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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Crotale on June 18, 2008, at 18:46:18
Hi everyone. I'm seeing my pdoc tomorrow. I've been having ECT with some success, but my insomnia is still causing problems. Only thing that seems to work is Ambien (benzos, antihistamines, etc. stop working after a few days resulting in dosage creep).
I've had problems in the past with REM sleep behaviour disorder (that's physically acting out one's dreams; doesn't happen now b/c I'm on Parnate, and MAOIs suppress REM sleep almost completely).
Needless to say I've tried many things, but I haven't tried some of the newer ones (Mirapex, NMDA antagonists, etc.). I had a seizure (they think) on desipramine, which is too bad because it actually worked pretty well.
Anyway...anyone have any ideas? I've been considering asking for a higher dose of Ambien but I'm already taking 20mg which is higher than the recommended dose. Ambien is the only sleeping pill I've ever taken to which I don't become tolerant. It also seems to have some anti-anxiety effect (which I know it's not *supposed* to...)
Anyway...ideas for the treatment-resistant?
Thanks....
Posted by Phoenix1 on June 18, 2008, at 19:38:53
In reply to appointment with pdoc tomorrow...ideas?, posted by Crotale on June 18, 2008, at 18:46:18
Hi Crotale,
I experiened bad insomnia on Nardil. I started out with zopiclone 7.5mg (Same as Lunesta 3mg roughly) but it quicly lost it's effectiveness. It was increased to 15mg, which also quickly lost effectiveness.
Adding 50-75mg of Seroquel did the trick. No more tolerance issues, no more insomnia.
Side effects were minimal at that low dose. So you might want to ask about adding a small dose of Seroquel to the Ambien?I know there's at least one other poster on Parnate who has also had good success with this combination.
Hope that helps.
Phoenix
> Hi everyone. I'm seeing my pdoc tomorrow. I've been having ECT with some success, but my insomnia is still causing problems. Only thing that seems to work is Ambien (benzos, antihistamines, etc. stop working after a few days resulting in dosage creep).
>
> I've had problems in the past with REM sleep behaviour disorder (that's physically acting out one's dreams; doesn't happen now b/c I'm on Parnate, and MAOIs suppress REM sleep almost completely).
>
> Needless to say I've tried many things, but I haven't tried some of the newer ones (Mirapex, NMDA antagonists, etc.). I had a seizure (they think) on desipramine, which is too bad because it actually worked pretty well.
>
> Anyway...anyone have any ideas? I've been considering asking for a higher dose of Ambien but I'm already taking 20mg which is higher than the recommended dose. Ambien is the only sleeping pill I've ever taken to which I don't become tolerant. It also seems to have some anti-anxiety effect (which I know it's not *supposed* to...)
>
> Anyway...ideas for the treatment-resistant?
>
> Thanks....
Posted by bleauberry on June 18, 2008, at 20:08:13
In reply to appointment with pdoc tomorrow...ideas?, posted by Crotale on June 18, 2008, at 18:46:18
I generally frown at the frivilous use of antipsychotics, but I must admit I do agree with the previous post in suggesting seroquel. At a very low dose such as 25mg to 75mg it should do the trick and other than being a good sleep aid should be fairly invisible as far as everything else goes, maybe some daytime sluggishness for the first week or two.
Posted by Justherself54 on June 18, 2008, at 21:08:20
In reply to Re: appointment with pdoc tomorrow...ideas?, posted by bleauberry on June 18, 2008, at 20:08:13
I have great success with 25 mg of seroquel and 7.5 mg of zopiclone. The only time I've had to increase my dosage was when I was on Nardil...I was scared to take seroquel, but as I can't tolerate mood stabilizers and I have fibromyalgia, rigid sleep hygiene is critical..I'm glad I listened to my pdoc despite my fears..
Posted by Crotale on June 18, 2008, at 21:51:03
In reply to Re: appointment with pdoc tomorrow...ideas?, posted by Phoenix1 on June 18, 2008, at 19:38:53
Hi. I should have been more specific as to what I've tried for insomnia.
Sonata and Lunesta did not work at all for me, not even temporarily. I've also tried a number of antipsychotic drugs like Zyprexa, Seroquel, and even Mellaril. (I lump these with antihistamines because I suspect a lot of their sedative action is due to antagonism of H1 receptors. Indeed, Thorazine was originally designed as a new antihistamine.) I also had a very bad reaction when I tried Risperdal.
I would like to be able to go on desipramine with the Parnate (I've done MAOI-TCA combinations before, and desipramine has been good for me), but I had what may have been a seizure while on desipramine (at the time I was uninsured so the stupid city hospital didn't even do an EEG).
I'm thinking along the lines of stuff like Mirapex, amantadine, and perhaps (if I can get my hands on some) adinazolam. I'm currently thinking along the lines of improved concentration.
I may decide to take the ECT a bit farther (e.g., try bilateral); I haven't decided.
-Crotale
Posted by Phillipa on June 19, 2008, at 0:07:25
In reply to Re: appointment with pdoc tomorrow...ideas?, posted by Crotale on June 18, 2008, at 21:51:03
The posts I've read suggest that bilateral is not as effective with more side effects than unilateral. Just what I've read. Love Phillipa
Posted by Justherself54 on June 19, 2008, at 7:02:20
In reply to Re: appointment with pdoc tomorrow...ideas?, posted by Crotale on June 18, 2008, at 21:51:03
I'm currently thinking along the lines of improved concentration.I find that Parnate actually helps me focus and concentrate better so you may not need an add-on to improve concentration.
Posted by Crotale on June 19, 2008, at 9:06:02
In reply to Re: appointment with pdoc tomorrow...ideas? » Crotale, posted by Justherself54 on June 19, 2008, at 7:02:20
> I find that Parnate actually helps me focus and concentrate better so you may not need an add-on to improve concentration.
I've tried higher doses of Parnate. Doesn't do it for me.
Crotale
Posted by Zeba on June 19, 2008, at 21:58:00
In reply to Re: appointment with pdoc tomorrow...ideas?, posted by Crotale on June 18, 2008, at 21:51:03
It is really hard for me to hear someone talk about getting bilateral ECT. I had only seven RUL ECT treatments but at five times the seizure threshold. The last treatment was done by a different doctor who let my seizure go for three times as long as the other doctor. I was so screwed after that treatment that I stopped the ECT. To this day over a year later I still have problems with memory and am getting neuropsych testing done soon. I guess I think unilateral can be just as bad. Afterall, the seizure is over the whole brain.
My regular ECT doctor told me that he would like to have done bilateral with me at 100% charge, but he knew I would never agree, and he also said that it would cause me permanent memory loss of all sorts. He told me with what I did have done that with the seven ECT treatments that I have likely lost around 15 IQ points. He said I had cognitve reserve so that I was still left with lots of smarts. GEE thanks doc. So, please be careful of what you do. I am on Parnate now, and it is working. Actually I think a big part of the reason it is working for me now is that I have a very good therapist/pdoc/analyst who I see three times per week now.
Research shows it is the combo of medication and therapy that works best and better than just one or the other. Take care.
Posted by Crotale on June 19, 2008, at 23:45:41
In reply to Re: appointment with pdoc tomorrow...ideas? » Crotale, posted by Zeba on June 19, 2008, at 21:58:00
> I had only seven RUL ECT treatments but at five times the seizure threshold.
Well, that's probably not enough for it to have helped you....
> The last treatment was done by a different doctor who let my seizure go for three times as long as the other doctor.
It sounds like that doctor was not very competent! I am having the treatments at a university hospital with doctors I know, trust, & respect. They have a lot of experience with ECT. I do feel fortunate that I haven't had any memory problems...the only side fx I've experienced are mild headaches following some of the treatments.
I'm really sorry about what happened to you. It sounds extremely traumatic. I don't blame you for stopping the ECT after that. For that matter, I wouldn't blame you if you never trusted a doctor again after that!
> Research shows it is the combo of medication and therapy that works best and better than just one or the other. Take care.
You mean talk therapy? I am seeing a psychotherapist, but I really haven't had much luck with various types of talk therapy over a number of years, ranging from psychodynamic to cognitive-behavioral. I just haven't been very impressed with it, personally. For a while I was seeing a psychoanalytic/psychodynamic psychotherapist several times a week like you are. I've also been involved in group therapy including several partial programs which were probably the most benefitial of all the talk-therapy I've done.
I think that whether talk-therapy or medical treatment works best depends on the individual patient. I've known people who benefitted from psychoanalysis or from CBT so I know it can be helpful stuff.
As far as ECT goes, it sounds like your doctor messed it up for you. Bear in mind that any kind of medical procedure can go badly if the doctor screws up.
Crotale
This is the end of the thread.
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