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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by novelagent on March 30, 2012, at 4:41:36
When I was on 225mg and couldn't refill my Effexor for a week, I would get terrible nightmares while I did without it. For the past 4 months, I've been on 75mg, and for the past 4 weeks, I've been on 37.5mg. I'm about a week left of the remaining 37.5mg, and then I have to fly solo and not taking anymore, as I will be going off the Effexor once the 37.5mg runs out this week.
My doc's a resident, so I have to tell her things like "Effexor withdrawal causes nightmares" and now I think I have to explain, after already telling her that, that there's drugs for blocking nightmares. I doubt she even knows that. I really do.
Anyhow, has anyone experienced nightmares from Effexor withdrawal? How long do they last (weeks? months?)?
For all I know, I'm tapering slowly enough to avoid them, but I doubt it. I only know about the REM drugs from reading once in passing they're used to block nightmares in general. Do they work? side effects?
Posted by SLS on March 30, 2012, at 6:25:42
In reply to Effexor withdrawal nightmares: REM-blocker drug?, posted by novelagent on March 30, 2012, at 4:41:36
> When I was on 225mg and couldn't refill my Effexor for a week, I would get terrible nightmares while I did without it. For the past 4 months, I've been on 75mg, and for the past 4 weeks, I've been on 37.5mg. I'm about a week left of the remaining 37.5mg, and then I have to fly solo and not taking anymore, as I will be going off the Effexor once the 37.5mg runs out this week.
>
> My doc's a resident, so I have to tell her things like "Effexor withdrawal causes nightmares" and now I think I have to explain, after already telling her that, that there's drugs for blocking nightmares. I doubt she even knows that. I really do.
>
> Anyhow, has anyone experienced nightmares from Effexor withdrawal? How long do they last (weeks? months?)?
>
> For all I know, I'm tapering slowly enough to avoid them, but I doubt it. I only know about the REM drugs from reading once in passing they're used to block nightmares in general. Do they work? side effects?
Maybe prazosin. It reduces nightmares in PTSD via the dampening of noradrenergic activity. Prazosin gets into the brain and blocks NE alpha-1 blockade receptors. However, it does not work by suppressing REM sleep. It will help stabilize sleep, including REM sleep. Dosages used in PTSD are 6 - 12 mg given at night. I really cannot guess if the REM rebound that you are currently experiencing will respond to prazosin. However, prazosin is usually a benign drug with few side effects.Let me look into clonidine. Just a guess.
Google:
Yes, clonidine will suppress REM sleep, but only at higher dosages. Lower dosages have the opposite effect. It works very differently than prazosin. Clonidine also reduces noradrenergic activity, but it accomplishes this by stimulating NE alpha-2 receptors. The dosage range for clonidine when used for hypertension is 0.2 - 0.6 mg/day given in divided doses. If you were to take it at night only, 0.2 mg might be enough.
So, we have two drugs that reduce noradrenergic activity that are capable of reducing nightmares. The two drugs work differently. Clonidine suppresses REM at higher dosages, but carries a risk of making depression worse. Prazosin might work, but without suppressing REM and perhaps helping with anxiety and depression.
- Scott
Posted by Phillipa on March 30, 2012, at 10:08:09
In reply to Re: Effexor withdrawal nightmares: REM-blocker drug? » novelagent, posted by SLS on March 30, 2012, at 6:25:42
Scott a 42 year old across the street takes prazosin for nightmares from PTSD and she said it really works. She is "normal" for the first time since I've known her and has a full time job. Was an opiod abuser now clean. Does take an ad and I think low dose abilify. She moved in with her parents and fortunately for her they are well off and could provide good medical care for her. She had mentioned that the med for nightmares was old and it started with a p so pretty sure it's this. And until you started it had no idea what it was. Phillipa
Posted by creepy on March 30, 2012, at 13:25:46
In reply to Effexor withdrawal nightmares: REM-blocker drug?, posted by novelagent on March 30, 2012, at 4:41:36
Effexor has some very harsh withdrawals. There are many people picking pellets out of the capsules and counting down that way.
You may want to ask about adding some prozac in.. it has a long halflife and is commonly used to help with discontinuation issues on other meds.
Its pretty safe and well known, bet that suggestion would fly with your doc.
Its cheap as dirt too.. if you have no insurance its not bad.
Anoter option might be going to a TCA which are also SNRI-like drugs. old and cheap as well.
Posted by mellow on March 30, 2012, at 16:51:53
In reply to Effexor withdrawal nightmares: REM-blocker drug?, posted by novelagent on March 30, 2012, at 4:41:36
If you need to calm down the dreams some SSRI's are known to repress REM sleep. But eventually you will have to taper that drug. I work at a sleep disorder clinic and many pt's on SSRI's get very little REM. Part of the discontinuation syndrome with AD's is that your body "rebounds" on dream sleep once the drugs are taken away. The physcian at my clinic says the body figures out it can dream again and kind of tries to make up for lost time.
My Celexa withdrawal was terrible. I would leap out bed screaming several times a night. My dreams were incredibly intense. It didnt even feel like sleep. You could try the prozac trick as others have suggested. The half life is longer than most AD's and it might slowly ease you back into a normal sleep architecture.
Have you considered low dose risperdal or seroquel just to take the edge off for a few nights rest?
mellow
Posted by Novelagent on March 31, 2012, at 7:22:39
In reply to Re: Effexor withdrawal nightmares: REM-blocker drug?, posted by mellow on March 30, 2012, at 16:51:53
I appreciate these last 2 posts, but given my only symptom is the nightmares, I don't feel it's necessary to play compounding pharmacy with the capsules, or take Prozac, or try an antipsychotic for the edge (an antipsychotic rather than plain old klonopin?) : )I actually take Invega Sustenna, and like Risperdal, it doesn't do anything for any edge... Oh well. But prazosin sounds effective, so, why not just nip it in the bud with that? : )
Any ideas on how long the nightmares might last, so I have a sense of how long I'll be on prazosin? My doc is waiting to switch me from Dexedrine spansules to Vyvanse after the Effexor is switched off, so I hope the process doesn't take a month or something...
She has a habit of also dragging her feet and "planning for later" when it comes time to actually switch my meds. She likes the idea of sitting on an idea for weeks after I first ask for a switch, and then by that time, some other med has to take priority first, like in this case.
> If you need to calm down the dreams some SSRI's are known to repress REM sleep. But eventually you will have to taper that drug. I work at a sleep disorder clinic and many pt's on SSRI's get very little REM. Part of the discontinuation syndrome with AD's is that your body "rebounds" on dream sleep once the drugs are taken away. The physcian at my clinic says the body figures out it can dream again and kind of tries to make up for lost time.
>
> My Celexa withdrawal was terrible. I would leap out bed screaming several times a night. My dreams were incredibly intense. It didnt even feel like sleep. You could try the prozac trick as others have suggested. The half life is longer than most AD's and it might slowly ease you back into a normal sleep architecture.
>
> Have you considered low dose risperdal or seroquel just to take the edge off for a few nights rest?
>
> mellow
Posted by Shes_Initforthemoney on April 1, 2012, at 14:46:58
In reply to Re: Effexor withdrawal nightmares: REM-blocker drug? » mellow, posted by Novelagent on March 31, 2012, at 7:22:39
Clonodine has some similar effects as Prazosin, which you may also want to try. Clonodine has tons of off-label uses, especially with Nightmares and PTSD, as well as an FDA approved treatment for ADD (it is not a stimulant). You just have to adjust and play with the dose a little to find exactly what you need. 0.2 to 0.4 mg at bedtime makes me sleep like a charm. No Intrusive Thoughts, bad dreams, nightmares, etc.
Best,
Jay
Posted by Novelagent on April 5, 2012, at 7:05:52
In reply to Re: Effexor withdrawal nightmares: REM-blocker drug? » Novelagent, posted by Shes_Initforthemoney on April 1, 2012, at 14:46:58
Wouldn't suppressing my REM only further worsen rebound REM when I go off the clonidine at some later point? I'm thinking of just dealing with it, especially since whenever I talk to my doctor, an idiot intern, she smiles like I said something cute and doesn't even bother saying she won't prescribe the thing-- she just doesn't.
At first, I thought it was isolated to not prescribing even prn doses of klonopin. When I noticing I was getting no response over synthetic fish oil (lovaza) I realized it was time to get on the waiting lists of the nearby clinics... I don't think she quite realizes I can't afford $10/month on OTC fish oil while living off of $100/week...
> Clonodine has some similar effects as Prazosin, which you may also want to try. Clonodine has tons of off-label uses, especially with Nightmares and PTSD, as well as an FDA approved treatment for ADD (it is not a stimulant). You just have to adjust and play with the dose a little to find exactly what you need. 0.2 to 0.4 mg at bedtime makes me sleep like a charm. No Intrusive Thoughts, bad dreams, nightmares, etc.
>
> Best,
> Jay
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