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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Budgie on October 2, 2003, at 11:28:39
Hi All,
My pdoc finally capitulated and prescribed a sleep med for my Parnate insomnia. He only gave me 15 pills for the next 28 days, though (but with one refill), out of worry that these hypnotics can cause dependency.
My question is this: Do drugs (or some drugs) have a higher rate of dependency/addiction/abuse when used on an as-needed basis versus at a daily, therapeutic dose? It seems more logical to me just to take the Ambien every night, let it do its thing without thinking about it than it is to lie awake wondering...wondering if I should take it. It seems to me that (the latter) has the potential to cause more damage, let alone a more erratic sleep schedule, which is what I'm trying to fix in the first place.
Now we obviously don't take our ADs on an as-needed basis. Matt pointed me towards some evidence a while ago that Klonopin causes less dependency when taken on a normal schedule. Is it logical to apply this to hypnotics, too, or is that a different beast altogether?
Thanks,
Budgie
Posted by utopizen on October 2, 2003, at 13:45:12
In reply to Ambien- dependency potential?, posted by Budgie on October 2, 2003, at 11:28:39
I took Ambien last July and August for insomnia, and it went away before the end of August. I was prescribed 10mg once at night.
It can only help. If you take it on an occassional basis, it may simply prolong your chances of being able to get out of the insomnia... then again, if you can feel comfortable about getting out of bed after 30 minutes of not sleeping and taking it then, that's good too... mostly, though, this would be every night when I had it, so I just took it every night. Eventually it went away.
The FDA requires that it be listed as a 7-10 day med because they're trying to over-compensate from a lack of any regulation over barbituates, Placidyl, and Qualludes which use to be widely abused and addicted to.
In my case, taking it every night for 2 months enabled me to cure my insomnia, and now I don't have to take it anymore.
Posted by jerrympls on October 2, 2003, at 20:52:51
In reply to Re: Ambien- dependency potential?, posted by utopizen on October 2, 2003, at 13:45:12
GOD- Psych docs afraid of prescribing a med for something that it was MADE to do. Ambien is a perfect sleep aid - and it rarely causes dependence. I've been on it for 3 years - 20mg at night. The clinical trials said that 10-20mgs were the best - but for some reason it's prescribed in 5mg and 10mg. I don't get it - ? Also, recenlty (within the last year) a major study showed that Ambien was the best med for insomnia due to antdepressant-caused sleeplessness. The 7-10 day thing is bull. I occassionally have developed a tolerance to it - maybe for a couple weeks or so - but it always comes back and helps me sleep. Problem with it is that it doesn't really help KEEP you to sleep. Only a 4 hour half-life. Sonata - a related sleep med - has only a 1-hour half-life. Sonata did NOTHING for me.
Get a new p-doc. I'm SO sick of scaredy-cat docs all worried about addiction and dependency and over-prescribing. HELL - you have insommnia from parnate - which is WELL known to happen. Problem with MAOI's is you can't mix them with sedating Trcyclics or many other meds. Ambien is a perfect fit. Tell your doc to throw away his PDA and look up the word "compassion." UGH.
Hope you get some sleep.
Jerry
Posted by femlite on October 2, 2003, at 23:05:38
In reply to Re: Ambien- dependency potential?, posted by jerrympls on October 2, 2003, at 20:52:51
Tell your doc to throw away his PDA and look up the word "compassion." UGH.
>
> Hope you get some sleep.
>
> JerryWhat a refreshingly honest perspective, thank you.
Question: Im taking sonata 10mg, after tiring of the trazodone 100mg hangover.
Problem is Im still hungover.(Limp legs, dizziness, cognitive difficulties) Does this go away eventually or is ambien superior in this respect?
Posted by jerrympls on October 2, 2003, at 23:28:46
In reply to Re: Ambien- dependency potential? » jerrympls, posted by femlite on October 2, 2003, at 23:05:38
> Tell your doc to throw away his PDA and look up the word "compassion." UGH.
> >
> > Hope you get some sleep.
> >
> > Jerry
>
> What a refreshingly honest perspective, thank you.
>
> Question: Im taking sonata 10mg, after tiring of the trazodone 100mg hangover.
> Problem is Im still hungover.(Limp legs, dizziness, cognitive difficulties) Does this go away eventually or is ambien superior in this respect?
>
>
HI Femlite-Trazodone is a very sedating antidepressant. It blocks the reuptake of serotonin. While it doesn't fit the profile of an SSRI, it's close. Dr's use Trazodone ALL the time for a sleep aid. When I was on it - I hated it. I could barely function until after noon - I was falling asleep in the aisles (I worked in a bookstore). Instead of helping me relax and calm my mind and help me gently go to sleep - it slammed me in the head and MADE me have to lie down. My mind would still be racing but trazodone would be forcing me to "sleep" like a bully forcing someone's head underwater.
When I was in the hospital this summer - many patients were on trazodone. Their doctors had told them it was a sleeping pill. I told them "No, it's an antidepressant." They were all shocked and felt betrayed their doctor didn't explain this fact to them.
It's ridiculous - Docs prescribe trazodone like it's candy - with 5-6 refills. But Nooooooooo when it comes to an ACTUAL sleeping aid that lets you actually sleep through all 4 stages of the sleep cycle. 7-10 days? What's the difference? If someone needs a sleep aid why give them months of trazodone adn then say "Oh no I can't prescribe you Ambien! You'll grow a dependency to it and have to be on it for months...:" And your point is??????? Be on Trazodone for months or Ambien - what's the difference?
I've had good docs and BAD docs and STUPID docs - the GOOD docs - the one's who know what compassion means and who know actually HOW medicines work, etc - prescribe the right kinds of medications. I had a GREAT research doctor who continued me on Ambien - first at 10mg. After a couple weeks I said "I can't get to sleep on 10mg." he said "Well, let's try 20." And it worked. What's so bad about Ambien or Sonata? Docs will start you off on 25-50mg of Trazodone and then keep bumping it up to 300mg or so - and make you a zombie and THEN they say "Oh you're tired during the day because of your DEPRESSION - not because of 300mg of Trazadone."
WHAT?!?! Trazodone sedates you because it contains antihistemic proprties - like Benedryl. Benedryl DOES NOT let your body or mind go into the deepest, most restoritive sleep stages. Anti-histamines only keep you at stage 1 - just slightly sedated and somewhat asleep. That's why you never feel rested after taking an anti-histamine for sleep.
Same for Trazodone - although, I must admit that it works for some people- I AM NOT SAYING IT DOESN NOT WORK FOR EVERYONE.
Recently my sister went into see a doctor - unfortunately a 2nd year resident - and said "10mg of Ambien is working great to help me sleep - I feel rested the next day and everything." So what did the resident do? She said "OH well, it's addictive so you can only take 5mg now." WHAT!?!??!??! How ignorant! Why decrease a med that is HELPING someone? That's like saying - "Oh well, a cast can make your skin itch, so you have to take it off and prop your foot on a table from now on - we don't want you to get dependent on wearing a cast for your broken ankle."
I'm sorry for all the ranting and everything- but I am sick of doctor's who have NO clue how to use medications and who deceive their patients by saying 'This is a sleeping pill" whenin fact it's an ANTIDEPRESSANT that makes you drowsy as a SIDE EFFECT.
OK...enough I have to go to bed.....hope this helps. To answer your question about Trazodone - the side effects you are experiencing may or maynot get better. For me Trazodone always stayed the same - made me fall asleep driving on the way to work, etc. I could have died - but the doc wanted to save himself any guilt for prescribing such a terribly addictive med like Ambien. Ambien is FAR superior because it has a SHORT half-life and is out f your system by the time you wake up - NO HANG OVER no antidepressant side effects like cognitive dulling, dizziness, weight gain.
Hope you can get some sleep - and relief.
Jerry
Posted by mattdds on October 3, 2003, at 0:29:57
In reply to Ambien- dependency potential?, posted by Budgie on October 2, 2003, at 11:28:39
Chris,
I couldn't have put it better than Jerry did.
Ambien is a tremendous medication, and I've been on it for over a year, continuously. Curiously, however, my wife started taking it too (out of my stash!). Needless to say, I ran out early.
I can't legally refill it for a few days, but I'm fine! I had absolutely no withdrawal, and I sleep exactly how I did a year ago - before I started taking the Ambien.
My point is, even after a YEAR, I went off cold turkey with *absolutely* no rebound insomnia - I simply reverted to my old (crappy) sleep patterns.
It seems your doc is overly conservative. Ambien is excellent! When I take it, sleep is not a problem whatsoever.
My only wish is that there were drugs as good as Ambien for other indications - for people with things like schizophrenia or bipolar (fortunately I don't suffer from either, but feel for people that do).
Get some sleep!
Matt
Posted by mattdds on October 3, 2003, at 0:51:09
In reply to Ambien- dependency potential?, posted by Budgie on October 2, 2003, at 11:28:39
Chris,
>>Matt pointed me towards some evidence a while ago that Klonopin causes less dependency when taken on a normal schedule
I should clarify this. What I meant to convey is that Klonopin works best in terms of *less side-effects* when taken consistently, rather than as-needed. This is due to differential tolerance (i.e. sedation, memory impairment, ataxia all go away, but anti-anxiety properties remain).
There is also good evidence that as-needed dosing interferes with cognitive therapy (which I believe you are still doing?). Continuous dosing does not seem to interfere with the CBT, and maintains its anxiolytic effect long-term.
In terms of *dependence*, continuous use of Klonopin *does* cause it. If you take a benzodiazepine for longer than a month (arbitrary, could be shorter or longer for some), you will need to slowly taper if and when you decide to discontinue the drug to prevent a withdrawal syndrome.
Now this is the downside of benzos (one of the only ones, in my opinion). You need to taper off slowly when discontinuing! But some people simply need ongoing therapy, and the fact is that for the vast majority, benzos continue to work, so this dependence is quite worth it.
It's like taking a beta-blocker for hypertension. Going off "cold turkey" has dangerous consequences. Patients with hypertension taking beta-blockers are indeed *dependent* on their medication. This is absolutely no different from taking a benzodiazepine for another medical disorder (anxiety disorder).
But your question was in relation to Ambien. Ambien is not a benzodiazepine, although it does act on the same receptor sites (albeit in a slightly different manner).
Here is the answer: there is no evidence of tolerance or dependence to zolpidem in a great number of studies. Patients will simply return to baseline (pre-treatment) sleep patterns after discontinuing Ambien. It's really that simple. This parallels the many anecdotal reports on this board - people come off "cold turkey" and return to how they were before - no better but certainly no worse!
Best,
Matt
Posted by Eurastus on October 3, 2003, at 9:49:07
In reply to Klonopin tolerance vs. Ambien tolerance » Budgie, posted by mattdds on October 3, 2003, at 0:51:09
I've been on Ambien for over a year now. I take it about 2-3 times a week when I think I need it. Some weeks more, some weeks less. The problem I've had is when refilling the medication. The insurance company wont authorize it because they say it's a 7-10 day medication. After calling the insurance company and asking them for their medical license number, I got my Ambien......sweet dreams!
Posted by utopizen on October 3, 2003, at 11:58:52
In reply to Re: Ambien- dependency potential? » femlite, posted by jerrympls on October 2, 2003, at 23:28:46
I went to a doc while I was out of state in Virginia... quite interesting... complained my 10mg of Ambien wasn't working, thinking of upping it to 20mg, and he said, "well, I can't stop you from taking 20mg, but I have no problem with that, it's a perfectly safe med."
So I said, okay, will you write for that? He goes, "I can't stop you from taking 20mg" Then writes for 10mg with a refill. I'm suppose to wink, wink, nod nod here? Then he tells me "well, have you tried alcohol?"
I tried to explain to him alcohol causes nighttime awakenings, early morning awakenings, and disrupts the sleep cycle... akk. Alcohol has more status over Ambien? Could someone please just make everything OTC before I vomit?
Posted by Budgie on October 3, 2003, at 14:53:05
In reply to Re: Ambien- dependency potential?, posted by utopizen on October 3, 2003, at 11:58:52
Thanks for the perspectives everyone.
Matt, do you happen to know where I can find these studies that say Ambien causes no tolerance or dependency? I would love to go in armed to my next psychiatrist appointment.
I have found many posts on other boards on the net (I know, I feel dirty for betraying PB) from people who claim they're having all sorts of problems getting off the stuff. So I don't know, there's anecdotal evidence on both sides of the coin, it seems. I would love to see the actual studies.
In the past three nights since I've been taking it, I've felt pretty crappy the next day. I did just come down with a cold and I've been trying to quit caffeine lately, so it's hard to tell what's what sometimes. Can everyone attest that there is no hangover and no (daytime) cognitive dulling on this med? It would be a great comfort to my mind if so.
Thanks again.
Posted by utopizen on October 3, 2003, at 15:03:41
In reply to Re: Ambien- dependency potential?, posted by Budgie on October 3, 2003, at 14:53:05
Maybe seeing a sleep doc would help, especially if you find even after 7-9 hours of sleep on a regular schedule, you're still tired during the day. Ambien really doesn't cause hangover (if you're lucky, it may actually keep you asleep for 7-8 hours).
I don't think anyone who saw a sleep doc would get any trouble with having Ambien, since they actually have experience with the stuff.
Posted by mattdds on October 3, 2003, at 15:55:55
In reply to Re: Ambien- dependency potential?, posted by Budgie on October 3, 2003, at 14:53:05
Chris,
Here are some abstracts of the evidence that I found. There is much more, believe me!
Lack of tolerance and physical dependence upon repeated treatment with the novel hypnotic zolpidem
G Perrault, E Morel, DJ Sanger and B ZivkovicSynthelabo Recherche (L.E.R.S.), Bagneux, France.
Zolpidem is a new, short-acting hypnotic of imidazopyridine structure which binds selectively to a subpopulation of receptors involved in the action of benzodiazepines [omega 1 (BZ1) sites of the gamma- aminobutyric acidA receptors]. The present study investigated whether tolerance and physical dependence develop after repeated treatment with zolpidem as is observed with benzodiazepines. Mice were given zolpidem or the benzodiazepine midazolam (2 x 30 mg/kg, p.o.) for 10 consecutive days. Tolerance to central depressant effects (evaluated by recording spontaneous locomotor activity) and to anticonvulsant effects (measured against pentylenetetrazole-, electroshock- and isoniazid-induced convulsions) was assessed 42 hr after the last administration. A decrease in the latency to isoniazid-induced convulsions was taken as an index of physical dependence and was evaluated 3, 6, 14, 24, 42 and 67 hr after the end of chronic drug treatment. Repeated treatment with midazolam produced tolerance to its sedative and anticonvulsant activities as indicated by shifts of the dose-response curves by a factor of 3 to 5. Fourteen hr after discontinuation of treatment, spontaneous withdrawal was observed and lasted 3 days. When flumazenil was given 3 or 6 hr after the final midazolam injection, precipitated withdrawal was observed. In contrast, after repeated treatment with zolpidem, there was no change in its ability to produce sedative and anticonvulsant effects. Moreover, neither spontaneous nor flumazenil- induced precipitated withdrawal was observed in zolpidem-treated mice.
**Ok, that was with mice, but...it looks promising. Here's a human one.**
****************************************
Non-benzodiazepines for the treatment of insomnia.
Wagner J, Wagner ML.
Department of Clinical Practices and Therapeutics, Merck-Medco-Managed Care, L.L.C. Franklin Lakes, NJ, USA
Benzodiazepine hypnotics, the mainstay of pharmacological treatment for insomnia, have been associated with altered sleep architecture, psychomotor and memory impairment, rebound insomnia, withdrawal effects, tolerance, dependence, abuse potential and respiratory depression. Non-benzodiazepines, such as zolpidem, zopiclone and zaleplon, demonstrate hypnotic efficacy similar to that of benzodiazepines along with excellent safety profiles. Non-benzodiazepines generally cause less disruption of normal sleep architecture than benzodiazepines. Psychomotor and memory impairment may be less problematic with non-benzodiazepines, especially when compared to longer-acting benzodiazepines. Rebound insomnia and withdrawal symptoms occur infrequently upon discontinuation of non-benzodiazepines and may be less common and milder than those seen upon discontinuation of some benzodiazepines. For the long-term treatment of insomnia, which is generally not recommended, zolpidem and zopiclone are particularly good options because they do not develop tolerance rapidly and have a low abuse potential. Limited data indicate that zaleplon has low tolerance and abuse potential, although further experience is needed to determine its long-term efficacy and safety profile. Since non-benzodiazepines produce minimal respiratory depression, they may be safer than benzodiazepines in patients with respiratory disorders. The choice of which hypnotic to use should be based on the patient's primary sleep complaint, health history, adverse effects and cost.
***********************************************
A double-blind, randomized and placebo-controlled study on the polysomnographic withdrawal effects of zopiclone, zolpidem and triazolam in healthy subjects.
Voderholzer U, Riemann D, Hornyak M, Backhaus J, Feige B, Berger M, Hohagen F.
Department of Psychiatry and Psychotherapy, Klinikum of the Albert-Ludwigs-University Hauptstrasse 5 79104 Freiburg, Germany. Ulrich_Voderholzer@psyallg.ukl.uni-freiburg.de
Rebound effects after withdrawal from hypnotics are believed to trigger their chronic use and to enhance the risk of tolerance and dependence. It was the purpose of this study to investigate the acute polysomnographic withdrawal effects after a 4 week treatment with standard doses of the non-benzodiazepine hypnotics zopiclone and zolpidem compared with triazolam and placebo. Healthy male subjects between 22 and 35 years of age participated in a parallel study design. They received either zopiclone 7.5 mg (n=11), zolpidem 10 mg (n=11), triazolam 0.25 mg (n=10) or placebo (n=7) over 4 weeks in randomized and double-blind order. Sleep EEG was registered during 2 nights before treatment under placebo, on days 1, 27 and 28 of treatment and on days 29,30,41 and 42 under placebo. Total sleep time and sleep efficiency were lower in the 1st night after discontinuation of triazolam (p < 0.05, t-test). After withdrawal from zopiclone or zolpidem slight but not significant rebound effects concerning sleep continuity were observed. Self-rating scales showed minimal rebound insomnia after discontinuation of all three hypnotics. In the placebo group no changes of sleep parameters were observed. Assuming that rebound insomnia is part of a withdrawal reaction, this study indicates that the risks of tolerance and dependency are low when administering zopiclone or zolpidem at the recommended doses.
********************************************
Precipitated and spontaneous withdrawal following administration of lorazepam but *not* zolpidem.
Elliot EE, White JM.
Department of Clinical and Experimental Pharmacology, University of Adelaide, South 5005, Australia.
Radiotelemetry was utilized to compare zolpidem and lorazepam tolerance and withdrawal in rats. Locomotor activity, electromyographic activity (EMG), and body temperatures were used to assess the acute drug effects, and as measures of tolerance and withdrawal. Lorazepam, zolpidem, or vehicle was administered for 12 days, and data were recorded daily, immediately, after treatment. Data were also recorded immediately after flumazenil (25 mg/kg, IP) precipitated withdrawal and during 4 days of spontaneous withdrawal. Complete tolerance to the acute effects of lorazepam administration developed within 7 days of treatment and both flumazenil-precipitated and spontaneous withdrawal were observed. In contrast, there was no tolerance to the sedative actions of zolpidem administration after 12 days, but complete tolerance to the hypothermic and muscle relaxant effects was apparent after 8 days of treatment. Despite the presence of tolerance, no evidence of either spontaneous or flumazenil-induced withdrawal was recorded in these rats. In conclusion, this model suggests that as a sedative zolpidem has significant advantages over the classic benzodiazepines.
**********************************************
Hope these help,
Matt
P.S. Sorry (Dr. Bob) for all the bandwidth hogging, but I was too lazy to look up how to drop a link!
Posted by femlite on October 3, 2003, at 21:52:38
In reply to Re: Ambien- dependency potential?, posted by utopizen on October 3, 2003, at 15:03:41
pdoc gave me sonata. is there a diff. between these sleep meds?
very helpful discussion all
Posted by Viridis on October 4, 2003, at 1:02:50
In reply to Ambien- dependency potential?, posted by Budgie on October 2, 2003, at 11:28:39
Here's an interesting overview of the use of anti-insomnia meds, including their potential for inducing tolerance. This seems to indicate considerable disagreement among sleep doctors as to whether these meds (especially the newer ones like Ambien) are likely to cause tolerance and/or dependency.
Posted by Budgie on October 4, 2003, at 9:44:53
In reply to Interesting link: Ambien- dependency potential?, posted by Viridis on October 4, 2003, at 1:02:50
Thanks for the abstracts and the link. I didn't see much in that article contraindicating the newer hypnotics like Ambien, other than one person pointing out that there is some anecdotal evidence that it does cause tolerance. But, like the article stated, this could very well be due to other factors, and it's hard to argue with a mountain of empirical evidence.
Thanks again,
Chris
Posted by mattdds on October 4, 2003, at 12:06:14
In reply to Thanks, posted by Budgie on October 4, 2003, at 9:44:53
Chris,
The article Viridis posted was really cool, I thought. It seemed overwhelmingly positive about the new hypnotics. I didn't really see too much disagreement. There seemed to be a general agreement on the fact that there is *much* less, if any rebound insomnia with zolpidem. And if there was, that it was transient (I think it showed 24 hours on the EEG) and mild.
This is consistent with my experience. I just got my Ambien refilled today (even though it was a little early, and the pharm tech hassled me about it), but there was a period where I stopped cold turkey for 3-4 days! I had no problem other than the same old insomnia that has plagued me my whole life, but no worse, or no better. No strange symptoms appeared, and I didn't have a seizure.
My dad says the same thing, he'll take it for a while (a month or two), then his doc will get uptight about it, saying "this is really only supposed to be for 7-10 days". So my dad will go off "cold turkey". He has no "withdrawal", just the return of his original lack of ability to fall asleep!
It's really annoying for people who think they know better to arbitrarily place a limit on how long (a mere 7-10 days, in this case) you can get relief from insomnia, especially when it continues to work for me after 2 years of nearly continuous use! On the other hand my mom gets 5 refills from an extremely conservative family MD on her trazodone which she uses nightly. As if they were candy or something.
To me, zolpidem is much more well studied in the context of sleep, so why in the heck prescribe something that is off-label like trazodone, amitriptyline. Doesn't make sense to me. I'ts only because Ambien is scheduled.
One question, perhaps the most important one. Is it working for you? Do you still feel hung-over? You mentioned you had a cold and perhaps this is obscuring the effects. For most (but obviously not all), this is the main advantage of Ambien - no hangover. YMMV, as they say in this weird little world.
Matt
Posted by kara lynne on October 4, 2003, at 12:13:01
In reply to Ambien vs. Sonata, posted by femlite on October 3, 2003, at 21:52:38
Ambien is a bit stronger. I prefer sonata if I can get away with it.
Posted by Viridis on October 4, 2003, at 18:42:16
In reply to Ambien- dependency potential?, posted by Budgie on October 2, 2003, at 11:28:39
The insomnia issues get pretty complicated, and I think that a lot of it comes down to what's causing it. I used to suffer from episodes of severe insomnia due to anxiety and depression. Occasionally I could get a prescription for Xanax, and it was great for insomnia -- plus the quality of sleep was excellent. But, the prescriptions I got were always short-term, and doctors warned me about "addiction" etc. etc.
Then I went through a period where I used Trazodone, which my GP touted as the "best" sleeping pill. I didn't like it at all -- I never felt truly rested, was groggy in the morning, and just wasn't comfortable with taking it on a regular basis. There are also some genuine safety issues, especially for males.
Finally, I found my current pdoc, who prescribed both Klonopin and Xanax for my anxiety problems. He emphasized, though, that he did not want me to use these for insomnia on a regular basis, because (in his experience) tolerance often develops rapidly to the anti-insomnia effects. In addition, he suspects that benzos disrupt sleep architecture. However, tolerance to the anti-anxiety effects isn't much of a problem in his opinion, so he's fine with daily use of Klonopin and as-needed use of Xanax -- just not regular use of either for sleep.
Well, since my anxiety has been reduced with Klonopin, insomnia isn't much of a problem any more. So, even though I'm not taking it as a sleep med, it has the side benefit of controlling insomnia. And I haven't developed any tolerance to its benefits yet, after 2 1/2 years.
For a long time, I took Xanax here and there for especially stressful situations, and occasionally for sleep. Strangely, though, I do seem to have developed tolerance to it, even though I may only take it every week or two. It now takes at least 3-4 times as much to achieve the same effects as previously, so I'm really limiting its use. My pdoc says he's seen this before with Xanax; he's quite willing to keep prescribing the same amount as usual, and doesn't mind if I use more at a time, as long as my frequency of use doesn't increase.
The point is that individual responses can vary a lot, even just to different benzos, and I expect that this applies to use of benzos and related drugs for sleep too. And, if anxiety (or an activating med like Parnate) is causing insomnia, perhaps use of a safe, reliable anti-anxiety med like Klonopin on a regular basis might help indirectly.
I haven't tried Ambien, but it sounds like it can be used safely for many in the long term, and in fact, I have a doctor friend who swears by it for insomnia (and has used it daily for quite a while at the same dosage).
Posted by LindaNYC on August 11, 2004, at 16:46:04
In reply to Re: Ambien- dependency potential?, posted by Budgie on October 3, 2003, at 14:53:05
I have just gone through a very bad 3 day withdrawal from 10mg nightly of Ambien. I was on it for 3 months. I decided to quit taking it because I was having severe sensitivity to noise, a feeling of panic or anxiety, and suicidal thoughts. These symptoms appeared about 8 days earlier, and were worsening daily. I have been on 60mg/day of Prozac for depression for 12 years, and 30mg of Adderral/day for ADD for 5 years.
When I looked up "noise sensitivity" on Google, benzodiazepine withdrawal kept coming up as a possible cause. Since Ambien is closely related to these drugs, I thought perhaps it might be causing the new symptoms. So, although the information I found said dependency on Ambien was likely with prolonged use, and it should not be stopped suddenly, I decided to quit it "cold turkey" and tough it out.
The withdrawal symptoms were severe three nights ago, and have almost completely dissapeared, as have the original symptoms of noise sensitivity and depression. The withdrawel symptoms included frequent waking up (rebound insomnia), upset stomach and nausea, and a feeling of agitation. I cut my dose of Adderral to 10mg/day for these 3 days, as I was having the agitation.
In my opinion, Ambien withdrawal, or side effects due to dependency could be the cause. Particularly in patients being treated for depression, Ambien has been linked to feelings of increased depression or suicidal thoughts. Although no one on the board seems to have had my experience, perhaps that is due to their continual use of the drug. I know for the first 2.5 months I had no ill effects. It was great for insomnia. If the sensitivity to noise hadn't become so unbearable (I live in New York City so noise sensitivity is an obvious liability here), and the onset of a depressive episode hadn't occured, I would still be taking the Ambien.
This is the end of the thread.
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