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Re: OCD Exacerbation Bones

Posted by SLS on July 25, 2020, at 10:04:09

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

Hi, Bones.

Using a benzodiazepine for sleep might be counterproductive. These drugs affect negatively sleep architecture, and might leave you feeling less rested the following day. And, yes, daily "withdrawal" from using a BZD with a short half-life might be worse than a longer-acting BZD. There is also the issue of rebound awakening. As far as BZDs to sleep, I think temazepam is a good choice, but I think the newer "Z" drugs that target only one BZD subreceptor that does not act as an anxiolytic might make more sense.

Zolpidem (Ambien) might be a better choice. It puts me to sleep right away. I usually wake up once during the night with zolpidem. Maybe it's a type of rebound awakening, but I'm not sure. Zolpidem does have a rather short half-life, but it is a clean drug - 10 mg at bedtime. The thing is, you need to get into bed *immediately* after taking zolpidem. There is a short "window" of time beyond which it is less effective - or not effective at all.

There are longer-acting Z-drugs, but I have no experience with them.

Peaple have recommended quetiapine (Seroquel) at very low dosages for sleep. It is not very potent as a D2 receptor antagonist at low dosages, so it might be the antipsychotic with the lowest incidence of extrapyramidal symptoms (EPS).

For me, trazodone and mirtazapine are too "yucky".


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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