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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by brynb on September 5, 2012, at 3:20:41
Hi,
Over the past two weeks, I haven't been able to sleep. I used to suffer from bad insomnia, but usually when I was anxious or during a depressive period.
Two weeks ago, I stopped a medication (Tramadol) as a "test" for my pdoc. My mood started to plummet again and I started to sleep a lot during the day, so I started it again and I think I'm doing a bit better now. But, I can't sleep. (And I'm no longer sleeping during the day, either.)
I can't help but worry that the sadness I'm feeling (again) and insomnia are indicative of a relapse or...?
I'm seeing my pdoc tomorrow, but as I'm up now, I've been thinking of sleep meds to discuss with him. I don' think he'll go for Ambien or any benzos (nothing "addictive"). I've taken Trazadone in the past, as well as TCAs, but I don't want another AD and more side effects. I've used Seroquel, but again, I'm concerned about side effects.
Feedback? Thanks in advance.
-bryn
Posted by SLS on September 5, 2012, at 7:04:49
In reply to Insomnia, posted by brynb on September 5, 2012, at 3:20:41
Maybe hydroxyzine or cyproheptadine?
Linkadge is a good resource for how to treat insomnia.
I don't hear much about Rozerem (ramelteon) anymore. It can be thought of as being a powerful version of melatonin. It is an agonist at M1 and M2 melatonin receptors.
- Scott
Posted by Phillipa on September 5, 2012, at 9:41:20
In reply to Re: Insomnia - Linkadge? » brynb, posted by SLS on September 5, 2012, at 7:04:49
Scott don't you like restoril? Phillipa
Posted by SLS on September 5, 2012, at 9:45:54
In reply to Re: Insomnia - Linkadge?, posted by Phillipa on September 5, 2012, at 9:41:20
> Scott don't you like restoril? Phillipa
Yes, but I don't think bryn wants to use a benzodiazepine.
- Scott
Posted by brynb on September 5, 2012, at 10:04:35
In reply to Re: Insomnia - Linkadge? » Phillipa, posted by SLS on September 5, 2012, at 9:45:54
> > Scott don't you like restoril? Phillipa
>
> Yes, but I don't think bryn wants to use a benzodiazepine.
>
>
> - ScottIt's funny, because I was thinking about Restoril last night. It's been a long time since I've taken it, but Scott is right, it's a benzo and I'm not sure I like the idea of taking a benzo on a nightly basis. I think my pdoc won't like the idea either. BUT, I'm going to ask for a benzo (to use as a prn) anyway because my anxiety has been pretty bad lately.
I'm feeling stuck here--not sure what to do. Right now I'm on 3 meds, and that's more than I like to take, so I'm not keen on adding anything new.
Thanks again.
Posted by rjlockhart37 on September 5, 2012, at 12:05:14
In reply to Re: Insomnia -Scott + Philippa, posted by brynb on September 5, 2012, at 10:04:35
Doxepin or Rozerm. Nuerontin is a good offlabel use for anxiety before sleep. Seroquel is vary effective at night.
rj
Posted by phidippus on September 5, 2012, at 15:08:45
In reply to Insomnia, posted by brynb on September 5, 2012, at 3:20:41
>I can't help but worry that the sadness I'm >feeling (again) and insomnia are indicative of a >relapse or...?
Depression and insomnia often go hand in hand. Treating the depression usually resolves the sleep disturbance. Of course you could just be having plain old insomnia.
For sleep we have:
Seroquel
Gabitril (improves stage 4 sleep)
Clonidine
Rozerem (a melatonin synthesist)
Oxazepam
Thorazine
Ambien
Lunesta
HydroxyzineADs:
Trazadone
Doxepin
MirtazapineAsk me anything you like about the drugs I've listed.
Eric
Posted by linkadge on September 5, 2012, at 16:41:47
In reply to Re: Insomnia, posted by phidippus on September 5, 2012, at 15:08:45
Insomnia is a bugger, and I have to admit that I have not found an adequate solution to my insomnia.
The problem, for me, is finding something that treats my depression without causing insomnia - or finding treatments for insomnia which doesn't cause depression.
I have benzos on hand, but they all seem to make me more depressed (when taken long term).
I have had some sucess with the migrane herb feverfew, for combatting antidepressant induced insomnia. The herb rosemary has helped a bit (it contains a gaba-t inhibitor). You can chew on the needles or make a tea.
Low dose remeron might be an option. I'd try it before trazodone or seroquel. Hydroxyzine is o.k. but there is still hangover and (for me) mood altering effects.
Posted by jono_in_adelaide on September 6, 2012, at 22:27:44
In reply to Re: Insomnia, posted by linkadge on September 5, 2012, at 16:41:47
You might have to accept some additional side effects if you want an effective drug.
OTC Option - 50-100mg of diphenhyydramine
Rx option 25mg of doxepin or 50mg Seroquel
I like the idea of rotating sleep meds, to avoid tolorance, taking an antihistaminic drug (doxepin or seroquel) one night and a GABA drug (temazepam or Ambien) the next
Posted by jono_in_adelaide on September 6, 2012, at 22:42:00
In reply to Re: Insomnia, posted by jono_in_adelaide on September 6, 2012, at 22:27:44
You can get generic Seroquel 50mg tabs, 10 dollars for 100, from a well known online Indian pharmacy.
They put you out like a light and you wake refreshed and with no hangover (doxepin can cause hangover due to its long half life)
Posted by linkadge on September 7, 2012, at 19:24:41
In reply to Re: Insomnia, posted by jono_in_adelaide on September 6, 2012, at 22:42:00
>They put you out like a light and you wake >refreshed and with no hangover
Seroquel? no hangover? huh?
Linkadge
Posted by jono_in_adelaide on September 8, 2012, at 18:23:00
In reply to Re: Insomnia, posted by linkadge on September 7, 2012, at 19:24:41
It has a short half life, hence much less hangover than doxepin
50mg gives me a good nights rest, and I wake refreshed and not groggy.
If you have hangover, you're taking too much, and should drop it to 25mg
Posted by brynb on September 9, 2012, at 14:00:41
In reply to Insomnia, posted by brynb on September 5, 2012, at 3:20:41
I appreciate the responses!
My pdoc didn't prescribe anything--he thinks I'll "cycle through it" and burn out. He's a less-is-more guy, and I actually really like that approach. I've tried many of the meds suggested in this thread, some with good results, some not.
I think exercise would really help, too, but I'm too tired to do anything at the moment. In time, I suppose.
Thanks again.
Posted by jono_in_adelaide on September 9, 2012, at 19:34:51
In reply to Thanks for the feedback..., posted by brynb on September 9, 2012, at 14:00:41
Given that he didnt give you anything, it would be worth trying 50-100mg of diphenhydramine (1 or 2 Unisom SleepGells) half an hour before bedtime.
The body develops a tollorance resonably quickly, so try and use it every second night if its going to be a longish term thing
This is the end of the thread.
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