Psycho-Babble Medication Thread 985294

Shown: posts 1 to 25 of 30. This is the beginning of the thread.

 

Sleep difficulty with MAOI

Posted by Sailboat77 on May 14, 2011, at 10:52:24

I've been having a lot of trouble sleeping lately. I take Parnate for treatment resistant depression and have difficulty both falling asleep and waking up in the middle of the night ----- I should mention that I also take small doses of Vyvanse (20mg) in the morning under my doctor's careful watch. I know the mixture of stimulants and MAOI's is said to be unsafe, but my doctor and I have made it work very well.

I've taken Ambien and Lunesta in the past, but they only work for a week before they become ineffective. The only thing that has consistently worked has been Seroquel, although it's not as effective as I would like. I also take Xanax from time to time, but I don't want to grow tolerant to it. My doctor agrees that my body is unusually resistant to sleep meds (it was the same way even before I took small doses of stimulants). Sleep is just so IMPORTANT for my mood that I need this fixed in order to manage my depression better.

Does anyone have suggestions for other sleep medications? Should I go back and try Ambien? Are there more powerful sleep meds on the market and are they safe enough to use?

-Thanks

 

Re: Sleep difficulty with MAOI » Sailboat77

Posted by floatingbridge on May 14, 2011, at 11:36:24

In reply to Sleep difficulty with MAOI, posted by Sailboat77 on May 14, 2011, at 10:52:24

Sailboat,

I want to follow this thread. I have sleep issues predating any med. Sleep aids, lunesta & sonata stopped working, so I'm back to xanax. I feel less rested. And now the xanax is escalating with the start of emsam. Soooo.

Some nights, a mix of 5mg of melatonin, (two mgs quick release, 3mgs of timed release), 250mg magnesium, and about 12mg zinc can help. Not many or all nights.

I was reconsidering ambien.

Any reason for you to hesitate about ambien?

 

Re: Sleep difficulty with MAOI » floatingbridge

Posted by SLS on May 14, 2011, at 12:15:59

In reply to Re: Sleep difficulty with MAOI » Sailboat77, posted by floatingbridge on May 14, 2011, at 11:36:24

What about combining Sonata and Ativan?

Sonata, with its short half-life, is good for initiating sleep, but not maintaining sleep. Ativan, with its longer half-life, is good at maintaining sleep, but not as good at initiating sleep. I have used this combination strategy with success.

The real bomb is Halcion + Ativan.


- Scott

 

Re: Sleep difficulty with MAOI » SLS

Posted by floatingbridge on May 14, 2011, at 12:45:10

In reply to Re: Sleep difficulty with MAOI » floatingbridge, posted by SLS on May 14, 2011, at 12:15:59

Scott, you know might know I'm a little skiddish about meds. Doesn't halcion have a checkered reputation? I remember something about sleepwalking?

I will think about it. But it doesn't quite get around the benzo....hmmm. Thank you for your input :-)

Sailboat, what do you think?

 

Re: Sleep difficulty with MAOI » floatingbridge

Posted by Phillipa on May 14, 2011, at 13:11:23

In reply to Re: Sleep difficulty with MAOI » SLS, posted by floatingbridge on May 14, 2011, at 12:45:10

Not Sailboat but I feel that if the xanax was working til the emsam that a temporary increase is okay as your dose is low. As for ambien that is one that causing strange amnesia in sleep. Lunesta doesn't that I'm aware of. Phillipa

 

Re: Sleep difficulty with MAOI » floatingbridge

Posted by SLS on May 14, 2011, at 13:19:30

In reply to Re: Sleep difficulty with MAOI » SLS, posted by floatingbridge on May 14, 2011, at 12:45:10

> Scott, you know might know I'm a little skiddish about meds. Doesn't halcion have a checkered reputation? I remember something about sleepwalking?

Amnesia, too.

Probably no more so than with Ambien.

I would not make Halcion my first choice to fill the role. I would choose Sonata first to add with the Ativan.

You gotta do what you gotta do. If nothing else is helping you, and your need for sleep is now critical, I would not hesitate to remedy it by using benzodiazepines. Hopefully, your need for sleep aids is only temporary.

My opinions here reflect my usage of these combinations myself. High dosages of Halcion never produced amnesia or sleep walking in me, even when combined with Ativan.


- Scott

 

Re: Sleep difficulty with MAOI » floatingbridge

Posted by SLS on May 14, 2011, at 13:37:14

In reply to Re: Sleep difficulty with MAOI » SLS, posted by floatingbridge on May 14, 2011, at 12:45:10

Of course, you are aware that sleep difficulties are a feature of fibroymalgia. It is possible that the Emsam is adding to this insomnia. I bet the insomnia abates over time, but it is difficult to say whether or not you will need sleep aids to help maintain sleep hygeine. It would be nice if you were to spontaneously recover a normal sleep-wake cycle. Be sure to work with your pain doctors to address your sleep difficulties.


- Scott

 

Re: Sleep difficulty with MAOI » floatingbridge

Posted by sigismund on May 14, 2011, at 14:10:21

In reply to Re: Sleep difficulty with MAOI » SLS, posted by floatingbridge on May 14, 2011, at 12:45:10

>Doesn't halcion have a checkered reputation?

William Styron said that it precipitated his depression.

"Darkness Visible"

 

Re: Sleep difficulty with MAOI » sigismund

Posted by SLS on May 14, 2011, at 14:44:23

In reply to Re: Sleep difficulty with MAOI » floatingbridge, posted by sigismund on May 14, 2011, at 14:10:21

> >Doesn't halcion have a checkered reputation?
>
> William Styron said that it precipitated his depression.
>
> "Darkness Visible"

I find that difficult to believe. Whose opinion was rendered in the book?


- Scott

 

Re: Sleep difficulty with MAOI

Posted by SLS on May 14, 2011, at 14:51:25

In reply to Re: Sleep difficulty with MAOI » sigismund, posted by SLS on May 14, 2011, at 14:44:23

As described in Wiki:

"Styron connects the onset of his depression with his sudden termination of his lifelong alcohol use, and argues that his condition was likely exacerbated by careless prescription of the drug Halcion"

It was Styron who came to this conclusion, not a doctor, as it seems he had to argue his case. I believe that it was his sudden termination of alcohol use and not the Halcion that precipitated his depression. If you have the book, perhaps you could check into this.


- Scott

 

Re: Sleep difficulty with MAOI » SLS

Posted by sigismund on May 14, 2011, at 17:00:35

In reply to Re: Sleep difficulty with MAOI » sigismund, posted by SLS on May 14, 2011, at 14:44:23

>Whose opinion was rendered in the book?

That was William Styron's opinion.

 

Re: Sleep difficulty with MAOI » SLS

Posted by sigismund on May 14, 2011, at 17:03:10

In reply to Re: Sleep difficulty with MAOI, posted by SLS on May 14, 2011, at 14:51:25

I don't know where the book is now. But I cannot recall the mention of alcohol, although he is clear in his opinion of the connection between his depression and Halcion.

I don't have an opinion about this, but some people do react badly to benzos in general and perhaps to halcion in particular.

 

Re: Sleep difficulty with MAOI » SLS

Posted by sigismund on May 14, 2011, at 17:10:54

In reply to Re: Sleep difficulty with MAOI, posted by SLS on May 14, 2011, at 14:51:25

I'll reread the relevant section.

Maybe the moral is that we only give up alcohol at our peril?

 

Re: Sleep difficulty with MAOI » sigismund

Posted by floatingbridge on May 14, 2011, at 17:50:20

In reply to Re: Sleep difficulty with MAOI » SLS, posted by sigismund on May 14, 2011, at 17:10:54

> Maybe the moral is that we only give up alcohol at our peril?

sigi, that's silly :-)

Gosh, writers and alcohol. A friend and I speculated once about a study we heard. Types of artists were ranked (somehow, who knows?) in order of mental illness and stability. Architects were the most
stable (and thank goodness if you think about it), and writers (esp fiction & poetry) won by a nose over musicians as far as being the most unstable.

We concluded that the medium was
responsible. Language being so weirdly
powerful yet intangible.

I think stopping drinking and/or starting
benzo's could precipitate a breakdown.

Was (is) Styron manic or unipolar? I could never get that straight. But it was lithium that pulled him through I believe.

 

Re: Sleep difficulty with MAOI

Posted by floatingbridge on May 14, 2011, at 18:07:35

In reply to Re: Sleep difficulty with MAOI » floatingbridge, posted by SLS on May 14, 2011, at 13:37:14

> Of course, you are aware that sleep difficulties are a feature of fibroymalgia. It is possible that the Emsam is adding to this insomnia. I bet the insomnia abates over time, but it is difficult to say whether or not you will need sleep aids to help maintain sleep hygeine. It would be nice if you were to spontaneously recover a normal sleep-wake cycle. Be sure to work with your pain doctors to
address your sleep difficulties.
>
>
> - Scott

Scott, you've probably read that sleep abnormalities might even (help) precipitate fibromyalgia. I am definitely looking at the sleep part of this. And I hope you are right about the insomnia abating. That would be great.

Still, I'm very interested in Sailboat's question. Because the insomnia does't respond as well to lunesta, sonata,
ambien.

I'll mention the ativan to my pdoc. I've also thought of Valium because longer half-life. The benzo's seem so varied in
effects. That doesn't mean I couldn't wisely trial a different one.

Thanks!

fb

 

Re: Sleep difficulty with MAOI

Posted by Sailboat77 on May 14, 2011, at 19:03:58

In reply to Re: Sleep difficulty with MAOI, posted by floatingbridge on May 14, 2011, at 18:07:35

Thanks everyone for your input. I've had sleep difficulties for as long as I've been on MAOI's (about 1 year). It's just strange how the Lunesta and Ambien stopped working in the past and how Seroquel was the only thing that worked to a certain degree.

All I know though is that I become more depressed with less sleep much like many people. I'll mention some of these meds to my doc and see what he says. I have a feeling I'll need a sleep aid for as long as I continue MAOI's, so this has to be a long term plan I'm guessing.

 

Re: Sleep difficulty with MAOI » Sailboat77

Posted by floatingbridge on May 14, 2011, at 22:02:41

In reply to Re: Sleep difficulty with MAOI, posted by Sailboat77 on May 14, 2011, at 19:03:58

> Thanks everyone for your input. I've had sleep difficulties for as long as I've been on MAOI's (about 1 year). It's just strange how the Lunesta and Ambien stopped working in the past and how Seroquel was the only thing that worked to a certain degree.
>
I agree that it's odd, too. Sonata, which I really liked just quit. That was before the
emsam, but it occurred just as I was about to give up on snri's. My pdoc said something definitely shifted. But what?

Have you tried sonata yet? And did you not like ambien (or did that not work)?

Has anyone mentioned the tca's in this thread? (Doxepin did not work for me, but does for some.)

I also take a muscle relaxant called zanaflex at night. 4mg. It is somehow different than other relaxants like, say, flexeril. No hangover or feeling muggy.

Good luck at the doc's. Will you let us know?

> All I know though is that I become more depressed with less sleep much like many people. I'll mention some of these meds to my doc and see what he says. I have a feeling I'll need a sleep aid for as long as I continue MAOI's, so this has to be a long term plan I'm guessing.

 

Re: Sleep difficulty with MAOI

Posted by Sailboat77 on May 15, 2011, at 0:59:55

In reply to Re: Sleep difficulty with MAOI » Sailboat77, posted by floatingbridge on May 14, 2011, at 22:02:41

Again, I appreciate your guys help so much and the experience you willingly share with me. I have tried tricyclics with no success but there is always the chance I can go back and give the Ambien or Lunesta another shot, although I wouldn't expect much from them considering the past dissapointment.

I have not yet tried "Sonata" + "Zanaflex" + " Ativan" + "Halcion"

I will discuss these medications with my doctor in 10 days or so. I've looked into them just a little bit so far.... are they generally more powerful than the other choices? I wouldn't mind something with a bigger kick because my body just won't sleep. Oh and also, can you use the meds on a regular basis or are they temporary?

_Much thanks all

 

Re: Sleep difficulty with MAOI

Posted by SLS on May 15, 2011, at 6:25:33

In reply to Re: Sleep difficulty with MAOI, posted by Sailboat77 on May 14, 2011, at 19:03:58

> Thanks everyone for your input. I've had sleep difficulties for as long as I've been on MAOI's (about 1 year). It's just strange how the Lunesta and Ambien stopped working in the past and how Seroquel was the only thing that worked to a certain degree.
>
> All I know though is that I become more depressed with less sleep much like many people. I'll mention some of these meds to my doc and see what he says. I have a feeling I'll need a sleep aid for as long as I continue MAOI's, so this has to be a long term plan I'm guessing.

Yes. Take the position that you will need to treat the insomnia with the same aggressiveness that you are treating the depression with, even though it is a side effect of another drug. This might mean using drug combinations. As a psyhchological strategy, CBT sometimes helps.


- Scott

 

Re: Sleep difficulty with MAOI » Sailboat77

Posted by floatingbridge on May 15, 2011, at 13:13:36

In reply to Re: Sleep difficulty with MAOI, posted by Sailboat77 on May 15, 2011, at 0:59:55

Sailboat,

Zanaflex only helps. It's part of my cumulative approach to creating optimal conditions for sleep.

Sonata used to work wonderfully, so if you haven't tried it, it could work. Seems that sleep aids are reccommended for a week or so max, but my pdoc said no
problem to nightly use. Given it's fast action, it's useful for sleep onset problems or mid-night awakenings. A full eight hours of time isn't necessary. I could take it at 3:00, even 4:00 am and be good to go by 7:00 or (ideally) 8:00.

(Hmmm. I might try it again for this
early awakenings that are now popping
up again....)

I had dug up some studies suggesting sonata created less disturbance of sleep architecture--but I think that is still debatable. I believe benzo's change the
architecture quite a bit--but some sleep is far better than no sleep. It's just
something to factor into a long term
sleep strategy.

There is a post on board right now about xyrem. That's considered by some to be heavy duty, and it's very controlled; however it is being carefully used by narcoleptics (with highly irregular sleep architecture to regulate) and off-label for others with chronic fatigue and other syndromes some success. It is suggested that it supports the most physically restorative stage of sleep (4?).

Good luck with this. I hope the parnate
is a long term helper for you, too.

fb

 

Re: Sleep difficulty with MAOI

Posted by Sailboat77 on May 16, 2011, at 0:20:38

In reply to Re: Sleep difficulty with MAOI, posted by Sailboat77 on May 15, 2011, at 0:59:55

I'll be sure to put up a post and let you guys know how it plays out when I see my doctor sometime mid-week. I'm interested to see what my doc will say about some of the medications we've discussed here.

And thanks for the encouragement, the Parnate with small doses of stimulants seems to have set me on a better path after 4 rough years in college.


(By the way, if anyone has questions about Major Depression and the treatment approach of MAOI's in combination with limited stimulant use, I would be happy to answer them if I can)

 

Re: Sleep difficulty with MAOI

Posted by creepy on May 16, 2011, at 8:32:54

In reply to Sleep difficulty with MAOI, posted by Sailboat77 on May 14, 2011, at 10:52:24

Prazosin worked well at knocking me out but it might drop your BP too low in combination with parnate.
What about antihistamines like hydroxyzine, or low dose seroquel?
sometimes I take a couple things to help me sleep. 1mg of melatonin with prazosin and/or benadryl.
Oddly, I found that hydroxyzine gives me a hangover the next day and benadryl does not.

 

Re: Sleep difficulty with MAOI

Posted by floatingbridge on May 16, 2011, at 8:41:13

In reply to Re: Sleep difficulty with MAOI » floatingbridge, posted by SLS on May 14, 2011, at 12:15:59

O.K. xanax isn't working. I woke up 3 hours after sleep onset! It used to last at least four.

I decided to revisit Sonata at 1:00am. Yes, I fell back asleep at 10mg. Good. Then awake again in 3 hours!

I usually sleep once asleep. Something has changed again.

Looking forward to what you find out Sailboat.

 

Re: Sleep difficulty with MAOI » floatingbridge

Posted by sigismund on May 16, 2011, at 16:17:47

In reply to Re: Sleep difficulty with MAOI, posted by floatingbridge on May 16, 2011, at 8:41:13

It makes the next day hard, doesn't it, like you have a hangover. And you get ratty and say things unwisely. If you're like me. And then what I do is get up and drink 6 cups of tea and the tea contains something other than caffeine that wrecks sleep the next night.

 

Re: Sleep difficulty with MAOI » floatingbridge

Posted by Phillipa on May 16, 2011, at 18:57:52

In reply to Re: Sleep difficulty with MAOI, posted by floatingbridge on May 16, 2011, at 8:41:13

FB am thinking Emsam has fully kicked in. Phillipa


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