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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by tabitha on September 2, 2004, at 14:19:16
I've had the same problem with my meds for a while. SSRIs work well for my depression, but they give me insomnia. I've tried adjusting the dose downward to the point where I don't have insomnia, but then I don't get enough mood lift. So if I up the dose to where my mood is acceptable, then I have to add a sedating med for sleep. With the sedating med, I end up oversleeping. So my mood is good but I'm sleeping 10 or more hours per night. With that much sleep plus working fulltime my life gets pretty out of balance. Plus I just don't feel physically well with that combo.
So I keep ping-ponging, going for a while with undertreated depression, then going for a while with the oversleep.
I just can't see a solution. I've tried other ADs but have an even harder time with their side effects. Any ideas? Maybe I'm missing something.
Posted by King Vultan on September 2, 2004, at 15:49:00
In reply to SSRIs versus Insomnia, posted by tabitha on September 2, 2004, at 14:19:16
I guess I would suggest perhaps substituting some of the nights of the week a benzo-type sleep aid with a shorter half life so that you don't oversleep, such as Sonata, Ambien, or Halcion--or perhaps Restoril if you wake up too soon on one of these. You might also try a lower dosage of the sedating med (I assume you are using something like trazodone or Remeron), or perhaps look at an antihistamine with a shorter half life, such as diphenhydramine (Benadryl), doxylamine (Unisom tablets), or hydroxyzine, which is a prescription antihistamine.
Todd
Posted by tabitha on September 2, 2004, at 23:51:41
In reply to Re: SSRIs versus Insomnia, posted by King Vultan on September 2, 2004, at 15:49:00
I used traz for a while, the doc took me off it due to pounding-heart. I hated it anyway, it gave me a sickening knocked-out feeling. Same with Remeron & doxepin. For a while I used nortryptiline, but it dried my mouth so badly, I didn't want to be on it long-term out of fear of dental problems. I used Neurontin for a while-- that's when I was sleeping >12 hours. Used Serzone for a time, but I had consistent unpleasant bowel issues with it.
Ambien helps with getting to sleep but not with the early-morning awakening, so I need something more long-acting. The ambien also seems to poop out after 2 nights in a row-- I never really tried using it nightly. I'm kind of reluctant to get a benzo dependency anyway.
You say Benadryl & unisom are short lived? That's what I've been using lately, plus melatonin. The melatonin alone was good when I was on a lower dose of SSRI. That didn't work after the increase, so I added unisom.
I take the melatonin plus 1/4 of a unisom and I'm out for 10+ hours, plus very groggy on awakening. If I take 1/2 a tab I'll be out for 11-12. One Benadryl seems equivalent to 1/2 unisom-- I don't use it much since it's a capsule and harder to split.
Maybe I should just try 1/8 of a tab. I don't think it's the best sleep anyway. I get really dark circles under my eyes after a while.
Posted by King Vultan on September 3, 2004, at 8:01:36
In reply to Re: SSRIs versus Insomnia, posted by tabitha on September 2, 2004, at 23:51:41
>
> Ambien helps with getting to sleep but not with the early-morning awakening, so I need something more long-acting. The ambien also seems to poop out after 2 nights in a row-- I never really tried using it nightly. I'm kind of reluctant to get a benzo dependency anyway.
>
> You say Benadryl & unisom are short lived? That's what I've been using lately, plus melatonin. The melatonin alone was good when I was on a lower dose of SSRI. That didn't work after the increase, so I added unisom.
>
> I take the melatonin plus 1/4 of a unisom and I'm out for 10+ hours, plus very groggy on awakening. If I take 1/2 a tab I'll be out for 11-12. One Benadryl seems equivalent to 1/2 unisom-- I don't use it much since it's a capsule and harder to split.
>
I alternate between a benzo one night and an antihistamine the next to avoid acquiring a tolerance of either. This really seems to work pretty well for me. Restoril is the benzo that is best for maintaining sleep but is not as good as Ambien, Sonata, or Halcion for falling asleep. The benzo I use is Halcion at half a pill, 0.125 mg/night, but I do wake up after about five hours. However, I also use a sleep/relaxation CD that keeps me relaxed enough so that I am able to fall back asleep. Back in the old days when I used to wake up in the middle of the night while on Zoloft or Effexor, I was using zero sleep aids, and it sometimes took me two or three hours to fall back asleep--not a very good thing at all.The antihistamines in Benadryl and the Unisom tablets are relatively short acting in comparison to some of the sedating ADs such as Remeron, or perhaps even trazodone, but that's not to say they are not necessarily completely without aftereffects the next day. You are correct that the Unisom tablets are stronger, as 25 mg doxylamine succinate is considered roughly equivalent to 50 mg diphenhydramine hydrochloride. My insomnia appears to be worse than yours, as I need to take 2 x 25 mg Benadryl or 1 x 25 of the Unisom tablets to have any chance of a good night's sleep, and I will certainly wake up at least once or twice, anyway. BTW, Benadryl is also available in tablets, in both brand and generic forms. If you are finding these types of products too strong, you might also want to experiment with other antihistamines that are not as powerful sedative/hypnotics, such as what is in the Dramamine products. Even the stuff in the non-drowsy Dramamine (meclizine) makes me drowsy, but I have not actually tried it for sleep.
Todd
Posted by Sad Panda on September 3, 2004, at 12:20:43
In reply to SSRIs versus Insomnia, posted by tabitha on September 2, 2004, at 14:19:16
Hi Tabitha,
How long did you stay on Remeron & Doxepin for? I found with Remeron that the oversleeping went away after a month or so of taking it every night. Also, it is very potent. 7.5 mg is a good place to start.
Cheers,
Panda.
Posted by tabitha on September 3, 2004, at 13:36:13
In reply to Re: SSRIs versus Insomnia, posted by Sad Panda on September 3, 2004, at 12:20:43
I must admit I didn't stay on either of them long at all. I ditched the remeron after reading up and finding it was a weight-gainer. The doxepin was given to me as a sleep aid-- he told me to take 150 mg. I tried 50 mg, got the most awful sick knocked-out feeling from it, like I had to lie down at once or I was going to pass out. Then the next morning woke with a hangover and a HUGE food craving. I'm normally not hungry til a couple hours after waking. The hangover lasted all day long. I may have only tried that one the one time. He had also told me it was not a tricyclic, but it is. I would not have even used it if I'd known. That was probably my most dramatically unpleasant med experience.
Posted by tabitha on September 3, 2004, at 13:37:04
In reply to Re: SSRIs versus Insomnia » tabitha, posted by King Vultan on September 3, 2004, at 8:01:36
Thanks for the tips. I've not tried restoril, or dramamine, or the alternating nights trick.
Posted by Sad Panda on September 4, 2004, at 0:02:33
In reply to Re: SSRIs versus Insomnia » Sad Panda, posted by tabitha on September 3, 2004, at 13:36:13
> I must admit I didn't stay on either of them long at all. I ditched the remeron after reading up and finding it was a weight-gainer. The doxepin was given to me as a sleep aid-- he told me to take 150 mg. I tried 50 mg, got the most awful sick knocked-out feeling from it, like I had to lie down at once or I was going to pass out. Then the next morning woke with a hangover and a HUGE food craving. I'm normally not hungry til a couple hours after waking. The hangover lasted all day long. I may have only tried that one the one time. He had also told me it was not a tricyclic, but it is. I would not have even used it if I'd known. That was probably my most dramatically unpleasant med experience.
>
>10mg would be a good starting place for Doxepin, used for depression you still wouldn't start at 150mg or even 50mg. :) Did Remeron cause hunger? Weight gain when taking TCA's or Remeron is caused by food cravings. Fortuneately I have been lucky not to get them.
Cheers,
Panda.
Posted by toughgirl on September 4, 2004, at 9:50:01
In reply to Re: SSRIs versus Insomnia » tabitha, posted by King Vultan on September 3, 2004, at 8:01:36
Hi all. I seem to have pretty bad insomnia but I have noticed that I dont need as much sleep as I used to. Has anyone else noticed this?
This is the end of the thread.
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