Psycho-Babble Medication Thread 16735

Shown: posts 1 to 25 of 41. This is the beginning of the thread.

 

INSOMNIA

Posted by Joanne on December 12, 1999, at 9:19:34

Hello everyone,
I've only just discovered this site yesterday, and I'd first like to thank Dr. Bob and everyone out there who visits/contributes to this site. Depression is a very lonely illness, and in spite of some progress, there is still a major stigma attached to it. I've been on various anti-depressants for three years now (they have saved my life!), and I'm currently taking Wellbutrin. Although it was working well for me for several months with no major side effects, just recently I've had terrible insomnia. This has lasted almost three weeks. It's 7:15am, and I still haven't slept since the night before. I'm wide awake as I type this. On other nights, I fall asleep and then wake up 2-3 hours later and am unable to go back to sleep. I'm deliriously tired, lightheaded, eyes burning, the whole bit..all day, exhausted physically but unable to sleep. I take Ambien, which worked great in the beginning, but now they only work once in awhile, and I still wake up 3 hours later. I've tried taking an Ativan in addition to the Ambien out of desparation, and sometimes it works, but then I sleep 10-11+ hours a day. (I work evenings, by the way) Is there an alternative to Ambien that anyone knows of? I love the Ambien because it leaves your system after 7 h

 

Re: INSOMNIA

Posted by michele on December 12, 1999, at 12:55:08

In reply to INSOMNIA, posted by Joanne on December 12, 1999, at 9:33:39

> Hi Everyone,
> I've just discovered this site yesterday, and I want to thank Dr. Bob and everyone out there who visits/contributes to this site. Depression is a very lonely illness, and despite a little progress, there is still a huge stigma attached to it. Anyway, I've been taking Wellbutrin for about eight months, and it has worked wonderfully. In the past three weeks, nowever, I've suffered from terrible insomnia. I can't fall asleep (as I type this, I haven't been to sleep since the night before, and I'm wide awake), or if I do manage to fall asleep, I wake up 2-3 hours later and am unable to go back to sleep. I'm so frustrated to the point of tears. I take Ambien, which worked wonderfully for awhile. Apparently, I've built a tolerance to it. I really like it because it only stays in your system for 7 hours, and then it's completely gone. (no "hangover" feeling, like from valium, etc.) Tonight, I took an Ativan in addition to my Ambien, and still nothing. Does anyone know of anything comparable to Ambien that might work on me? I'm desparate! Thanks, Joanne

Michele here and welcome,

I am a newcomer too! Seems like you are having a hell of a time. Perhaps a reevaluation of the Wellbutrin might be in order - you can't continue with the insomnia thing and work.

Any particular reason you posted the message sooooo many times???

Good Luck

 

Re: INSOMNIA

Posted by S. Suggs on December 12, 1999, at 14:05:37

In reply to INSOMNIA, posted by Joanne on December 12, 1999, at 9:19:34

Joanne: One of the nice things about Welbutrin is that it mixes well with a lot of ad's. I'd suggest trazodone. It works on seratonin and has a very short half life. A lot of doc's use it for a sleep aid in combo with other ad's with great results. You can buy it in generic and it's cheap. Good luck and Blessings,

S. Suggs

 

Re: INSOMNIA

Posted by jamie on December 12, 1999, at 14:09:08

In reply to INSOMNIA, posted by Joanne on December 12, 1999, at 9:19:34

> Hello everyone,
> I've only just discovered this site yesterday, and I'd first like to thank Dr. Bob and everyone out there who visits/contributes to this site. Depression is a very lonely illness, and in spite of some progress, there is still a major stigma attached to it. I've been on various anti-depressants for three years now (they have saved my life!), and I'm currently taking Wellbutrin. Although it was working well for me for several months with no major side effects, just recently I've had terrible insomnia. This has lasted almost three weeks. It's 7:15am, and I still haven't slept since the night before. I'm wide awake as I type this. On other nights, I fall asleep and then wake up 2-3 hours later and am unable to go back to sleep. I'm deliriously tired, lightheaded, eyes burning, the whole bit..all day, exhausted physically but unable to sleep. I take Ambien, which worked great in the beginning, but now they only work once in awhile, and I still wake up 3 hours later. I've tried taking an Ativan in addition to the Ambien out of desparation, and sometimes it works, but then I sleep 10-11+ hours a day. (I work evenings, by the way) Is there an alternative to Ambien that anyone knows of? I love the Ambien because it leaves your system after 7 h

A lot of people take a small dose 25mg or 50mg trazodone. But I hate that drug. Headaches. Horrible nightmares. The best I've ever had for sleep is 7 1/2mg or 15mg of Remeron. It will knock you out within an hour of dosing, have a slight hangover feeling upon waking that goes away in about 30 minutes, and no daytime sedation after a couple of weeks getting used to it. You'll sleep all night. No sexual side effects. It does commonly cause weight gain, but that backs off in time and will probably be counteracted by the wellbutrin anyway. Not much of a problem at such a low dose. I only gained 3 pounds on Remeron, which I later lost without trying. Remeron in my experience is an antidepressant with excellent sleep characteristics and may help the wellbutrin work better than it does alone. Another option would be a small dose of a sedating tricyclic like amitriptyline or imipramine. It just makes sense to me that if we are going to add a drug for sleep, it might as well be another antidepressant. jamie

 

Re: INSOMNIA

Posted by S. Suggs on December 12, 1999, at 16:02:00

In reply to Re: INSOMNIA, posted by jamie on December 12, 1999, at 14:09:08

Joanne: Considered Pamelor (nortryptyline)25 mg or so. TCA that is sedating, but may not be as sedating as amitryptyline. Food for thought, good luck and Blessings,

S. Suggs

 

Re: INSOMNIA

Posted by Joanne on December 13, 1999, at 6:37:30

In reply to Re: INSOMNIA, posted by michele on December 12, 1999, at 12:55:08

> > Hi Everyone,
> > I've just discovered this site yesterday, and I want to thank Dr. Bob and everyone out there who visits/contributes to this site. Depression is a very lonely illness, and despite a little progress, there is still a huge stigma attached to it. Anyway, I've been taking Wellbutrin for about eight months, and it has worked wonderfully. In the past three weeks, nowever, I've suffered from terrible insomnia. I can't fall asleep (as I type this, I haven't been to sleep since the night before, and I'm wide awake), or if I do manage to fall asleep, I wake up 2-3 hours later and am unable to go back to sleep. I'm so frustrated to the point of tears. I take Ambien, which worked wonderfully for awhile. Apparently, I've built a tolerance to it. I really like it because it only stays in your system for 7 hours, and then it's completely gone. (no "hangover" feeling, like from valium, etc.) Tonight, I took an Ativan in addition to my Ambien, and still nothing. Does anyone know of anything comparable to Ambien that might work on me? I'm desparate! Thanks, Joanne
>
> Michele here and welcome,
>
> I am a newcomer too! Seems like you are having a hell of a time. Perhaps a reevaluation of the Wellbutrin might be in order - you can't continue with the insomnia thing and work.
>
> Any particular reason you posted the message sooooo many times???
>
> Good Luck
Many thanks to michele, S.Suggs, and jamie for all the great info. I'm seeing my pdoc Thursday, and I'm going to ask him about each of your suggestions. In response to michele, sorry, I'm still kind of getting the hang of this thing, and I wasn't sure my message posted; therefore, like any amateur computer user would do, I hit the "Submit" button 20-25 times. Nothing happened, so I rewrote a shorter message, and hit that one a couple of times as well, and it seemed to go through. sincere thanks to all of you. I'll let you know how it goes. joanne


 

Re: INSOMNIA

Posted by JohnL on December 13, 1999, at 12:36:22

In reply to INSOMNIA, posted by Joanne on December 12, 1999, at 9:19:34

Hi Joanne,

I think I've tried most everything out there for insomnia. Such as tricyclics, benzos, Remeron, Serzone, Trazodone. Of them all I personally have to say I like the tricyclics best. Even though they all put me to sleep and pretty much kept me asleep, the tricyclics gave me that feeling in the morning like I had really slept well. The others seem to give a strange kind of sleep for me.

Tricyclics for me are smooth. And it seems like a high quality kind of sleep, not a drugged kind of false sleep that I get from everything else. I take one of the less sedating ones, called Nortriptyline, and it's just right. There are more sedating ones. And you won't need much more than a low dose which shouldn't affect you during the day. Since they come on a little slower and more subtle than other drugs, I dose anywhere from 3:00 to 5:00 in the afternoon. That way it's kicking in strongest just about bedtime. Any later messes with the next morning. I've seen the tricyclics, especially Nortriptyline, combined with Wellbutrin for refractory depression as well. Based on my experience, I'm putting a vote in here for a tricyclic for insomnia. Imipramine, Anafranil, and Amitriptyline are the more sedating ones, while Nortriptyline is a bit more mild. So before you see your doctor, sleep on it. :) JohnL

 

Re: INSOMNIA

Posted by mary on December 13, 1999, at 13:36:51

In reply to Re: INSOMNIA, posted by JohnL on December 13, 1999, at 12:36:22

Just put in a search for Effexor XR which brought me to this
site. I am going to bookmark it for sure!

I have had problems with depression my whole adult life. (from age 19
to now.... age 52)
The insomnia business has kicked in the past couple of
years... and nothing has seemed to help for long.

Trazodone does give me nightmares also. And I *hate* nightmares.
Ambien no longer helps. Currently between ad's. Have an appointment
this afternoon to see about starting Effexor XR again.

Allergic to Wellbutrin and Celexa. Prozac just doesn't really do the
job.

Guess I'm off topic. Sorry. Just good luck to all of you trying
to find something that will allow you to sleep at night. It is so
frustrating to lie in bed, knowing you need rest, and not be able to
go to sleep.

 

Re: INSOMNIA

Posted by S. Suggs on December 13, 1999, at 21:30:25

In reply to Re: INSOMNIA, posted by Joanne on December 13, 1999, at 6:37:30

Joanne: You are more than welcome. I hope the suggestion helps out. Many Blessings,

S. Suggs

 

Re: INSOMNIA

Posted by S. Suggs on December 13, 1999, at 21:33:17

In reply to Re: INSOMNIA, posted by mary on December 13, 1999, at 13:36:51

Mary: Have you considered the TCA's, ie. Nortriptyline (Pamelor). Great for sleep, but not too sedating. There were several post touching on this drug. Good luck and Blessings,

S. Suggs

 

Re: INSOMNIA

Posted by Joanne on December 14, 1999, at 6:41:13

In reply to Re: INSOMNIA, posted by JohnL on December 13, 1999, at 12:36:22

> Hi Joanne,
>
> I think I've tried most everything out there for insomnia. Such as tricyclics, benzos, Remeron, Serzone, Trazodone. Of them all I personally have to say I like the tricyclics best. Even though they all put me to sleep and pretty much kept me asleep, the tricyclics gave me that feeling in the morning like I had really slept well. The others seem to give a strange kind of sleep for me.
>
> Tricyclics for me are smooth. And it seems like a high quality kind of sleep, not a drugged kind of false sleep that I get from everything else. I take one of the less sedating ones, called Nortriptyline, and it's just right. There are more sedating ones. And you won't need much more than a low dose which shouldn't affect you during the day. Since they come on a little slower and more subtle than other drugs, I dose anywhere from 3:00 to 5:00 in the afternoon. That way it's kicking in strongest just about bedtime. Any later messes with the next morning. I've seen the tricyclics, especially Nortriptyline, combined with Wellbutrin for refractory depression as well. Based on my experience, I'm putting a vote in here for a tricyclic for insomnia. Imipramine, Anafranil, and Amitriptyline are the more sedating ones, while Nortriptyline is a bit more mild. So before you see your doctor, sleep on it. :) JohnL

Not to be repetitive, but just want to thank everyone again for all the helpful info. Note to JohnL, I think I'm definitely going to ask my doctor about trying the nortryptyline. After spending endless sleepless hours exploring this site (I'm so glad I "stumbled into" this gem!) I noticed a lot of positive info regarding this trycyclic, and enjoyed reading your posts about it. Can't wait to see my doc Thurs. Another "Thank you" to everyone. Joanne

 

Re: INSOMNIA

Posted by S. Suggs on December 14, 1999, at 7:16:03

In reply to Re: INSOMNIA , posted by Joanne on December 14, 1999, at 6:41:13

Joanne: Something I read (if correct) that I found interesting was that nortriptyline was a first pass metabolite of amitriptyline. I really think you will enjoy the benefits over amitriptyline. Good luck,keep us informed and of course, Blessings

S. Suggs

 

Re: INSOMNIA

Posted by mary on December 14, 1999, at 21:28:05

In reply to Re: INSOMNIA, posted by S. Suggs on December 13, 1999, at 21:33:17

> Mary: Have you considered the TCA's, ie. Nortriptyline (Pamelor). Great for sleep, but not too sedating. There were several post touching on this drug. Good luck and Blessings,
>
> S. Suggs

Started back on the 37.5 Effexor XR today... and my doctor prescribed
Ambien for 30 days for the sleep problems. We'll see. Also am setting
up appointments with a sleep clinic.... as my husband is quite sure that
I have sleep apnea. Mary

 

Re: INSOMNIA

Posted by Andy on December 15, 1999, at 12:57:20

In reply to Re: INSOMNIA, posted by mary on December 14, 1999, at 21:28:05

I'm surprised so few of you mention Ambien. I think it's terrific

> > Mary: Have you considered the TCA's, ie. Nortriptyline (Pamelor). Great for sleep, but not too sedating. There were several post touching on this drug. Good luck and Blessings,
> >
> > S. Suggs
>
> Started back on the 37.5 Effexor XR today... and my doctor prescribed
> Ambien for 30 days for the sleep problems. We'll see. Also am setting
> up appointments with a sleep clinic.... as my husband is quite sure that
> I have sleep apnea. Mary

 

Re: INSOMNIA

Posted by S. Suggs on December 15, 1999, at 22:54:40

In reply to Re: INSOMNIA, posted by Andy on December 15, 1999, at 12:57:20

Andy: From what I understand, Ambien is a great drug, but (please correct me if I a wrong)it's for short term use, whereas nortriptyline can be used for extended periods of time.

Blessings,

S. Suggs

 

Re: INSOMNIA

Posted by Elizabeth on December 15, 1999, at 23:27:25

In reply to Re: INSOMNIA, posted by S. Suggs on December 15, 1999, at 22:54:40

> Andy: From what I understand, Ambien is a great drug, but (please correct me if I a wrong)it's for short term use, whereas nortriptyline can be used for extended periods of time.

I asked my pdoc about this when he prescribed Ambien to use for insomnia daily. He replied that many people are able to take it longer term without developing tolerance. He also said that in his experience it actually works better if you take it every day than sporadically - perhaps this is because it keeps you on a regular sleep schedule (something that's always been a problem for me).

I took it - 20mg/night - for a year or so, pretty much every night, without tolerance. My main peeve about it is that it's too short-acting.

BTW, nortriptyline was not sedating for me, and it had anticholinergic effects that I had trouble tolerating, even at very low doses.

 

Re: INSOMNIA

Posted by Joanne on December 16, 1999, at 10:05:16

In reply to Re: INSOMNIA, posted by Elizabeth on December 15, 1999, at 23:27:25

> > Andy: From what I understand, Ambien is a great drug, but (please correct me if I a wrong)it's for short term use, whereas nortriptyline can be used for extended periods of time.
>
> I asked my pdoc about this when he prescribed Ambien to use for insomnia daily. He replied that many people are able to take it longer term without developing tolerance. He also said that in his experience it actually works better if you take it every day than sporadically - perhaps this is because it keeps you on a regular sleep schedule (something that's always been a problem for me).
>
> I took it - 20mg/night - for a year or so, pretty much every night, without tolerance. My main peeve about it is that it's too short-acting.
>
> BTW, nortriptyline was not sedating for me, and it had anticholinergic effects that I had trouble tolerating, even at very low doses.

When I first started taking Ambien, it worked extremely well. It was very fast-acting, and had no "hangover" feeling the next day. I've been taking it for several months; unfortunately, I must have built up a tolerance to it, because now it no longer works on me. However, if you've never tried it, I would highly recommend it for insomnia. Mary, let me know how you're doing with the Ambien. I hope it's working well for you. Joanne

 

Re: INSOMNIA

Posted by Andy on December 16, 1999, at 14:04:52

In reply to Re: INSOMNIA, posted by Elizabeth on December 15, 1999, at 23:27:25

>
I've used it for a couple of years and have not developed tolerance. I try to stay under 10mg since at 10 I begin to have some side effect the next day (slight dizzyness, slightly slurred speech, slightly slowed thinking). Under 10mg no side effect for me.

Often it won't get me through the night. So I "cheat"--I break a 5mg pill in half and that is usually enough for me to get to sleep. If (usually when) I wake up two or three hours later I take the other half. If I wake up again I might take 2mg (break a 5mg pill unevenly and take the smaller piece).

Works for me. I started it for straight sleeping difficulties. Need it regularly now because I started prozac about six months ago.

> Andy: From what I understand, Ambien is a great drug, but (please correct me if I a wrong)it's for short term use, whereas nortriptyline can be used for extended periods of time.
>
> I asked my pdoc about this when he prescribed Ambien to use for insomnia daily. He replied that many people are able to take it longer term without developing tolerance. He also said that in his experience it actually works better if you take it every day than sporadically - perhaps this is because it keeps you on a regular sleep schedule (something that's always been a problem for me).
>
> I took it - 20mg/night - for a year or so, pretty much every night, without tolerance. My main peeve about it is that it's too short-acting.
>
> BTW, nortriptyline was not sedating for me, and it had anticholinergic effects that I had trouble tolerating, even at very low doses.

 

Re: INSOMNIA

Posted by Adam on December 17, 1999, at 15:11:53

In reply to Re: INSOMNIA, posted by Andy on December 16, 1999, at 14:04:52

We've all heard about it, and it has been kicked around in the media quite a lot, with unrealistic claims both about its benefits and its risks...

Has anybody here tried melatonin? My take on it is it probably won't make you sleep, but it might help "renormalize" your sleep patterns and improve the quality of the sleep you do get if the timing of administration and the dosing is correct.

Has anyone tried it? Did it help?

Also, has anyone tried this with an MAOI? Are there any risks or issues with dosing beyond whatever should be the normal constraints on its use?

Thanks!


Thanks!

 

Re: INSOMNIA [Melatonin]

Posted by dove on December 19, 1999, at 9:50:39

In reply to Re: INSOMNIA, posted by Adam on December 17, 1999, at 15:11:53

I think a number of us have discussed the melatonin thing. While taking Prozac I had to up the amount I took every night, but since quiting the Prozac I am back to Melatonin 1mg. sublingual. I still take Amitriptyline before bed, but that alone is not, usually, enough to get me to sleep. My problem is not staying asleep but falling asleep, so this may be why sublingual melatonin works so well for me.

I am still in a bit of a funk, it worries me, one of the biggest lows I have had since I was a teenager, [and the longest time I have gone without being pregnant since getting married at 19] anyway, after reading Dr. Bob's pharmo-tips and finding the depressive effects of melatonin, I tried to go without, challenging the depression so-to-speak. I found myself even worse in the morning, so I still don't know if the melatonin is adding to the low or what?

My advice is, try melatonin if you wish, but be aware that it may add to any depressive characteristics, or it may help, I don't know. And try to get by with the smallest dosage that helps, the sublingual enables me to take way less that the normal swallow kind.

dove

 

Re: INSOMNIA

Posted by Elizabeth on December 19, 1999, at 10:16:22

In reply to Re: INSOMNIA, posted by Adam on December 17, 1999, at 15:11:53

> Has anyone tried it? Did it help?
>
> Also, has anyone tried this with an MAOI? Are there any risks or issues with dosing beyond whatever should be the normal constraints on its use?

I had mild symptoms of central serotonin syndrome (dilated pupils, inappropriate sweating, and - get this - insomnia) when I tried taking a low dose (1/2 mg I think) with Parnate.

I also tried it when I wasn't taking an MAOI. Despite the fact that I supposedly have a circadian rhythm disorder, it didn't do a thing, even at high doses.

 

Re: INSOMNIA

Posted by Adam on December 19, 1999, at 12:34:28

In reply to Re: INSOMNIA, posted by Elizabeth on December 19, 1999, at 10:16:22

That's what I was afraid of, melatonin being a derivative of 5-HT. I could find nothing in the
literature about such a combination, though, or melatonin being associated with serotonin syndrome.
Despite the inkling there could be risks, and your apparent confirmation of this, I can't think of a
concrete reason, mechanistically, why this should happen. Do you have any theories. Does melatonin
have sympathomimetic properties? Is it recycled into 5-HT? Is it a 5-HT receptor agonist? Nothing
I have read would indicate any of these possibilites, but that certainly could be because I didn't
know where to look.

Thanks in advance for your thoughts...


> > Has anyone tried it? Did it help?
> >
> > Also, has anyone tried this with an MAOI? Are there any risks or issues with dosing beyond whatever should be the normal constraints on its use?
>
> I had mild symptoms of central serotonin syndrome (dilated pupils, inappropriate sweating, and - get this - insomnia) when I tried taking a low dose (1/2 mg I think) with Parnate.
>
> I also tried it when I wasn't taking an MAOI. Despite the fact that I supposedly have a circadian rhythm disorder, it didn't do a thing, even at high doses.

 

Re: INSOMNIA [Melatonin], dove.

Posted by Adam on December 19, 1999, at 13:18:14

In reply to Re: INSOMNIA [Melatonin], posted by dove on December 19, 1999, at 9:50:39

Thank you, dove.

I may just give melatonin a try. I'm still scratching my head over Elizabeth's adverse
troubles with it, and hopefully will get some insight into this. I did read about
it's possible depressive effects, and I think we both have to weigh such cautions against
the fact that even antidepressants can aggravate depression, depending on the individual
response to a drug.

The trouble for me at this point is I am in a clinical trial, and this severely limits
what other drugs I can take concomitantly with selegiline. I can't even take Benadryl.
I might run into the same problem with melatonin under any circumstances, and so for the
next few months it might not be an option anyway.

At this point exercise is the only solution I can think of that isn't forbidden.

What's weird, and has been my experience all along with selegiline, is that I got maybe
three hours of sleep last night (I should say this morning), and I feel fine. I feel
better and more alert than I used to feel getting my usual six or seven hours of sleep.
The problems have been that I am slowly moving into a nocturnal lifestyle, and I am
finding it very hard to reverse this. I am completely out-of-whack with the day-to-day
rhythms of my friends and coworkers. The vampire jokes have inevitably started, and
I sometimes wonder if Vlad the Impaler or whoever the inspiration for Dracula was didn't
have a sleep disorder. I'm hoping that melatonin might help me at least exert some
control over the pattern. I see my doctor in a few days. I'll let folks know what his
take on melatonin, combo. with MAOI, etc. is.

Lastly, is it possible for a person to just go forever on 3-4 hours max. of sleep/day
and be healthy? Is one liable at this point to resort to hypnotics for self-preservation?


> I think a number of us have discussed the melatonin thing. While taking Prozac I had to up the amount I took every night, but since quiting the Prozac I am back to Melatonin 1mg. sublingual. I still take Amitriptyline before bed, but that alone is not, usually, enough to get me to sleep. My problem is not staying asleep but falling asleep, so this may be why sublingual melatonin works so well for me.
>
> I am still in a bit of a funk, it worries me, one of the biggest lows I have had since I was a teenager, [and the longest time I have gone without being pregnant since getting married at 19] anyway, after reading Dr. Bob's pharmo-tips and finding the depressive effects of melatonin, I tried to go without, challenging the depression so-to-speak. I found myself even worse in the morning, so I still don't know if the melatonin is adding to the low or what?
>
> My advice is, try melatonin if you wish, but be aware that it may add to any depressive characteristics, or it may help, I don't know. And try to get by with the smallest dosage that helps, the sublingual enables me to take way less that the normal swallow kind.
>
> dove

 

Re: INSOMNIA [Melatonin], dove.

Posted by Noa on December 19, 1999, at 14:21:12

In reply to Re: INSOMNIA [Melatonin], dove., posted by Adam on December 19, 1999, at 13:18:14

Adam,

I vaguely remember hearing that melatonin can cause depression.

The guy at Yale that I told you about is, I think, THE expert on melatonin research. You might want to ask him.

 

melatonin

Posted by Elizabeth on December 19, 1999, at 14:58:47

In reply to Re: INSOMNIA, posted by Adam on December 19, 1999, at 12:34:28

> Despite the inkling there could be risks, and your apparent confirmation of this, I can't think of a
> concrete reason, mechanistically, why this should happen. Do you have any theories. Does melatonin
> have sympathomimetic properties? Is it recycled into 5-HT? Is it a 5-HT receptor agonist?

I dunno if this applies, but what about le Chatelier's principle?


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