What are your considerations when treating insomnia in perimenopausal patients with comorbid anxiety or mood disorders?
Answer from: at Community Practice
I would choose to first try nortriptyline for such a patient. While being an older medication, I find it to be excellent. It is generally well tolerated and helps with insomnia, anxiety, and depression. It isn’t studied much, because it’s been generic for so long, and oftentimes, clinici...
Comments
at Thapar Renu K Office Nortriptyline is an excellent drug overall, even t...
at Thapar Renu K Office I have seen a cardiac conduction defect with it, a...
I graduated in 1992 and did have patients OD on TC...
at UT Southwestern School of Medicine What is the weight gain like for nortriptyline in ...
at Private Practice Negligible weight gain, especially with doses of 2...
If the insomnia is due to vasomotor symptoms, the venlafaxine might improve sleep and treat depression/anxiety. SSRIs also have data for vasomotor symptoms.
I would first consider gabapentin or pregabalin in such a patient. While CBT-I is first line, I would anticipate medication therapy being necessary in this setting. Gabapentin has some data that shows positive benefits in perimenopause as well as sleep benefits. If a patient has excessive next-day s...
Comments
at DHCS My choice and practice is to keep my patients away...
at Private Practice Nortriptyline is an excellent medication. Its card...
at Thapar Renu K Office Agree totally
each patient is different and...
As with all people, I would try to understand, and help the patient to understand, what she is anxious about and why, psychologically. Psychological investigation and potential psychotherapy are the first rule for people with psychological symptoms. If an antidepressant is needed later, that's fine....
Given measurable levels, titration to a known therapeutic window is a definite plus.
Many years ago, I was the psychiatrist for a geriatric psychiatric unit… Having measurable levels and a known therapeutic window was a huge plus, especially in treatment-resistant patients.
If the insomnia:
is a new feature that is not typical of the prior anxiety and mood
clearly began in the perimenopausal timeframe
was not triggered by a clear psychological or social stressor
Then I think psychopharm options (like those mentioned above) should be considered and not frowned u...
Nortriptyline is an excellent drug overall, even t...
I have seen a cardiac conduction defect with it, a...
I graduated in 1992 and did have patients OD on TC...
What is the weight gain like for nortriptyline in ...
Negligible weight gain, especially with doses of 2...