Posted by bleauberry on March 17, 2010, at 16:44:49
In reply to Lunesta and Lexapro, posted by vic80 on March 17, 2010, at 12:15:52
Lunesta may or may not worsen depression. We all respond differently. If it makes you feel worse, stop taking it.
A better sleep med in my opinion is ultra low dose Remeron. 1mg to 7.5mg, by cutting pills to size. There is some carryover drowsiness into the next day for a week or so, but that goes away. Who knows, at higher doses it might even help your depression, since I think it does a better job combined with ssris than it does by itself.
I agree with you on the benzo/sleep thing. Others might have different opinions, but I personally do not see benzos as good first choices for insomnia. Very low dose remeron or amitriptyline, sometimes nortriptyline, are much better starting points. My opinion.
SSRIs of all kinds can worsen depression, especially at the start of treatment. Some people feel a lot better almost right away, as their systems seem to love the extra serotonin. But others feel a lot worse right away, or on dose increases, as maybe they already have too much serotonin. Too much serotonin would be squashing out dopamine and norepinephrine, which is a reliable way to create depression or worsen it if those neurotransmitters are more deficient than serotonin. An ssri is probably not going to be very helpful to someone with a low norepinephrine or low dopamine depression.
I am not a fan of SSRI monotherapy, so I can't really help much on that topic. I think increasing any single neurotransmitter at the expense of the others, or at the ignorance of the others, is asking for trouble sooner or later.
Some people say it is normal to feel more depressed on dose increase, but the recovery and feeling good comes later. I personally disagree with that. Too many people kill themselves in that stage. Not a good benefit/risk balance. And no guarantee that they ever will get out of the funk given more time.
For now I guess you kinda have to do what your doctor says, as long as he is a real good doctor you trust completely, and see what happens. At some point though if things get really bad, you gotta put your foot down and speak up.
poster:bleauberry
thread:939820
URL: http://www.dr-bob.org/babble/20100305/msgs/939833.html