Posted by Racer on December 13, 2008, at 17:57:13
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 16:11:33
From reading this thread, there are two issues I'd like to focus on:
1. Your OCD seems to be working against you.
Since my OCD gets into lockstep with my depression whenever I try to start something new, that's as far from criticism as it's possible to get on this planet. The question, though, is what to do about it?
Since it's such a problem for me, I'll offer you some of the things that have helped me:
Discussing my OCD-related reactions with my doctor in advance, so that we can work together to head them off. We've hit on two strategies that work well together, and have helped more than everything else we've tried put together -- and far more than benzos, for me.
A: Before starting a new medication, we discuss what we'll do if it doesn't work. We'll go through our entire list of possibilities -- it's a lot quicker now, since we've already discussed the options so many times. That reduces my anxiety -- not only about the medication and whether I'll have a good or bad experience on it, but also that my doctor will still be helping me even if this drug isn't a good one for me. That last part is the important part, by the way: a huge part of the fear is that the doctor will be angry and blame me if the drug doesn't work. (Unfortunately, I have had that experience.)
B. We set up a schedule of check ins during the start up period. We do it via email, because that's how we usually communicate between sessions, but telephone could work just fine, too. The check ins are short -- just whether anything is happening, good or bad, really. The reassurance is beyond my ability to communicate to you. I think that's been the best part -- I know that, if I do have a bad experience, my doctor will know within days (unless it's so bad I email right away instead of waiting), and I trust him to help me with it. Sometimes that means stopping a drug right away, other times, he's got a way to help me stay on it. Those email check ins are great for me.
The other thing that helps me is simply reminding myself that it's likely I'm experiencing a start up phase effect, rather than a long term effect, and reminding myself that I will never get relief if I can't get through the start up phase.
B. You seem to be focused on SSRIs, which don't appear to be helpful to you right now.
You only managed the one dose of Remeron, which would be high on my list of suggestions. I'd suggest trying again -- just on its own. (I hate hearing about starting multiple drugs at once -- not good science.) If you can set up a check in with SOMEONE -- your doctor, a nurse or PA in his/her office, even the receptionist! -- you might find it possible to get through the start up phase.
Otherwise -- Effexor or Cymbalta? Effexor is considered an old reliable by a lot of doctors -- it's a good medication, and worth trying. Despite the stories one hears about the discontinuation, it's still a good drug. Cymbalta, though, might be a better choice to try first. It's like a kinder, gentler Effexor -- although not as reliable, according to anecdotal reports.
Zyprexa, which might be helpful for the OCD, and help you get onto the antidepressant.
And, if you are convinced that you will respond best to one of the SSRIs, I suggest strongly you choose one -- Zoloft is my favorite, for whatever that's worth -- and take something with it to counter the insomnia. Personally, I like Rozerem best -- I try to take it the same time every day, about an hour before I go to bed. It's subtle, but I sleep well on it -- I sleep nearly all night, it doesn't seem to affect my dreams at all, it doesn't seem to have any negative effects on my sleep quality, and it's the only one I've tried that doesn't leave me feeling a little weird the next day.
Those are my suggestions. I hope something in here helps.