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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 flipsactown on May 8, 2004, at 21:34:44
I can't believe it! I just got a phone call from my outgoing pdoc's office where I sent a fax. He was the one that was adamant that Trazodone was very contraindicated with Nardil, so now he Rx's Seroquel which I understand is for bipolar and schizophrenia. I have unipolar depression mainly caused by chronic low back pain which I suffered in 1980's when I was struck by a truck.
I have an appointment with a new pdoc later next week but because I have not gotten any quality sleep since I started Nardil 4 weeks ago, I was desperate to get an Rx for insomnia. Do you good people think Seoquel is appropriate for unipolar depression? It appears to me that this outgoing pdoc is not going to give me the satisfaction of proving to him that Trazodone is being used for Nardil induced insomnia.
I have decided not to pick up the Seroquel which is already waiting for me at Kaiser Pharmacy. I will wait until later next week when I see my new pdoc and hope that he will be more open in the use of Trazodone for insomnia. Anyway, I have some left over Remeron which I can take to help me sleep, but I don't want the weight gain either. I gained 40 lbs on Remeron. I would rather take my chances on Trazodone. Your thoughts will be much appreciated.
Again here is the website addressing Trazodone:
http://www.currentpsychiatry.com/2002_06/06_02_maoi.asp
"Trazodone is frequently employed as a remedy for
MAOI-induced insomnia.19 Mirtazapine can be used safely
in combination with MAOIs, and the agent has been
reported to acutely treat serotonin syndrome.20"19. Nierenberg AA, Keck PE Jr. Management of
MAOI-associated insomnia with trazadone. J Clin
Psychopharmacol 1989:9(1):42-5.
20. Hoes MJ, Zeijpveld JH. Mirtazapine as a treatment
for serotonin syndrome. Pharmacopsychiatry 1996;29(2):81.FST
Posted by harryp on May 9, 2004, at 2:36:06
In reply to Seroquel for Nardil Induced Insomnia, posted by flipsactown on May 8, 2004, at 21:34:44
Good for you.
I do not understand why for the past five years or so psychiatrists have been prescribing antipsychotics reflexively to people who obviously do not need them. The SE profile of all the AP's is horrible for many, orca-grade weight gain (esp. atypicals), occasional diabetes (atypicals), "lobotomy effect" (all--that was their original purpose, after all), tardive dyskinesia (all--yes even the newer ones), not to forget possible neuroleptic malignant syndrome!
I had three different major med-school faculty members put me on AP's (instead of benzos--which have a long safety record but--oh no!--could cause dependency!) I can't count how many people I know or have read about on PB who have been inappropriately given AP's.
It's simple incompetence. I manage my own meds now by necessity.
Thanks for listening to me rant!
In response...
Like the other AP's, Seroquel can be useful in controlling psychotic symptoms or near-psychotic anxiety. It is incredibly sedating, though and is especially bad in the weight gain department. I cannot conceive how it would be useful in non-psychotic depression.
All the serious MAOI literature agrees that Trazodone is ideal for MAOI-induced insomnia. I use it myself.Your doctor likely got skittish about the Trazodone because the prescribing info says you shouldn't use it with MAOI's. I believe this is because it is serotonergic, and someone thought that it might cause serotonin syndrome if used with a MAOI. This might be a problem with very high dosages, but when used at sleep-aid dosages it appears to be perfectly safe.
Posted by King Vultan on May 9, 2004, at 10:00:28
In reply to Re: Seroquel for Nardil Induced Insomnia » flipsactown, posted by harryp on May 9, 2004, at 2:36:06
Your thoughts echo mine on the subject of atypical antipsychotics--I do not understand why they are so widely prescribed with their horrible side effect profile to people who are not schizophrenic to begin with. Interestingly, when I discussed sleep aids with my pdoc (whom I have a fairly high opinion of) for my own Nardil insomnia, he also mentioned either Seroquel or Zyprexa--I forget which--as an alternative to the trazodone that I was interested in trying. I did get a prescription for trazodone, and while it did induce sleep at 25-50 mg/night, it unfortunately did not really agree with me and left me feeling rather out of sorts the next day.
So as a stopgap until my next appointment, I am using 2 x 25 mg/night Benadryl (the plain, allergy only version, which is equivalent to generic diphenhydramine). I'm still waking up several times a night but am generally able to get back to sleep and am making a go of it. My pdoc said I could use Ambien every night if I wished to because the drug is sitting on the receptor for such a short length of time, but with a $50/month copay and questionable efficacy in my case, I am looking for other options. An older drug that I'm interested in which is only a $10 copay on my insurance is triazolam (Halcion). I don't think it's as safe as Ambien, but it does have a relatively short half life, and I was thinking maybe I would bring it up at my next appointment.
Todd
Posted by SLS on May 9, 2004, at 10:38:40
In reply to Re: Seroquel for Nardil Induced Insomnia » harryp, posted by King Vultan on May 9, 2004, at 10:00:28
> An older drug that I'm interested in which is only a $10 copay on my insurance is triazolam (Halcion). I don't think it's as safe as Ambien, but it does have a relatively short half life, and I was thinking maybe I would bring it up at my next appointment.
Hi Todd.Halcion is more powerful than most, if not all, benzos to help someone fall asleep. For some people, however, it does not act long enough to allow them to sleep the whole night. Some people even complain of a rebound insomnia when they do wake up in the middle of the night. I needed to use it when I was on Parnate, because falling asleep was so difficult. What I ended up doing was taking both Halcion and Ativan together. The Ativan prevented the early morning awakenings. Restoril is another good drug for allowng someone to stay asleep, but is generally less effective at initiating sleep. My experience with Halcion and MAOI induced insomnia is that Halcion just doesn't do the trick for a full night's sleep. I have had some success using Ativan alone. It is also cheap as the generic lorazepam.
Good luck.
- Scott
Posted by flipsactown on May 9, 2004, at 11:44:44
In reply to Re: Seroquel for Nardil Induced Insomnia » flipsactown, posted by harryp on May 9, 2004, at 2:36:06
Thanks everyone for your input.
I hope Trazodone will allow me to sleep throughout the night for at least 6 or 7 hours, if not more. I have taken Remeron for 4 days now and my voracious appetite has returned, especially for chocolates and sweets. When I went off the Remeron, I was able to limit my intake of both.
I am currently taking OTC generic Benadryl and while it is helping me to fall asleep, I am wide awake in a couple of hours and unable to go back to sleep until I take another dose of 50mg Benadryl in 4 or 5 hours. What is strange is, although I am only getting 1 to 2 hours of continous sleep, I feel refreshed and am able to do a lot of house chores I have been procrastinating about, which is a good thing, except that I am having to take more pain meds for my chronic back pain.
FST
> Good for you.
>
> I do not understand why for the past five years or so psychiatrists have been prescribing antipsychotics reflexively to people who obviously do not need them. The SE profile of all the AP's is horrible for many, orca-grade weight gain (esp. atypicals), occasional diabetes (atypicals), "lobotomy effect" (all--that was their original purpose, after all), tardive dyskinesia (all--yes even the newer ones), not to forget possible neuroleptic malignant syndrome!
>
> I had three different major med-school faculty members put me on AP's (instead of benzos--which have a long safety record but--oh no!--could cause dependency!) I can't count how many people I know or have read about on PB who have been inappropriately given AP's.
>
> It's simple incompetence. I manage my own meds now by necessity.
>
> Thanks for listening to me rant!
>
> In response...
>
> Like the other AP's, Seroquel can be useful in controlling psychotic symptoms or near-psychotic anxiety. It is incredibly sedating, though and is especially bad in the weight gain department. I cannot conceive how it would be useful in non-psychotic depression.
>
>
> All the serious MAOI literature agrees that Trazodone is ideal for MAOI-induced insomnia. I use it myself.
>
> Your doctor likely got skittish about the Trazodone because the prescribing info says you shouldn't use it with MAOI's. I believe this is because it is serotonergic, and someone thought that it might cause serotonin syndrome if used with a MAOI. This might be a problem with very high dosages, but when used at sleep-aid dosages it appears to be perfectly safe.
Posted by gardenergirl on May 9, 2004, at 12:04:49
In reply to Seroquel for Nardil Induced Insomnia, posted by flipsactown on May 8, 2004, at 21:34:44
I had similar side effects of early awakening when I started Nardil. It actually was good for me as excessive sleep was one of the symptoms of my atypical depression. But when it started getting as early as 4 a.m. it was kinda annoying. I did get a lot done and got to places on time for once. This effect, however, seemed to go away in time. I'm sorry you are having trouble with it right now, but it may go away when you are on Nardil longer. In fact, all of my SE's have gone away (at 45mg, some return when I am at 60mg), with the exception of hyperreflexia. And that's kind of fun when you are bored... :)
Good luck!
gg
Posted by Sad Panda on May 9, 2004, at 13:12:20
In reply to Seroquel for Nardil Induced Insomnia, posted by flipsactown on May 8, 2004, at 21:34:44
Seroquel or Zyprexa for sleep always sounds like a drug company reps idea to me.
Dirt cheap Doxepin would be good for sleep too.
Cheers,
Panda.
Posted by harryp on May 9, 2004, at 14:57:52
In reply to Re: Seroquel for Nardil Induced Insomnia » harryp, posted by King Vultan on May 9, 2004, at 10:00:28
Hi Todd,
I'm pretty sensitive to the trazodone, too. When my insomnia gets bad, I use 1 mg lorazapam and 25 mg trazodone, and I sleep very well for about 8 hours, without any hangover.
The trazodone-morning effect went away after only a couple days if I remember correctly.
Personally, I have found that a low dose of trazodone and possibly a low benzo dose makes a very good combo. You might want to try a quarter-tab trazodone with a short-acting benzo.
If you just react badly to trazodone, I think the benedryl is a good idea (maybe with a benzo). I don't recommend chlorpheneramine maleate, though, since its metabolism is greatly slowed by MAOI's and it really caused a "morning effect" for me.
Posted by flipsactown on May 9, 2004, at 20:01:08
In reply to Re: Seroquel for Nardil Induced Insomnia, posted by Sad Panda on May 9, 2004, at 13:12:20
Yes, it really does seem that way. It would seem likely that the Kaiser Health higher ups would want their pdocs to prescribe the lower costing drugs, especially in the beginning of treatment when there are old reliable less costing meds available. I think in my case, my former pdoc decided to rx me anything but Trazodone, to make a point to me that he had already made up his mind and that no faxed information, valid or not, would change it.
FST
> Seroquel or Zyprexa for sleep always sounds like a drug company reps idea to me.
>
> Dirt cheap Doxepin would be good for sleep too.
>
> Cheers,
> Panda.
>
Posted by nephron on May 10, 2004, at 3:53:31
In reply to Re: Seroquel for Nardil Induced Insomnia » harryp, posted by King Vultan on May 9, 2004, at 10:00:28
I don't know- I know one of my friends found Seroquel really good for sleeping- reducing nightmares also- at really low doses (25-50mg).
He'd tried just about everything else, but Seroquel did the trick.
Really depends on the individual person.
Posted by King Vultan on May 10, 2004, at 7:47:30
In reply to Re: Seroquel for Nardil Induced Insomnia » King Vultan, posted by SLS on May 9, 2004, at 10:38:40
Posted by Tony P on May 11, 2004, at 12:31:19
In reply to Re: Seroquel for Nardil Induced Insomnia, posted by nephron on May 10, 2004, at 3:53:31
I have used Seroquel the last couple of months for insomnia. I find it poor for me - long onset, short effectiveness and shallow uncomfortable sleep.
Even on 25-50 mg, not every night I have gained 15 lb. and am seeing my MD today about my cholesterol - tests ordered by my my pdoc who said "oh, yes"! But do others get significant weight gain on such small doses?
There've been a couple of other possible factors - weird depression eating habits like cookieholic;, and I had to go off DHEA about 3 months back, which helps prevent weight gain amongst other things but is hard to get in Canada.
Trazadone, alas is no longer available up here (take Rant as given). I agree with a previous poster who said DPH (diphenhydramine) is as good as anything other than the ususal Rx, and easily available in many antihistamine & OTC/counter sleep aids -- buy the cheapest generic 50 mg tabs or caplets and split them if it's too much.
Tony
This is the end of the thread.
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