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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by beccab on November 24, 2001, at 23:26:32
Hi, everyone.
I'm new to psycho-babble. I am 21 and have been depressed since I was in grade school. My main symptom is pretty severe anhedonia, and my second worst is poor sleep/insomnia. I tend wake up a lot and dream a lot and sleep very very lightly. I don't feel like I ever get deep sleep. Under certain circumstances it will take me several hours to fall asleep and then I will wake up in the middle of the night absolutely wide awake (yet exhausted) and not be able to get back to sleep.
My depression is the extremely anergic type and I have a lot of problems with disabling fatigue and mental cloudiness. I do have some anxiety, but it is not so bad as the other symptoms. So, I am trying to find a drug or drug combo that will rid me of the anhedonia and anergy, whil simultaneously allowing me to actually sleep at night.
I started taking reboxetine 2 weeks ago I don't think I am up to a therapeutic dosage. This drug is not helping my sleep, but is not hurting it too much either, since I have been titrating slowly. I was really interested in reboxetine's supposed ability to increase motivation and social functioning (which is a huge problem for me- I am unable to feel the feeling of "like" towards other people for the most part).
I am thinking about adding remeron for its sleep inducing properties, but I am concerned about two things: 1. Will remeron necessarily increase REM sleep? I don't need any more but would probably accept more if I could just get some deep sleep too. 2. I really don't want increased appetite. The reboxetine has blessedly decreased my appetite. I wonder if a remeron/reboxetine combo might give me good sleep, motivation and no increased appetite. Can anyone else think of a better sleep drug for me?
I am also seriously considering mirapex for the anhedonia. It sounds really good.
One other thing is that I am trying to get back to college in about 5 weeks and I know that is not a lot of time. If anyone can offer me any advice about getting better ASAP, I would really appreciate it.
Here is what I have taken previously: Prozac, Paxil, ( no effect good or bad for either), Tofranil (nothing), Wellbutrin (nothing), Elavil for sleep (poor quality sleep and hangover), 5-HTP and St. John's Wort, stupidly taken in higher than recommended doses (ANxiety and sleeplessness for three days with suicidal ideation).
That's about all I can think of. Thanks a lot.Beccab
Posted by jay on November 25, 2001, at 5:13:01
In reply to Help for Insomnia Plus Anergy, posted by beccab on November 24, 2001, at 23:26:32
Have you considered taking a good strong benzo dose with an antidepressant? It zaps anxiety while letting your antidepressant give you the boost. I would highly suggest that in combo with an antidepressant before going through the round and round of other meds that have even little efficacy on anxiety in comparrison to a good benzo dose.
Best wishes..
> Hi, everyone.
> I'm new to psycho-babble. I am 21 and have been depressed since I was in grade school. My main symptom is pretty severe anhedonia, and my second worst is poor sleep/insomnia. I tend wake up a lot and dream a lot and sleep very very lightly. I don't feel like I ever get deep sleep. Under certain circumstances it will take me several hours to fall asleep and then I will wake up in the middle of the night absolutely wide awake (yet exhausted) and not be able to get back to sleep.
> My depression is the extremely anergic type and I have a lot of problems with disabling fatigue and mental cloudiness. I do have some anxiety, but it is not so bad as the other symptoms. So, I am trying to find a drug or drug combo that will rid me of the anhedonia and anergy, whil simultaneously allowing me to actually sleep at night.
> I started taking reboxetine 2 weeks ago I don't think I am up to a therapeutic dosage. This drug is not helping my sleep, but is not hurting it too much either, since I have been titrating slowly. I was really interested in reboxetine's supposed ability to increase motivation and social functioning (which is a huge problem for me- I am unable to feel the feeling of "like" towards other people for the most part).
> I am thinking about adding remeron for its sleep inducing properties, but I am concerned about two things: 1. Will remeron necessarily increase REM sleep? I don't need any more but would probably accept more if I could just get some deep sleep too. 2. I really don't want increased appetite. The reboxetine has blessedly decreased my appetite. I wonder if a remeron/reboxetine combo might give me good sleep, motivation and no increased appetite. Can anyone else think of a better sleep drug for me?
> I am also seriously considering mirapex for the anhedonia. It sounds really good.
> One other thing is that I am trying to get back to college in about 5 weeks and I know that is not a lot of time. If anyone can offer me any advice about getting better ASAP, I would really appreciate it.
> Here is what I have taken previously: Prozac, Paxil, ( no effect good or bad for either), Tofranil (nothing), Wellbutrin (nothing), Elavil for sleep (poor quality sleep and hangover), 5-HTP and St. John's Wort, stupidly taken in higher than recommended doses (ANxiety and sleeplessness for three days with suicidal ideation).
> That's about all I can think of. Thanks a lot.
>
> Beccab
>
>
Posted by beccab on November 25, 2001, at 7:21:29
In reply to Re: Help for Insomnia Plus Anergy » beccab, posted by jay on November 25, 2001, at 5:13:01
> Have you considered taking a good strong benzo dose with an antidepressant? It zaps anxiety while letting your antidepressant give you the boost. I would highly suggest that in combo with an antidepressant before going through the round and round of other meds that have even little efficacy on anxiety in comparrison to a good benzo dose.
>
> Best wishes..
>
>
Actually, anxiety is only a minor problem for me. When I wake up in the middle of the night, there are usually no emotions going on, and during the daytime, my anxiety is fairly minor in comparison to a lot of people's, I can mostly control it without any medication. I also worry about benzos being addictive.beccab
Posted by jay on November 25, 2001, at 7:51:48
In reply to Re: Help for Insomnia Plus Anergy, posted by beccab on November 25, 2001, at 7:21:29
> > Have you considered taking a good strong benzo dose with an antidepressant? It zaps anxiety while letting your antidepressant give you the boost. I would highly suggest that in combo with an antidepressant before going through the round and round of other meds that have even little efficacy on anxiety in comparrison to a good benzo dose.
> >
> > Best wishes..
> >
> >
> Actually, anxiety is only a minor problem for me. When I wake up in the middle of the night, there are usually no emotions going on, and during the daytime, my anxiety is fairly minor in comparison to a lot of people's, I can mostly control it without any medication. I also worry about benzos being addictive.
>
> beccab
Well, a couple of things. Ummm, as far as the benzos being addictive, as mentioned in many posts, it's HIGHLY overplayed. Benzos show just as much addiction potential as Paxil et al, and myself included, have used benzos on and off over a 10 year period. I can stop and start when I want..no bones about it.Second, benzos may be good for anhedonia, as they may lift you inhibitions, allowing you a bit more of a free-flowing feeling. Of course, I would suggest these in use with a small amount of a antidepressant, as you will get the "feel good" chemicals going with the combo. Stress AND getting joy out of life will be much, much easier.
People muck around with the antipsychotics, anticonvulsants, all that stuff, and I have have been there...tried 'em, but they compare in no way to bezo + a.d. You will surprise yourself...and likely your doctor to. If your doctor doesn't co-operate, fire 'em, and get another. It is your right.
Best Wishes...
Jay
Posted by jazzdog on November 25, 2001, at 11:38:08
In reply to Re: Help for Insomnia Plus Anergy » beccab, posted by jay on November 25, 2001, at 7:51:48
I was addicted to xanax for years - it was total hell, and I suspect some brain damage was permanent. The withdrawal nearly killed me - I ended up in rehab, with my blood pressure soaring through the roof. Benzos are far more addictive than ads because of their short-term 'cocktail' effect. They hit the same receptors as alcohol - addiction counsellors call them alcohol in pill form. I have no doubt that some people can use them safely and wisely, and I've no doubt some people find them helpful. But to minimize their addictive potential does no service to anyone.
- Jane
Posted by Mitch on November 25, 2001, at 13:18:53
In reply to Help for Insomnia Plus Anergy, posted by beccab on November 24, 2001, at 23:26:32
> Hi, everyone.
> I'm new to psycho-babble. I am 21 and have been depressed since I was in grade school. My main symptom is pretty severe anhedonia, and my second worst is poor sleep/insomnia. I tend wake up a lot and dream a lot and sleep very very lightly. I don't feel like I ever get deep sleep. Under certain circumstances it will take me several hours to fall asleep and then I will wake up in the middle of the night absolutely wide awake (yet exhausted) and not be able to get back to sleep.
> My depression is the extremely anergic type and I have a lot of problems with disabling fatigue and mental cloudiness. I do have some anxiety, but it is not so bad as the other symptoms. So, I am trying to find a drug or drug combo that will rid me of the anhedonia and anergy, whil simultaneously allowing me to actually sleep at night.
> I started taking reboxetine 2 weeks ago I don't think I am up to a therapeutic dosage. This drug is not helping my sleep, but is not hurting it too much either, since I have been titrating slowly. I was really interested in reboxetine's supposed ability to increase motivation and social functioning (which is a huge problem for me- I am unable to feel the feeling of "like" towards other people for the most part).
> I am thinking about adding remeron for its sleep inducing properties, but I am concerned about two things: 1. Will remeron necessarily increase REM sleep? I don't need any more but would probably accept more if I could just get some deep sleep too. 2. I really don't want increased appetite. The reboxetine has blessedly decreased my appetite. I wonder if a remeron/reboxetine combo might give me good sleep, motivation and no increased appetite. Can anyone else think of a better sleep drug for me?
> I am also seriously considering mirapex for the anhedonia. It sounds really good.
> One other thing is that I am trying to get back to college in about 5 weeks and I know that is not a lot of time. If anyone can offer me any advice about getting better ASAP, I would really appreciate it.
> Here is what I have taken previously: Prozac, Paxil, ( no effect good or bad for either), Tofranil (nothing), Wellbutrin (nothing), Elavil for sleep (poor quality sleep and hangover), 5-HTP and St. John's Wort, stupidly taken in higher than recommended doses (ANxiety and sleeplessness for three days with suicidal ideation).
> That's about all I can think of. Thanks a lot.
>
> Beccab
>
>Hi Beccab,
You might ask your doctor about a Dexedrine spansule (a pstim) to take in the morning. Then, just let yourself "crash" on it later in the day. I have a similar problem with sleep quality during my seasonal major depressions (but Wellbutrin is helping me this time around). The amphetamine tends to "contrast" your sleep/wake cycles (if you don't take too much and take too late in the day). It seemed to work well to produce about a 7-hour dense restful sleep without much dreaming. If you got a hang-over from Elavil you probably won't like Remeron, either.
Mitch
Posted by beccab on November 25, 2001, at 16:00:26
In reply to Re: Help for Insomnia Plus Anergy » beccab, posted by Mitch on November 25, 2001, at 13:18:53
>
> Hi Beccab,
>
> You might ask your doctor about a Dexedrine spansule (a pstim) to take in the morning. Then, just let yourself "crash" on it later in the day. I have a similar problem with sleep quality during my seasonal major depressions (but Wellbutrin is helping me this time around). The amphetamine tends to "contrast" your sleep/wake cycles (if you don't take too much and take too late in the day). It seemed to work well to produce about a 7-hour dense restful sleep without much dreaming. If you got a hang-over from Elavil you probably won't like Remeron, either.
>
> MitchWhat do you think about adrafanil (sp) as opposed to dexedrine? I am becoming very interested in JohnL's prozac, zyprexa, adrafanil combo. Thanks for the suggestion.
Beccab
Posted by jay on November 25, 2001, at 21:39:26
In reply to Re: Help for Insomnia Plus Anergy, posted by jazzdog on November 25, 2001, at 11:38:08
Well, I am sorry for your suffering, but your perspective is loaded with value judgements. There is strong scientific proof that if used right, benzos are among the safest meds, and most effective, on the planet. It is not uncommon for a benzo+a.d. to be prescribed together here in Canada permenently, and myself and many others I know have used them on and off for decades, with great results. They have saved me from suicide a number of times, and there are many docs who think a benzo now MUST be taken with an a.d. to counter usual anxiety.
Jay
> I was addicted to xanax for years - it was total hell, and I suspect some brain damage was permanent. The withdrawal nearly killed me - I ended up in rehab, with my blood pressure soaring through the roof. Benzos are far more addictive than ads because of their short-term 'cocktail' effect. They hit the same receptors as alcohol - addiction counsellors call them alcohol in pill form. I have no doubt that some people can use them safely and wisely, and I've no doubt some people find them helpful. But to minimize their addictive potential does no service to anyone.
>
> - Jane
Posted by Mitch on November 25, 2001, at 22:29:23
In reply to Re: Help for Insomnia Plus Anergy, posted by beccab on November 25, 2001, at 16:00:26
>
>
> >
> > Hi Beccab,
> >
> > You might ask your doctor about a Dexedrine spansule (a pstim) to take in the morning. Then, just let yourself "crash" on it later in the day. I have a similar problem with sleep quality during my seasonal major depressions (but Wellbutrin is helping me this time around). The amphetamine tends to "contrast" your sleep/wake cycles (if you don't take too much and take too late in the day). It seemed to work well to produce about a 7-hour dense restful sleep without much dreaming. If you got a hang-over from Elavil you probably won't like Remeron, either.
> >
> > Mitch
>
> What do you think about adrafanil (sp) as opposed to dexedrine? I am becoming very interested in JohnL's prozac, zyprexa, adrafanil combo. Thanks for the suggestion.
>
> Beccab
Beccab,I think it might be worth a try. I haven't yet tried it or modafinil (Provigil). A lot of my *depression* I believe is actually adult ADHD symptoms. In other words, if you can find a way to treat the inattentiveness, excessive daytime drowsiness, sleep architecture,etc., you may likely knock out the *depression* as well.
I also think JohnL's combination could be helpful. I just wince a bit at the thought of taking any antipsychotics (atypical or conventional) if you don't have psychosis. I would feel uncomfortable recommending them. But, that is just from my own personal experience of years of being on different ones and having lingering dystonia as a likely result. If you were to try an atypical-I found Seroquel 25mg at bedtime did the trick for me.
Mitch
Posted by ChrisK on November 26, 2001, at 4:22:22
In reply to Help for Insomnia Plus Anergy, posted by beccab on November 24, 2001, at 23:26:32
My combo would probably work great for you too if you gave it a couple of weeks. I am a big fan of both Mirapex and Zyprexa. The Zyp will help a lot with the sleep and foggy thoughts. It cleared up my extreme ruminating thoughts in a matter of a week. The problem is that you will get the appetite increase that you say you don't want. It can be controlled if you try hard enough.
As for the Mirapex it worked great to lift my anhedonia/apathy. I wouldn't say it is energizing like a stimulany might be but it did work on the mental problems associated with anergy.
I take these with Nortriptyline but I don't believe that your main AD makes a difference with these two as augmentors. I would suggest adding them one at a time to an AD which has already given you some AD effect but not necessarily a total recovery.
Just my two cents,
Chris
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