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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by SLS on July 14, 2002, at 14:53:46
Hi.
I'm having a lot of trouble sleeping while taking Nardil.
I'm using Ativan (lorazepam), but I've noticed that I have begun to feel somehow more depressed during the day. I'm pretty sure it's the Ativan.
Can anyone offer some input?
I am interested to know how well people have done with Ambien. Does it leave you with a "hangover" the next day? How does Ambien compare with Ativan in terms of efficacy and side effects.
Without sleeping medication, I get no sleep at all. Zero. However, in the past, this has been a good prognosticator for me when responding to antidepressants.
Thanks much.
- Scott
Posted by JonW on July 14, 2002, at 17:36:28
In reply to Ambien vs Ativan - which is better?, posted by SLS on July 14, 2002, at 14:53:46
Hi,
I hear you with the sleep problems! I'm on Nardil and I sleep zero without a sleep aid as well. I take ambien 20mg which is twice the recommended max dose and it puts me to sleep but the amount of sleep I get varies. I usually get 4 maybe 4.5 uninterrupted hours of sleep. Oh how I long for a good deep 8 hour sleep! Nardil makes me tired several times during the day so I catch up on my sleep then, but that obviously isn't a permanent solution. The most noteable thing is that I never sleep long. During the day I sleep deeply, but never more than 2 hours at a time, even if I only got 2 hours the night before. Anyway, I like ambien because it is much better than nothing. 10mg never gave me a hangover, but I used to think 20mg did. However, getting up in the morning always feels like a hangover for me so it is hard to tell. The last 2 days I've taken 20mg and no hangover. I've also used a lightbox during the last few days so I'm going to stop that today to see which one is causing the improvement. I hope Nardil is making my mornings better, that would be a good sign. I've found playing a cd I like + turning on a fan + ambien to be the best combination so far for sleep but like I said before it only gets me like 4 or 5 hours. Anyway, I'd go for the ambien. Listen, if you find a solution to the sleep problems you are having let me know! I need sleep, among other things :-)
Jon
Posted by Mr Beev on July 14, 2002, at 21:52:36
In reply to Ambien vs Ativan - which is better?, posted by SLS on July 14, 2002, at 14:53:46
Hello,
My experience with ambien has been similar to JonW's: four to five hours of sleep. I can get by at half his dose, or 10mg. Occasionally a single pill (5mg) will work, sometimes 10mg has no effect at all. Now and then I get two or three hours of sleep; rarely, six; and once sublime night, I got seven hours.
Ambien is said to mimic our natural sleep patterns better than the benzos, in spite of its sharing some similarities. My experience with ambien vs. halcion certainly verified this proposition - for me at least.
At first I suffered 'hangovers': it was quite difficult to arise after awakening. But this went away, never to return.
There appears to be some dispute as to whether one suffers withdrawal when ceasing. That happened to me. The only effect was 'rebound insomnia' for a week. Then I was all right.
My pdoc does not care for sleeping pills, for they can all trigger depression, or so she claims. Since I am already undergoing treatment for depression, I cannot say. But I can say: ambien certainly has not made things worse, unlike halcion.
A lot of folks dislike ambien because of its short half-life. It sounds like a little sleep might still be acceptable for you, as the alternative is none at all. Believe me, I sympathize. Since I am a chronic, life-long insomniac, five hours of guaranteed good sleep is just peachy; six is a superb surprise; seven, a miracle from heaven; and if someday I should ever attain eight unbroken hours of good sleep, I shall frolic through the streets like an overstimulated baboon.
Best wishes,
Mr Beev
Posted by terra miller on July 14, 2002, at 22:16:41
In reply to Ambien vs Ativan - which is better?, posted by SLS on July 14, 2002, at 14:53:46
hi. i'm not on nardil, but i have used both ativan and ambien at different times (not at same time.) i felt ativan was better for helping me sleep and stay asleep longer. it took longer to take effect (an hour+), but i never felt hungover in the morning. i currently use ambien. i take 15mg. but i have to take it by 11pm, because it does stay with me through the morning if i take it too late. the positive is that it works within 5 minutes. it works the best if i am really dog-tired. then i'm most likely to sleep at least 6 hours. if i'm not dying for sleep, then it's possible to wake up after 4 hours. but i can feel it stay in my system and it's there at least 8 hours.
bottom line is that i actually prefer a combination of benzo and ambien (i have replaced the ativan with xanax, and if i'm using xanax for sleep deprivation from a panic attack, then i only take 5 mg ambien for same effect). but you of course should check with your doc.
terra
Posted by Shawn. T. on July 15, 2002, at 3:05:09
In reply to Ambien vs Ativan - which is better?, posted by SLS on July 14, 2002, at 14:53:46
Ativan is so awful. A friend's doctor said that you can get addicted to it in two weeks. Personal experience would seem to verify that. I forgot everything on Ativan. It's actions on GABA effectively slow down neurotransmission in your brain. I did some stupid things on it and didn't even remember doing them later. Ack.
Shawn
Posted by fachad on July 15, 2002, at 10:10:49
In reply to Ambien vs Ativan - which is better?, posted by SLS on July 14, 2002, at 14:53:46
I've taken both, individually and together.
Ambien alone works fast but wears off too quickly, giving only about 4 hrs of sleep.
Ativan does not put me out like Ambien, but once I fall asleep, I can sleep thru the whole night. Ativan definitely causes me to feel dull and melancholy the next day.
For awhile I took both, a very small dose of Ativan with my Ambien. That was better, because the Ambien put me to sleep and the Ativan kept me asleep.
I don't think there is anything better for putting you to sleep than Ambien, but I think there are better ways to stay asleep than Ativan.
I'm now trying low dose trimipramine (an old TCA like Elavil and doxepin) with the Ambien for sleep maintenance.
> Hi.
>
> I'm having a lot of trouble sleeping while taking Nardil.
>
> I'm using Ativan (lorazepam), but I've noticed that I have begun to feel somehow more depressed during the day. I'm pretty sure it's the Ativan.
>
> Can anyone offer some input?
>
> I am interested to know how well people have done with Ambien. Does it leave you with a "hangover" the next day? How does Ambien compare with Ativan in terms of efficacy and side effects.
>
> Without sleeping medication, I get no sleep at all. Zero. However, in the past, this has been a good prognosticator for me when responding to antidepressants.
>
> Thanks much.
>
> - Scott
Posted by Seamus2 on July 15, 2002, at 11:27:26
In reply to Ambien vs Ativan - which is better?, posted by SLS on July 14, 2002, at 14:53:46
Have you tried taking your last dose of Nardil no later than 2 PM? No caffeine after 2 PM? (I noticed Nardil potentiated effect of caffeine.)
Posted by JonW on July 15, 2002, at 11:59:57
In reply to Re: Ambien vs Ativan - which is better?, posted by Seamus2 on July 15, 2002, at 11:27:26
> Have you tried taking your last dose of Nardil no later than 2 PM? No caffeine after 2 PM? (I noticed Nardil potentiated effect of caffeine.)
You might want to try taking it all in the morning. That's what I do, but as you know I still have problems.
Jon
Posted by oracle on July 15, 2002, at 18:36:41
In reply to Ambien vs Ativan - which is better?, posted by SLS on July 14, 2002, at 14:53:46
Does it leave you with a "hangover" the next day?
If I need to take Atavin for sleep, I take it
several hours prior to sleep. Still have some residual effects in the AM.
Posted by SLS on July 17, 2002, at 9:15:56
In reply to Re: Ambien vs Ativan - which is better?, posted by oracle on July 15, 2002, at 18:36:41
Thank you everyone!
ALL of your input has helped me very much.
I think I'll try taking the Nardil earlier in the day and opt for
continuing with Ativan in lieu of switching to Ambien. We'll see.
I'll try to keep you guys posted. My energy has been very limited.Thanks again.
Sincerely,
Scott
Posted by SLS on July 17, 2002, at 11:17:16
In reply to Re: Ambien vs Ativan - which is better? » SLS, posted by JonW on July 14, 2002, at 17:36:28
Hi Jon.
Thanks for your input.
> I hear you with the sleep problems! I'm on Nardil and I sleep zero without a sleep aid as well.
How long have you been taking Nardil for? Is it helping? Have you stopped dreaming or find that it has been significantly reduced?
> I take ambien 20mg which is twice the recommended max dose and it puts me to sleep but the amount of sleep I get varies. I usually get 4 maybe 4.5 uninterrupted hours of sleep. Oh how I long for a good deep 8 hour sleep! Nardil makes me tired several times during the day so I catch up on my sleep then, but that obviously isn't a permanent solution. The most noteable thing is that I never sleep long. During the day I sleep deeply, but never more than 2 hours at a time, even if I only got 2 hours the night before. Anyway, I like ambien because it is much better than nothing. 10mg never gave me a hangover, but I used to think 20mg did. However, getting up in the morning always feels like a hangover for me so it is hard to tell. The last 2 days I've taken 20mg and no hangover. I've also used a lightbox during the last few days so I'm going to stop that today to see which one is causing the improvement. I hope Nardil is making my mornings better, that would be a good sign. I've found playing a cd I like + turning on a fan + ambien to be the best combination so far for sleep but like I said before it only gets me like 4 or 5 hours. Anyway, I'd go for the ambien. Listen, if you find a solution to the sleep problems you are having let me know! I need sleep, among other things :-)
It is my doctor's approach that, if necessary, to treat the insomnia as aggressively as the depression itself. One of the things he would want me to try is:Sonata 2mg + Ativan 4mg + Risperdal 1mg
Have you tried adding either Zyprexa or Risperdal?
For you, I think the best initial plan of attack is to break down the insomnia into its two components and target them both:
1. Getting to sleep:
(powerful first punch)
- Sonata
- Halcion2. Staying asleep:
(and preventing rebound awakenings due to the disappearance from the blood-stream of the short-acting drugs in #1
- Ambien
- Restoril
- Ativan
- Xanax
- KlonipinThe one and only time I got well was in 1987 using a combination of Parnate 60mg + desipramine 150mg. I also had total insomnia. My doctor at the time chose Halcion + Ativan to treat it. Halcion probably packs the most punch of any hypnotic. The strategy worked very well. I can't remember the exact dosages, though. Most doctors now are very reluctant to prescribe Halcion, I think overly so. There are some genuine issues regarding its use, and with the advent of Sonata, would certainly not be a first choice. My current doctor wants to try to avoid it. However, I like the drug and feel that it is a powerful tool. I hope it remains available. Unjohn cut their recommended dosages by half to try to stave off the resistence to its usage. I think most of the complaints revolved around the fact that a small percentage of people will develop amnesia. I had no problem at all with it, and would not be afraid to use it again. If necessary, I will push my doctor into using it. I think it is worth a try using the original prescribed dosage range: 0.5-1.0mg immediately before bed.
I hope I've helped you a bit.
- Scott
Posted by JonW on July 18, 2002, at 17:34:50
In reply to Re: Ambien vs Ativan - which is better? » JonW, posted by SLS on July 17, 2002, at 11:17:16
> How long have you been taking Nardil for? Is it helping? Have you stopped dreaming or find that it has been significantly reduced?
Thanks for the post Scott... actually, I just had an appointment with my pdoc today and he did one of your suggestions (maybe he read your post, too? <g>) He prescribed Restoril -- we'll see how it goes. All I know is I really need some sleep! :)
I've been taking Risperdal for awhile now. It's done wonders for my agitation and irritability, but it hasn't really helped any with sleep. Actually, the first few days I took it I got very good sleep and had very vivid dreams. So vivid that it was hard to distinguish them from reality at times. That went away very quickly, and in fact, Nardil has stolen my dreams completely. I've been taking Nardil for 6 weeks total, 4 weeks at 60mg. I hope these side-effects lessen with time. Thanks again for your reply!
Jon
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