Posted by Ron Hill on January 28, 2001, at 15:56:33
In reply to Reality check: anticonvulsants/neurontin/lamictal, posted by Abby on January 24, 2001, at 14:47:30
Hi Abby,
I am BP II and daily I take 600 mg Lithobid, 20 mg Prozac, and 100 mg Wellbutrin. I too had trouble with insomnia and I'll share with you what has (so far) worked for me. I have not experienced the headache symptoms, so I have no input there other than to hope that when you begin to get good quality sleep the headaches will go away on their own.
First, the following paper on the topic is very informative. The author addresses the issue of insomnia in special populations (e.g. us bp's) and divides ADs into two categories, activating and sedating. You will notice that SSRIs (Zoloft for you and Prozac for me) are activating and, therefore, are prone to cause insomnia. When you attempt to access the article you will need to register (free) on Medline if you haven't already. Here is the link to the article:
http://psychiatry.medscape.com/Medscape/psychiatry/ClinicalMgmt/CM.v02/CM.v02-08.html
Second, please take time to read through two recent threads on this site in which I asked for advice regarding my insomnia issues. The advice was good and may have some application to your situation. Here are the links to the two threads:
http://www.dr-bob.org/babble/20010111/msgs/51755.html
http://www.dr-bob.org/babble/20010111/msgs/51834.html
Here is what is working quite well for me right now with regard to the insomnia issue:
1) Good sleep hygiene is absolutely essential. NO SLEEPING DURING THE DAY IS ALLOWED. It was difficult for the first few days, but it pays off in the end. Also, I make myself get up at the same time every day no matter how much (or how little) sleep I got. I have limited control over when I actually am able to fall asleep, but I am fully able to determine what time I get up. By doing this, my body has figured out that if it wants good sleep it had better get it at night because the days of napping during the day are over. Again, this was difficult for the first few days, but it paid off in the end. Good sleep hygiene involves several other things, but I will not belabor the point here. If you want more information on this topic, let me know and I will send you some links.
2) Melatonin helps in my case. Melatonin is available in three (maybe more?) forms, regular oral down the hatch, sublingual, and extended release. The regular oral helped me but did not solve the problem. But 1.25 mg of sublingual (hold under tongue to dissolve) melatonin works well in my case. The sublingual product enters the blood stream much more quickly that the down the hatch form and this has a couple of advantages. First, its actions are almost immediate and, second, since the sublingual goes more directly to the bloodstream, much of the "first pass metabolism" of the melatonin is avoided. I bought some extended release but have not used it because the sublingual is working. The dose range is typically between 0.3 mg and 3 mg. I personally do not think it best to take it every night, but instead on an as needed basis. Here is a link to a thread on melatonin:
http://www.dr-bob.org/babble/20010111/msgs/51473.html
3) I asked my pdoc to prescribe some Sonata (zaleplon) for me to use in those "emergency" situations when, for whatever reason, I just can't get to sleep. So far I have not needed to use it because the sleep hygiene and melatonin have fixed my problem for the time being. However, I did try the Sonata one night just to make sure it works. It worked great with no hangover (an advantage of Sonata).
Okay, enough about what works for me, let's focus on your insomnia case:
Do you think Zoloft is causing your insomnia? If yes, then perhaps a switch from the activating AD Zoloft to a sedating AD (like Remeron) could show promise. From what I read, the upside of Remeron is great sleep and the potential down sides are daytime sedation and weight gain.
Do you think mania or hypomania is causing the insomnia? If so, an increase in Li, or augmentation of your Li with an AED like lamictal or neurontin, might help. I don't know about you, but for me it's hard to tell what comes first, the chicken or the egg, with regard to hypomania and insomnia. In other words, if I don't sleep I become hypomanic and if I become hypomanic, I can't sleep.
Do you believe good sleep hygiene can help in your situation?
How do you feel about adding a sleeping aid of some kind like Sonata, Ambien, a benzo, etc? How about a natural substance like melatonin? Some researchers feel that people younger than about 40 years old should not take melatonin.
Abby, I wish you well as you find a solution to your sleep problem(s). If I can help you let me know. As you are aware, sleep is SO VERY IMPORTANT to us bipolars!
-- Ron
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> I'm having a really hard time, and I wanted some feedback before I go see my pdoc on Monday.
>
> I'm taking 150 mg of zoloft and 300mg morning and night of lithium.
>
> I think I'd like to try to get the zoloft down to 50mg. I want to try to add an anticonvulsant probably neurontin or lamictal, but I'm not sure which would be better.
>
> I'm having a really hard time sleeping--I nap in the afternoon and calm down and then can't sleep most of the night and I have terrible headaches throughout most of the day, though they wax and wane. My concentration is pretty bad, and I'm very anxious.
>
> I've read that some people use neurontin for headaches too. I do have a bipolar dx. I'm worried about being sedated and tired which would make one think that lamictal might be better, but I've also read that neurontin has anxiolytic antiagitation properties. And I guess that tehre have even been cases of hypomania w/neurontin.
>
> Thoughts?
>
> Abby
poster:Ron Hill
thread:52432
URL: http://www.dr-bob.org/babble/20010122/msgs/52764.html