![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by uncouth on September 21, 2011, at 11:07:49
Here is my report. If anyone else has some experience comparing, please add to this thread.
I have been on all three of these meds the past few weeks to help treat my bipolar 2, predominantly depression, and sleeplessness.
I went off of Saphris, which was working great for sleep. I was on it for a few months, 10mg at night, 5mg at night. I went off because i had this sneaking suspicion it was "tamping me down", less creative thoughts, some anti-dopamine activity. But it definitely helped with stability, and when things got really bad, increasing to 20mg a day was pretty antidepressive but I was very zonked.
So I went off. I tried nothign for a few weeks, to see what life "without an AAP" woudl be like, which I had not experienced in a long time. I held up OK mood wise, but sleep was a disaster---I just could not sleep. Normal sleep inducing meds weren't working, my dr. was convinced the only thing that would help would be another AAP.
So we tried Seroquel. First low dose, just for sleep. That worked. 50-100mg and i'd mostly sleep through the night. Half of the time even with that i'd wake up in the middle of the night and have to redose a bit. I'd feel a little groggy (well sometimes more than a little groggy) upon wakeup but it worked well and I got used to it.
I even think that low dose had some positive effect on mood. But I got a little unstable, could feel hypomania come on, low grade, with some obsessive symptoms, maybe definitely feeling some NE activation. So we increased dose to 200 and 300mg of the XR (before I was on the IR). Whoa. Totally zonked. But mood def. improved, at least the times when I wasn't laying on the couch during the day because I was so tired. So had to ditch that. Doc said seroquel probably not right med for me, either IR or XR.
So lastly we tried Latuda. I spent just three nights on it, so please bear that in mind. First night at 20mg, didn't help much with sleep initiation, woke up in the middle of the night. No good. But upon wakeup i felt pretty clear headed although tired. Not zonked, mood ok. Next night, 20mg, still didn't sleep through the night, had to dose a seroquel to help out. Last night, 40mg, still didnt sleep through, had to redose a seroquel (25-50mg) but felt pretty good next morning mood wise.
So since Latuda alone wasn't doing it for sleep, doc said go back on Saphris 10mg at night. Ugh, back to Saphris, whole point was to get off of AAP but I just have to sleep. Took 10mg last night, slept, had deep dreams (always have very deep dreams on saphris), woke up, but woke up feeling dysphoric! Total mood change. Realized that all those months on saphris, this is sorta how i felt, pretty blah upon wakefulness, definitely too much antagonism going on it feels like.
SO I'm back at Square One having felt a bunch of AAP effects the last few weeks. I hope my experience helps and it will help me to read it someday when I have to go through this again, I'll search and find my own experience! I think i'm going to experiment again with the Latuda, it did feel like a pretty clean drug and now that I'm experiencing Saphris, I think Latuda was good for mood although I only had 3 days on it. Maybe I will eventually start sleeping with Latuda only. Other than that, I might go back to Seroquel IR just for sleep to eliminate the heavy AAP feeling of Saphris, or dose 5mg saphris at night. But my differential on Saphris is that it is probably really good for stability but definitely took "something away" and caused some dysphoria compared to the others.
Seroquel 300xr when it kicked in really was great, toally get why its indicated for BP 2 depression, but totally intolerable in terms of sleepyness and fatigue. I didnt work out for a month on that drug!
Ok over and out.
Posted by Phillipa on September 21, 2011, at 11:29:47
In reply to Saphris vs Seroquel vs Latuda for BP2 depression, posted by uncouth on September 21, 2011, at 11:07:49
Wow that's a lot of changes. Don't know what to say? Phillipa
Posted by Christ_empowered on September 21, 2011, at 12:51:20
In reply to Re: Saphris vs Seroquel vs Latuda for BP2 depression » uncouth, posted by Phillipa on September 21, 2011, at 11:29:47
Have you tried other meds, like maybe Lamictal+a sleeping pill? AAP meds seem kind of heavy-duty for BP II.
Posted by uncouth on September 21, 2011, at 13:08:53
In reply to Re: Saphris vs Seroquel vs Latuda for BP2 depression, posted by Christ_empowered on September 21, 2011, at 12:51:20
Yeah tried lamictal, i like it but it caused memory and cognitive problems. My doctor seems to think sleeping pills won't work for me, like my insomnia is more dopamine related or something. We've tried lunesta traozdone antihistamines before. My problem is staying asleep and early morning awakening, agitated, instead of falling asleep.
He got back to me and said no to the experimentaiton and that i should try staying on saphris for the next few days and that dysphornia may abate but that if necessary i can backtrack to seroquel. we'll see.
Posted by SLS on September 21, 2011, at 15:29:30
In reply to Re: Saphris vs Seroquel vs Latuda for BP2 depression, posted by uncouth on September 21, 2011, at 13:08:53
> Yeah tried lamictal, i like it but it caused memory and cognitive problems. My doctor seems to think sleeping pills won't work for me, like my insomnia is more dopamine related or something. We've tried lunesta traozdone antihistamines before. My problem is staying asleep and early morning awakening, agitated, instead of falling asleep.
>
> He got back to me and said no to the experimentaiton and that i should try staying on saphris for the next few days and that dysphornia may abate but that if necessary i can backtrack to seroquel. we'll see.I recently tried combining zaleplon with lorazepam taken immediately before going to bed. It worked great. I suffer from an insomnia that presents as trouble falling asleep, multiple awakenings, and waking up too early. My sleep went from being very choppy to being smooth. I felt refreshed in the morning. I am hoping that using this treatment a few times a week will help entrain the brain to assume a more normal sleep pattern. Nardil probably screwed things up.
I don't think it matters whether you are BP I or BP II when choosing a hypnotic treatment. You use what works. I think that delegating Seroquel to be used exclusively with BP I and not BP II is a philosophical issue rather than a medical one.
I remember when I was scared to death to take
Zyprexa when it first came out. As my alternatives dwindled, so did my resistance to taking AAPs. I think I have tried every AAP except for clozapine. I have had no movement EPS. Akathisia may have occurred with Abilify early in treatment, but it soon dissipated.
- Scott
- Scott
Posted by floatingbridge on September 22, 2011, at 14:23:13
In reply to Saphris vs Seroquel vs Latuda for BP2 depression, posted by uncouth on September 21, 2011, at 11:07:49
Uncouth, can you provide anymore information about this:
> My doctor seems to think sleeping pills won't work for me, like my insomnia is more dopamine related or something.
I haven't heard sleep and dopamine put together before. It's usually GABA I hear about.
I have similar sleep issues, and the z's have cr*pp*d out, and benzos escalating.
Interesting.
(Sorry I don't know the answer to your question.)
Posted by B2chica on September 22, 2011, at 15:22:03
In reply to Saphris vs Seroquel vs Latuda for BP2 depression, posted by uncouth on September 21, 2011, at 11:07:49
sorry to tack on another AAP but have you done the zyprexa route?
it usually helped me with sleep, maybe not always at 5 but usually at 10.
just a suggestion.
b2c.
Posted by SLS on September 22, 2011, at 15:42:56
In reply to Re: Saphris vs Seroquel vs Latuda for BP2 depression » uncouth, posted by B2chica on September 22, 2011, at 15:22:03
> sorry to tack on another AAP but have you done the zyprexa route?
>
> it usually helped me with sleep, maybe not always at 5 but usually at 10.
>
> just a suggestion.
> b2c.
>The main liability to taking Zyprexa is weight-gain and diabetes. Otherwise, it does good work to treat mania and bipolar depression. I'm not so sure about its potential to treat unipolar depression or anxiety disorders. These uses remain debated.
You might want to look into the use of metformin to prevent weight gain and diabetes. I have never tried it.
- Scott
Posted by uncouth on September 22, 2011, at 22:17:50
In reply to Re: Saphris vs Seroquel vs Latuda for BP2 depression » uncouth, posted by B2chica on September 22, 2011, at 15:22:03
> sorry to tack on another AAP but have you done the zyprexa route?
>
> it usually helped me with sleep, maybe not always at 5 but usually at 10.
>
> just a suggestion.
> b2c.
>yeah zyprexa big no no, hunger issues out of control, although i think zyprexa is one of the most efficacious meds i've ever tried. but big big weight gain, even with metformin. it also helps with sleep
Posted by uncouth on September 22, 2011, at 22:24:52
In reply to Re: Saphris vs Seroquel vs Latuda for BP2 depression » uncouth, posted by floatingbridge on September 22, 2011, at 14:23:13
> Uncouth, can you provide anymore information about this:
>
> > My doctor seems to think sleeping pills won't work for me, like my insomnia is more dopamine related or something.
>
> I haven't heard sleep and dopamine put together before. It's usually GABA I hear about.
>
> I have similar sleep issues, and the z's have cr*pp*d out, and benzos escalating.
>
> Interesting.
>
> (Sorry I don't know the answer to your question.)i dont know but i trust my pdoc, he's one of the best in the area. i think the d2 antagonism helps to settle the brain in a way other things can't. i mean my experience was that this time, that seemed to be totaly true. maybe the antipsychotics screwed me up or sent my brain to an equilibrium point which then required some d2 antagonism to go to sleep (my most likely guess) becuase I used to be able to sleep through the night (both go to sleep and stay asleep) just fine with trazodone or lunesta, but now, this time, neither of them worked sufficiently.
so far so good, last two nights of saphris totally knocked me out, slept like a baby, but woke up feeling pretty groggy and out of it until afternoon. so going to try seroque low dose instead (once again) and see if i can make it through the night without getting hypomanic risk or depression the next day. saphris definitely does exert a stabilization effect on the brain, that is for sure. not sure i like it though!
also been using my CES device the last few days, after reading another study came out recently showing CES has positive effects on insomnia. i hadn't been using the CES functionality of the device for a few months regularly, instead I was using the device for tDCS for the past few weeks. but i dont think it shealthy to be sending DC thorugh my brain every day, all the studies for tDCS were somewhat time delimited, so i'm taking month long breaks in between my 4 weeks of tDCS. we'll see. who knows, not sure that tdcs is even working but hey its something and hey i'm not suicidal so all i know is that something chemical electrical sleepywise or therapy wise is working at least SOMEWHAT. now i just need job money girlfriend romance sex motivation fun house family weightloss to be happy! ;-)
Posted by floatingbridge on September 23, 2011, at 16:06:43
In reply to Re: Saphris vs Seroquel vs Latuda for BP2 depression, posted by uncouth on September 22, 2011, at 22:24:52
Uncouth, thanks for explaining more about your pdoc's dopamine/insomnia connection.
Risperdone used to knock me out, but no more. I wake w/in two hours if that's all I have on board for the night.
Glad you got some good sleep with saphris. Don't know really anything about it except it's sublingual and supposedly very fast acting (?).
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.