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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by MTNDOG on February 10, 2005, at 15:06:03
Hi Everyone- I can't believe how many posts there have been about insomnia. Here's my story- I'm on 60 mg of Celexa (20 in the a.m., 40 in the p.m.), 150 mg of Wellbutrin in the morning, 1 mg of klonopin in the morning and two mg of klon at night. I never had insomnia until my mother passed away about two years ago but in the last year it's gotten really bad.
First I tried neurontin- I took 300 mg and slept 12 hours a night plus needed 4 more hours during the day (and I got depressed and lethargic- miserable). So we cut down to 100 mg at bedtime and added Wellbutrin. Worked for awhile but really irritated my stomach.
Then, in December I switched to trazodone. In order to sleep, I need 75 mg but in combination with the celexa, I get too much serotinin reception and end up feeling really sick (like I have the flu).
So, off the traz this week and i started seroquel. Sleep great but it made me so irritable. Something felt really off- I was overreacting to things and I just felt really angry. So, I didn't take it last night (I took 1 mg ativan instead) and slept about six hours. I feel better today (less irritable) despite the lack of sleep.
I also started going to yoga so I'm hoping that will help. I see my pdoc tomorrow but i wanted to have people run some ideas by me. One idea was to cut out the Wellbutrin and see what happens. Any thoughts? Thanks in advance, Mountain Dog
Posted by Phillipa on February 10, 2005, at 17:43:25
In reply to Insomnia- Neurontin, Trazodone, Seroquel- now what, posted by MTNDOG on February 10, 2005, at 15:06:03
Since wellbutrin is activating that might be an option. But, since I've been on all the sleep Threads, I wanted to say that of all the meds I've tried, Chloral Hydrate seems to work the best in combination with some low dose benzos. It only cost $4.60 for a months supply. And, I found so far that it was only the last pdoc that "had a problem with it". So she Rx's ambien for $90 and that doesn't work. I hope the new pdoc will agree. It's old and most have never heard of it. They use it in babies, so it must be safe. Fondly, Phillipa
Posted by med_empowered on February 10, 2005, at 19:47:50
In reply to Re: Insomnia- Neurontin, Trazodone, Seroquel- now what » MTNDOG, posted by Phillipa on February 10, 2005, at 17:43:25
I've personally never tried chloral hydrate--I wanted to, but my old doc thought it was "primitive"--but everyone I've heard talk about their experience with it has had only good things to say, so go figure. Anyway, you could cut the wellbutrin, but if its helping you, you may not find out just how much you need it until after its gone and depression sets in. I hear you on the seroquel thing...I hate the use of antipsychotics for sleep. I mean, aren't there actual SLEEPING PILLS for this purpose? Anyway, Ativan is a good med for sleep...I used to swear by 4mgs at bedtime. Unfortunately, its hard to find a doc who will do long-term RXs for 2+ benzos. Gabatril is neurontin-ish and can help a lot with sleep. Obviously, there's Ambien and Sonata...if your doc is OK with benzos, you might want to try Restoril or Dalmane. I'd avoid Halcion just b/c of its bad reputation for causing craziness. There's also Remeron...just keep in mind that the effect in some people is only temporary; another problem is that as the dosage moves up to say, 30mgs, the sedation actually LESSENS considerably compared to the initial dose (usually 7.5-15mgs). Why, no one seems sure (best guess: it becames more activating at higher doses, which negates the sleepiness). Good luck!
Posted by Phillipa on February 10, 2005, at 20:03:10
In reply to Insomnia- Neurontin, Trazodone, Seroquel- now what, posted by MTNDOG on February 10, 2005, at 15:06:03
How come the last two pdocs until the current one I'm leaving never had a problem with combining two benzos? I know the one I'm about to see doesn't as my daughter-in-law is on 4mg of klonopin and 4mg of xanax? She also has written articles that JAMA have published regarding addiction. I don't believe CH fits into any of those catagories but is called a hypnotic. On second thought, Dalmane, Halcion, etc., are considered hypnotics too arent't they. Fondly Phillipa
Posted by med_empowered on February 11, 2005, at 0:06:02
In reply to Re: Insomnia- Neurontin, Trazodone, Seroquel- now what » MTNDOG, posted by Phillipa on February 10, 2005, at 20:03:10
hey! I must say, lucky you. True, benzos can be abused both by the patient and by the prescribing doc (think the old school docs who would just fling mad doses of valium at people), but I think lately the problem is their UNDERUSE. I mean, come on; Neurontin instead of Klonopin? Who comes up with this? One of my docs did RX Klonopin, begrudgingly, but always regarded me with suspicion; I never got refills, I sometimes had to guess for him how many pills were left in the bottle, and he openly accused me of taking 2X as much as prescribed with absolutely no proof of this or even reason to suspect it! This resulted in my RX changing from 1mg pills to lots and lots of 1/2mg pills so I wouldn't get "confused" and double up. Please. I was incredibly insulted. Anyway, its good to know there are still docs out there who can carefully and skillfully use the benzos without many problems.
Posted by MTNDOG on February 11, 2005, at 8:01:17
In reply to Re: Insomnia- Neurontin, Trazodone...phillipa, posted by med_empowered on February 11, 2005, at 0:06:02
Thanks guys- my doctor isfine with prescribing benzos- I take 3 mg of klonopin already and I have ativan to take on an as needed basis but it's not helping. I returned to yoga this week and seem to be sleeping a little bit longer (I slept 7 hours last night instead of 5-6, but what I really need is 8-9).
So, I should ask about chloral hydrate? We've ruled out Remeron (serotonin? I forget). But I was talking to a friend of mine last night who is on Paxil and his pdoc prescribed 25 mg of amitryptaline at bedtime and he sleeps like a baby. When i was first diagnosed with depression/GAD I took imipramine for 11 years and God could I sleep. It was so great- I really miss it sometimes but it pooped out. I was under the impressions that you couldn't combine TCA's with SSRI's. Anyone?
Posted by med_empowered on February 11, 2005, at 8:31:56
In reply to Re: Insomnia- Amitryptaline and SSRI's?, posted by MTNDOG on February 11, 2005, at 8:01:17
hey! Tricyclic antidepressants are tricky alone, and they get trickier when combined with other meds, like the ssris or newer drugs such as effexor or cymbalta. Apparently, tricyclics tend to boost blood levels of the other antidepressant, and, more importantly, the reverse is also true, so its possible to take a therapeutic tricyclic dose and have your other antidepressant boost your blood-levels up to toxic levels. Kinda sucks. That said, I did it...I took a full therapeuric dose of Tofranil PM, which is just slightly reformulated, once-daily imipramine (I took 150-200mgs) along with 60mgs Cymbalta and 60mgs adderall. At first, everything was fine, and my depression did lessen in intensity...but then my blood-pressure started to rise and stayed at the high-normal/high range, and then I saw spots one day...kinda scary. BUT I don't see how a small, sleep inducing dose of elavil or something could have the same effect, assuming you kept the dosage smallish and your doctor was good about monitoring you. A friend of mine takes lexapro, trazadone, adderall (which boosts levels of everything in your brain, apparently), AND an occasional elavil without incident. Good luck!
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