Posted by King Vultan on September 12, 2004, at 12:36:08
In reply to Re: Trouble sleeping - please help » King Vultan, posted by KaraS on September 11, 2004, at 22:09:29
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> > > So how have you prevented tolerance to Halcion? Are you only taking it once or twice a week?
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> > No, I take it every other night, alternating with either the Benadryl or Unisom.
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> How long have you been doing that for? When I had problems with Ativan, I took it for 2 or 3 weeks only a small amount at night to sleep. Then I went off of it for 3 weeks. Then I started it again for 3 weeks at night. Then I stopped it and I had some severe discontinuation effects. I couldn't understand it because I followed all of the precautions and didn't use it for more than 3 weeks at a time. My doctor said that my system "remembered" it so once those receptors are primed (for want of a better word), that can last a while. Some people are just highly sensitive I guess. If the same dosage is working for you and/or you don't start getting nauseous a couple of hours before you're due to take it, then I think you're safe. (The latter should have been my clue.) At any rate, I got back on doxepin and discontinued the Ativan very slowly and all was fine.
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I've been going back and forth between Halcion one night and then Benadryl or Unisom the next night for three months now, and can't say I've really noticed any tolerance developing. I did recently increase the Halcion to a whole 0.25 mg pill, but this was partly because Parnate seems to give me worse insomnia than Nardil, and also because even with Nardil, 0.125 mg Halcion wasn't enough to prevent me from waking up several times a night.
Halcion has a much shorter half life than Ativan (1.5-5 hours vs. 10-20 hours) and is much more skewed towards being sedative/hypnotic than is Ativan, which is more anxiolytic. For those reasons, I think Halcion is likely both a superior med for sleep and less likely to induce tolerance, as long as one doesn't use it every night.
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> I did some research on (hydroxyzine) myself. Does your book give a reason why it doesn't recommend that it be used on a regular basis?
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My assumption is that this is just the personal prejudice of one or more of the authors. So much comes down to a particular doctor's own experience and mindset regarding their views on a particular drug.
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> > > Does the fact that I respond paradoxically to dopaminergics mean that I also have presynaptic hypersensitive dopamine autoreceptors or are there other possible explanations? (BTW, Provigil didn't make me sleepy or alert - just produced that leaden limbs feeling. I may not have tried enough to get more of a reaction though.)
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> > It's quite possible this could be your problem, but it is only a theory, and there might be some other conceivable explanation.
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> But how does one distinguish that from too much MAO? Why do you think that the latter isn't your problem?
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Having too much MAO sounds like a good, intuitive hypothesis of depression, but it is not one that seems to be widely held based on the reading I have done. However, there have been some studies done looking at MAO-B platelet activitity in relation to different psychiatric disorders (platelets contain only MAO-B), and there do appear to be some correlations. It is also true that the level of MAO-B in a person's brain does increase with age--there may be a relationship here to disorders such as Alzheimer's and Parkinson's Disease.>
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> BTW, how are you doing on the Parnate so far?
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> Kara
Oh, I guess I'm doing all right. I am experiencing a fair amount of depression at times; hopefully, this means the dopamine being released by the Parnate is hammering away at my autoreceptors in an attempt to downregulate them. I'm scheduled to see my pdoc Wednesday about going up to 40 mg/day. I will have been on 30 mg/day for two weeks at that time and was on 20 mg/day for a week before that.Todd
poster:King Vultan
thread:388936
URL: http://www.dr-bob.org/babble/20040909/msgs/389979.html