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Dr. Bob is Robert Hsiung, MD,
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Posted by floatingbridge on March 27, 2011, at 10:30:42
In reply to Re: Alpha-delta sleep and cymbalta?, posted by Christia on March 26, 2011, at 17:08:25
Christia,
Do you use any other medication? Or sleep aid? Those sleep aids can alter sleep architecture significantly.
I'm assuming the sleep study place made no comments or suggestions regarding medication and sleep.
Who ordred the test? I would hope they would have some good answers for you.
Please post back what you hear, would
you? Good luck with this.
Posted by Christia on March 27, 2011, at 12:24:02
In reply to Re: Alpha-delta sleep and cymbalta? » Christia, posted by floatingbridge on March 27, 2011, at 10:30:42
Thanks for the responses! My pdoc ordered the test because of my complaints of fatigue on 60 mgs. I take no other medicines at the moment, except a flintstones vitamin (all the stomach can handle).
I thought the fatigue might be that I was missing REM sleep since if I forget a dose I have wild dreams--like a rebound.
I see the pdoc in 1.5 weeks, but my follow-up at the sleep clinic is not until June. I do have a chronic pain disorder (not fibro or CFIDS), but I was not in a great deal of pain during the night of the study. The alpha-delta can be associated with alpha-delta, but they it's unclear whether its cause of effect.
In the meantime, I'm down to 30 mg. Still tired, but who knows how long it'd take to be better if it were the meds.
> Christia,
>
> Do you use any other medication? Or sleep aid? Those sleep aids can alter sleep architecture significantly.
>
> I'm assuming the sleep study place made no comments or suggestions regarding medication and sleep.
>
> Who ordred the test? I would hope they would have some good answers for you.
>
> Please post back what you hear, would
> you? Good luck with this.
Posted by Christia on March 27, 2011, at 12:25:02
In reply to Re: Alpha-delta sleep and cymbalta? » Christia, posted by floatingbridge on March 27, 2011, at 10:30:42
Thanks for the responses! My pdoc ordered the test because of my complaints of fatigue on 60 mgs. I take no other medicines at the moment, except a flintstones vitamin (all the stomach can handle).
I thought the fatigue might be that I was missing REM sleep since if I forget a dose I have wild dreams--like a rebound.
I see the pdoc in 1.5 weeks, but my follow-up at the sleep clinic is not until June. I do have a chronic pain disorder (not fibro or CFIDS), but I was not in a great deal of pain during the night of the study. The alpha-delta can be associated with pain syndromes, but they it's unclear whether its cause or effect.
In the meantime, I'm down to 30 mg. Still tired, but who knows how long it'd take to be better if it were the meds.
> Christia,
>
> Do you use any other medication? Or sleep aid? Those sleep aids can alter sleep architecture significantly.
>
> I'm assuming the sleep study place made no comments or suggestions regarding medication and sleep.
>
> Who ordred the test? I would hope they would have some good answers for you.
>
> Please post back what you hear, would
> you? Good luck with this.
Posted by floatingbridge on March 27, 2011, at 17:28:18
In reply to Re: Alpha-delta sleep and cymbalta? » floatingbridge, posted by Christia on March 27, 2011, at 12:25:02
Christia, recently had a failed trial of cymbalta for double-duty AD & chronic pain. Impacted sleep greatly, negatively affected depression, and gave me intractable GI issues. (I hung on for about 8 weeks to wrangle the GI issue because it reduced the *other* pain so successfully.)
My dreaming and sleep altered quite a bit, though; more than pristiq. I, too, wonder about a med that disrupts the stages of sleep in which the body repairs
tissues, including nerves....So, no less pain now, but maybe, deep sleep/health deficit down the road? Medications can prompt some difficult decisions.
fb
Posted by Christia on March 28, 2011, at 23:08:10
In reply to Re: Alpha-delta sleep and cymbalta? » Christia, posted by floatingbridge on March 27, 2011, at 17:28:18
They sure do prompt difficult questions. Have you had success with other meds or med combos for the pain/depression one-two punch?
Effexor worked for me for depression, but caused me to to have to sleep 12 hours per night. (And I mean I HAD to!) I won;t even try pristiq, since it's basically effexor.
Lyrica for pain made me completely depressed within a week, even though the pain docs said this was not a SE (except for the suicide warning of course). The physical pain was almost magically gone, however.
While I am always grateful for meds that make me feel better, I'm always constantly aggravated as well. I wish I did not always get the side effects!
On a side-note. I saw that agomelatine works in part by increasing slow-wave sleep. I am half-ready to import it now!
Thanks.
> Christia, recently had a failed trial of cymbalta for double-duty AD & chronic pain. Impacted sleep greatly, negatively affected depression, and gave me intractable GI issues. (I hung on for about 8 weeks to wrangle the GI issue because it reduced the *other* pain so successfully.)
>
> My dreaming and sleep altered quite a bit, though; more than pristiq. I, too, wonder about a med that disrupts the stages of sleep in which the body repairs
> tissues, including nerves....
>
> So, no less pain now, but maybe, deep sleep/health deficit down the road? Medications can prompt some difficult decisions.
>
> fb
Posted by desolationrower on March 30, 2011, at 12:02:17
In reply to Re: Alpha-delta sleep and cymbalta? » floatingbridge, posted by Christia on March 27, 2011, at 12:25:02
IN general, antidepressants improve sleep architecture. Problems with 'delta' or deep sleep are common in depression. Dreaming mostly occurs in REM, and excess REM occurs with depression. The rebound effect is an exaggeration of hte problem you had without the antidepressant.
Something like trazadone would be ok, except if you have problems with fatigue already, a long-half-life drug that is mostly sedative is probably going to make sleepiness worse.
It might be the sri effect of the cymbalta that is causing fatigue. Is it a lassitude and indifference?
I'd say switch from cymbalta to nortriptaline; it has less sri effect, and 5ht2 antagonism that also improve sleep architecture.-d/r
Posted by desolationrower on March 30, 2011, at 12:03:55
In reply to Re: Alpha-delta sleep and cymbalta?, posted by Christia on March 28, 2011, at 23:08:10
oh, and agomelatine works by melatonin agonism and 5ht2c antagonism. take notrityline & melatonin and you're 110% there.
-d/r
Posted by Christia on March 30, 2011, at 15:48:28
In reply to Re: Alpha-delta sleep and cymbalta?, posted by desolationrower on March 30, 2011, at 12:03:55
Thanks for the info! I can't handle Tricyclics well at all, but do you think milnacipran and melatonin would work?
Posted by Phillipa on March 30, 2011, at 21:04:13
In reply to Re: Alpha-delta sleep and cymbalta?, posted by desolationrower on March 30, 2011, at 12:03:55
Hi d/r long time so you like ago? Phillipa
Posted by desolationrower on March 30, 2011, at 21:15:58
In reply to Re: Alpha-delta sleep and cymbalta? » desolationrower, posted by Christia on March 30, 2011, at 15:48:28
> Thanks for the info! I can't handle Tricyclics well at all, but do you think milnacipran and melatonin would work?
yes, i think that would be close to as good. 5ht2c inhibition is about 2x as effective as 5ht2a inhibition. I would worry that it won't help the fatigue, if it is the sri effect of duloxetine that is causing it. have you ever taken an ssri, and did you have fatigue?
which TCA did you try before? desipramine and notriptyline have less side effects than some of the others.
You could also ask about cyproheptadine. it is an antihistamine as well as 5ht2 antagonist, but it has a reasonably short half-life.
-d/r
Posted by desolationrower on March 30, 2011, at 21:16:52
In reply to Re: Alpha-delta sleep and cymbalta? » desolationrower, posted by Phillipa on March 30, 2011, at 21:04:13
> Hi d/r long time so you like ago? Phillipa
haha what
hi
-d/r
Posted by Christia on March 31, 2011, at 22:25:01
In reply to Re: Alpha-delta sleep and cymbalta? » Christia, posted by desolationrower on March 30, 2011, at 21:15:58
Hi,
I've tried imipramine, desipramine, and one other (not sure which--long time ago).
I seem to be incredibly sensitive to meds. I tried every one of the SSRIs in turn. None worked for me. Most made me sleepy, some more than others. Effexor made me super-tired but at least worked on the depression. Had to sleep 10 hours/night on 37.5 and 12 on 75 mgs. I was a grad student at the time so I could actually live with that.
Cymbalta has been by far the best, has always made me somewhat fatigued but that seems worse now. I'm not sure why that would be?
This site is great! So much knowledge. I have to look up 5ht2c and 5ht2a to see what they are. Had to look up cyproheptadine as well. WOuld this be to improve sleep?
Thanks again!
> yes, i think that would be close to as good. 5ht2c inhibition is about 2x as effective as 5ht2a inhibition. I would worry that it won't help the fatigue, if it is the sri effect of duloxetine that is causing it. have you ever taken an ssri, and did you have fatigue?
>
> which TCA did you try before? desipramine and notriptyline have less side effects than some of the others.
>
> You could also ask about cyproheptadine. it is an antihistamine as well as 5ht2 antagonist, but it has a reasonably short half-life.
>
> -d/r
Posted by floatingbridge on April 1, 2011, at 0:38:01
In reply to Re: Alpha-delta sleep and cymbalta? » desolationrower, posted by Christia on March 31, 2011, at 22:25:01
Just a comment. Cymbalta, pristiq, strattera, make me sleepy, too. Cymbalta made me very sleepy and foggy yet worsened my insomnia. I could never really achieve real sleep. I too wonder why that is?
Posted by mtdewcmu on April 1, 2011, at 0:45:33
In reply to Re: Alpha-delta sleep and cymbalta? » Christia, posted by floatingbridge on April 1, 2011, at 0:38:01
> Just a comment. Cymbalta, pristiq, strattera, make me sleepy, too. Cymbalta made me very sleepy and foggy yet worsened my insomnia. I could never really achieve real sleep. I too wonder why that is?
Maybe you were sleepy and foggy because the drugs prevented you from getting a good sleep?
Posted by floatingbridge on April 1, 2011, at 0:52:41
In reply to Re: Alpha-delta sleep and cymbalta?, posted by mtdewcmu on April 1, 2011, at 0:45:33
:D
I'm smiling at one of those *elementary my dear Watson* moments.
Yeah, guess that about sums it up for me.
Cymbalta was a real sleep disaster followed by Lyrica which placed me in a permanent trance....so fibro flare supreme right now.
Thanks for this.
fb
Posted by mtdewcmu on April 1, 2011, at 0:57:44
In reply to Re: Alpha-delta sleep and cymbalta? » desolationrower, posted by Christia on March 31, 2011, at 22:25:01
> This site is great! So much knowledge. I have to look up 5ht2c and 5ht2a to see what they are. Had to look up cyproheptadine as well. WOuld this be to improve sleep?
>Here's what I know about 5-ht2a/c in a nutshell:
5-ht stands for serotonin, which is also known as 5-hydroxytryptamine.
5-hta/c are 5-ht receptors. So they are like buttons that are pressed by 5-ht. Having lots of 5-ht around due to an SSRI means they get pressed more often. Here's what they do:
5-ht2a is the receptor for psychedelic drugs and causes hallucinations. Newer antipsychotics block it.
5-ht2c is thought to cause a lot of SSRI side effects, like anxiety and agitation.
Blocking those receptors is thought to have an antidepressant effect.
Actually, that's not *everything* I know, but that's what's pertinent to the discussion.
Posted by mtdewcmu on April 1, 2011, at 1:10:17
In reply to Re: Alpha-delta sleep and cymbalta? » mtdewcmu, posted by floatingbridge on April 1, 2011, at 0:52:41
> :D
>
> I'm smiling at one of those *elementary my dear Watson* moments.
>
> Yeah, guess that about sums it up for me.
>
> Cymbalta was a real sleep disaster followed by Lyrica which placed me in a permanent trance....so fibro flare supreme right now.
>
> Thanks for this.
>
> fbSure. Life is miserable when you can't get good sleep. I tried going down to 10mg of Paxil and after a couple weeks I started waking up feeling like I hadn't even slept. Life becomes nearly impossible to deal with when you never feel refreshed and one day runs into the next. It's scary to think that I used to live like that when I had untreated depression.
Posted by floatingbridge on April 1, 2011, at 1:50:19
In reply to Re: Alpha-delta sleep and cymbalta?, posted by mtdewcmu on April 1, 2011, at 0:57:44
I can't quite do the math tonight. Can I run this past you?
I still remember experiencing my first anti-depressant for the first time. It was zoloft (and depakote). I thought I was on an acid trip for the first two days. Surely I would never be able to function, drive a car, much less stand up.
The next week, I remember staring at a red pear in the market. How could I have forgotten the beauty of it, of everything?
What was that iyho? Why so acidy? (Not mania like scrubbing the grout of my bathroom w/a toothbrush, nor any grand plans. Just a week of one big giant *wow*.)
> This site is great! So much knowledge. I have to look up 5ht2c and 5ht2a to see what they are. Had to look up cyproheptadine as well. WOuld this be to improve sleep?
> >
>
> Here's what I know about 5-ht2a/c in a nutshell:
>
> 5-ht stands for serotonin, which is also known as 5-hydroxytryptamine.
>
> 5-hta/c are 5-ht receptors. So they are like buttons that are pressed by 5-ht. Having lots of 5-ht around due to an SSRI means they get pressed more often. Here's what they do:
>
> 5-ht2a is the receptor for psychedelic drugs and causes hallucinations. Newer antipsychotics block it.
>
> 5-ht2c is thought to cause a lot of SSRI side effects, like anxiety and agitation.
>
> Blocking those receptors is thought to have an antidepressant effect.
>
> Actually, that's not *everything* I know, but that's what's pertinent to the discussion.
Posted by mtdewcmu on April 1, 2011, at 2:32:59
In reply to Re: Alpha-delta sleep and cymbalta? » mtdewcmu, posted by floatingbridge on April 1, 2011, at 1:50:19
> I can't quite do the math tonight. Can I run this past you?
>
> I still remember experiencing my first anti-depressant for the first time. It was zoloft (and depakote). I thought I was on an acid trip for the first two days. Surely I would never be able to function, drive a car, much less stand up.
>
> The next week, I remember staring at a red pear in the market. How could I have forgotten the beauty of it, of everything?
>
> What was that iyho? Why so acidy? (Not mania like scrubbing the grout of my bathroom w/a toothbrush, nor any grand plans. Just a week of one big giant *wow*.)
>
>I felt like that when I first took Prozac. It must be 5-ht2a stimulation.
Posted by floatingbridge on April 1, 2011, at 10:16:37
In reply to Re: Alpha-delta sleep and cymbalta?, posted by mtdewcmu on April 1, 2011, at 2:32:59
O.K. no on else has ever mentioned feeling that degree of being tripped out.
Thanks.
Posted by desolationrower on April 1, 2011, at 13:09:57
In reply to Re: Alpha-delta sleep and cymbalta? » desolationrower, posted by Christia on March 31, 2011, at 22:25:01
> Hi,
>
> I've tried imipramine, desipramine, and one other (not sure which--long time ago).
>
> I seem to be incredibly sensitive to meds. I tried every one of the SSRIs in turn. None worked for me. Most made me sleepy, some more than others. Effexor made me super-tired but at least worked on the depression. Had to sleep 10 hours/night on 37.5 and 12 on 75 mgs. I was a grad student at the time so I could actually live with that.
>
> Cymbalta has been by far the best, has always made me somewhat fatigued but that seems worse now. I'm not sure why that would be?
>
> This site is great! So much knowledge. I have to look up 5ht2c and 5ht2a to see what they are. Had to look up cyproheptadine as well. WOuld this be to improve sleep?
>
> Thanks again!
>no problem.
Yes, it does a couple things, all of which should improve sleep quality, especially slow wave (delta) sleep.
cymbalta isn't too unusual, i would guess any difference would just be in how your brain is working now.
If you have good antidepressant or pain effect, and it is just fatigue, have you thought about a stimulant (probably modafinil) for the fatigue?
or, could try mirtazapine. But make sure you get up to a high enough dose, or it will just make you super tired all the time.
Also, i'm not sure are you trying to treat the depression or pain or sleep more?
-d/r
Posted by mtdewcmu on April 1, 2011, at 13:37:48
In reply to Re: Alpha-delta sleep and cymbalta?, posted by desolationrower on April 1, 2011, at 13:09:57
> or, could try mirtazapine. But make sure you get up to a high enough dose, or it will just make you super tired all the time.This is only partly true. Some people do best at 15mg. More than that made me feel too stimulated during the day. It's best to give mirtazapine a chance to work at 15, 30, and 45 and choose the one that works best.
Posted by mtdewcmu on April 1, 2011, at 14:25:20
In reply to Re: Alpha-delta sleep and cymbalta? » mtdewcmu, posted by floatingbridge on April 1, 2011, at 10:16:37
> O.K. no on else has ever mentioned feeling that degree of being tripped out.
>
> Thanks.When I first took Prozac, I was truly shocked at how much I felt like I was on some illegal drug. And I had a lot of other weird and annoying side effects, like having this intense sensation of the air coming in with each breath, and sweating. After a week I was becoming really edgy and restless, and colors were intense and uncomfortable to look at. I was torn, because this weird trippy feeling was in some ways better than how I had been feeling, but it was also hard to deal with the restlessness, and it was changing as the Prozac accumulated in my system and I didn't know where this "trip" was headed. So I did a web search on Prozac side effects and got a lot of horror stories of people engaging in bizarre behavior and ruining their lives. I stopped taking it and refused to take another antidepressant for a couple of years.
Eventually I let a doctor talk me into taking Celexa, but only at a tiny dose, because I was convinced I was super sensitive to antidepressants. After probably a year at a minute dose of Celexa, my symptoms were so bad that I let another doctor increase it to something therapeutic. Celexa felt somewhat similar to Prozac at first, but much milder and the trippiness was in gentle soft focus.
It would have made things easier the first time around if the doctor had warned me that I might feel like I had taken half a tab of acid and some speed for the first few weeks, or had informed me that other SSRIs had wildly different levels of side effects. Even now, I doubt that new patients are getting that information. Although, many doctors have begun to prescribe a short course of Klonopin to ease the initial side effects, which is a very humane thing to do.
When someone asks me about starting antidepressants, I always recommend starting with Celexa. Lexapro may be even better, but I have no personal experience with it.
Posted by Phillipa on April 1, 2011, at 19:35:31
In reply to Re: Alpha-delta sleep and cymbalta? » floatingbridge, posted by mtdewcmu on April 1, 2011, at 14:25:20
What do you take now or did I miss it? Phillipa
Posted by mtdewcmu on April 1, 2011, at 20:34:43
In reply to Re: Alpha-delta sleep and cymbalta? » mtdewcmu, posted by Phillipa on April 1, 2011, at 19:35:31
> What do you take now or did I miss it? Phillipa
I have been on Paxil+Remeron+Wellbutrin for a while, but I am in the process of shuffling my meds again. I'm trying to switch to Zoloft as the Paxil causes lots of sweating and the benefits are insufficient and possibly fading. Zoloft caused akathisia at 150mg before, but I'm hoping I can tolerate it this time around with Remeron on board. I'm also trying to get something to help with my ADD. The doc prescribed Ritalin two weeks ago, but it's not cutting it. My prior experience tells me that amphetamine works better, but I need Dexedrine, because Adderall makes me feel awful. I'm hoping the doc will let me try Dexedrine next time. Ritalin is not even worth the cost of the monthly visits to get the controlled substance prescription.
In short, I'm not too happy with my current meds. I would like to try Effexor, but I am waiting for generic XR to become affordable.
This is the end of the thread.
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