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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by gardenergirl on August 10, 2004, at 20:45:39
Hi, I have been on 75 mg Nardil for one week now. At first, I took one pill four times per day, and two pills at my last dose before bed (yeah, I know now that was a bad arrangement... )
Saturday I moved the 2 pill dose to morning by taking only 60 mg that day, so I didn't get too much in one 24 hour period.By day three last week, I was feeling pretty good, actually, as good as when I first started Nardil last fall. But then the insomnia and activation started.
I've been having terrible early awakening. Every night I seem to wake up about 3:00 a.m. feeling hot (especially in my hands and feet), but not sweaty, terribly restless like I have to get out of bed right now!, and wide awake. I checked my BP, and it was fine. Pulse is fine. Blood sugar is still normal. Nothing I have tried so far has helped this...not benadryl, meditation, exercise, herbal tea, deep breathing, etc. I just have to get up and move or I feel like I'm going to go crazy. Now this effect is lasting all day, and I can't even nap or rest. I'm too old to be existing on an average of 3 hours sleep. Last night was only one hour. I feel so sleepy and exhausted and yet surging with internal energy at the same time. I can't concentrate well, because I am so uncomfortable.
My question is this: I've had some early awakening before, although not this early and not with the accompanying restlessness. It eventually got better, and I was still getting at least six hours per night. What do you all think? Will this go away, and how soon can we guesstimate? I can try to stick it out if I feel confident it will get better soon, but I know I can't handle this much more than this week.
Pdoc called me back to day and recommended dropping to 67.5 mg to see if that helps. Otherwise, she thinks go back to 60 mg, although that seemed like it was not enough.
Also, I recently had started Cytomel, but my PCP started me way too high, and I went hyperthyroid. I stopped that last Thursday. That may be part of it, but I don't know how long to expect it to take to go back to a normal T3 and TSH count.
Sorry so long, but please please please, any and every advice you can think of from your knowledge and experience will be welcomed.
Thanks,
gg
Posted by Sad Panda on August 10, 2004, at 22:36:35
In reply to 75 mg Natdil...insomnia and restlessness--help!, posted by gardenergirl on August 10, 2004, at 20:45:39
Hi GG,
I'd ask your doc if you could take Remeron, Doxepin or Trimipramine for sleep. Remeron doesn't alter blood pressure, Doxepin or Trimipramine will lower it. If he is uncomfortable with adding another AD to an MAOI then suggest an AP like Seroquel or Zyprexa.
Cheers,
Panda.
Posted by King Vultan on August 10, 2004, at 23:15:09
In reply to 75 mg Natdil...insomnia and restlessness--help!, posted by gardenergirl on August 10, 2004, at 20:45:39
I had similar insomnia problems on Nardil, except that I would wake up even earlier, but I did not have the extreme restlessness you describe. You might want to consider trying Restoril, which is a powerful benzo that is good at maintaining sleep, as opposed to falling asleep. Even if your doctor will only let you take it every other night (which would probably be a good idea to avoid dependence/tolerance issues), you might still have a chance of getting one good's night sleep out of every two. I took (and am still taking) Halcion, a shorter half life benzo, alternating with Benadryl. I have almost completely tapered off the Nardil but am still suffering insomnia from REM rebound syndrome, something that was not even on my radar screen to begin with. Well, you learn all sorts of interesting things when dealing with these antidepressants.
There is a prescription antihistamine my pdoc suggested to me as perhaps a more effective alternative to the Benadryl. It's called hydroxyzine (Vistaril is one of the trade names) and is apparently very anxiolytic. I haven't tried it, but if I were in your place, I would consider alternating between some short half life antihistamine like this and a benzo like the Restoril. I think taking two drugs, each every other night, will tend to lower the chance of developing tolerance for either one.
Todd
Posted by SLS on August 11, 2004, at 7:35:41
In reply to Re: Nardil insomnia and restlessness » gardenergirl, posted by Sad Panda on August 10, 2004, at 22:36:35
> I'd ask your doc if you could take Remeron, Doxepin or Trimipramine for sleep.
I would be a bit hesitant to recommend doxepin with that high a dosage of Nardil. At 60mg and higher, I think any drug with appreciable serotonin reuptake properties might be problematic. At low dosages of doxepin, perhaps the combination would be OK, but I think the trimipramine and Remeron are the better choices. Hypotension might be a consideration with trimipramine, but I'm not sure of its potency at NE alpa-1 receptors.
- Scott
Posted by Sad Panda on August 11, 2004, at 9:00:04
In reply to Re: Nardil insomnia and restlessness, posted by SLS on August 11, 2004, at 7:35:41
> I would be a bit hesitant to recommend doxepin with that high a dosage of Nardil. At 60mg and higher, I think any drug with appreciable serotonin reuptake properties might be problematic.
>
>Hi Scott,
Doxepin isn't really an SRI, you might be thinking of Dothepin. :)
Cheers,
Panda.
Posted by King Vultan on August 11, 2004, at 9:49:30
In reply to Re: Nardil insomnia and restlessness » SLS, posted by Sad Panda on August 11, 2004, at 9:00:04
> > I would be a bit hesitant to recommend doxepin with that high a dosage of Nardil. At 60mg and higher, I think any drug with appreciable serotonin reuptake properties might be problematic.
> >
> >
>
> Hi Scott,
>
> Doxepin isn't really an SRI, you might be thinking of Dothepin. :)
>
> Cheers,
> Panda.
>Doxepin does have some effect on 5-HT reuptake, but it appears to be swamped by its much more powerful H1 blockade, and is probably not a big cause for concern IMO. I agree trimipramine is safer, however, and this is the one I would choose if I had to pick between the two.
The problem I have with using these two tricyclics rather than stuff like Benadryl or hydroxyzine is that the tricyclics have such long half lives in comparison that I think there is a greatly increased chance of being overly sedated the next day. OTOH, these tricyclics have extremely strong histamine blockades and are probably more powerful sleep aids.
Todd
Posted by gardenergirl on August 11, 2004, at 20:51:45
In reply to Re: Nardil insomnia and restlessness » gardenergirl, posted by Sad Panda on August 10, 2004, at 22:36:35
Thanks for the info. especially on the different effects. I really am hoping this will be temporary since it was temporary (albeit not so bad) before. But if not, I think those are definitely worth considering. What about using something like Remeron or one of the others short term? Would it be difficult to stop?
I suppose since my BP is normally on the low end of the normal range, I wouldn't want to risk lowering it more, especially when I would be sleepily getting out of bed. Don't need to be taking a header first thing in the a.m.! :)
Thanks again,
gg
Posted by gardenergirl on August 11, 2004, at 20:54:17
In reply to Re: 75 mg Natdil...insomnia and restlessness--help! » gardenergirl, posted by King Vultan on August 10, 2004, at 23:15:09
Thanks for your response. REM rebound? Is that having an excess of REM time to make up for REM suppression? I always wonder about the REM suppression and MAOI's. I thought REM was important to well being and maybe consolication of memory. Incidentally, I eventually began dreaming again on Nardil, which made me wonder if it was pooping out.
Also, how funny that you mention Atarax. My dog takes that three times per day for allergies. I suppose I could swipe one and try it! Although last night actually was better. A little benadryl and a little red wine seemed to be a good mix.
Thanks again,
gg
Posted by gardenergirl on August 11, 2004, at 20:57:50
In reply to Re: Nardil insomnia and restlessness, posted by SLS on August 11, 2004, at 7:35:41
Thanks Scott.
It sounds like if I combine your advice with the others, then Remeron may be a good choice. I'll keep that in mind. For now my pdoc said to lower my dose by half a pill. That worked really well as I slept somewhat better, woke at 5:00 but was able to doze again for about a half hour (much better than 3:00 a.m. and no more sleep at all). I even napped successfully today, although I hope that doesn't interfere with tonight.However I took the one and a half pill dose at noon instead of morming, because it made sense to me that that's when I could use the boost. And I felt the restlessness come on very very quickly and last about an hour until I could rest. Now it's sort of in the background. If the half tab decrease doesn't help, I think I will go back to 60mg until I see her again in about three weeks.
Thanks again.
gg
Posted by gardenergirl on August 11, 2004, at 21:01:13
In reply to Re: Nardil insomnia and restlessness, posted by King Vultan on August 11, 2004, at 9:49:30
Thanks for the info about tricyclics. I think a chance of being oversedated would make me a little nervous about trying it unless other stuff has failed first. I tend to be fairly sensitive to sedating meds. But then again, I can have weird med reactions anyway. I once got really activated, almost hypomanic from the antibiotic Biaxin XR. That was an interesting experience!
Thanks again,
gg
Posted by Ilene on August 11, 2004, at 23:46:30
In reply to 75 mg Natdil...insomnia and restlessness--help!, posted by gardenergirl on August 10, 2004, at 20:45:39
I take Neurontin. It doesn't put me to sleep, but it keeps me there. It's compatible w/ MAOIs.
Posted by Piquet on August 12, 2004, at 5:05:07
In reply to Re: 75 mg Natdil...insomnia and restlessness--help! » King Vultan, posted by gardenergirl on August 11, 2004, at 20:54:17
> Thanks for your response. REM rebound? Is that having an excess of REM time to make up for REM suppression? I always wonder about the REM suppression and MAOI's. I thought REM was important to well being and maybe consolication of memory. Incidentally, I eventually began dreaming again on Nardil, which made me wonder if it was pooping out.
>
> Also, how funny that you mention Atarax. My dog takes that three times per day for allergies. I suppose I could swipe one and try it! Although last night actually was better. A little benadryl and a little red wine seemed to be a good mix.
>
> Thanks again,
> ggHi gg. If you'd like to know some interesting facts about Nardil and REM sleep, I discovered an article the other day. It's longish, so I won't post it, but if you follow the link and then scroll down about a third of the way, you'll see phenelzine/REM specific info.
http://www.bbsonline.org/documents/a/00/00/04/67/bbs00000467-00/bbs.vertes.html
Regards, Piquet.
Posted by Sad Panda on August 12, 2004, at 6:24:20
In reply to Re: Nardil insomnia and restlessness » Sad Panda, posted by gardenergirl on August 11, 2004, at 20:51:45
> Thanks for the info. especially on the different effects. I really am hoping this will be temporary since it was temporary (albeit not so bad) before. But if not, I think those are definitely worth considering. What about using something like Remeron or one of the others short term? Would it be difficult to stop?
>
> I suppose since my BP is normally on the low end of the normal range, I wouldn't want to risk lowering it more, especially when I would be sleepily getting out of bed. Don't need to be taking a header first thing in the a.m.! :)
>
> Thanks again,
> gg
>
>Hi GG,
If your BP is low I would say that the TCA's & Trazodone would not be for you. Remeron is actually the most potent antihistamine you can get, it knocks you out pretty good for the first month you take it. It's withdrawl consists of a few days of rebound insomnia & nausea. If you try that, start at just 7.5mg. A stronger OTC antihistamine than Benadryl would be Phenergan, & a very interesting OTC antihistamine is Periactin. It is considered to be the most potent 5-HT2A antagonist & a primary antidote to serotonin syndrome. Not sure how sedating it is, but it would be handy stuff to have on hand. The atypical AP's Zyprexa & Seroquel are also potent antihisatmines, but like the TCA's, they are also strong Alpha-1 NE antagonists which is what causes orthostatic hypotension & reflex tacycardia. Piquets link is a good read too, I would guess that it's the hydrazine based MAOI's that cause REM reduction as they are gabaergic like benzos. I would guess that Parnate & Selegeline would not have this problem.
Cheers,
Panda.
Posted by SLS on August 12, 2004, at 7:18:02
In reply to Re: Nardil insomnia and restlessness, posted by gardenergirl on August 11, 2004, at 21:01:13
> I once got really activated, almost hypomanic from the antibiotic Biaxin XR. That was an interesting experience!
I'll say!
I have been thinking about trying doxycyline for my bipolar depression because of its anti-imflammatory effects.
Can you describe your experience? Was it a transient reaction, or did it persist for the entire time you took it? If you don't mind my asking, what did you take it for?
Thanks GG.
- Scott
Posted by gardenergirl on August 12, 2004, at 8:37:22
In reply to Re: 75 mg Natdil...insomnia and restlessness--help!, posted by Piquet on August 12, 2004, at 5:05:07
Wow, what a great article. Thanks for posting it. If their proposed purpose of sleep and the REM phase of sleep is correct, that really explains the frequent awakening.
Thanks,
gg
Posted by gardenergirl on August 12, 2004, at 8:50:36
In reply to Re: Nardil insomnia and restlessness » gardenergirl, posted by Sad Panda on August 12, 2004, at 6:24:20
Interesting...according to my Palm program Epocrates, here in the states, Periactin has been discontinued. Also, phenergan is still a prescription med. I think I had that once when I was sick. I remember not liking taking it because it made me too drowsy.
I think I would like to avoid atypical AP's if at all possible. I've gained weight on the Nardil, and adding something that also leads to weight gain might just be asking for complications.
Thanks,
gg
Posted by gardenergirl on August 12, 2004, at 8:56:14
In reply to Re: Nardil insomnia and restlessness » gardenergirl, posted by SLS on August 12, 2004, at 7:18:02
>
> I have been thinking about trying doxycyline for my bipolar depression because of its anti-imflammatory effects.I don't know enough about the neurochemistry of bipolar to understand this. How would an anti-inflammatory help?
>
> Can you describe your experience? Was it a transient reaction, or did it persist for the entire time you took it? If you don't mind my asking, what did you take it for?My reaction started within about two days of starting the Biaxin. I was taking it for a nasty sinus infection. The doctor blamed the Drixoral I was also taking because it has pseudoephedrine in it, but I stopped taking that and the hyperness continued. He also said that there was no way the Biaxin could do this. Hello! Look at the insert. Among the more rare, but documented S/E's were transient CNS symptoms and mania or psychosis. Ahem.
It lasted the whole week I was on the Biaxin. I did not take it the day I went back in to the doctor, but I was still a bit ramped up. It stopped pretty much by the next day, I think. So I had a week of being hyper. If I could stand that feeling, it might be helpful to take it again when finals are coming up. ;)
Take care,
gg
Posted by Racer on August 12, 2004, at 12:51:54
In reply to Re: Nardil insomnia and restlessness » gardenergirl, posted by Sad Panda on August 12, 2004, at 6:24:20
>
> Hi GG,
>
> If your BP is low I would say that the TCA's & Trazodone would not be for you. Remeron is actually the most potent antihistamine you can get, it knocks you out pretty good for the first month you take it.
NOT true for everyone, though. When I tried Remeron, I didn't sleep and was just out of control. Little things that might normally irritate me ENRAGED me. (And I rarely raise my voice -- just don't get worked up enough under normal circumstances to bother.) Dr EyeCandy told me that he'd had that happen with a few of his patients who tried it.('Course, just 'cause it happened to me doesn't mean that GG wouldn't be more average in this. Just wanted to mention that it can't be relied upon to be sedating...)
Hi, Panda! Good to see you!
Posted by Sad Panda on August 12, 2004, at 17:42:18
In reply to Re: Nardil insomnia and restlessness » Sad Panda, posted by Racer on August 12, 2004, at 12:51:54
> >
> > Hi GG,
> >
> > If your BP is low I would say that the TCA's & Trazodone would not be for you. Remeron is actually the most potent antihistamine you can get, it knocks you out pretty good for the first month you take it.
>
>
> NOT true for everyone, though. When I tried Remeron, I didn't sleep and was just out of control. Little things that might normally irritate me ENRAGED me. (And I rarely raise my voice -- just don't get worked up enough under normal circumstances to bother.) Dr EyeCandy told me that he'd had that happen with a few of his patients who tried it.
>
> ('Course, just 'cause it happened to me doesn't mean that GG wouldn't be more average in this. Just wanted to mention that it can't be relied upon to be sedating...)
>
> Hi, Panda! Good to see you!
>
>Hi Racer,
That's alpha-2 NE antagonism kicking in, I hate it too. For me 15mg was bliss, when I increased to 30mg they became angry pills & it took me months to get use to it. :)
Remeron at low doses is a powerful H1 antagonist, at moderate doses it blocks 5-HT2 & 5-HT3, as you increase further, Alpha-2 NE antagonism kicks in & this is why higher doses are supposed to be stimulating. I guess the majority of people like A2 antagonism, but people like us don't. It's the reason I suggest people start low & creep up on the doseage slowly rather than going straight to a high doseage. I also urge people to try 22.5mg because 15, 22.5 & 30mg do distictly different things for me.
Cheers,
Panda.
Posted by Racer on August 12, 2004, at 20:05:49
In reply to Remeron Rage » Racer, posted by Sad Panda on August 12, 2004, at 17:42:18
For me, this kicked in at 7.5mg -- and literally the first night I took it I had a hard time getting to sleep, then woke up the next morning OVER THE TOP. After a few days of trying to tough it out, and reading here that differing doses have differing effects, I tried going up to 15mg. No real change, except for *really* wanting to die -- as long as I could take a few other people with me. (OK -- that was mostly for a joke, but it was very frightening for me -- and for my husband, who had to watch this -- and I was seriously considering suicide by any means during the time I was on it. I only lasted 8 days on it, but the after-effects went on for a while and were pretty unpleasant.)
Trust me, Panda -- I was reading all the Remeron posts here, as well as looking through the usual suspects, and knew that lower doses were supposed to be sedating. (Really, the only reason I tried raising it to 15 -- besides seriously questionable judgement on my part -- was related to all the problems I've been having with getting treatment through the county system. I was desperate to get some relief, and thought that if I didn't respond to this -- or if I called the doctor to tell him it wasn't working *quite* the way he might have expected -- I'd end up either hospitalized or scheduled for ECT. At the time, I was also rather hopeful that the misery I was experiencing while on the drug would be enough to galvanize me into suicide. NOT the right reason to stay on something. My husband finally stepped in and made me call the doctor's office.)
The worst part? When I was trying to describe this a bit to the doctor, he just said, "Yeah, a few of my patients have reacted that way to it..." Sheesh! If I'd called sooner, he probably wouldn't have said I was just making it up...
And Panda? On a personal note, it's always a pleasure to read your posts.
Posted by Piquet on August 12, 2004, at 22:07:39
In reply to Re: 75 mg Natdil...insomnia and restlessness--help! » Piquet, posted by gardenergirl on August 12, 2004, at 8:37:22
Posted by Sad Panda on August 13, 2004, at 3:16:30
In reply to Re: Remeron Rage » Sad Panda, posted by Racer on August 12, 2004, at 20:05:49
> For me, this kicked in at 7.5mg -- and literally the first night I took it I had a hard time getting to sleep, then woke up the next morning OVER THE TOP. After a few days of trying to tough it out, and reading here that differing doses have differing effects, I tried going up to 15mg. No real change, except for *really* wanting to die -- as long as I could take a few other people with me. (OK -- that was mostly for a joke, but it was very frightening for me -- and for my husband, who had to watch this -- and I was seriously considering suicide by any means during the time I was on it. I only lasted 8 days on it, but the after-effects went on for a while and were pretty unpleasant.)
>
> Trust me, Panda -- I was reading all the Remeron posts here, as well as looking through the usual suspects, and knew that lower doses were supposed to be sedating. (Really, the only reason I tried raising it to 15 -- besides seriously questionable judgement on my part -- was related to all the problems I've been having with getting treatment through the county system. I was desperate to get some relief, and thought that if I didn't respond to this -- or if I called the doctor to tell him it wasn't working *quite* the way he might have expected -- I'd end up either hospitalized or scheduled for ECT. At the time, I was also rather hopeful that the misery I was experiencing while on the drug would be enough to galvanize me into suicide. NOT the right reason to stay on something. My husband finally stepped in and made me call the doctor's office.)
>
> The worst part? When I was trying to describe this a bit to the doctor, he just said, "Yeah, a few of my patients have reacted that way to it..." Sheesh! If I'd called sooner, he probably wouldn't have said I was just making it up...
>
> And Panda? On a personal note, it's always a pleasure to read your posts.
>
>Thanks! Your post are good to read too. :)
Your reaction to Remeron sounds paradoxial. Have you had any problems with OTC antihistamines?
Cheers,
Panda.
Posted by Racer on August 13, 2004, at 12:09:33
In reply to Re: Remeron Rage » Racer, posted by Sad Panda on August 13, 2004, at 3:16:30
OTC antihistimines? You're assuming I've ever taken one... Yes, I have taken Benadryl, but that's the only one. I'm one of those people who hardly take aspirin for a headache, so I don't have a lot of experience with over the counter drugs at all. In fact, I'd never taken a Tums before the blood bank gave them to me during aphoresis! Benadryl I keep around in case I'm stung by a bee. That happens so rarely that epipens expire and I always put off getting another, so I just pop a couple of Benadryls and get someone to pour me into a car and start heading for the nearest ER. (And, if the Benadryl turns out to be enough, we just drop me at home.) Since I've never taken it except when I was already in an altered state, I can't tell you what my reaction to it has been, you know? (And, thankfully, even the Benadryl usually expires between stings.)
Hey, Panda, I don't know if you saw the post in which I gave you my email address, but I'd like to re-extend the invitation -- share info that isn't appropriate here, do the "oh to be in Oz" thing, etc. If you didn't, it's babbler39 at excite dot com.
Posted by gardenergirl on August 15, 2004, at 19:30:24
In reply to Re: Remeron Rage » Sad Panda, posted by Racer on August 13, 2004, at 12:09:33
I wanted to thank everyone who took the time to post. I think I probably sounded a lot like "yes, but" which I ddidn't mean as a dismissal of all of your advice. I guess I was really hoping it would just get better.
It has improved somewhat in that the restlessness, jitteriness and agitation has gone away. I still wake up at 4:00 a.m....what the heck is so special at 4 in the morning, I ask? But at least I can actually stay in bed now. I don't feel like I HAVE to get up and MOVE like before. So maybe I'm at least getting some rest in the early hours. But this is getting tiring...and I can't nap. I love napping. :(
So, for now I am cutting out all caffeine ('cept what's in chocolate) and trying herbal tea. I may keep a thermos of chammomile by my bed for 4 a.m. to see if it helps me get back to sleep. And when I see my pdoc in a couple more weeks, I feel much more informed and ready to consult with her about the remaining insomnia thanks to all of your posts.
Thanks again!
gg
Posted by JohnSky on December 13, 2007, at 13:02:44
In reply to Re: Nardil insomnia and restlessness, posted by King Vultan on August 11, 2004, at 9:49:30
What seems to help the best with Nardil Insomnia... and does the insomnia go away through time.
Thanks
John
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