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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Gerry S. on July 4, 2001, at 9:26:06
I was taking 15-20mg Ambien nightly for much of the past year. At the same time I ripped through a series of antidepressants. They would work initially, but after two weeks or so I would experience this crippling anxiety, like I had never seen before. I also experienced panic attacks, which I had also never had before. My pdoc thought I could not tolerate the AD's and recommended ECT. The anxiety was as debilitating as the depression I was trying to alleviate with the AD's.
Anyway, before purusing ECT, I decided to run an experiment, which was to stop all antidepressants. I waited one month taking just the ambien. The anxiety did not lift. I then stopped the ambien. I crashed, and felt like a junkie after stopping ambien---nervousness, sweating, panicky, etc. However, after three weeks ambien free the anxiety has lifted 90 percent. My new pdoc says it takes a month for the GABA receptors to recover from the ambien.
This experience accords with the fact--that my old pdoc apparently was not aware of--that long-term use of short-acting hypnotics (sleep meds) can cause daytime anxiety. I am now on an antidepressant that is working just fine and the anxiety is nearly gone.
Beware long-term use of ambien or similar meds.
And god bless.
Posted by kid_A on July 4, 2001, at 13:06:59
In reply to A Warning on Long-Term Use of Ambien, posted by Gerry S. on July 4, 2001, at 9:26:06
I'm on ambien right now, and I must say initially it has been working to help me sleep... However my insurance will only cover 14 in one month time so its not an every night thing...In any case, it does cause dependancy and withdrawl, a fact which seems odd that so many people's pdocs seem unaware of....
Posted by SalArmy4me on July 4, 2001, at 20:40:00
In reply to A Warning on Long-Term Use of Ambien, posted by Gerry S. on July 4, 2001, at 9:26:06
There are no studies on the long-term use of many popular sleep medications:
Reynolds, Charles F. III, MD. Buysse, Daniel J. MD. Kupfer, David J. MD. Treating Insomnia in Older Adults: Taking a Long-term View. JAMA. 281(11):1034-1035, March 17, 1999:
"Benzodiazepine sedative hypnotic agents and zolpidem have a proven place in the short-term clinical management of chronic primary insomnia. Our reviews of 30 years of treatment studies of chronic insomnia in nonelderly and elderly patients have shown short-term clinical trials evaluating the efficacy of benzodiazepines and other sedative hypnotic agents over generally fewer than 3 to 4 weeks. The current study documents efficacy for 8 weeks, similar to a previous comparison of temazepam with midazolam. Yet patients use these medications for long periods in the absence of good data on beneficial and adverse effects..."
Posted by Elizabeth on July 4, 2001, at 22:03:50
In reply to A Warning on Long-Term Use of Ambien, posted by Gerry S. on July 4, 2001, at 9:26:06
Sedative withdrawal symptoms are unusual (but not unheard of) after long-term use of Ambien. Habituation is the exception, not the rule. In general, people can take Ambien for six months or more without signs of dependence or tolerance.
-elizabeth
Posted by Gerry S. on July 5, 2001, at 10:22:46
In reply to Re: Long-Term Use of Ambien, posted by Elizabeth on July 4, 2001, at 22:03:50
The key issue is not one of habituation or withdrawal (although I disagree with you on that also, see for example, Guidelines for the Rational Use of Benzodiazepines, When and What to Use. Review Article from: Drugs 48 (1):25-40. 1994). Rather, the key issue I was trying to get across is that long-term use of rapidly-eliminated hypnotics can, and often does, cause daytime anxiety (as well as insomnia in the last third of the night).
There have been many studies of long-term use of short-acting hypnotics. It has been well known for 30 years that the consequences of this are daytime anxiety (e.g. for an early study see Morgan K, Oswald I. Anxiety caused by a short-life hypnotic. BMJ 1982; 284: 942). This fact is stated directly in the prescription monograph for Ambien as a warning against using it for more than 30 days (the period covered by the longest ambien studies).
Posted by PaulB on July 5, 2001, at 17:31:48
In reply to Re: Long-Term Use of Ambien, posted by Gerry S. on July 5, 2001, at 10:22:46
> The key issue is not one of habituation or withdrawal (although I disagree with you on that also, see for example, Guidelines for the Rational Use of Benzodiazepines, When and What to Use. Review Article from: Drugs 48 (1):25-40. 1994). Rather, the key issue I was trying to get across is that long-term use of rapidly-eliminated hypnotics can, and often does, cause daytime anxiety (as well as insomnia in the last third of the night).
>
> There have been many studies of long-term use of short-acting hypnotics. It has been well known for 30 years that the consequences of this are daytime anxiety (e.g. for an early study see Morgan K, Oswald I. Anxiety caused by a short-life hypnotic. BMJ 1982; 284: 942). This fact is stated directly in the prescription monograph for Ambien as a warning against using it for more than 30 days (the period covered by the longest ambien studies).PaulB writes:
The newer sleeping pills such as Ambien and Zaleplon have a pharmacological profile that gives them advantages over the benzo's and disadvantages to the benzo's . It is the frequency of 'reinforcement' at the bz omega site that is responsible for tolerance. Would it not be for Ambiens selective bz omega binding properties it would have no superiority over other benzodiazepines that are taken just once a day in the evening to induce sleep. Its superiority lies in the fact that it is selective for bz omega receptors and the benzodiazepines are not, supposedly making it less addictive. However if people are waking up in the night, particularly Ive read with Zaleplon then these drugs hvae much more addictive potential than the classical benzodiazepines such as Clonazepam that will see you sleep through till dawn.
Posted by Elizabeth on July 6, 2001, at 0:49:10
In reply to Re: Long-Term Use of Ambien, posted by Gerry S. on July 5, 2001, at 10:22:46
> The key issue is not one of habituation or withdrawal (although I disagree with you on that also, see for example, Guidelines for the Rational Use of Benzodiazepines, When and What to Use. Review Article from: Drugs 48 (1):25-40. 1994).
Ambien isn't a benzodiazepine, and as far as I can tell, isn't mentioned in that article. (And in any case, I'm generally suspicious of the opinions of British authors on the use of benzodiazepines; they tend to be extremely conservative.)
> Rather, the key issue I was trying to get across is that long-term use of rapidly-eliminated hypnotics can, and often does, cause daytime anxiety (as well as insomnia in the last third of the night).
"Rebound" would be an appropriate term for that. And Ambien generally doesn't usually do that, either (there are, no doubt, exceptions, and Halcion, a benzodiazepine with a comparable duration of action, definitely can cause rebound anxiety and insomnia).
> There have been many studies of long-term use of short-acting hypnotics. It has been well known for 30 years that the consequences of this are daytime anxiety (e.g. for an early study see Morgan K, Oswald I. Anxiety caused by a short-life hypnotic. BMJ 1982; 284: 942). This fact is stated directly in the prescription monograph for Ambien as a warning against using it for more than 30 days (the period covered by the longest ambien studies).
First of all, Ambien is not a benzodiazepine, and the results of studies of benzodiazepines cannot be assumed to apply to Ambien. Ambien has not even been around in research settings for thirty years, much less in clinical use. There have, however, been some studies of long-term use of Ambien (post-marketing), and they demonstrated that serious tolerance, dependence, and daytime anxiety are relatively rare. (There have been isolated cases of these phenomena.)
A couple studies I'm aware of in which patients were treated with zolpidem for about 6 months (with no untoward effects, incidentally):
J Int Med Res 1993 Jul-Aug;21(4):171-84. Long-term polysomnographic study of the efficacy and safety of zolpidem in elderly psychiatric in-patients with insomnia. Kummer J, Guendel L, Linden J, Eich FX, Attali P, Coquelin JP, Kyrein HJ.
J Int Med Res 1992 Apr;20(2):162-70. The safety and efficacy of zolpidem in insomniac patients: a long-term open study in general practice. Maarek L, Cramer P, Attali P, Coquelin JP, Morselli PL.
Again: statements about benzodiazepines cannot necessarily be applied to Ambien, because Ambien is not a benzodiazepine and has been found to be dissimilar to benzodiazepines in many ways.
-elizabeth
Posted by Gerry S. on July 6, 2001, at 9:12:42
In reply to Re: Long-Term Use of Ambien, posted by Elizabeth on July 6, 2001, at 0:49:10
The Ambien monograph states:
"If the drug has a short elimination half-life, it is possible that a relative deficiency of the drug or its active metabolites (i.e., in relationship to the receptor site) may occur at some point in the interval between each night's use. This sequence of events may account for two clinical findings reported to occur after several weeks of nightly use of other rapidly eliminated hypnotics, namely, increased wakefulness during the last third of the night, and the appearance of increased signs of daytime anxiety."
The anxiety effect is exactly what happened to me--I was on no other medications, and since stopping ambien the anxiety has disappeared over a course of 3 weeks. Two psychopharmacologists that I visited have no doubt it is Ambien. The studies you cite do not consider 20mg doses, which is what I was on, but rather use much lower doses. MAYBE 5-10mg nightly for an extended period of time will not cause a problem, but I can tell you first hand that 20mg nightly for an extended period CAN cause tremendous daytime anxiety.
Posted by Elizabeth on July 6, 2001, at 23:16:01
In reply to Re: Long-Term Use of Ambien, posted by Gerry S. on July 6, 2001, at 9:12:42
Gerry,
I don't doubt your story, and it's unfortunate. What is good news is that it's unusual: most people don't have this type of problem with Ambien.
BTW, I take 20 mg of Ambien, and I've never experienced daytime anxiety or any other problems from it. I'm just saying this to point out that individuals may have widely varying experiences with a drug, and that a single individual's story doesn't prove anything about the general properties of the drug.
Most people don't need more than 10mg, so higher doses have not been studied adequately. This is unfortunate for those of us who do need more. (The problem I've had is that pharmacists always screw up and only give me thirty pills instead of the prescribed sixty, or they insist on calling my doctor to question the prescription. I wish they'd do their jobs and let the doctor do his! < g >)
-elizabeth
Posted by Gerry S. on July 7, 2001, at 11:57:01
In reply to Re: Long-Term Use of Ambien » Gerry S., posted by Elizabeth on July 6, 2001, at 23:16:01
Elizabeth,
I see what you are saying, and I agree. I felt it might be helpful to share my experience with others who might be having similar experiences and, as in my case, are possibly erroneously implicating AD's as the source of the problem (which I acknowledge could in some cases be the true source of anxiety rather than ambien).
How long have you been taking 20mg by the way?
Posted by Elizabeth on July 7, 2001, at 21:15:36
In reply to Re: Long-Term Use of Ambien, posted by Gerry S. on July 7, 2001, at 11:57:01
> I see what you are saying, and I agree. I felt it might be helpful to share my experience with others who might be having similar experiences and, as in my case, are possibly erroneously implicating AD's as the source of the problem (which I acknowledge could in some cases be the true source of anxiety rather than ambien).
Sure. Sharing experiences is always good, since others may be having the same experience.
> How long have you been taking 20mg by the way?
I first started taking it in fall 1996. The longest I took it continuously was somewhere between two and three years. (I've always needed 20 mg. Fortunately, my pdoc suggested trying 20 when 10 didn't do anything.)
-elizabeth
This is the end of the thread.
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