![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 44. Go back in thread:
Posted by KaraS on September 10, 2004, at 23:01:40
In reply to Re: Trouble sleeping - please help, posted by Jaynee on September 10, 2004, at 21:55:46
> Can you get ahold of zopiclone? If not, you are probably in the US, and will have to wait for Estorra, the new and improved zopiclone.
>
> I have been on zopiclone for a year, and it works pretty good.What kind of medications are those and what country are you in? I've never heard of either of them.
Posted by KaraS on September 10, 2004, at 23:06:18
In reply to Re: Trouble sleeping - please help, posted by Jaynee on September 10, 2004, at 21:55:46
I reacted paradoxically to it. When I tried 5 mg. of generic methylphenidate it put me to sleep. It wears off so I wouldn't be groggy in the morning. I wonder if this would work on a regular basis? Would there be a tolerance kind of issue in that it would stop putting me to sleep? Anyone have any thoughts on this?
Posted by sb417 on September 11, 2004, at 0:11:12
In reply to Re: Trouble sleeping - please help » sb417, posted by KaraS on September 10, 2004, at 17:06:11
> > Both trouble falling asleep and staying asleep. Trazodone made me feel nauseous and it didn't go away even after a couple of months. Neurontin I only took once or twice and I just remember that I felt awful the next day. Maybe it's worth trying a smaller dosage. I wish I remembered how much of each I had taken but it was a long time ago.>
Hi Kara,
You and I have similar reactions to some medications. I felt awful after trying Neurontin also. In fact, I felt awful for several days after taking it. I had a paradoxical reaction to Trazadone.
> > Delayed sleep phase syndrome - is that when you keep going to bed later and later because your natural clock is much longer than the normal 24 hours?>In the delayed sleep phase syndrome, I want to go to bed later and get up later each day. If left to my own devices, I would probably do just that. I do remember reading about some studies done a few years ago in which the subjects were in a cave, deprived of all external cues that would indicate the time of day. There was no sunlight, no clocks, etc. If I remember correctly, I believe the subjects ended up on a 25 hour cycle, or perhaps it was even a bit longer.
>
> > > These days I'm so exhausted and out of it until later in the day. There's no way I can make myself move in the morning. I know it would be great for me so maybe once I start to feel better... I can do it.>I feel like that in the morning until I exercise. It takes nearly superhuman effort to get myself to the pool, but once I've done my exercise, I really do feel better. I've come to believe that one reason I hate to go to bed at night is that it takes so much effort to get to a point where I feel good and productive that I don't want to let go of it by going to sleep because the next morning I have to start all over again.
> I've been taking a high carb snack before bed but think it's probably good advice to have my dinner be high carbs as well. (Sugar gives me blood sugar problems so tends to disrupt my sleep.) >Yes, you're absolutely right about the sugar. I shouldn't have mentioned that except that when I have PMS, I find a bit of sugar seems to help. Too much makes it worse.
Oh, another thing that seems to help at night before you go to bed is to have very few lights on, and use very low wattage light bulbs. This helps me wind down. If I use any bulb above 60 watts, that keeps me up later. Even 60 is too much. Also, if you wake up in the middle of the night to go to the bathroom, try to use only a flashlight or a nightlight. Turning on the lights for even a moment can wreak havoc with melatonin.
Posted by KaraS on September 11, 2004, at 2:58:49
In reply to Re: Trouble sleeping - please help » KaraS, posted by sb417 on September 11, 2004, at 0:11:12
> > > Both trouble falling asleep and staying asleep. Trazodone made me feel nauseous and it didn't go away even after a couple of months. Neurontin I only took once or twice and I just remember that I felt awful the next day. Maybe it's worth trying a smaller dosage. I wish I remembered how much of each I had taken but it was a long time ago.>
>
>
> Hi Kara,
> You and I have similar reactions to some medications. I felt awful after trying Neurontin also. In fact, I felt awful for several days after taking it. I had a paradoxical reaction to Trazadone.
>
>
> > > Delayed sleep phase syndrome - is that when you keep going to bed later and later because your natural clock is much longer than the normal 24 hours?>That's what I thought it meant.
>
> In the delayed sleep phase syndrome, I want to go to bed later and get up later each day. If left to my own devices, I would probably do just that.That's exactly my problem and since I haven't been working, I have been doing just that. Then I'll get some temporary work and have to try to get on a normal schedule for a few days. It's absolutely hell on my body.
I do remember reading about some studies done a few years ago in which the subjects were in a cave, deprived of all external cues that would indicate the time of day. There was no sunlight, no clocks, etc. If I remember correctly, I believe the subjects ended up on a 25 hour cycle, or perhaps it was even a bit longer.
I had also heard of that study but I wonder why others don't have the same problems that we do if everyone is on a 25 hour clock. (One of nature's nasty little jokes, wouldn't you say?)> >
> > > > These days I'm so exhausted and out of it until later in the day. There's no way I can make myself move in the morning. I know it would be great for me so maybe once I start to feel better... I can do it.>
>
> I feel like that in the morning until I exercise. It takes nearly superhuman effort to get myself to the pool, but once I've done my exercise, I really do feel better. I've come to believe that one reason I hate to go to bed at night is that it takes so much effort to get to a point where I feel good and productive that I don't want to let go of it by going to sleep because the next morning I have to start all over again.EXACTLY!! I'm finally getting some motivation and feeling like I have some energy at that point. Is this just the depression and if that's ever under control, we won't experience this anymore?
> > I've been taking a high carb snack before bed but think it's probably good advice to have my dinner be high carbs as well. (Sugar gives me blood sugar problems so tends to disrupt my sleep.) >
>
> Yes, you're absolutely right about the sugar. I shouldn't have mentioned that except that when I have PMS, I find a bit of sugar seems to help. Too much makes it worse.
>
> Oh, another thing that seems to help at night before you go to bed is to have very few lights on, and use very low wattage light bulbs. This helps me wind down. If I use any bulb above 60 watts, that keeps me up later. Even 60 is too much. Also, if you wake up in the middle of the night to go to the bathroom, try to use only a flashlight or a nightlight. Turning on the lights for even a moment can wreak havoc with melatonin.No kidding, that little bit of light can wreak that much havoc? Have you ever taken melatonin? I'm wondering if you're supersensitive to its effects or if we all are that sensitive to it?
Do you take anything to help you sleep or are these lifestyle changes enough? Also, would you mind telling me what other meds you take? If you have already done that in the past, I apologize for asking again. My memory is not terribly good right now.
Posted by King Vultan on September 11, 2004, at 10:07:28
In reply to Re: Trouble sleeping - please help » King Vultan, posted by KaraS on September 10, 2004, at 17:21:55
>
>
> Why are you not worried about Halcion and yet you were worried about Ambien? Halcion seems scarier to me than Ambien but that might just be because of the bad press it got a few years back. Was the hype unwarranted?
>
> What was your experience on trazadone the first time? That would seem to be ideal to me if you could tolerate it. I don't know hydroxyzine at all. I'll have to check into that one more.
>
> >
I'm not actually worried about either Ambien or Halcion anymore, as I decided the hang up I used to have about these types of meds was silly. Why the change? Probably from starting to read message boards like this one. I use Halcion rather than Ambien because Halcion is available as a generic and costs me only $10 for 30 pills, compared to Ambien at $50 for 30 pills. I believe Halcion is also more powerful.I only used trazodone for three days while on Nardil, as it made me more and more depressed each day I used it. I now believe this may have something to do with the same issue that caused me to get very sleepy on Provigil--the hypothesis that this may be a result of having hypersensitive dopamine autoreceptors. Since my thought was that the extra dopamine being made available by Provigil was shutting down my dopamine neurons via this mechanism, trazodone could quite possibly do the same thing because one of its major effects is to blockade serotonin 2A receptors, which also releases dopamine. This is also one of the mechanisms by which atypical antipsychotics work--they release dopamine to counteract negative psychotic symptoms by blockading serotonin 2A receptors.
I found an Australian site yesterday listing the dosage of doxylamine succinate, the stuff in the OTC Unisom tablets, as 25-50 mg for sleep. I believe the maximum recommended in the US is only 25 mg, but I have been having so much trouble sleeping, I did decide to go with 2 x 25. I did sleep drastically better than I did on the 2 x 25 mg Benadryl I had used a couple nights before, but I was a little zonked this morning. I think I will try one Unisom pill next time and see if I can get away with that.
Todd
Posted by Sad Panda on September 11, 2004, at 12:29:16
In reply to Re: Trouble sleeping - please help » Sad Panda, posted by KaraS on September 10, 2004, at 16:49:32
> > > I don't know what to do about it. I'm either in a cycle where I can't do anything but sleep or else I can't sleep at all. (Actually I can sleep in the afternoon without a problem. It's at nighttime that I can't sleep at all. Is that cortisol related?) There's a bit of anxiety and some RLS involved.
> > >
> > > I have some Ambien and Sonata samples here but I'm afraid to try them. I don't want to become dependent as I once was on Ativan. After reading the Ambien abuse thread below, I'm even more scared. How is it that some people can take Ambien, Restoril or another benzo indefinitely without a problem and someone else ends up with a 90 pill a day habit?
> > >
> > > I've tried trazadone and Neurontin and they both made me feel quite sick. I still have the neurontin and may try it again in smaller dosage. I tried Benadryl again last night and it makes my heart race while making the rest of me groggy. It was a very strange and scary experience.
> > >
> > > 5-htp made me groggy the next day. Melatonin gets me to sleep but doesn't keep me there for long. I haven't tried Valerian yet. I've read different things about whether or not people develop tolerance to it as well.
> > >
> > > Lastly, there's the sedating tricyclics. Doxepin works well but I'm also quite groggy the next day. Maprotiline worked well with less grogginess but still some. On top of that they both made me fat. All I wanted to do was eat when I took them. I'm finally thin again and I want to stay that way, da-- it! Do I have to choose between being thin and exhausted or fat and sleeping at night??????
> > >
> > > Any suggestions would be greatly appreciated.
> > >
> > > Kara
> > >
> > >
> >
> >
> > Hi Kara,
> >
> > A TCA with less antihistamine activity might be enough, I would try Nortriptyline. Trazodone might be worth trying again at lower doseages. The AP Risperdal taken at low doseage might also be worth a shot.
> >
> > Cheers,
> > Paul.
> >
>
> Hi Panda, (can't call you Paul yet - I'm just not used to it yet)
>
> Nort. was one of the most stimulating meds I've ever taken. I know most people can take it for sleep - but definitely not me. I don't remember how much trazadone I took but it might be worth trying again. Risperdal sounds intriguing - something I hadn't considered yet. Is it one of the newer APs? I'll have to read up on it more. Thanks!
>
> BTW, How are you doing? Last I heard you had hit a bit of a rough spot yourself. Are you feeling better now?
>
> -K
>
>Hi Kara,
I am fine now, thanks for asking. :)
A little Amitriptyline might be worth trying, it falls half way between Nortriptyline & Doxepin as far as sedation & appetite is concerned.
Trazodone & Serzone are interesting because they are 5-HT2A antagonists which gives high quality sleep & they are 5-HT2C agonists which is believed to supress appetite. Most 5-HT2A antagonists tend to be 5-HT2C antagonists too. The drugs that are equipotent 5-HT2A & C antagonist as well as being H1 antagonists, such as Remeron & Zyprexa, tend to cause the most weight gain.
Cheers,
Paul.
Posted by Jaynee on September 11, 2004, at 14:34:39
In reply to Re: Trouble sleeping - please help » Jaynee, posted by KaraS on September 10, 2004, at 23:01:40
I am in Canada. We have zopiclone here, but it is not available in the US. Estorra should be available in the US sometime this year or early 2005.
"They" say that Estorra can be taken long term.
Look it up on google, lots of info.
Good luck.
ps, don't give up until you find something that works for you, sleep is too important.
Posted by KaraS on September 11, 2004, at 15:47:51
In reply to Re: Trouble sleeping - please help » KaraS, posted by King Vultan on September 11, 2004, at 10:07:28
> I'm not actually worried about either Ambien or Halcion anymore, as I decided the hang up I used to have about these types of meds was silly. Why the change? Probably from starting to read message boards like this one. I use Halcion rather than Ambien because Halcion is available as a generic and costs me only $10 for 30 pills, compared to Ambien at $50 for 30 pills. I believe Halcion is also more powerful.
So how have you prevented tolerance to Halcion? Are you only taking it once or twice a week?
Can you tell me more about hydroxyzine and it's use for sleep?
> I only used trazodone for three days while on Nardil, as it made me more and more depressed each day I used it. I now believe this may have something to do with the same issue that caused me to get very sleepy on Provigil--the hypothesis that this may be a result of having hypersensitive dopamine autoreceptors. Since my thought was that the extra dopamine being made available by Provigil was shutting down my dopamine neurons via this mechanism, trazodone could quite possibly do the same thing because one of its major effects is to blockade serotonin 2A receptors, which also releases dopamine. This is also one of the mechanisms by which atypical antipsychotics work--they release dopamine to counteract negative psychotic symptoms by blockading serotonin 2A receptors.
Does the fact that I respond paradoxically to dopaminergics mean that I also have presynaptic hypersensitive dopamine autoreceptors or are there other possible explanations? (BTW, Provigil didn't make me sleepy or alert - just produced that leaden limbs feeling. I may not have tried enough to get more of a reaction though.)
> I found an Australian site yesterday listing the dosage of doxylamine succinate, the stuff in the OTC Unisom tablets, as 25-50 mg for sleep. I believe the maximum recommended in the US is only 25 mg, but I have been having so much trouble sleeping, I did decide to go with 2 x 25. I did sleep drastically better than I did on the 2 x 25 mg Benadryl I had used a couple nights before, but I was a little zonked this morning. I think I will try one Unisom pill next time and see if I can get away with that.
>
> ToddI should try the Unisom because it would be a cheap and easy fix but I'm so afraid to. The Benadryl was so awful. I was so exhausted and drugged feeling yet my heart was racing (as I said earlier). It's a horrible state to be in because you can't sleep yet you can't do anything else because you're so drugged feeling. Each minute was like an hour. Wish I could know the result without having to do the experiment.
Kara
Posted by KaraS on September 11, 2004, at 15:55:45
In reply to Re: Trouble sleeping - please help » KaraS, posted by Sad Panda on September 11, 2004, at 12:29:16
> > > > I don't know what to do about it. I'm either in a cycle where I can't do anything but sleep or else I can't sleep at all. (Actually I can sleep in the afternoon without a problem. It's at nighttime that I can't sleep at all. Is that cortisol related?) There's a bit of anxiety and some RLS involved.
> > > >
> > > > I have some Ambien and Sonata samples here but I'm afraid to try them. I don't want to become dependent as I once was on Ativan. After reading the Ambien abuse thread below, I'm even more scared. How is it that some people can take Ambien, Restoril or another benzo indefinitely without a problem and someone else ends up with a 90 pill a day habit?
> > > >
> > > > I've tried trazadone and Neurontin and they both made me feel quite sick. I still have the neurontin and may try it again in smaller dosage. I tried Benadryl again last night and it makes my heart race while making the rest of me groggy. It was a very strange and scary experience.
> > > >
> > > > 5-htp made me groggy the next day. Melatonin gets me to sleep but doesn't keep me there for long. I haven't tried Valerian yet. I've read different things about whether or not people develop tolerance to it as well.
> > > >
> > > > Lastly, there's the sedating tricyclics. Doxepin works well but I'm also quite groggy the next day. Maprotiline worked well with less grogginess but still some. On top of that they both made me fat. All I wanted to do was eat when I took them. I'm finally thin again and I want to stay that way, da-- it! Do I have to choose between being thin and exhausted or fat and sleeping at night??????
> > > >
> > > > Any suggestions would be greatly appreciated.
> > > >
> > > > Kara
> > > >
> > > >
> > >
> > >
> > > Hi Kara,
> > >
> > > A TCA with less antihistamine activity might be enough, I would try Nortriptyline. Trazodone might be worth trying again at lower doseages. The AP Risperdal taken at low doseage might also be worth a shot.
> > >
> > > Cheers,
> > > Paul.
> > >
> >
> > Hi Panda, (can't call you Paul yet - I'm just not used to it yet)
> >
> > Nort. was one of the most stimulating meds I've ever taken. I know most people can take it for sleep - but definitely not me. I don't remember how much trazadone I took but it might be worth trying again. Risperdal sounds intriguing - something I hadn't considered yet. Is it one of the newer APs? I'll have to read up on it more. Thanks!
> >
> > BTW, How are you doing? Last I heard you had hit a bit of a rough spot yourself. Are you feeling better now?
> >
> > -K
> >
> >
>
> Hi Kara,
>
> I am fine now, thanks for asking. :)
>
> A little Amitriptyline might be worth trying, it falls half way between Nortriptyline & Doxepin as far as sedation & appetite is concerned.
>
> Trazodone & Serzone are interesting because they are 5-HT2A antagonists which gives high quality sleep & they are 5-HT2C agonists which is believed to supress appetite. Most 5-HT2A antagonists tend to be 5-HT2C antagonists too. The drugs that are equipotent 5-HT2A & C antagonist as well as being H1 antagonists, such as Remeron & Zyprexa, tend to cause the most weight gain.
>
> Cheers,
> Paul.
>
>Panda,
I've tried Amitriptyline and it really knocked me out - more so than doxepin. It's strange how unique our systems are sometimes.I tried Serzone and it was wonderful for sleep and it didn't increase my appetite. Too good to be true you say? Of course it was. It also made me really itchy all the time esp. when I exercised. Didn't they take this off of the market recently in the U.S.? Do you stil have it in Australia?
Glad to hear you're doing well now!
Kara
Posted by KaraS on September 11, 2004, at 15:59:25
In reply to Kara, posted by Jaynee on September 11, 2004, at 14:34:39
> I am in Canada. We have zopiclone here, but it is not available in the US. Estorra should be available in the US sometime this year or early 2005.
>
> "They" say that Estorra can be taken long term.
>
> Look it up on google, lots of info.
>
> Good luck.
>
> ps, don't give up until you find something that works for you, sleep is too important.
>
>Didn't they say that Ambien could be taken long-term when it first came out? It reminds me of how the drug companies always say that their new antidepressants get results within a week but that never seems to be the case.
Anyway, I sure hope that it's the truth. I'll keep my fingers crossed for all of us insomniacs.
I won't give up. I have to function - and soon.
Thanks.
-K
Posted by invisiblemanpa on September 11, 2004, at 17:10:17
In reply to Re: Kara » Jaynee, posted by KaraS on September 11, 2004, at 15:59:25
I started on Remeron in addition Effexor Xr last month. The Remeron has really helped with my sleep and initially with my depression...I started at 30mg and am now going to start 45mg which I think is the max dosage as my depression has been creeping back in. My Psy doc has also given me a prescreption for Restoril, which is a benzo prescribed for sleep but I rarely use it now as the Remeron does the trick.
Posted by KaraS on September 11, 2004, at 20:43:09
In reply to Sleep Help, posted by invisiblemanpa on September 11, 2004, at 17:10:17
> I started on Remeron in addition Effexor Xr last month. The Remeron has really helped with my sleep and initially with my depression...I started at 30mg and am now going to start 45mg which I think is the max dosage as my depression has been creeping back in. My Psy doc has also given me a prescreption for Restoril, which is a benzo prescribed for sleep but I rarely use it now as the Remeron does the trick.
Remeron can really increase your appetite a lot though. Have you found this to be the case yet?
Posted by King Vultan on September 11, 2004, at 21:08:33
In reply to Re: Trouble sleeping - please help » King Vultan, posted by KaraS on September 11, 2004, at 15:47:51
>
> So how have you prevented tolerance to Halcion? Are you only taking it once or twice a week?
>No, I take it every other night, alternating with either the Benadryl or Unisom.
> Can you tell me more about hydroxyzine and it's use for sleep?
>
>It's a drug I had never heard of that my pdoc happened to mention on a recent visit. It appears to be a very anxiolytic antihistamine that is mainly used as a sedative. Apparently, it can also be used for sleep, too, and has antinausea properties. My book "Psychotropic Drugs" does not recommend it for routine use as a sedative, but they do recommend chloral hydrate, which strikes me as a little bit strange. I was actually thinking about inquiring about chloral hydrate myself, but it has been shown to cause cancer in mice. I don't know how much chloral hydrate was necessary to give the mice cancer, though, or the implications as far as people.
> Does the fact that I respond paradoxically to dopaminergics mean that I also have presynaptic hypersensitive dopamine autoreceptors or are there other possible explanations? (BTW, Provigil didn't make me sleepy or alert - just produced that leaden limbs feeling. I may not have tried enough to get more of a reaction though.)
>
>It's quite possible this could be your problem, but it is only a theory, and there might be some other conceivable explanation.
> I should try the Unisom because it would be a cheap and easy fix but I'm so afraid to. The Benadryl was so awful. I was so exhausted and drugged feeling yet my heart was racing (as I said earlier). It's a horrible state to be in because you can't sleep yet you can't do anything else because you're so drugged feeling. Each minute was like an hour. Wish I could know the result without having to do the experiment.
>
> Kara
>
I remained kind of hung over from the two Unisom pills into the afternoon. I think I will go back to one pill next time. It does have a very similar structure to that of Benadryl, but so do the tricyclic antidepressants closely resemble each other also, and they can have very different properties.Todd
Posted by KaraS on September 11, 2004, at 22:09:29
In reply to Re: Trouble sleeping - please help, posted by King Vultan on September 11, 2004, at 21:08:33
> >
> > So how have you prevented tolerance to Halcion? Are you only taking it once or twice a week?
> >
>
> No, I take it every other night, alternating with either the Benadryl or Unisom.
How long have you been doing that for? When I had problems with Ativan, I took it for 2 or 3 weeks only a small amount at night to sleep. Then I went off of it for 3 weeks. Then I started it again for 3 weeks at night. Then I stopped it and I had some severe discontinuation effects. I couldn't understand it because I followed all of the precautions and didn't use it for more than 3 weeks at a time. My doctor said that my system "remembered" it so once those receptors are primed (for want of a better word), that can last a while. Some people are just highly sensitive I guess. If the same dosage is working for you and/or you don't start getting nauseous a couple of hours before you're due to take it, then I think you're safe. (The latter should have been my clue.) At any rate, I got back on doxepin and discontinued the Ativan very slowly and all was fine.
> > Can you tell me more about hydroxyzine and it's use for sleep?
> >
> >
>
> It's a drug I had never heard of that my pdoc happened to mention on a recent visit. It appears to be a very anxiolytic antihistamine that is mainly used as a sedative. Apparently, it can also be used for sleep, too, and has antinausea properties. My book "Psychotropic Drugs" does not recommend it for routine use as a sedative, but they do recommend chloral hydrate, which strikes me as a little bit strange. I was actually thinking about inquiring about chloral hydrate myself, but it has been shown to cause cancer in mice. I don't know how much chloral hydrate was necessary to give the mice cancer, though, or the implications as far as people.I did some research on it myself. Does your book give a reason why it doesn't recommend that it be used on a regular basis?
Re: chloral hydrate, it's so hard to determine from those studies in mice. You just don't know what the dosage implications are for humans. Your book obviously doesn't get into that. Still, it would scare me off too.
> > Does the fact that I respond paradoxically to dopaminergics mean that I also have presynaptic hypersensitive dopamine autoreceptors or are there other possible explanations? (BTW, Provigil didn't make me sleepy or alert - just produced that leaden limbs feeling. I may not have tried enough to get more of a reaction though.)
> >
> >
>
> It's quite possible this could be your problem, but it is only a theory, and there might be some other conceivable explanation.
But how does one distinguish that from too much MAO? Why do you think that the latter isn't your problem?
> > I should try the Unisom because it would be a cheap and easy fix but I'm so afraid to. The Benadryl was so awful. I was so exhausted and drugged feeling yet my heart was racing (as I said earlier). It's a horrible state to be in because you can't sleep yet you can't do anything else because you're so drugged feeling. Each minute was like an hour. Wish I could know the result without having to do the experiment.
> >
> > Kara
> >
>
> I remained kind of hung over from the two Unisom pills into the afternoon. I think I will go back to one pill next time. It does have a very similar structure to that of Benadryl, but so do the tricyclic antidepressants closely resemble each other also, and they can have very different properties.
>
> ToddOne little atom can make all kinds of difference. I've seen that all over the boards here.
BTW, how are you doing on the Parnate so far?
Kara
Posted by King Vultan on September 12, 2004, at 12:36:08
In reply to Re: Trouble sleeping - please help » King Vultan, posted by KaraS on September 11, 2004, at 22:09:29
> > >
> > > So how have you prevented tolerance to Halcion? Are you only taking it once or twice a week?
> > >
> >
> > No, I take it every other night, alternating with either the Benadryl or Unisom.
>
> How long have you been doing that for? When I had problems with Ativan, I took it for 2 or 3 weeks only a small amount at night to sleep. Then I went off of it for 3 weeks. Then I started it again for 3 weeks at night. Then I stopped it and I had some severe discontinuation effects. I couldn't understand it because I followed all of the precautions and didn't use it for more than 3 weeks at a time. My doctor said that my system "remembered" it so once those receptors are primed (for want of a better word), that can last a while. Some people are just highly sensitive I guess. If the same dosage is working for you and/or you don't start getting nauseous a couple of hours before you're due to take it, then I think you're safe. (The latter should have been my clue.) At any rate, I got back on doxepin and discontinued the Ativan very slowly and all was fine.
>
>
I've been going back and forth between Halcion one night and then Benadryl or Unisom the next night for three months now, and can't say I've really noticed any tolerance developing. I did recently increase the Halcion to a whole 0.25 mg pill, but this was partly because Parnate seems to give me worse insomnia than Nardil, and also because even with Nardil, 0.125 mg Halcion wasn't enough to prevent me from waking up several times a night.
Halcion has a much shorter half life than Ativan (1.5-5 hours vs. 10-20 hours) and is much more skewed towards being sedative/hypnotic than is Ativan, which is more anxiolytic. For those reasons, I think Halcion is likely both a superior med for sleep and less likely to induce tolerance, as long as one doesn't use it every night.
>
> I did some research on (hydroxyzine) myself. Does your book give a reason why it doesn't recommend that it be used on a regular basis?
>
My assumption is that this is just the personal prejudice of one or more of the authors. So much comes down to a particular doctor's own experience and mindset regarding their views on a particular drug.
>
> > > Does the fact that I respond paradoxically to dopaminergics mean that I also have presynaptic hypersensitive dopamine autoreceptors or are there other possible explanations? (BTW, Provigil didn't make me sleepy or alert - just produced that leaden limbs feeling. I may not have tried enough to get more of a reaction though.)
> > >
> > >
> >
> > It's quite possible this could be your problem, but it is only a theory, and there might be some other conceivable explanation.
>
> But how does one distinguish that from too much MAO? Why do you think that the latter isn't your problem?
>
Having too much MAO sounds like a good, intuitive hypothesis of depression, but it is not one that seems to be widely held based on the reading I have done. However, there have been some studies done looking at MAO-B platelet activitity in relation to different psychiatric disorders (platelets contain only MAO-B), and there do appear to be some correlations. It is also true that the level of MAO-B in a person's brain does increase with age--there may be a relationship here to disorders such as Alzheimer's and Parkinson's Disease.>
>
> BTW, how are you doing on the Parnate so far?
>
> Kara
Oh, I guess I'm doing all right. I am experiencing a fair amount of depression at times; hopefully, this means the dopamine being released by the Parnate is hammering away at my autoreceptors in an attempt to downregulate them. I'm scheduled to see my pdoc Wednesday about going up to 40 mg/day. I will have been on 30 mg/day for two weeks at that time and was on 20 mg/day for a week before that.Todd
Posted by KaraS on September 12, 2004, at 14:02:17
In reply to Re: Trouble sleeping - please help » KaraS, posted by King Vultan on September 12, 2004, at 12:36:08
> I've been going back and forth between Halcion one night and then Benadryl or Unisom the next night for three months now, and can't say I've really noticed any tolerance developing. I did recently increase the Halcion to a whole 0.25 mg pill, but this was partly because Parnate seems to give me worse insomnia than Nardil, and also because even with Nardil, 0.125 mg Halcion wasn't enough to prevent me from waking up several times a night.
>
> Halcion has a much shorter half life than Ativan (1.5-5 hours vs. 10-20 hours) and is much more skewed towards being sedative/hypnotic than is Ativan, which is more anxiolytic. For those reasons, I think Halcion is likely both a superior med for sleep and less likely to induce tolerance, as long as one doesn't use it every night.
Sounds like you have it under control. What was the hype against Halcion a number of years back and why did it go out of favor for usage?
> Having too much MAO sounds like a good, intuitive hypothesis of depression, but it is not one that seems to be widely held based on the reading I have done. However, there have been some studies done looking at MAO-B platelet activitity in relation to different psychiatric disorders (platelets contain only MAO-B), and there do appear to be some correlations. It is also true that the level of MAO-B in a person's brain does increase with age--there may be a relationship here to disorders such as Alzheimer's and Parkinson's Disease.
Thanks for that explanation.
> > BTW, how are you doing on the Parnate so far?
> >
> > Kara
>
>
> Oh, I guess I'm doing all right. I am experiencing a fair amount of depression at times; hopefully, this means the dopamine being released by the Parnate is hammering away at my autoreceptors in an attempt to downregulate them. I'm scheduled to see my pdoc Wednesday about going up to 40 mg/day. I will have been on 30 mg/day for two weeks at that time and was on 20 mg/day for a week before that.
>
> ToddDefinitely too early to judge the Parnate in your case (as I know you know but sometimes it's still good to hear)
One last question, when I take low dose selegiline, it sedates me a bit for several hours and then around 8 or 9 hours after I took it, I start to get the stimulation effect. Do you have any idea why it would work like that? Does that fit in with the hypersensitive dopamine autoreceptors theory?
Thanks,
Kara
Posted by KaraS on September 12, 2004, at 18:03:33
In reply to Re: Trouble sleeping - please help » King Vultan, posted by KaraS on September 12, 2004, at 14:02:17
Posted by King Vultan on September 12, 2004, at 23:53:53
In reply to Re: Trouble sleeping - please help » King Vultan, posted by KaraS on September 12, 2004, at 14:02:17
>
>
> Sounds like you have it under control. What was the hype against Halcion a number of years back and why did it go out of favor for usage?
>
Mainly memory problems, especially in the elderly, and there was also an incident involving someone--a researcher or MD maybe?--attending a conference and using Halcion to try to combat jet lag who developed amnesia after taking a 0.5 mg dose (he couldn't even remember arriving at the hotel). This is why they stopped producing that size pill and lowered the maximum recommended dosage to 0.25 mg/night.
>
> One last question, when I take low dose selegiline, it sedates me a bit for several hours and then around 8 or 9 hours after I took it, I start to get the stimulation effect. Do you have any idea why it would work like that? Does that fit in with the hypersensitive dopamine autoreceptors theory?
>
>
> Thanks,
> Kara
It might, but I don't know that much about selegiline other than it both inhibits MAO-B and produces amphetamine metabolites when taken orally, including methamphetamine. Obviously, these are relatively dopaminergic and could theoretically sedate someone who has hypersensitive dopamine autoreceptors. As far as the subsequent stimulation you describe, however, I'm afraid I don't have the understanding to provide an adequate explanation.Todd
Posted by Sad Panda on September 13, 2004, at 5:49:20
In reply to Re: Trouble sleeping - please help » Sad Panda, posted by KaraS on September 11, 2004, at 15:55:45
> > > > > I don't know what to do about it. I'm either in a cycle where I can't do anything but sleep or else I can't sleep at all. (Actually I can sleep in the afternoon without a problem. It's at nighttime that I can't sleep at all. Is that cortisol related?) There's a bit of anxiety and some RLS involved.
> > > > >
> > > > > I have some Ambien and Sonata samples here but I'm afraid to try them. I don't want to become dependent as I once was on Ativan. After reading the Ambien abuse thread below, I'm even more scared. How is it that some people can take Ambien, Restoril or another benzo indefinitely without a problem and someone else ends up with a 90 pill a day habit?
> > > > >
> > > > > I've tried trazadone and Neurontin and they both made me feel quite sick. I still have the neurontin and may try it again in smaller dosage. I tried Benadryl again last night and it makes my heart race while making the rest of me groggy. It was a very strange and scary experience.
> > > > >
> > > > > 5-htp made me groggy the next day. Melatonin gets me to sleep but doesn't keep me there for long. I haven't tried Valerian yet. I've read different things about whether or not people develop tolerance to it as well.
> > > > >
> > > > > Lastly, there's the sedating tricyclics. Doxepin works well but I'm also quite groggy the next day. Maprotiline worked well with less grogginess but still some. On top of that they both made me fat. All I wanted to do was eat when I took them. I'm finally thin again and I want to stay that way, da-- it! Do I have to choose between being thin and exhausted or fat and sleeping at night??????
> > > > >
> > > > > Any suggestions would be greatly appreciated.
> > > > >
> > > > > Kara
> > > > >
> > > > >
> > > >
> > > >
> > > > Hi Kara,
> > > >
> > > > A TCA with less antihistamine activity might be enough, I would try Nortriptyline. Trazodone might be worth trying again at lower doseages. The AP Risperdal taken at low doseage might also be worth a shot.
> > > >
> > > > Cheers,
> > > > Paul.
> > > >
> > >
> > > Hi Panda, (can't call you Paul yet - I'm just not used to it yet)
> > >
> > > Nort. was one of the most stimulating meds I've ever taken. I know most people can take it for sleep - but definitely not me. I don't remember how much trazadone I took but it might be worth trying again. Risperdal sounds intriguing - something I hadn't considered yet. Is it one of the newer APs? I'll have to read up on it more. Thanks!
> > >
> > > BTW, How are you doing? Last I heard you had hit a bit of a rough spot yourself. Are you feeling better now?
> > >
> > > -K
> > >
> > >
> >
> > Hi Kara,
> >
> > I am fine now, thanks for asking. :)
> >
> > A little Amitriptyline might be worth trying, it falls half way between Nortriptyline & Doxepin as far as sedation & appetite is concerned.
> >
> > Trazodone & Serzone are interesting because they are 5-HT2A antagonists which gives high quality sleep & they are 5-HT2C agonists which is believed to supress appetite. Most 5-HT2A antagonists tend to be 5-HT2C antagonists too. The drugs that are equipotent 5-HT2A & C antagonist as well as being H1 antagonists, such as Remeron & Zyprexa, tend to cause the most weight gain.
> >
> > Cheers,
> > Paul.
> >
> >
>
> Panda,
> I've tried Amitriptyline and it really knocked me out - more so than doxepin. It's strange how unique our systems are sometimes.
>
> I tried Serzone and it was wonderful for sleep and it didn't increase my appetite. Too good to be true you say? Of course it was. It also made me really itchy all the time esp. when I exercised. Didn't they take this off of the market recently in the U.S.? Do you stil have it in Australia?
>
> Glad to hear you're doing well now!
>
> Kara
>
>Hi Kara,
That's really strange, Doxepin is about 5x stronger than Amitriptyline as an antihistamine. If you take them continuosly, the zombifying effects of H1 blockade will eventually go away, but you will always sleep very well due to 5-HT2A blockade.
Cheers,
Paul.
Posted by karaS on September 13, 2004, at 9:53:17
In reply to Re: Trouble sleeping - please help » KaraS, posted by Sad Panda on September 13, 2004, at 5:49:20
> Hi Kara,
>
> That's really strange, Doxepin is about 5x stronger than Amitriptyline as an antihistamine. If you take them continuosly, the zombifying effects of H1 blockade will eventually go away, but you will always sleep very well due to 5-HT2A blockade.
>
> Cheers,
> Paul.
Paul,That is strange. I always assumed it was the other way around based on my experience. I may have been prejudiced though because I started out on Amitriptyline at too high a dosage initially. I took doxepin and then maprotiline for many years and the zombifying effect didn't go away completely either. I was still quite groggy for half of the day. Maprotiline was better in this regard but still I was somewhat groggy.
Kara
Posted by karaS on September 13, 2004, at 9:55:03
In reply to Re: Trouble sleeping - please help » KaraS, posted by King Vultan on September 12, 2004, at 23:53:53
> >
> >
> > Sounds like you have it under control. What was the hype against Halcion a number of years back and why did it go out of favor for usage?
> >
>
>
> Mainly memory problems, especially in the elderly, and there was also an incident involving someone--a researcher or MD maybe?--attending a conference and using Halcion to try to combat jet lag who developed amnesia after taking a 0.5 mg dose (he couldn't even remember arriving at the hotel). This is why they stopped producing that size pill and lowered the maximum recommended dosage to 0.25 mg/night.
>
>
> >
> > One last question, when I take low dose selegiline, it sedates me a bit for several hours and then around 8 or 9 hours after I took it, I start to get the stimulation effect. Do you have any idea why it would work like that? Does that fit in with the hypersensitive dopamine autoreceptors theory?
> >
> >
> > Thanks,
> > Kara
>
>
> It might, but I don't know that much about selegiline other than it both inhibits MAO-B and produces amphetamine metabolites when taken orally, including methamphetamine. Obviously, these are relatively dopaminergic and could theoretically sedate someone who has hypersensitive dopamine autoreceptors. As far as the subsequent stimulation you describe, however, I'm afraid I don't have the understanding to provide an adequate explanation.
>
> Todd
Thanks, Todd. So scary about that doctor not remembering arriving at the hotel! I guess since we don't hear about that problem anymore that the dosage was the issue.Kara
Posted by Sad Panda on September 13, 2004, at 21:32:12
In reply to Re: Trouble sleeping - please help » Sad Panda, posted by karaS on September 13, 2004, at 9:53:17
>
> > Hi Kara,
> >
> > That's really strange, Doxepin is about 5x stronger than Amitriptyline as an antihistamine. If you take them continuosly, the zombifying effects of H1 blockade will eventually go away, but you will always sleep very well due to 5-HT2A blockade.
> >
> > Cheers,
> > Paul.
>
>
> Paul,
>
> That is strange. I always assumed it was the other way around based on my experience. I may have been prejudiced though because I started out on Amitriptyline at too high a dosage initially. I took doxepin and then maprotiline for many years and the zombifying effect didn't go away completely either. I was still quite groggy for half of the day. Maprotiline was better in this regard but still I was somewhat groggy.
>
> Kara
>
>It might be the antimuscarinic side effects making you more groggy. Amitriptyline is the worst TCA & is about 4x more powerful than Doxepin as an M1 blocker.
Cheers,
Paul.
Posted by karaS on September 13, 2004, at 22:56:24
In reply to Re: Trouble sleeping - please help » karaS, posted by Sad Panda on September 13, 2004, at 21:32:12
> >
> > > Hi Kara,
> > >
> > > That's really strange, Doxepin is about 5x stronger than Amitriptyline as an antihistamine. If you take them continuosly, the zombifying effects of H1 blockade will eventually go away, but you will always sleep very well due to 5-HT2A blockade.
> > >
> > > Cheers,
> > > Paul.
> >
> >
> > Paul,
> >
> > That is strange. I always assumed it was the other way around based on my experience. I may have been prejudiced though because I started out on Amitriptyline at too high a dosage initially. I took doxepin and then maprotiline for many years and the zombifying effect didn't go away completely either. I was still quite groggy for half of the day. Maprotiline was better in this regard but still I was somewhat groggy.
> >
> > Kara
> >
> >
>
> It might be the antimuscarinic side effects making you more groggy. Amitriptyline is the worst TCA & is about 4x more powerful than Doxepin as an M1 blocker.
>
> Cheers,
> Paul.
>That's got to be it then.
The first time I took Amitriptyline it was in a 75 mg. dosage. I didn't know how high that was. A doctor gave me a handful of samples of it as well as doxepin and Ativan and propanolol and told me to "be my own detective". Fortunately I am very afraid of medications so I didn't try a lot and not all at once as she had recommended (except I was to try doxepin and amitriptyline separately). The 75 mg. of A. knocked me out so much that I slept for more than 2 days straight. That was many years ago but even hearing the name of that medication still frightens me!
Posted by Sad Panda on September 14, 2004, at 3:06:17
In reply to Re: Trouble sleeping - please help » Sad Panda, posted by karaS on September 13, 2004, at 22:56:24
> > >
> > > > Hi Kara,
> > > >
> > > > That's really strange, Doxepin is about 5x stronger than Amitriptyline as an antihistamine. If you take them continuosly, the zombifying effects of H1 blockade will eventually go away, but you will always sleep very well due to 5-HT2A blockade.
> > > >
> > > > Cheers,
> > > > Paul.
> > >
> > >
> > > Paul,
> > >
> > > That is strange. I always assumed it was the other way around based on my experience. I may have been prejudiced though because I started out on Amitriptyline at too high a dosage initially. I took doxepin and then maprotiline for many years and the zombifying effect didn't go away completely either. I was still quite groggy for half of the day. Maprotiline was better in this regard but still I was somewhat groggy.
> > >
> > > Kara
> > >
> > >
> >
> > It might be the antimuscarinic side effects making you more groggy. Amitriptyline is the worst TCA & is about 4x more powerful than Doxepin as an M1 blocker.
> >
> > Cheers,
> > Paul.
> >
>
> That's got to be it then.
>
> The first time I took Amitriptyline it was in a 75 mg. dosage. I didn't know how high that was. A doctor gave me a handful of samples of it as well as doxepin and Ativan and propanolol and told me to "be my own detective". Fortunately I am very afraid of medications so I didn't try a lot and not all at once as she had recommended (except I was to try doxepin and amitriptyline separately). The 75 mg. of A. knocked me out so much that I slept for more than 2 days straight. That was many years ago but even hearing the name of that medication still frightens me!
>
>75mg for the first doseage of Amitrip is hefty! 25mg would have been good. I'd start Doxepin even lower at 10mg. I am finding Amitrip to be very good for me. I am taking 100mg at night & have lowered my Effexor to 75mg. Amitrip is the Swiss army knife of AD's. It's reduced my bowels to just one/day, reduced my stomachs acid output, gives me an excellent nights sleep & is very anxiolytic. It's great if you can tolerate it's side effects.
Cheers,
Paul.
Posted by sb417 on September 14, 2004, at 3:20:39
In reply to Re: Trouble sleeping - please help » Sad Panda, posted by karaS on September 13, 2004, at 22:56:24
KaraS,
Hi. I just wanted to let you know that Doxepin is available in a liquid form. I have tremendous difficulty tolerating most medications, and I'm very sensitive to even tiny doses, so measuring the liquid form with a finely graduated medicine dropper is very helpful. It makes it easier to titrate gradually. It also makes withdrawing from medicines much less painful, and it's so much neater than trying to cut those crumbly tablets.
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