I've had a troubled 3 or 4 weeks on Atripla after what had been a better start in the spring. Nighttime sleep with its vivid dreams and early waking (possibly made worse by the early morning light) has left me feeling pretty exhausted. The daily diarrhoea and occasional incontinence which went away when I changed from previous treatment (Kaletra/Truvada) is back most days. I have been feeling fatigued and mildly depressed much of the time. I've managed the last few nights by taking 10 - 20mgs of Amitriptyline with the Atripla shortly before bedtime which has helped me sleep longer; bowel movements in the morning have been less aggressive and less frequent, and the diarrhoea less severe. Is this a good way to manage things - or should I be thinking about another change in treatment? Best wishes to all - Simon

Amitryptiline is a very reasonable treatment option and can be safely used longterm. A switch to a different booste PI regimen (such as darunavir or atazanavir), a raltegravir based regimen, or a nevirapine based regimen might be options to consider depending on treatment and resistance history if annoying central nervous side effects from the efavirenz persist. KH