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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by SLS on September 26, 2004, at 16:17:27
How has Cymbalta affected your REM sleep or dreaming?
Thanks.
- Scott
Posted by Pfinstegg on September 26, 2004, at 16:34:42
In reply to Cymbalta and REM sleep - dreaming?, posted by SLS on September 26, 2004, at 16:17:27
I'm under the impression that ADs that inhibit serotonin re-uptake all do affect REM sleep. The three I've taken- Prozac, Paxil and Lexapro all left me dreamless- and so wishing that I could dream! Cymbalta is sounding like a really good drug, without too many serious side-effects, from what you and others have been saying here. Does it prevent or alter your usual dream pattern?
Posted by VelvetElvis on September 26, 2004, at 19:21:19
In reply to Re: Cymbalta and REM sleep - dreaming? » SLS, posted by Pfinstegg on September 26, 2004, at 16:34:42
I've not had this particular problem. If it is a problem for you, recent studies have shown that Gabatril has the potential to increase the ammount of time spent in REM.
Posted by zeugma on September 26, 2004, at 19:34:41
In reply to Re: Cymbalta and REM sleep - dreaming? » SLS, posted by Pfinstegg on September 26, 2004, at 16:34:42
the therapeutic effect of AD's is believed to be linked to their ability to inhibit REM sleep- or more exactly, to lengthen the amount of time it takes to enter REM after induction of sleep- known as 'REM latency.'
Posted by SLS on September 26, 2004, at 20:13:20
In reply to Re: Cymbalta and REM sleep - dreaming?, posted by zeugma on September 26, 2004, at 19:34:41
> the therapeutic effect of AD's is believed to be linked to their ability to inhibit REM sleep- or more exactly, to lengthen the amount of time it takes to enter REM after induction of sleep- known as 'REM latency.'
>Yes.
That's the reason I'm asking. I have been dreaming with Cymbalta. I am wondering if this is a sign that it will ultimately fail to work for me.
I wish there were some way to measure REM latency without going to a sleep lab. I haven't a clue as to how this has been affected.
- Scott
Posted by verne on September 26, 2004, at 21:41:06
In reply to Cymbalta and REM sleep - dreaming?, posted by SLS on September 26, 2004, at 16:17:27
Hi,
I've always been a very active dreamer - I was constantly waking up out of some dream several times a night and during daytime naps. I have atypical depression and love to sleep.
With inderal I dreamed even more but the dreams tended to have negative emotions. Now after a week of cymbalta I haven't had any dreams that I can recall.
I'm going to lower the dose from 30mgs to 20mgs per day and hope I can live with the side effects: insomnia, urinary/sexual, and sweating.
I think it helps with the depression and I seem to think more clearly - although my memory isn't as good. It's like I know where I'm going but can't remember the street names. I guess if I can't remember half of what's going on, I can't obsess or worry about it.
verne
Posted by Racer on September 26, 2004, at 22:12:10
In reply to Cymbalta and REM sleep - dreaming?, posted by SLS on September 26, 2004, at 16:17:27
I've been dreaming in Technicolor -- vivid dreams, lots of anxiety related topics, etc. I do remember similar dreams on Effexor, although I don't think I've had them on other drugs? Too long ago to remember.
On the other hand, at least they're different from my old anxiety dreams -- these are in English! And no Nazis in them at all!
Then again, Effexor was never effective on its own, and this still hasn't shown any signs of really wanting to make friends with me -- yet. Maybe it's still trying to get to know me?
Posted by TenMan on September 26, 2004, at 23:34:10
In reply to Re: Cymbalta and REM sleep - dreaming?, posted by zeugma on September 26, 2004, at 19:34:41
> the therapeutic effect of AD's is believed to be linked to their ability to inhibit REM sleep- or more exactly, to lengthen the amount of time it takes to enter REM after induction of sleep- known as 'REM latency.'
>I don't understand. I dream like crazy on Wellbutrin and have had a great response to it. They also seem to come on very quickly.
Posted by SLS on September 27, 2004, at 0:26:04
In reply to Re: Cymbalta and REM sleep - dreaming? » zeugma, posted by TenMan on September 26, 2004, at 23:34:10
> > the therapeutic effect of AD's is believed to be linked to their ability to inhibit REM sleep- or more exactly, to lengthen the amount of time it takes to enter REM after induction of sleep- known as 'REM latency.'
> >
>
> I don't understand. I dream like crazy on Wellbutrin and have had a great response to it. They also seem to come on very quickly.Wellbutrin is a notable exception to the rule.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7840365
- Scott
Posted by VelvetElvis on September 27, 2004, at 0:32:34
In reply to Re: Cymbalta and REM sleep - dreaming?, posted by zeugma on September 26, 2004, at 19:34:41
> the therapeutic effect of AD's is believed to be linked to their ability to inhibit REM sleep- or more exactly, to lengthen the amount of time it takes to enter REM after induction of sleep- known as 'REM latency.'
>That's a new one to me. Can you post some cites please?
Posted by zeugma on September 27, 2004, at 18:09:28
In reply to Re: Cymbalta and REM sleep - dreaming?, posted by VelvetElvis on September 27, 2004, at 0:32:34
> > the therapeutic effect of AD's is believed to be linked to their ability to inhibit REM sleep- or more exactly, to lengthen the amount of time it takes to enter REM after induction of sleep- known as 'REM latency.'
> >
>
> That's a new one to me. Can you post some cites please?
No problem:This one is especially relevant as it compares duloxetine (Cymbalta) and desipramine, two powerful inhibitors of NE reuptake. An interesting point made in this study is that 80 mg QD improved sleep continuity more than 60 mg BID.
For a disturbing look at some of the more ominious long-term side effects of the SSRI's, which I predict will rapidly wane in popularity, take a look at this:
A crucial fact to keep in mind is that the neuromodulators- serotonin, norepinephrine, dopamine, and acetylcholine- are integrally involved in global state changes of the brain such as the transition from sleep to waking, as well as in the construction of what Dr. Gerald Edelman- in a fascinating, difficult book, "A Universe of Consciousness"- calls 'value systems.' And this is in addition, too, to their well-known role in mood disorders.
As a side note, the sleep disorder narcolepsy is treated with drugs that enhance norepinephrine and serotonin, because it is these drugs that actually block the sudden onset of REM atonia known as cataplexy. it appears that the TCA's, which have more powerful effects on NE than on 5-HT, are also more effective in controlling cataplexy. The incidence of REM without atonia which is ordinarily only found in those in late stages of Parkinson's among SSRI users is disturbing, and suggests that serotonin is involved in the control of body movements. It also could be that the hyperserotonergetic state induced by SSRI's causes a hypodopaminergic state similar to that found in Parkinson's. MAOI's do not cause this loss of atonia, possibly because the boost the levels of dopamine as well as serotonin.
Posted by zeugma on September 27, 2004, at 18:24:15
In reply to Re: Cymbalta and REM sleep - dreaming?, posted by SLS on September 26, 2004, at 20:13:20
> > the therapeutic effect of AD's is believed to be linked to their ability to inhibit REM sleep- or more exactly, to lengthen the amount of time it takes to enter REM after induction of sleep- known as 'REM latency.'
> >
>
> Yes.
>
> That's the reason I'm asking. I have been dreaming with Cymbalta. I am wondering if this is a sign that it will ultimately fail to work for me.
>
> I wish there were some way to measure REM latency without going to a sleep lab. I haven't a clue as to how this has been affected.
>
>
> - ScottScott,
I wouldn't necesaarily think that dreaming is a sign of returning depression. I had the first *normal* dreams in years (not hypnagogic hallucinations or other disruptions) on 150 mg Provigil plus 100 mg nortriptyline. I think this was because the Provigil, due to its effect on orexingenic transmission, somehow normalized my REM/NREM/wake cycle. This return coincided with improved mood and energy. Unfortunately, I had to discontinue the Provigil soon after, and the Ritalin I have replaced it with seems to have less effect on these underlying patterns. It could be that Cymbalta is having a normalizing effect on your circadian cycle. Of course this is pure speculation on my part :) Has your mood suffered since you noticed the dreams?
-z
Posted by lemon68 on September 27, 2004, at 20:24:36
In reply to Re: Cymbalta and REM sleep - dreaming?, posted by zeugma on September 26, 2004, at 19:34:41
I have been taking Effexor Xr for a few years @ 225 mg, and I have always noticed a lack of dreams -or the ability to remember them. I considered this unfortunate, as I really like to dream ( I'll take a really memorable dream over watching a good movie any day). My doctor recently prescribed me Risperdal to curb some of the angry tendencies, and bang, my dreams were back.
I think the importance of dreams and dreaming is severely understated, and it's too bad some meds kill 'em....
Posted by zeugma on September 27, 2004, at 20:51:36
In reply to Re: Cymbalta and REM sleep - dreaming?, posted by lemon68 on September 27, 2004, at 20:24:36
> I have been taking Effexor Xr for a few years @ 225 mg, and I have always noticed a lack of dreams -or the ability to remember them. I considered this unfortunate, as I really like to dream ( I'll take a really memorable dream over watching a good movie any day). My doctor recently prescribed me Risperdal to curb some of the angry tendencies, and bang, my dreams were back.
>
> I think the importance of dreams and dreaming is severely understated, and it's too bad some meds kill 'em....Some forms of depression are associated with an excess of dreaming. The draining quality of my sleep when not on an AD cannot be described. not to mention the disruptive, and even painful character of my narcolepsy symptoms (tactile sensations of extreme pain, 'brain zaps' like those have described withdrawing from Effexor).
Yes, I enjoyed the brief spell of having 'normal' dreams. But it is not normal for me to have normal dreams. I had almost forgotten what it was like. But the abnormality of my dreams cannot be blamed on meds, as I had spent a decade off meds while the character of my dreaming became progressively more abnormal. I am not typical of most who take AD's as I believe I have narcolepsy as well as depression. My waking life is 'dream-like' anyway, as I feel like I am half asleep virtually all day, every day. The ritalin is beginning to help in this regard finally. Without meds to wake me up and to help me sleep dreamlessly but uninterruptedly is essential to my functioning anything like a normal human being.
-z
Posted by karaS on September 28, 2004, at 0:34:18
In reply to Re: Cymbalta and REM sleep - dreaming? » VelvetElvis, posted by zeugma on September 27, 2004, at 18:09:28
> For a disturbing look at some of the more ominious long-term side effects of the SSRI's, which I predict will rapidly wane in popularity, take a look at this:
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15124729
>
> A crucial fact to keep in mind is that the neuromodulators- serotonin, norepinephrine, dopamine, and acetylcholine- are integrally involved in global state changes of the brain such as the transition from sleep to waking, as well as in the construction of what Dr. Gerald Edelman- in a fascinating, difficult book, "A Universe of Consciousness"- calls 'value systems.' And this is in addition, too, to their well-known role in mood disorders.
>
> As a side note, the sleep disorder narcolepsy is treated with drugs that enhance norepinephrine and serotonin, because it is these drugs that actually block the sudden onset of REM atonia known as cataplexy. it appears that the TCA's, which have more powerful effects on NE than on 5-HT, are also more effective in controlling cataplexy. The incidence of REM without atonia which is ordinarily only found in those in late stages of Parkinson's among SSRI users is disturbing, and suggests that serotonin is involved in the control of body movements. It also could be that the hyperserotonergetic state induced by SSRI's causes a hypodopaminergic state similar to that found in Parkinson's. MAOI's do not cause this loss of atonia, possibly because the boost the levels of dopamine as well as serotonin.
zeugma,How do you see an SNRI like Cymbalta fitting in here? Just as much potential for those "ominous long-term side effects" or could the addition of NE change things? If I'm interpreting what you wrote above correctly, then it can only make things worse, no?
Kara
Posted by zeugma on September 28, 2004, at 4:26:36
In reply to Re: Cymbalta and REM sleep - dreaming? » zeugma, posted by karaS on September 28, 2004, at 0:34:18
How do you see an SNRI like Cymbalta fitting in here? Just as much potential for those "ominous long-term side effects" or could the addition of NE change things? If I'm interpreting what you wrote above correctly, then it can only make things worse, no?
Kara
Kara,I think that probably the addition of noradrenergic effects helps the dopaminergic side of things because norepinephrine and dopamine are closely related (NE is one of the building blocks of dopamine). Imipramine, amitriptyline and clomipramine are dual reuptake inhibitors and have been around for many years without producing reports of REM behavior sleep disorder. Although admittedly I am less sure about clomipramine- it may be one of the 'serotonergetic AD's' referred to in the abstract. But if I had to guess, I would say that Cymbalta's dual reuptake inhibition helps to maintain the balance of monoamines in the brain.
-z
Posted by karaS on September 28, 2004, at 15:12:42
In reply to Re: Cymbalta and REM sleep - dreaming? » karaS, posted by zeugma on September 28, 2004, at 4:26:36
> How do you see an SNRI like Cymbalta fitting in here? Just as much potential for those "ominous long-term side effects" or could the addition of NE change things? If I'm interpreting what you wrote above correctly, then it can only make things worse, no?
>
> Kara
>
>
> Kara,
>
> I think that probably the addition of noradrenergic effects helps the dopaminergic side of things because norepinephrine and dopamine are closely related (NE is one of the building blocks of dopamine). Imipramine, amitriptyline and clomipramine are dual reuptake inhibitors and have been around for many years without producing reports of REM behavior sleep disorder. Although admittedly I am less sure about clomipramine- it may be one of the 'serotonergetic AD's' referred to in the abstract. But if I had to guess, I would say that Cymbalta's dual reuptake inhibition helps to maintain the balance of monoamines in the brain.
>
> -z
Thanks, zThat's what I would have thought (and hoped). I think I just misinterpreted something you said in your previous post which made me question it.
-K
Posted by karaS on September 28, 2004, at 17:17:47
In reply to Re: Cymbalta and REM sleep - dreaming? » karaS, posted by zeugma on September 28, 2004, at 4:26:36
> How do you see an SNRI like Cymbalta fitting in here? Just as much potential for those "ominous long-term side effects" or could the addition of NE change things? If I'm interpreting what you wrote above correctly, then it can only make things worse, no?
>
> Kara
>
>
> Kara,
>
> I think that probably the addition of noradrenergic effects helps the dopaminergic side of things because norepinephrine and dopamine are closely related (NE is one of the building blocks of dopamine). Imipramine, amitriptyline and clomipramine are dual reuptake inhibitors and have been around for many years without producing reports of REM behavior sleep disorder. Although admittedly I am less sure about clomipramine- it may be one of the 'serotonergetic AD's' referred to in the abstract. But if I had to guess, I would say that Cymbalta's dual reuptake inhibition helps to maintain the balance of monoamines in the brain.
>
> -z
I also think that the SSRIs are highly overrated. It seems that way too many people get the hypodopaminergic, flat affect, no motivation effect from taking them exclusively. I read in Michael J. Norden's "Beyond Prozac" that he estimates the number of those experiencing poop-out from SSRIs as being around 20%. (He gave the low dopamine explanation as the probable reason for the poop-out.)It seems to me that the 20% figure is way too low - or maybe that's just my take on it from reading this board that is composed disproportionately of TRDs. I'm always amazed when I do hear of someone who has been taking only an SSRI for many years and it is still helping them without causing the low dopamine side effects. I wonder why they're able to benefit like this without the repercussions that many others of us have experienced.
-K
Posted by zeugma on September 30, 2004, at 20:21:09
In reply to Re: Cymbalta and REM sleep - dreaming? ALSO » zeugma, posted by karaS on September 28, 2004, at 17:17:47
yes I agree that 20% is quite low. But keep in mind the phenomenon of 'placebo drift' - placebos are getting stronger over the years! No, they're not slipping covert mood-elevators into the sucrose. People with less severe depressions, who would not have been among the populations in which the AD effects of TCA's and MAOI's were first observed, are now routinely included in AD trials. Such people are more likely to have a placebo effect. Can placebos poop out, too? Probably for someone who has a severe depression, but likely not for one who has never been acquianted with the safe confines (I mean in terms of razor-free and carefully monitored) of a psych hospital.
Have you made up your mind to try Cymbalta?
-z
Posted by karaS on September 30, 2004, at 22:21:35
In reply to placebos, poop-out and Cymbalta » karaS, posted by zeugma on September 30, 2004, at 20:21:09
> yes I agree that 20% is quite low. But keep in mind the phenomenon of 'placebo drift' - placebos are getting stronger over the years! No, they're not slipping covert mood-elevators into the sucrose. People with less severe depressions, who would not have been among the populations in which the AD effects of TCA's and MAOI's were first observed, are now routinely included in AD trials. Such people are more likely to have a placebo effect. Can placebos poop out, too? Probably for someone who has a severe depression, but likely not for one who has never been acquianted with the safe confines (I mean in terms of razor-free and carefully monitored) of a psych hospital.
>
> Have you made up your mind to try Cymbalta?
>
> -z
I couldn't imagine the placebo effect changing over time but you do make a convincing case for it.Funny you should ask about Cymbalta. I just saw my doctor today for the first time in a long while. I really like him. He's very considerate of my situation. Anyway, he gave me samples of Cymbalta. I will be his first guinea pig, er, I mean patient, to try it. He would have preferred that I try something else first (maybe something he knows better?) but he didn't think this was a bad idea for me. I will start it this weekend. Fortunately I got the capsules so i can open them and start out slowly. (I'm too afraid to do it any other way.)
The interesting thing about this visit was that he brought up the idea of me possibly being one of the "soft bipolars". He said that many people without overt symptoms of bipolar disease are benefitting from treatment with Abilify, Lamictal and/or lithium. He really encouraged me to try one of these medications. On the one hand after reading a lot on this board, the thought had crossed my mind too. On the otherhand, I'm wondering if this isn't just the latest diagnosis "du jour". But if those drugs could help me, then what difference does the label or diagnosis really make? So, to make a long story short, I'm going to start on the Cymbalta and if I have no or partial success, then I'm going to look into adding one of those drugs.
How about you? Are you concentrating any better lately? Are you able to study? I read one of your recent posts and it seemed as if you were having a rough time of it. What are your current thoughts for treatment (other than periodically going back on the Strattera)?
I am hoping that you find a good solution soon. You are one of my favorite people here.Kara
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