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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Lamdage22 on August 6, 2021, at 0:43:16
Hey guys, the outside world miraculuosly pulled another trigger on me and I can't wind down at night. Yesterday I took 2mg Lorazepam. I don't want to get addicted, so I am looking for an alternative.
Posted by linkadge on August 6, 2021, at 14:08:05
In reply to Carbamazepine to calm down at bedtime?, posted by Lamdage22 on August 6, 2021, at 0:43:16
magnesium, niacin, valerian combo
carbamazepine could help, but its not quite as selective towards anxiety as a benzo, but it could help.
Linkadge
Posted by Lamdage22 on August 10, 2021, at 9:10:35
In reply to Re: Carbamazepine to calm down at bedtime?, posted by linkadge on August 6, 2021, at 14:08:05
The psychiatrist said this is not a problem to be solved pharmacologically. I like that. He gave me Prothipendyl to be taken as needed. He doesnt think I should restart antidepressants either, if I interpret his facial expression right. I made so many bad experiences, maybe it made me blind to the good guys working in the mental health field.
Posted by Lamdage22 on August 10, 2021, at 9:31:19
In reply to Re: Carbamazepine to calm down at bedtime?, posted by Lamdage22 on August 10, 2021, at 9:10:35
I hold the belief that you first have to recover somewhat and have to have some insight before you can tell wether its a good or a bad guy or gal infront of you. (Adult) children of dysfunctional families have a tendency to call and see the weirdest possible Psychologist or Doctor. That is my hypothesis. I have seen it with my mother. She seems to have seen mostly extremely unprofessional people.
Like they talked much more about the Therapists problems than hers, even though she paid him. And these problems were really effed up, too. WTF? I could tell you many more equally disturbing tales.
They are used to weird dynamics, so they are drawn to weird people. They feel at home there.
That is the most unsettling thing. If you had a broken home, you are likely to create a broken home yourself unless you get decent therapy. Cruel No insight= no therapy. But yeah, how do you prevent that? Maybe more awareness and media coverage?
Posted by SLS on August 10, 2021, at 12:17:14
In reply to Re: Carbamazepine to calm down at bedtime?, posted by linkadge on August 6, 2021, at 14:08:05
> magnesium, niacin, valerian combo
>
> carbamazepine could help, but its not quite as selective towards anxiety as a benzo, but it could help.
>
> Linkadge
My vote is for zolpidem (Ambien).1. I would recommend zolpidem if your problem is an over-active mind at bedtime. It really works almost like triazolam (Halcion) as far as sleep-initiation is concerned. Like triazolam, zolpidem knocks you out relative quickly. Like triazolam, zolpidem also has a short half-life. Perhaps there is an extended release version. I'm too lazy at the moment.
2. It is incredibly clean, and I don't think it interferes with sleep architecture. Perhaps Linkadge could take a closer look at this.
3. Zolpidem is more for sleep-initiation than sleep maintenance. However, I found that an early awakening (rebound?) still allows you to fall asleep quite easily again.
4. There are no withdrawal symptoms like those of benzodiazepines. You can actually stop taking 10 mg abruptly all at once. The consequence of this is limited to difficulty sleeping for a perhaps a week. However, I would make the initial decrease in dosage to be no lower than 5.0 mg. I had more "light sleep" as opposed to complete insomnia.
I have since restarted zolpidem because my behavioral sleep hygiene became chaotic.
_________________________________________________________________
BIG NEWS!SLEEP HYGIENE and depression.
Please read!!!
My personal experience with poor sleep hygiene and relapse of depression:
After 3 consecutive days of getting less than 4 hours of sleep, I experienced the reemergence of depression - a partial relapse of significant severity. After a single night of normal sleep, I recovered almost completely, although I did fade a little towards evening. Today, I have returned to where was previous to the sleep deprivation.
The cause-and-effect was unequivocal.
When I was a research patient at the National Institutes of Health (NIH), I was required to go to bed at exactly 11:00 PM. In the morning, I was not allowed to leave the room until exactly 7:00 AM. Sleep cycles were maintained throughout my stay there. Thomas Wehr and Norman Rosenthal were on their staff. Dr. Wehr researched biological rhythms. Dr. Rosenthal is credited as having described Seasonal Affective Disorder (SAD). In actuality, much of the theoretical work was performed by Peter S. Mueller.
- Scott
Posted by Lamdage22 on August 10, 2021, at 14:01:26
In reply to Re: Carbamazepine to calm down at bedtime?, posted by Lamdage22 on August 10, 2021, at 9:10:35
80mg Prothipendyl does the job. Today I am trying without becaise I am really tired. Im not sure, is that even available in the US&A. (Little Borat reference:))
Posted by undopaminergic on August 12, 2021, at 7:22:13
In reply to Re: Carbamazepine to calm down at bedtime?, posted by Lamdage22 on August 10, 2021, at 14:01:26
> 80mg Prothipendyl does the job. Today I am trying without becaise I am really tired. Im not sure, is that even available in the US&A. (Little Borat reference:))
>I've never heard of prothipendyl. It's my impression that Germany has some unusual drugs available to prescribers. There is perazine too, for example, which I only heard of recently.
So, he prescribed it after saying it was not a problem to be resolved pharmacologically?
-undopaminergic
Posted by Lamdage22 on August 24, 2021, at 0:50:50
In reply to Re: Carbamazepine to calm down at bedtime?, posted by undopaminergic on August 12, 2021, at 7:22:13
Posted by undopaminergic on August 24, 2021, at 9:14:25
In reply to So Zolpidem is less addictive than Lorazepam? (nm), posted by Lamdage22 on August 24, 2021, at 0:50:50
> So Zolpidem is less addictive than Lorazepam? (nm)
I think so. It is a more partial GABA-receptor modulator that has found use specifically for insomnia, rather anxiety for instance, and I think the anti-anxiety property is the most addictive aspect of benzodiazepines. Psychologically, however, it is probably as addictive as other hypnotics.
-undopaminergic
Posted by SLS on August 24, 2021, at 13:18:05
In reply to Re: So Zolpidem is less addictive than Lorazepam?, posted by undopaminergic on August 24, 2021, at 9:14:25
> > So Zolpidem is less addictive than Lorazepam? (nm)
Absolutely!
And check this out: You can stop taking zolpidem (Ambien) all at once and suffer no withdrawal effects except for a short stint of partial rebound insomnia.
>
> I think so. It is a more partial GABA-receptor modulator that has found use specifically for insomnia, rather anxiety for instance, and I think the anti-anxiety property is the most addictive aspect of benzodiazepines. Psychologically, however, it is probably as addictive as other hypnotics.
>
> -undopaminergicYou are 100% right about becoming psychologically dependent on zolpidem. If your mind is very active when you go to bed, zolpidem is great. However, you start taking the easy way out. You don't bother to ever sooth your mind to allow yourself to fall asleep. Zolpidem does it for you. Sleep comes on all at once. You don't remember much the next morning. It is almost as amnesic as triazolam (Halcion). There is really no system wide physiological dependence that develops. No rebound anxiety. No tremors. No brain zaps. I have done this before. This time, I will be coming off of it by cutting the pills in half initially, and moving down from there. It depends on how much rebound insomnia emerges.
DANGER: Night eating.
- Scott
Posted by linkadge on August 29, 2021, at 19:59:38
In reply to Re: So Zolpidem is less addictive than Lorazepam?, posted by SLS on August 24, 2021, at 13:18:05
>And check this out: You can stop taking zolpidem >(Ambien) all at once and suffer no withdrawal >effects except for a short stint of partial >rebound insomnia.
I would push back on that a little bit. I think initially it was promoted as being less addictive than benzos, but I don't know if this has been confirmed.
Personally, I have found it harder to discontinue Z drugs than benzos.
From Pubmed:
Main message: Evidence of drug abuse and dependency was found in case reports and small patient series. Dependency symptoms of severe rebound, severe anxiety, tremor, palpitations, tachycardia, and seizures were observed in some patients after withdrawal. Abuse occurred more commonly among patients with previous drug abuse or psychiatric illnesses. Many clinical trials have found evidence of rebound insomnia after recommended dosages were stopped, albeit for a minority of patients. Comparative studies of zopiclone and benzodiazepines or other "Z" drugs are conflicting.
https://pubmed.ncbi.nlm.nih.gov/18077750/
Conclusion: Zopiclone has the potential for being an agent of abuse and addiction. While many have suggested that the addictive potential for this and other "Z" drugs is less than for most benzodiazepines, caution should be taken when prescribing this agent for insomnia. Ideally, prescriptions should be given for a short period of time and within the recommended dosage guidelines.
However, this is an area that I have not fully explored, so I don't know for sure.
Linkadge
Posted by SLS on August 30, 2021, at 16:32:28
In reply to Re: So Zolpidem is less addictive than Lorazepam? » SLS, posted by linkadge on August 29, 2021, at 19:59:38
Hi, Linkadge.
I hope things aren't too rough at the moment.
> >And check this out: You can stop taking zolpidem >(Ambien) all at once and suffer no withdrawal >effects except for a short stint of partial >rebound insomnia.
>
> I would push back on that a little bit. I think initially it was promoted as being less addictive than benzos, but I don't know if this has been confirmed.
>
> Personally, I have found it harder to discontinue Z drugs than benzos.
I am very surprised to hear you report that Z drugs produce a more intense withdrawal syndrome than BZDs. Was Ambien (zolpidem) among those you tried?The abstract you cited regarding zopiclone is pretty scary. I'm glad you posted it. I can only personally attest to zolpidem and me. I had absolutely no hint of typical benzodiazepine withdrawal symptoms when I stopped taking it abruptly. The first two or three nights, I experienced frequent awakenings. Also, I could tell that it was a much lighter sleep. It was an unambiguous rebound sleep disturbance. Unfortunately, I chose to restart it during a particularly difficult time emotionally. There are a couple of things I can report regarding Ambien.
1. Sleep sneaks up on you abruptly and there is a strange amnesia as to actually feeling yourself fall asleep. I never knew that memory somehow records the sensation of falling asleep. I guess it's normally gradual enough to remember vaguely.
2. Whatever you do, do NOT go near the kitchen after taking Ambien, even if you wake up later in the night. If I leave my bedroom, I wake up finding that I had binged on a large amount of carbohydrates. Bread with butter is my weakness. Each time, you think you will be able to control yourself, even if you swear to not open the refrigerator under any circumstances. There is no sense of satiation and self-discipline disappears.
3. Taking Ambien sublingually maximizes its potency to initiate sleep, but might eventually lead to regular single rebound awakening 2-3 hours later. However, it is easy to fall back to sleep. Ambien has a very short half-life (2.5 - 3.5 hours?). Maybe I should try taking it orally to find out if I experience an awakening.
4. One can become psychologically dependent on Ambien. It's the lazy man's way of getting to sleep when your mind is occupied or otherwise active. You don't have to worry about soothing the thoughts in order to fall asleep. It's a quick fix. You become habituated to the routine, and always have a reason why you need it that particular night. Soon, it becomes a regular part of your daily routine.
5. Ambien can produce a strange, but brief period of mild stimulation at first. My doctor noted that happening to many of his patients. Stay in bed and away from the refrigerator!
7. Ambien, like Halcion (triazolam) - the most potent hypnotic benzodiazepine, can produce retrograde amnesia for events that occurred immediately before the onset of sleep. Both are very potent, and both have a very short half-life. Halcion is used for aerophobia and for anxious dental patients. The retrograde amnesia leaves them with no memory of the event, including the application of injections or the process of being given anesthesia.
8. It appears to me that both Ambien and Halcion have a liability for producing rebound awakenings. However, I have been taking Ambien sublingually rather than orally, which might account for this. There is probably a tendency for a large spike in blood levels to occur when taken Ambien sublingually.
I intend to discontinue Ambien again in a few days. I'll start off with taking 1/2 of the 10 mg tablet. I'll let you know how I do.
- Scott> From Pubmed:
>
> Main message: Evidence of drug abuse and dependency was found in case reports and small patient series. Dependency symptoms of severe rebound, severe anxiety, tremor, palpitations, tachycardia, and seizures were observed in some patients after withdrawal. Abuse occurred more commonly among patients with previous drug abuse or psychiatric illnesses. Many clinical trials have found evidence of rebound insomnia after recommended dosages were stopped, albeit for a minority of patients. Comparative studies of zopiclone and benzodiazepines or other "Z" drugs are conflicting.
>
> https://pubmed.ncbi.nlm.nih.gov/18077750/
>
> Conclusion: Zopiclone has the potential for being an agent of abuse and addiction. While many have suggested that the addictive potential for this and other "Z" drugs is less than for most benzodiazepines, caution should be taken when prescribing this agent for insomnia. Ideally, prescriptions should be given for a short period of time and within the recommended dosage guidelines.
>
> However, this is an area that I have not fully explored, so I don't know for sure.
>
> Linkadge
Posted by Lamdage22 on August 30, 2021, at 20:58:26
In reply to Re: So Zolpidem is less addictive than Lorazepam? » linkadge, posted by SLS on August 30, 2021, at 16:32:28
Thanks, Scott. For now Prothipendyl does the trick. Its a weak antipsychotic with hypnotic effects.
Posted by SLS on August 30, 2021, at 22:14:52
In reply to Re: So Zolpidem is less addictive than Lorazepam?, posted by Lamdage22 on August 30, 2021, at 20:58:26
> Thanks, Scott. For now Prothipendyl does the trick. Its a weak antipsychotic with hypnotic effects.
Never heard of it. You are resourceful, indeed.
- Scott
Posted by iforgotmypassword on September 1, 2021, at 6:00:08
In reply to So Zolpidem is less addictive than Lorazepam? (nm), posted by Lamdage22 on August 24, 2021, at 0:50:50
This is the end of the thread.
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