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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by greenhornet on October 26, 2005, at 12:18:54
I have been taking 25mgm of Seroquel for sleep for about a year. I have tried several times to stop it, without success. I tried Benadryl and warm milk which seemed to work at first. Then one night, although I felt very sleepy, I tossed and turned until 3AM then woke up at 6AM! I guess that all of the Seroquel was finally out of my system. Anyway, my doctor has started me on Ativan 0.5mgm at bedtime. Last night was the first night for Ativan-no Seroquel and I fell asleep but woke up at 3AM and could not go back to sleep, so I took another Ativan. All well and good, but that put me over how much Ativan that I am supposed to take in 24 hours...Any advice here?
Posted by yxibow on October 26, 2005, at 22:07:55
In reply to Getting off Seroquel, posted by greenhornet on October 26, 2005, at 12:18:54
> I have been taking 25mgm of Seroquel for sleep for about a year. I have tried several times to stop it, without success. I tried Benadryl and warm milk which seemed to work at first. Then one night, although I felt very sleepy, I tossed and turned until 3AM then woke up at 6AM! I guess that all of the Seroquel was finally out of my system. Anyway, my doctor has started me on Ativan 0.5mgm at bedtime. Last night was the first night for Ativan-no Seroquel and I fell asleep but woke up at 3AM and could not go back to sleep, so I took another Ativan. All well and good, but that put me over how much Ativan that I am supposed to take in 24 hours...Any advice here?
You were probably withdrawing from the Seroquel even though 25mg is not per se an antipsychotic level dosage.
Short term insomnia can be managed by benzodiazepines such as Ativan, but you run the risk of an escalating dose as it has a half life of about 16 hours at most.
Benadryl can be used temporarily but in my recollection of using it, it creates second-day depression.
Personally, though I take Seroquel for an off label purpose, I don't think neuroleptics should be used for a sleep aid by themselves unless there is some other reason for taking it.
I would advocate either something more soporific in the benzo category like temazepam (Restoril), or a long term sleep aid like Lunesta or Ambien/Ambien CR which is more intended for managing insomnia
Hope you get some sleep
Posted by UgottaHaveHope on October 26, 2005, at 23:59:59
In reply to Re: Getting off Seroquel, posted by yxibow on October 26, 2005, at 22:07:55
That is an interesting post, Green. Since I am Seroquel, the first thing I woulda tried was Benedryl. What you may consider doing is going back on Seroquel, but only half a tablet, for a month. Then go down to 1/4 after that and keep weening down. Hope it works out.
Posted by med_empowered on October 27, 2005, at 9:36:34
In reply to Re: Take less and less ..., posted by UgottaHaveHope on October 26, 2005, at 23:59:59
hey! OK... 0.5mgs/ativan isnt much at all. It might be sufficient for some panic attacks but...for managing insomnia, its not much (unless you're hyper-sensitive to sedatives). Ambien/Ambien CR, sonata, lunesta, restoril, halcion, doral, etc..those are good SLEEPING pills. Upping the benadryl might help; in the past, docs have advised me to use up to 100mgs/nite for sleep, plus low-doses of other stuff (klonopin, neurontin, etc.) if necessary. Hydroxyzine (vistaril, atarax) might help, but I personally hate the stuff...if you do opt to use it, I think its usually dosed at 100-200mgs/nite when used for sedation. Trazadone is another option, but it can cause priapism, so I avoid it like the plague. Neurontin doesn't do much for anxiety or mood (at least for me), but it can work well short-term as a non-addictive sleeping pill...you'll develop tolerance but, for me at least, the tolerance is good; it makes it easier to taper and re-establish your sleep habits w/o medication (or you can switch meds, if needed). Other than that..I really dont know what to say. Seroquel's sedation at low doses is probably due to its histamine action, so it pretty much functions like incredibly over-priced Benadryl when used as a sedative...so, antihistamines will give you a similar effect, minus any neuroleptic-type side effects. Some people swear by herbal stuff (valerian, passion flower, kava if you can find it). I think its OK..it usually helps me use *less* benardyl (say, 25mgs instead of 75) and the overall experience is better..less hangover, a "cleaner" feel, etc. Good luck!
Posted by greenhornet on October 27, 2005, at 16:09:18
In reply to Re: Take less and less ..., posted by med_empowered on October 27, 2005, at 9:36:34
> hey! OK... 0.5mgs/ativan isnt much at all. It might be sufficient for some panic attacks but...for managing insomnia, its not much (unless you're hyper-sensitive to sedatives). Ambien/Ambien CR, sonata, lunesta, restoril, halcion, doral, etc..those are good SLEEPING pills. Upping the benadryl might help; in the past, docs have advised me to use up to 100mgs/nite for sleep, plus low-doses of other stuff (klonopin, neurontin, etc.) if necessary. Hydroxyzine (vistaril, atarax) might help, but I personally hate the stuff...if you do opt to use it, I think its usually dosed at 100-200mgs/nite when used for sedation. Trazadone is another option, but it can cause priapism, so I avoid it like the plague. Neurontin doesn't do much for anxiety or mood (at least for me), but it can work well short-term as a non-addictive sleeping pill...you'll develop tolerance but, for me at least, the tolerance is good; it makes it easier to taper and re-establish your sleep habits w/o medication (or you can switch meds, if needed). Other than that..I really dont know what to say. Seroquel's sedation at low doses is probably due to its histamine action, so it pretty much functions like incredibly over-priced Benadryl when used as a sedative...so, antihistamines will give you a similar effect, minus any neuroleptic-type side effects. Some people swear by herbal stuff (valerian, passion flower, kava if you can find it). I think its OK..it usually helps me use *less* benardyl (say, 25mgs instead of 75) and the overall experience is better..less hangover, a "cleaner" feel, etc. Good luck!
Thanks yall for the helpful suggestions. I am already cutting 10mgm tablets in quarters to get the 25mgm, so I guess I will go to the liquid - that worked well getting me off Lexepro.... Where are you having trouble getting kava? My husband swears by it and we get it fron GNC.
Posted by blueberry on October 27, 2005, at 17:38:55
In reply to Getting off Seroquel, posted by greenhornet on October 26, 2005, at 12:18:54
If you want to just stop the seroquel, then I think lunesta 1mg to 3mg per night could be very helpful. I get 3mg pills and cut them in half to get 1 1/2mg per night. The side effect of a bad taste in the mouth lasted one day for me. It is pretty good for insomnia, both falling asleep and staying asleep, with hardly any hangover at waking. And it has been tested up to 6 months without developing tolerance to it.
Or you could slowly decrease the dose of seroquel over a period of 1 to 2 months. You can do that by using a knife to cut off just tiny chunks. Is it a 25mg tab? If so, you could cut it in half...then with a knife cut just a little corner off one of the halves, and take both halves. After 2 or 3 days of doing that, cut off a little bit bigger chunk. Keep going like that and slowly decreasing.
Posted by Phillipa on October 27, 2005, at 20:02:29
In reply to Re: Getting off Seroquel, posted by blueberry on October 27, 2005, at 17:38:55
Blueberry if you've been on a benzo for over 30years do you think you could substitute lunesta for l5mg of valium? thanks, Fondly, Phillipa
Posted by med_empowered on October 28, 2005, at 5:54:32
In reply to Re: Getting off Seroquel » blueberry, posted by Phillipa on October 27, 2005, at 20:02:29
Personally, I think if someone has been on a benzo for 30 years, and its helped, it really doesn't make sense to make them withdraw from the medication to put them on something more expensive that might not help as well (or at all). This whole benzo-phobic thing that some doctors have is ridiculous, especially when you look the drugs they're using to substitute for benzos. Antidepressants? don't work. Antipsychotics? They're expensive, mind-numbing, and cause massive weight gain, diabetes, and tardive dyskinesia. And how do these same docs get all Holier-than-thou about giving adults benzos to help with crippling anxiety when they're pumping school-age kids full of Ritalin and amphetmaines? Its totally ilogical and not at all helpful.
Posted by SLS on October 28, 2005, at 7:58:59
In reply to Getting off Seroquel, posted by greenhornet on October 26, 2005, at 12:18:54
Hydroxyzine was recently reported to help quite a bit by someone withdrawing from Seroquel. It is an antihistamine that treated both anxiety and nausea. It should help you sleep.
- Scott
Posted by ed_uk on October 28, 2005, at 15:00:02
In reply to Phillipa, posted by med_empowered on October 28, 2005, at 5:54:32
>And how do these same docs get all Holier-than-thou about giving adults benzos to help with crippling anxiety when they're pumping school-age kids full of Ritalin and amphetmaines? Its totally ilogical and not at all helpful.
Well said!!
~ed
Posted by blueberry on October 28, 2005, at 17:58:24
In reply to Re: Getting off Seroquel » blueberry, posted by Phillipa on October 27, 2005, at 20:02:29
Phillipa,
I would not think lunesta could subsitute for a benzo after so many years. Mainly because it is weaker and it has a much shorter half life. Lunesta could be helpful I think, but by itself probably not enough.
In my limited experience with it (been on it about 6 weeks), I think depakote could be helpful. It is rather gaba-ergic. I don't take xanax very often any more, but when I do, it seems tons stronger with depakote in the background. I'm only at 500mg, but I bet 1000mg or 1500mg (common low-medium doses) would be helpful in dealing with longterm benzo use, probably at least allowing a lower dose.
Zyprexa has some affinity for GABA receptors. And it can block the excess dopamine anxiety rush that accompanies lowering benzo doses.
After 30 years, ya know, that's a tough one.
Posted by Phillipa on October 28, 2005, at 18:32:43
In reply to Re: Getting off Seroquel » Phillipa, posted by blueberry on October 28, 2005, at 17:58:24
Hey guys well said. And I totally agree. Didn't know Depakote could help though blueberry. But I still need a pdoc who will prescribe valium. Fondly, Phillipa
Posted by Declan on October 29, 2005, at 14:47:07
In reply to Re: Getting off Seroquel, posted by Phillipa on October 28, 2005, at 18:32:43
Hi Phillipa, I agree with all that. Ambien won't (completely) substitute for Valium. You might be able to take half your normal Valium dose and some Ambien as well, or sometimes with herbs I can take less Valium and some herbs (Chinese ones) at night. But it hasn't been that successful, I've been taking benzos for 30 years too. You've got to find a prescribing doctor, have you?
When I was in Tasmania my normal prescription was not cashable, so I had to find a doctor in a strange town. I explained I was being Rxd Valium, he said what for, and in an inspired moment I said that I was being treated for agitated depression with Valium and Parnate. Had a remarkable effect.
Another time I needed some going overseas and I asked for Valium and the doctor said no, not unless you're addicted to it. I wasn't so quick there. You have to think on your feet.Declan
Posted by katia on October 30, 2005, at 12:41:09
In reply to Re: Getting off Seroquel » Phillipa, posted by Declan on October 29, 2005, at 14:47:07
Hi All,
Interesting discussion on Seroquel. I've been on it for over two years as a sleep aid. I'm apparrently BPII. I vary from 25mg to 12.5mg depending on what my "cycle" is doing. If I'm racy and up, then I go to 25mg or even sometimes 50mg. At the moment, 12.5mg is doing a fine job. So I guess for me, it helps sedate a partial up cycle? So therefore could help with hypomania and could be used as a mood stablizer too? I've always assumed that it was a duel action med - for hypomania and insomnia.I also worry about using a drug too long and have written down all the suggestions for insomnia. I asked my pdoc over two years ago when he gave me seroquel for sleep if there would be withdrawals...his response was "some people experience insomnia, but you're already experiencing it now...." makes sense. So I wonder how much of the insomnia is produced by withdrawal or the ugly head of insomnia is just rearing its ugly head on its own w/o Seroquel?
Katia
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