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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by tonyz on February 16, 2010, at 14:55:13
I have posted here before but not nearly as often as I should have. This group has provided a lot of support. I am desperate for sleep - I thought I had my depression licked but it came back like a firestorm. I was seeing a new doctor and she had prescribed buspar and lexapro - the lexapro was started at a low dose like 5mg for a while it seemed to be doing something but then anxiety went through the roof and insomnia started. Stopped both of these meds and started back on Nortriptyline - I am 100 mg now and will bump up to 125mg tonight, also taking seroquel 50-75mg and clonazepam. The clonazepam I had been trying to get rid of but I think I need it now.
I had a very rough night last night I went to bed around 11pm took my meds (100 nortriptyline, 50 seroquel and 0.25mg of clonazepam) 1am took another 25 seroqeul and by 1:30am took another 0.25mg of clonazepam. At best I got 2 hours sleep but I don't even think that much.
I called my doctor and told her I was going to take 1mg of clonazepam in the morning to try and get some sleep. I know this is a bad pattern and can screw up your sleep cycle but anyway I took 1mg around 11am and haven't been able to sleep. I had a lot of anxiety and it helped with that but didn't put me under.
Tomorrow I will check into hospital as an outpatient
Anyone have any suggestions for me on how to get through tonight - I can't take this insomnia.
I thought of increasing the Nortriptyline to 125mg (it is due for a raise), the seroquel to at least 100 maybe 125, and adding at least another 0.5 of clonazepam. I don't like messing with my meds myself but I haven't been able to get back with my doctor.
Posted by janejane on February 16, 2010, at 15:45:14
In reply to Desperate for sleep - Help someone, posted by tonyz on February 16, 2010, at 14:55:13
Sorry to hear you have this problem. I do too, though thankfully it's not as bad. Are you allowed to take benadryl or that contraindicated with your meds? You could also try magnesium.
There are old threads on this topic you might want to dig up, for more ideas.
Posted by Phillipa on February 16, 2010, at 17:36:14
In reply to Re: Desperate for sleep - Help someone » tonyz, posted by janejane on February 16, 2010, at 15:45:14
Tony seriously the same thing happened to me when a pdoc took away the 50mg of luvox raised benzos to long acting. I didn't sleep for two weeks ended up in ER. The docs said add the luvox backin as evidently my brain needed it. Maybe your're brain brain also missed a med that was stopped without any withdrawal just a thought. Glad your're getting help. Hang on tomorrow will come. I'd try the higher dose of klonopin sometimes you just must do what you must. Phillipa
Posted by tonyz on February 16, 2010, at 18:52:04
In reply to Re: Desperate for sleep - Help someone, posted by Phillipa on February 16, 2010, at 17:36:14
> Tony seriously the same thing happened to me when a pdoc took away the 50mg of luvox raised benzos to long acting. I didn't sleep for two weeks ended up in ER. The docs said add the luvox backin as evidently my brain needed it. Maybe your're brain brain also missed a med that was stopped without any withdrawal just a thought. Glad your're getting help. Hang on tomorrow will come. I'd try the higher dose of klonopin sometimes you just must do what you must. Phillipa
Thanks for the info. Yep I got in touch w/ my doc and she felt that taking some additional clonazepam along with raising the seroquel made sense. Been ramping up the Nortriptyline - I was going to bump it up but in never occurred to me that the serotonergic action could be too stimulating for me and that may be why the insomnia always gets worse at the beginning of the depression. The good think about Nortriptyline is that there is a therapeautic window and they can do a blood level. So tonight will be the fourth night at 100mg so should get a good reading assuming they take my blood tomorrow. I had a horrible experience with Lexapro - I guess I am one of those 12% people who are affected with insomnia from Lexapro and if you start with insomnia you are in real trouble. I had only taken for a short time and fairly low dosage, but you don't know.
Not sleeping sucks doesn't it?
Tomorrow I go in the hospital as an outpatient, I'm sure I will get slightly berated for having stopped my meds. I actually had been stable on SAM-E for a year and at some point I may give that another try.(that was several years ago) Only problem I think it may have been affecting my sleep a bit. For major depression a really high dose is needed gets expensive. I'm not sure if they have a maintenance dosage for that figured out yet.
I just wish there were another way for all of us instead of resorting to these medicines - so many side effects to deal with. I was even on Nardil at one time.
L-Tryptophan is also something to try for insomnia. Be careful of the brand though. From what I understand the stuff manufactured by Ajinomoto is the best - they claim on their website that when Tryptophan was banned from the US market due to a defective filtering process by another Japanese manufacturer, Ajinomoto was the only company that was still allowed to export to the US. Natural Balance is a label that uses this form of tryptophan. The other brand was marketed under the GNC label; if you do some googling you will see the transcripts from GNC claiming no responsibility. Apparently people got very very ill and settlements were made by the Japanese company so I suspect a lot of the history has not surfaced.
But the current stuff by Ajinomoto should be ok.
However if you check drug interactions a severe reaction is indicated - serotonin syndrome. When I was on 125 Nortriptyline I was taking 1500 mg of Tryptophan and didn't have any problems. That was under doctor's advice.
Anyway thanks for your replies and encouragement.
Posted by Maxime on February 16, 2010, at 20:22:35
In reply to Desperate for sleep - Help someone, posted by tonyz on February 16, 2010, at 14:55:13
I feel your pain. I suffer from insomnia a lot myself. The only thing that has helped me to sleep is Nozinan and Loxapine. They are old antipsychotics.
I really hope you can get some sleep soon.
Posted by tonyz on February 16, 2010, at 21:19:17
In reply to Re: Desperate for sleep - Help someone » tonyz, posted by Maxime on February 16, 2010, at 20:22:35
Thank you - appreciate the support. Hopefully tonight will be better and maybe the doc at the hospital will have some suggestions
Posted by X-ray on February 17, 2010, at 6:27:35
In reply to Desperate for sleep - Help someone, posted by tonyz on February 16, 2010, at 14:55:13
Hi,
Have you tried amitriptyline?
This drug is a very good sleep aid.I used to be on amitriptyline for many years,
but I never liked the side effects.Now I take mirtazapine and a low dose of Lyrica for sleep.
There is another option for you.Best regards,
X-rayWellbutrin 150 mg
Mirtazapine 45 mg
Lyrica 50 mg
Buspar 20 + 20 mg
Fluanxol 0,5 + 0,5 mg
Posted by tonyz on February 17, 2010, at 15:38:46
In reply to Re: Desperate for sleep - Help someone, posted by X-ray on February 17, 2010, at 6:27:35
> Hi,
>
> Have you tried amitriptyline?
> This drug is a very good sleep aid.
>
> I used to be on amitriptyline for many years,
> but I never liked the side effects.
>
> Now I take mirtazapine and a low dose of Lyrica for sleep.
> There is another option for you.
>
> Best regards,
> X-ray
>
> Wellbutrin 150 mg
> Mirtazapine 45 mg
> Lyrica 50 mg
> Buspar 20 + 20 mg
> Fluanxol 0,5 + 0,5 mgI used to take amitriptyline but the side effects as you know are awful. Hospital doc has some suspicions that the Nortriptyline may be activating for me and contributing to the insomnia, but of course he doesn't want to change anything until he gets a blood level. They could have done that today if they were a little faster in admissions.
I tried buspar recently and my doc suspected that it may have been activating for me.
When I am not agitated a small doseage of Mirtazapine has worked well.
Have not tried Lyrica - that I guess is something to investigate.
Thanks very much for your suggestions.
Posted by Phillipa on February 18, 2010, at 19:39:09
In reply to Re: Desperate for sleep - Help someone, posted by tonyz on February 17, 2010, at 15:38:46
What was the dose of buspar once I took 5mg with benzos and nothing. As for lyrica I think it can be sedating and activating at different doses. Phillipa
Posted by tonyz on February 20, 2010, at 14:21:16
In reply to Re: Desperate for sleep - Help someone » tonyz, posted by Phillipa on February 18, 2010, at 19:39:09
As was explained to me buspar takes a while to work so. Initial dose was 7.5mg 2x a day for about a week and then 10mg 2x a day for about a week, then stopped. It's posssible it may have been the lexapro that was stimulating in my case. I am sleeping better now but not happy with the combination of drugs.- 50mg Nortriptyline, 100 mg seroquel, 0.75mg clonazepam and 1500mg L-tryptophan
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