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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Seraphim on May 6, 2001, at 11:03:05
Any and all advice is welcome.
A little background - I have had problems, periodically, with nightmares in the past. Everyone does on occasion, especially in response to a great deal of stress. Sometimes they would continue for weeks or months and start to become a real problem. They would affect my waking life; it's hard to let go of some of them, as they are terrifying and very memorable. Anyway, nightmares hadn't been a problem for years; then I went into a severe depressive state almost three years ago. Woke up screaming almost every night. Terrified my husband. I think it was the depression that brought on such an extended bout. For depression (until a few years ago I had never taken any medications), my doctor prescribed Effexor(went up to 300mg), Elavil(200mg), and Seroquel(small dosage of seroquel). I truly think I was over-medicated the past few years, but thought that since it was a professional recommending them, I must need the meds. Looking back, I was a fool. I certainly shouldn't have stayed on them so long.
About four months ago, I stopped taking the Elavil. I cut my dosage of Seroquel to 50mg a day. About two months ago I started weaning from Effexor. Now down to 37.5mg a day. Severe withdrawal symptoms. I'm sick and in pain. I have had a few days of enlightenment; optimistic and determined. About two weeks ago the nightmares started again. I figured it was in response to withdrawal and the stress involved, but they are not stopping. Every night, even during brief naps lately, I am having the most vivid, horrifying nightmares. They seem to continue all night. Like a horror movie where I'm the main character. I remember every detail, or so it seems. I've had problems sleeping (waking a lot, not sleeping for more than 2 hour straight) on and off for many years, even while taking all of the meds. Doesn't bother me though. I get a lot of reading done. But I can't handle the nightmares much longer. It's affected my outlook on everything right now. I asked my general physician, years ago, if there was anything that would help and I was told no. I asked my pdoc two years ago and was told that there wasn't a med. that can treat nightmares. So no help there. Anyone have any suggestions? Thanks.
Seraphim
Posted by mila on May 6, 2001, at 14:10:39
In reply to Nightmares! , posted by Seraphim on May 6, 2001, at 11:03:05
address the issues spelled out in your nightmares.
It MIGHT be that your depression was not cured, or its cause not been dealt with. A single nightmare understood, can stop the train of nightmares forever.
sorry to hear that you suffering that much. God knows how much I understand you.
if you want to educate yourself about nighmares and ways to deal with them, tell me, I'll post some book titles.
best
mila
Posted by mila on May 6, 2001, at 16:12:04
In reply to Nightmares! , posted by Seraphim on May 6, 2001, at 11:03:05
Oops, Seraphim,
forgot to address the medication in the prevous post.=== I asked my pdoc two years ago and was told that there wasn't a med. that can treat nightmares. So no help there.
that is so not true. There is such a thing as nightmare disorder.(no pun intended, but sounds funny anyway:) frequently it is comorbid with depression, anxiety disorder or PTSD. When treating nightmares accompanying such disorders, the first emphasis in treatment is on them.
Otherwise, pharmacological suppression of persistent troubling nightmares goes like so
low doses of REM-suppressing drugs such as antihistamines ( cyproheptadine, 4-24 mg at bedtime)
trycyclic antidepressants (impiramine, 10-50 mg)
sedative SSRIs (sertraline, 50-100 mg at bedtime)
mood stabilizers (carbamazepine, 100-400 mg at bedtime)
or anxiolytics (clonazepam, 0.25 -1.0 mg at bedtime)
best of luck
mila
Posted by Elisabeth on May 6, 2001, at 17:29:27
In reply to Re: Nightmares! , posted by mila on May 6, 2001, at 14:10:39
When my dreams were TOO busy...too much REM stuff going on...the Restoril (temazepam) worked with Valium. I got my 7 hours+ with little dreaming..but was so desensitised that I had no happy or sad emotions either. That's why I weaned off.
After going through some heavy duty REM sleep...I have settled down to less active dreams, but short sleep cycle...4 hours at once at most! But am more refreshed in morning. Just trying to get used to it. Valerian helps now that the benzos are not part of my regular routine. I miss the calm, but not the numbness which literally made my arms numb in the morning which was scary.
Posted by Elizabeth on May 7, 2001, at 7:20:02
In reply to pharmacological suppression of nightmares, posted by mila on May 6, 2001, at 16:12:04
Some other pharmacological approaches that I've heard of (most, if not all, are known REM suppressors):
amphetamine and some related drugs (e.g., Ritalin)
anticholinergics (this category includes many antihistamines, tricyclics (especially amitriptyline), as well as drugs like Cogentin and Artane)
benzodiazepines
clonidine
valproateMost effective antinarcolepsy drugs are REM suppressors (Provigil is an exception). If medication is required for children with primary nightmare disorder (i.e., not secondary to PTSD or some such), I think the usual treatment is benzodiazepines (Klonopin is a good choice but higher doses may be required).
I'd avoid SSRIs for antidepressant withdrawal nightmares, as SSRIs can cause nightmares (either as a side effect, or when you try to withdraw from the SSRI). Although they do decrease the total time spent in REM sleep, SSRIs increase REM *density*, which can lead to vivid dreams. On the other hand, because your problem seems to result from withdrawal of Effexor, Prozac might be beneficial (it does not need to be taken at bedtime). Other SSRIs (which have much shorter elimination half-lives) are quite likely to cause a repeat of the REM rebound upon discontinuation.
MAOIs are very powerful REM suppressors (IMHO they would be an excellent choice for PTSD), but they cause REM rebound on withdrawal as well. (In my own experience, this just consists of weird, vivid dreams, but if you're predisposed to nightmares it could be really bad.)
Posted by grapebubblegum on May 7, 2001, at 9:27:45
In reply to Re: Nightmares! , posted by Elisabeth on May 6, 2001, at 17:29:27
The only thing I can say to help is that my father was given klonopin at bedtime to prevent nightmares.
Posted by Noa on May 8, 2001, at 7:55:26
In reply to Re: Nightmares! , posted by Elisabeth on May 6, 2001, at 17:29:27
Periactin (an antihistamine, I think) that is used to supress nightmares. I think it was used for PTSD in combat soldiers. Apparently, it also counters some of the sexual side effects of SSRIs.
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