![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by tonyz on May 22, 2009, at 16:06:06
Depression and anxiety are worsening. Pdoc keeps pushing that I should add seroquel. Every doc has a different opinion. Seroquel terrifies me. I'm getting very little sleep now -- taking 20mg valium and 10-20mg sonota and up to 100 mg NTP. Doc thinks I should add seroquel if I want to sleep. The problem is the type of sleep I am getting now is not very good. I sleep for maybe 3-4 hours. I am confused during the day, hard to focus hard to do much of anything and memory is deteriorating.
I was hospitalized in the past and the first thing that was done was to lower my nortriptyline from 175mg to 100mg and increase seroquel to maybe 300mg. Don't remember the exact numbers w/o checking my notes.
I don't know what to do at this point.
NTP is being titrated by 25mg every 3 days so it will take some time to do anything.
Are my fears of seroquel justified?
Posted by Phillipa on May 22, 2009, at 16:32:23
In reply to Nortriptyline and Seroquel, etc, posted by tonyz on May 22, 2009, at 16:06:06
What's your diagnosis? Personally didn't do well on seroquel but that's me. Phillipa
Posted by desolationrower on May 22, 2009, at 17:43:08
In reply to Nortriptyline and Seroquel, etc, posted by tonyz on May 22, 2009, at 16:06:06
i can't tell if you are increasing or decreasing the nortr. now... have you had plasma measurement. i'm not sure what the ideal dose of it is for sleep, i guess it would depend on 5ht2 and alpha1 occupancy. gapentin might help too.
have you asked about using mirtazipine instead of quitiapine
temazepam seems to tbe the prefered benzo for sleep.
Have you had sleep test and cbt for insomnia? i think anyone would have difficulting during the day on that little sleep. was depression or insomnia the first thing?
-d/r
Posted by tonyz on May 23, 2009, at 15:02:37
In reply to Re: Nortriptyline and Seroquel, etc, posted by desolationrower on May 22, 2009, at 17:43:08
> i can't tell if you are increasing or decreasing the nortr. now... have you had plasma measurement. i'm not sure what the ideal dose of it is for sleep, i guess it would depend on 5ht2 and alpha1 occupancy. gapentin might help too.
>
> have you asked about using mirtazipine instead of quitiapine
>
> temazepam seems to tbe the prefered benzo for sleep.
>
> Have you had sleep test and cbt for insomnia? i think anyone would have difficulting during the day on that little sleep. was depression or insomnia the first thing?
>
> -d/r
Always starts with high anxiety which leads to confusion and lack of sleep and rapidly turns into a very bad depression. 10 years ago when this would happen I would treat it with amitryptyline and a little valium and/or temazepam. The recovery was usually pretty quick maybe 3 months or so and I maintained some level of functionality during that time period.I never had much faith in the SSRIs because of the anxiety component of my depression.
Started back on the seroquel last night, I can't be sure but I think I got about 6.5 hours sleep - the quality of it is questionnable.
The problem with all of these drugs is that they interfere with sleep architecture. I wish I could find a different alternative. I have not been to a sleep lab. I'm not sure what they would do - could they adjust your medication based on what they observe? Not sure what cbt is?
Nortriptyline is being increased will probably go up to 150-175 mg. I've had blood levels in those ranges before so I know that is the therapeutic point for me.
For maintenance they seem to think I should be on either lithium or lamictal although no one thinks I'm bipolar.
Because of side effects Nortriptyline is not something I could stay on for the long haul.
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.