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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by JonW on June 22, 2002, at 8:57:46
Hi all,
If I have any kind of recognizeable "cycle" (that is, somethings that is predictable) it is that at night my mood is elevated my energy is up and the opposite is true in the morning. Dr. Liebowitz thinks that Nardil will treat this in time. Does anyone have any experience with these kind of symptoms? Did they respond to something like Nardil? I'm skeptical, but I trust my doctor and we'll cross that bridge when we come to it. In the meantime, I was just curious.
Jon
Posted by Mr Beev on June 22, 2002, at 12:19:25
In reply to Alive at Night, Dead in the Morning!, posted by JonW on June 22, 2002, at 8:57:46
Not sure this is what you are seeking, but for what it's worth I have had very similar symptoms, but only when I am taking ADs, and then only for a few months! I have no idea why this occurs; neither do my pdocs.
A MAOI like Nardil seems like a rather big sledgehammer for this difficulty, but I admit I am hardly knowledgeable about such things.
To treat this problem, my previous pdoc prescribed sleeping pills. Halcion (trizolam) was, so to speak, a nightmare. Ambien (zolpidem) worked well enough, but as many posters here have noted, it tends to produce a short sleep. It is also quite expensive. It does have a much better "sleep profile" than halcion, and, while addictive like halcion, did not lend itself to habituation.
My current pdoc believes - correctly, no doubt - that sleeping pills treat symptoms, not causes. She prescribed Neurontin (gabapentin) at first, but I had a life-threatening reaction. Next she tried me out on zyprexa (olanzapine) 2.5mg, which I am currenty taking. So far, it has worked quite well: side-effects bearable and passed rapidly, produces excellent sleep with moderately rapid onset, I feel reasonably alert throughout the day, and I have not suffered withdrawal problems when I (twice) abruptly discontinued it. Still, I have not taken it long enough to form any long-term conclusions.
These are just my experiences, but I hope this helps,
Mr Beev
Posted by JonW on June 22, 2002, at 12:58:45
In reply to Re: Alive at Night, Dead in the Morning!, posted by Mr Beev on June 22, 2002, at 12:19:25
Hi Mr. Beev,
Thanks for the reply! Actually, I have a whole mess of stuff going on... Nardil I take for atypical depression and social phobia. I also take risperdal, depakote, and neurontin, and ambien for sleep. I didn't know ambien was addictive. What do you mean when you say addictive? I found zyprexa helpful also but I was taking it for irritability and agitation. The only problem with it was that I would twitch every few seconds. This isn't so much a problem with risperdal. Anyway, thanks for the post!
Jon
Posted by katekite on June 22, 2002, at 15:30:58
In reply to Re: Alive at Night, Dead in the Morning! » Mr Beev, posted by JonW on June 22, 2002, at 12:58:45
Hi -- Ambien and Sonata and Restoril all act just like benzodiazepines, which is why they can be called addictive. The withdrawal after prolonged use (a few weeks) might be worse insomnia than you had before, for a few days or week. Or, at some point you may need to increase the dose to keep up with acclimating to it.
The reason they are advertised as non-benzodiazepines is that their chemical structure is technically quite different. So the drug companies can say it. But, they bind to a place the same or very close to where klonopin etc would bind to (on the gaba receptor). For all intents and purposes, they are benzodiazepines without significant anti-anxiety properties.
If you are not worried about the benzo acclimation, or haven't had a problem stopping benzos in the past, its probably not a big deal. Seems to hit some people worse than others. Sonata and Ambien are probably not as bad this way as most true benzodiazepines.
I have pretty bad insomnia and I'm also dependent on klonopin at the moment (when my insomnia gets a bit better I will get off of it). So I have prescriptions for ambien, sonata and vistoril (like benadryl, a sedating antihistamine and definitely not addictive in any way) and I rotate them and skip a day altogether now and then, so that I don't do more than two days in a row of any particular drug. It's worked so far and I haven't had to up the dose of anything.
So that's my understanding of ambien.
kate
Posted by Mr Beev on June 22, 2002, at 18:29:32
In reply to Re: Alive at Night, Dead in the Morning! » Mr Beev, posted by JonW on June 22, 2002, at 12:58:45
Hello Jon,
>I didn't know ambien was addictive. What do you mean when you say addictive?
By "addictive" I mean that if you abruptly stop taking a substance, you will suffer withdrawal symptoms. By this definition, for example, most would find coffee addictive - the infamous "caffeine headache" sometime after cessation.
By "habituative" I mean that, over time, you must take higher and higher dosages to maintain the same desired effects. I remember reading a study which found that smokers who switch from "regular" to "lights" or to (so-called) "ultralights" often ended up smoking more cigarettes per day in order to obtain the nicotene levels they were used to! (I have observed this phenomenon in two friends of mine.)
Many people have no trouble with ambien. I had used two pills (10mg) every night for about three months. It was most effective, I did not become habituated. When I stopped cold turkey - for my pdoc said it was non-addictive - I suffered headaches and rebound insomnia for about a week. I slept hardly a wink, but since I otherwise felt all right, I resolved to stick it out. I was okay after that abysmal week.
>I found zyprexa helpful also but I was taking it for irritability and agitation. The only problem with it was that I would twitch every few seconds.
If I am not mistaken, "neuroleptic" drugs, such as the anti-psychotics, of which zyprexa is one, can over time cause tardive dyskinesia in some folks. TD is the fancy name for involuntary muscle twitchings. Sometimes TD can be permanent. Zyprexa is a newer, "atypical" anti-psychotic and is thought to be safer than older APs. It was good though, I think, that you got off the zyprexa when you noticed the twitchings.
Hope this helps & best wishes,
Mr Beev
Posted by Mr Beev on June 22, 2002, at 18:29:55
In reply to butting in about ambien, posted by katekite on June 22, 2002, at 15:30:58
Hello, katekite, thank you for that most informative post.
I confess it had never occurred to me to try regularly rotating several sleeping aids! An interesting approach that I shall definitely keep in mind the next time I am taking sleeping pills. Right now, zyprexa is working nicely on the sleep front, with the advantage of producing a longer lasting sleep than I got with ambien (10mg of which provided 4-5 hours on average).
Best regards,
Mr Beev
Posted by jay on June 23, 2002, at 1:35:41
In reply to Re: Alive at Night, Dead in the Morning! » Mr Beev, posted by JonW on June 22, 2002, at 12:58:45
Actually, I am the same way. The night brings a sence of mental and physical peace. I always think of this statistic when I think of mornings....that more people die of many diseases in the morning..more people have heart attacks in the morning..morning is also the pro-cortisol time of day. It is what I think gives us with mood problems a real "kick in the ass" that we (anybody!) don't deserve.Have you tried taking your meds a bit earlier in the evening? Even with, or just after, supper, it might help temper your body down to feel a bit more like sleeping at night. Just a thought.
Ambien is just as 'addictive', maybe less, than any antidepressant. People have to continue to take a.d.'s, often at large amounts, for a long time, and this is 'less' addictive then a med you don't even need every night for sleep?(Ambien)
Best wishes..
Jay
> Hi Mr. Beev,
>
> Thanks for the reply! Actually, I have a whole mess of stuff going on... Nardil I take for atypical depression and social phobia. I also take risperdal, depakote, and neurontin, and ambien for sleep. I didn't know ambien was addictive. What do you mean when you say addictive? I found zyprexa helpful also but I was taking it for irritability and agitation. The only problem with it was that I would twitch every few seconds. This isn't so much a problem with risperdal. Anyway, thanks for the post!
>
> Jon
Posted by krazy kat on June 23, 2002, at 9:55:54
In reply to Alive at Night, Dead in the Morning!, posted by JonW on June 22, 2002, at 8:57:46
jon:
i don't know if you're diagnosed bipolar, but this seems to be a common trait for bipolars, regardless of the part of the spectrum a bipolar falls into, which, where, for art thou... boy that sentence came out badly.
the best thing you can do, imho, is get to bed as early as possible with a sleeping aid that's tried and true (frankly a half a dose of Exedrin PM works better for me than prescription meds I've tried) and get up the same time every morning. Same old, same old, and I'm still sleeping too late every day after working on this for a good two months.
Also, don't worry about the amount of sleep unless it changes, I've learned. I feel better if I sleep a good 10 hours. BUT, I sleep better if I don't take a nap (no surprise). So, I'm using a stimulant to keep me awake thru the day as best i can.
I've heard it since I started getting treated for this illness - good sleep hygiene is a priority and meds can definitely help. Watch out for groginess the morning after taking a med - that's a bad sign. The other sleep aid that works for me -- a glass or two of beer or wine.
- kk
Posted by JonW on June 24, 2002, at 6:23:29
In reply to Alive at Night, Dead in the Morning!, posted by JonW on June 22, 2002, at 8:57:46
Posted by JonW on June 24, 2002, at 6:48:39
In reply to bipolar's and nighttime » JonW, posted by krazy kat on June 23, 2002, at 9:55:54
> i don't know if you're diagnosed bipolar, but this seems to be a common trait for bipolars, regardless of the part of the spectrum a bipolar falls into, which, where, for art thou... boy that sentence came out badly.
Yeah, I don't know what my diagnonsense is, either... Two doctors have said I'm certainly part bipolar, but I feel guilty agreeing when it seems to be a matter of *how* bipolar one is and I'm not sure I am enough to get a label but then certainly enough to complicate treatment.
> the best thing you can do, imho, is get to bed as early as possible with a sleeping aid that's tried and true (frankly a half a dose of Exedrin PM works better for me than prescription meds I've tried) and get up the same time every morning. Same old, same old, and I'm still sleeping too late every day after working on this for a good two months.
I may try the exedrin PM sometime... what makes it PM? Is it the same stuff in benadryl? Actually, since taking the sleeping pill on a regular basis I seem to get up "naturally" at a normal hour but my head still wakes up in a fog. Waking up at a normal hour and having a little bit more energy in the morning has only happened recently and since my pdoc increased the Nardil to 60mg so maybe he is right and it's more the Nardil that is helping. It's hard to tell which is responsible, but anyway there's a good trend as of late.
> Also, don't worry about the amount of sleep unless it changes, I've learned. I feel better if I sleep a good 10 hours. BUT, I sleep better if I don't take a nap (no surprise). So, I'm using a stimulant to keep me awake thru the day as best i can.
I usually love a *lot* of sleep! But recently I just wake up after like 5 to 7 hours, and maybe that's because that's when the ambien wears off or the depression is getting better. I hope it's the depression improving but it's probably the ambien wearing off. There's that damn depression again, making me all negative! ;)
> I've heard it since I started getting treated for this illness - good sleep hygiene is a priority and meds can definitely help. Watch out
I'm definitely significantly affected by changes in sleep and sunlight!
Jon
Posted by krazy kat on June 24, 2002, at 9:11:17
In reply to Re: bipolar's and nighttime » JonW » krazy kat , posted by JonW on June 24, 2002, at 6:48:39
>> part bipolar,
I like that. I'd like to have a part Bipolar makeup please, with a touch of OCD, and a pinch of Anxiety thrown in - I'd say that's me.
>> but I feel guilty agreeing when it seems to be a matter of *how* bipolar one is and I'm not sure I am enough to get a label but then certainly enough to complicate treatment.
I personally know that guilt. let it go if you can... there's a spectrum of bipolar disorder, which is probably what you're mentioning and it doesn't matter if one is dysthimic or seeing ghosts and super heroes. the disorder is disruptive and needs to be treated b/c it gets worse.
> I may try the exedrin PM sometime... what makes it PM? Is it the same stuff in benadryl?Exedrin PM sans Aspirin:
Each caplet contains: Acetaminophen (500 mg), Diphenhydramine Citrate (38 mg)
Benadryl is:
Diphenhydramine HCl (25mg - Antihistamine)
Are those the same? It's something to do with the combo in Exedrin PM, the addition of the acetaminophen, b/c the Diphen. Citrate is sold on its own and did nothing for me.
>> It's hard to tell which is responsible, but anyway there's a good trend as of late.
Good. Good luck!
- kk
Posted by larunyan on August 15, 2002, at 11:49:25
In reply to Re: bipolar's and nighttime » JonW, posted by krazy kat on June 24, 2002, at 9:11:17
I would like to know if anyone has experienced sleepwalking and/or trancelike state while taking ambien. Especially if they are doing activities that are complicated like talking to people or moving heavy objects or if it is strange and unusual behavior. Thanks.
Posted by JonW on August 15, 2002, at 15:45:47
In reply to ambien side effects, posted by larunyan on August 15, 2002, at 11:49:25
I've never had any problem with ambien. Maybe slight hangover if I take it too late, but other than that I like it a lot.
Posted by nikioct73 on August 15, 2002, at 18:01:55
In reply to Re: ambien side effects » larunyan, posted by JonW on August 15, 2002, at 15:45:47
HI..I have taken Ambien on and off for about a year to combat insomia when on SSRI's (also have had chronic insomia since early adolescence)and I think it is the best thing since sliced bread..ie i can fall asleep with in 30 minutes and usally sleep at least 5 hours which for me is awesome..but the first couple of times i took it I did do some weird stuff..like got up out of bed sometime during the night and ate a whole pint of Ben and Jerrys...only reason I knew it was me was because I lived alone and the cat has a hard time with the silverware draw...and if I take it too early as in more than 60 minutes before going o bed I can behave quite strangely I've been told...sent some strange emails made phone call i don't remember..kinda like a "blackout"from drinking very heavily...I still do this on occ. but usually its because (again) I've taken it too early..and it does give me the major munchies if i'm awake too long after taking it....kinda makes me feel really high so ...I can see its potential for abuse..but anyways..
Niki
Posted by racf on August 16, 2002, at 13:31:25
In reply to Re: ambien side effects, posted by nikioct73 on August 15, 2002, at 18:01:55
I have only had side effects when I have taken four or so and wash them down with a beer or two. Of course I don't rember anything the next day. This is the reason for taking four. I have been told I can gett quite angry and often see things and little green kinda thing. I usually on take a half and this does the job of my sllep. I have been taking ambien for two years now. My only concern would be it's long term effect and what I might be doing to my body when I decide I need to forget things and taken more than I should.
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