, or imipramine if your mind won't get over its fears about clomipramine. And for sedation ditch the mirtazapine for something else such as doxepin. Also try lowering the trazodone to no more than 50mg to boost its sedative effects.

Imho, mirtazapine is at the heart of most of your problems. It is almost certainly the principle cause of your hunger issues. Do something about them and the others things would likely become more manageable.

By the sounds of it imaprimine is useless in your eyes?

Why would you think that? I was on it for years. Great med. Clomipramine probably has an edge with OCD, but for other anxiety disorders imipramine is often very effective. It was the 'gold standard' AD for panic disorders for decades until the SSRIs became available and they didn't become more popular because they are more effective, they are not, but because they are thought safer in overdose which isn't actually true of all of them.

[SEANML]

I think side effects wise amitriptyline is better the doxepin. I just need to convince myself ana wont happen. And the other med would be imaprimine for ocd/anxiety if that makes sense? Can I take 2 tcas? Can imaprimine help with OCD? Clomiaprimine makes me nervous for the breast fibrodenosis and systemic lupus rash. You have almost settled my mind on amitriptyline.

Also what am i missing , are antipsychotics that intense to take 2 at once (olanzapine and ziprasidone). I dont get noticed side effects from 1.

[panic_down_under]

I think side effects wise amitriptyline is better the doxepin.

I'm not suggesting you take doxepin for OCD/anxiety, but only a low dose for insomnia.

I just need to convince myself ana wont happen. And the other med would be imaprimine for ocd/anxiety if that makes sense? Can I take 2 tcas?

Taking amitriptyline at low doses for insomnia won't work. If you take it at antidepressant level doses then no, you can't also take clomipramine, or imipramine and you shouldn't need to anyway.

Can imaprimine help with OCD?

Yes, it could, as I have repeatedly told you. Are you hoping for a different answer?

Clomiaprimine makes me nervous for the breast fibrodenosis

Do you lay awake at night worrying about getting ovarian cancer? If not, why not?

and systemic lupus rash.

You got seborrheic dermatitis from quetiapine (Seroquel). Did your world end? No? Lupus is no different. In the very unlikely event it becomes a problem then you switch to another med and life goes on.

Also what am i missing , are antipsychotics that intense to take 2 at once (olanzapine and ziprasidone). I dont get noticed side effects from 1.

Then you've been lucky.

We seem to be just going around in circles getting nowhere. You're not really in a frame of mind to do anything.

My advice, replace the mirtazapine because it is doing you real harm right now because of weight gain. Once you are settled on the replacement then you can start thinking about treating the OCD/anxiety. Insomnia and OCD are two separate issues and should be treated as such.