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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by linkadge on August 26, 2005, at 14:19:40
http://www.drugawareness.org/Archives/1stQtr_2003/record0030.html
I've had a hunch that SSRI's were consistantly (5 years) messing up my sleep. Is this artacle believable, or is it bunk ?
Linkadge
Posted by zeugma on August 26, 2005, at 15:52:20
In reply to What do people think of this article ?, posted by linkadge on August 26, 2005, at 14:19:40
> http://www.drugawareness.org/Archives/1stQtr_2003/record0030.html
>
> I've had a hunch that SSRI's were consistantly (5 years) messing up my sleep. Is this artacle believable, or is it bunk ?
>
> LinkadgeThe article isn't bunk. SSRI's can cause serious sleep problems, and should not be prescribed at anything like the rate that they are being prescribed today.
I find it ironic that one of the drugs used to control SSRI-induced RBD- clonazepam- is considered a 'bad' drug that the SSRI's were designed to replace. I heard someone say recently, "Xanax is a band-aid, Paxil is a cure.' An absurd statement.
There is reason to be cautious about the use of any psychotropic. I wonder if I'm inflicting glutaminergic damage on my brain by taking Provigil, but I have to get through the day.
-z
Posted by Ilene on August 26, 2005, at 16:29:06
In reply to What do people think of this article ?, posted by linkadge on August 26, 2005, at 14:19:40
> http://www.drugawareness.org/Archives/1stQtr_2003/record0030.html
>
> I've had a hunch that SSRI's were consistantly (5 years) messing up my sleep. Is this artacle believable, or is it bunk ?
>
> Linkadge
I think the article is inconclusive. I've been having problems w/insomnia on a Prozac/Wellbutrin combo. Here's an abstract that may be of interest:Drugs. 2005;65(7):927-47.
Antidepressants and sleep: a qualitative review of the literature.
Wilson S, Argyropoulos S.
Psychopharmacology Unit, University of Bristol, Bristol, UK. sue.wilson@bristol.ac.uk
Most antidepressants change sleep; in particular, they alter the physiological patterns of sleep stages recorded overnight with EEG and other physiological measures. These effects are greatest and most consistent on rapid eye movement (REM) sleep, and tend to be in the opposite direction to the sleep abnormalities found in major depression, but are usually of greater degree. Reductions in the amount of REM sleep and increases in REM sleep onset latency are seen after taking antidepressants, both in healthy volunteers and in depressed patients. Antidepressants that increase serotonin function by blocking reuptake or by inhibiting metabolism have the greatest effect on REM sleep. The decrease in amount of REM sleep appears to be greatest early in treatment, and gradually diminishes during long-term treatment, except after monoamine oxidase inhibitors when REM sleep is often absent for many months. Sleep initiation and maintenance are also affected by antidepressants, but the effects are much less consistent between drugs. Some antidepressants such as clomipramine and the selective serotonin receptor inhibitors (SSRIs), particularly fluoxetine, are sleep-disturbing early in treatment and some others such as amitriptyline and the newer serotonin 5-HT2-receptor antagonists are sleep promoting. However, these effects are fairly short-lived and there are very few significant differences between drugs after a few weeks of treatment. In general, the objectively measured sleep of depressed patients improves during 3-4 weeks of effective antidepressant treatment with most agents, as does their subjective impression of their sleep. Sleep improvement earlier in treatment may be an important clinical goal in some patients, perhaps when insomnia is particularly distressing, or to ensure compliance. In these patients, the choice of a safely used and effective antidepressant which improves sleep in short term is indicated. Patients with other sleep disorders such as restless legs syndrome and REM sleep behaviour disorder should be identified before choosing a treatment, as some antidepressants worsen these conditions. Conversely, there is evidence that some antidepressants may be useful in the treatment of sleep disorders such as night terrors.I.
Posted by Phillipa on August 26, 2005, at 18:38:38
In reply to Re: What do people think of this article ? » linkadge, posted by Ilene on August 26, 2005, at 16:29:06
Well I don't sleepwalk, but nothing but benzos have ever helped me sleep. Fondly, Phillipa
Posted by linkadge on August 27, 2005, at 6:42:02
In reply to Re: What do people think of this article ?, posted by zeugma on August 26, 2005, at 15:52:20
I was prescribed SSRI's for over 5 years. The whole time I constantly complained to my doctor that my sleep was terrable. I don't remember a single time that I slept through the night.
I would wake up literally every 20 minautes in a state of panic, throughout the whole night.
Sometimes I would be literally running down the hall before I woke up.
On effexor, I would wake up and my vision would be flickering like a strobe light. I thought I was having a seizure or something.
The doctor kept saying I would adapt to it, but I never did.
When I stopped them I started sleeping like a rock. (of course I have become very depressed since)
I find it difficult to trust doctors. Not because they aren't nice people, but just because they don't know what they are prescribing.
YOu are right about glutamate excitotoxicity. In my oppinion Effexor was a long-acting excitotoxin.
Linkadge
Posted by linkadge on August 27, 2005, at 6:53:30
In reply to Re: What do people think of this article ? » linkadge, posted by Ilene on August 26, 2005, at 16:29:06
The thing that bothers me is that these drugs change sleep patterns in healthy normals.
The article admits that the drugs go beyond reducing increased REM sleep in depressed individuals.
When rem parameters return to normal is probably when the drug poops out.
Here is an article that says that prozac decreases melatonin secretion. (this is potentially dangerous as melatonin is one of the brain's most potent defence antioxidants.http://bjp.rcpsych.org/cgi/content/abstract/166/2/196
Here is an article that says that melatonin reduces the antidepressant effect of fluoxetine.
Which also serves to conferm my theory that SSRIs actually work by messing up sleeping patterns.
I have 3 friends that have taken prozac. The one who reports sleeping the longest on the drug says he only sleeps max 4 hours a night !
Linkadge
Posted by djmmm on August 27, 2005, at 7:50:18
In reply to What do people think of this article ?, posted by linkadge on August 26, 2005, at 14:19:40
> http://www.drugawareness.org/Archives/1stQtr_2003/record0030.html
>
> I've had a hunch that SSRI's were consistantly (5 years) messing up my sleep. Is this artacle believable, or is it bunk ?
>
> Linkadge
Sure...if you think about the connection between serotonin and melatonin, it makes perfect sense. Flooding your brain with serotonin offsets the natural balance of serotonin/melatonin--serotonin being produced during the day, melatonin at twlight). Plus, SSRI is a bit of a misnomer, all drugs in this class effect various neurotransmitter systems. Personally, I found Prozac to be much more stimulating than Parnate..
Posted by zeugma on August 27, 2005, at 8:02:56
In reply to Re: What do people think of this article ? » zeugma, posted by linkadge on August 27, 2005, at 6:42:02
find it difficult to trust doctors. Not because they aren't nice people, but just because they don't know what they are prescribing.>>
True, and we don't either really.
The problem is that I was off meds for about ten years after having problems with SSRI's and conventional stimulants, and things got worse and worse with time. So now I take the meds and accept the fact that I am putting my brain in an altered state, because I don't have a pristine state to keep in place.
I think that despite all the articles that says that SSRI's are no worse than other AD's when it comes to sleep problems, that the TCA's are much more protective of sleep architecture. Norepinephrine and serotonin play subtly different roles in sleep states, and because serotonin controls the saccadic system that generates eye movements, this causes dreaming to migrate from REM stage to the other states where it is interfering with their functions.
Contrary to what one of the articles said, I think NRI's are much more efficient at limiting REM to periods where it is appropriate. NRI's are much better anticataleptics than SSRI's, and cataplexy is an intrusion of REM into waking.
-z
Posted by linkadge on August 27, 2005, at 9:32:27
In reply to Re: What do people think of this article ? » linkadge, posted by zeugma on August 27, 2005, at 8:02:56
My patterns of sleep were unacceptable. I don't care if the doctor says its helping me, my own intuition tells me that if I am not sleeping properly than I am not going to recover.
What is the psychological effect of blunted REM sleep (other than an AD effect). Perhaps by blunting REM sleep you are simply creating an amnesia to the problems you experienced in the day, instead of learning from them.
Cognatively, the longer I took SSRI's the worse things became. Eventually I merged into a zombie like state where I didn't know if it was day or night, or if I was dead or alive.
Linkadge
Posted by Ilene on August 27, 2005, at 14:00:15
In reply to Re: What do people think of this article ? » Ilene, posted by linkadge on August 27, 2005, at 6:53:30
I'm taking 80 mg Prozac and 150 mg Wellbutrin SR and I have problems w/ early morning awakening. My pdoc prescribed Trazodone to counteract it. So far it's worked well. This is a new combo for me (less than a week). However, I feel better than I have in years, so I'm reluctant to quit the Prozac. It's hard to argue against feeling better, especially when I've been on at least a dozen drugs with no improvement. I think I'll just have to live with messed-up sleep architecture, given the alternative.
I.
Posted by 4WD on August 27, 2005, at 17:12:12
In reply to What do people think of this article ?, posted by linkadge on August 26, 2005, at 14:19:40
When I was on Prozac (8-9 years) I had terrible trouble falling asleep, it took at least 2 hours to fall asleep, sometimes longer. However, once I did fall asleep I'd sleep for 10-12 hours. Maybe because the sleep I was getting wasn't all that restful?
I notice I don't sleep very well on Celexa and very badly when I was on Lexapro. It's more a waking up too early thing, now, though. I feel like I sleep well, just not long enough.
Marsha
Posted by Dave001 on August 27, 2005, at 22:29:42
In reply to Re: What do people think of this article ?, posted by zeugma on August 26, 2005, at 15:52:20
> There is reason to be cautious about the use of any psychotropic. I
> wonder if I'm inflicting glutaminergic damage on my brain by taking
> Provigil, but I have to get through the day.There is some evidence of neuroprotection from modafinil in animal studies.
Posted by zeugma on August 28, 2005, at 4:40:28
In reply to Re: What do people think of this article ?, posted by Dave001 on August 27, 2005, at 22:29:42
I know modafinil has evidence of neuroprotection, and it stresses my system much less than high doses of Ritalin- which itself is not neurotoxic. Modafinil is actually supposed to protect against glutamate-induced cytotoxicity- which would be a good thing if its mechanism really were glutaminergic enhancement.
-z
Posted by linkadge on August 28, 2005, at 16:52:59
In reply to modafinil » Dave001, posted by zeugma on August 28, 2005, at 4:40:28
I'd like to see an article supporting its protection againts glutamate excitotoxicity. After all, does't the drug work primarily through enhancement of glutamatergic function ??
Linkadge
Posted by zeugma on August 28, 2005, at 17:00:36
In reply to Re: modafinil, posted by linkadge on August 28, 2005, at 16:52:59
> I'd like to see an article supporting its protection againts glutamate excitotoxicity. After all, does't the drug work primarily through enhancement of glutamatergic function ??
>
There is one, actually:Neuroreport. 1998 Dec 21;9(18):4209-13. Related Articles, Links
Modafinil prevents glutamate cytotoxicity in cultured cortical neurons.Antonelli T, Ferraro L, Hillion J, Tomasini MC, Rambert FA, Fuxe K.
Department of Experimental and Clinical Medicine, University of Ferrara, Italy.
The ability of modafinil (Modiodal) to protect cortical neurons from glutamate-induced degeneration was evaluated by measuring electrically evoked [3H]GABA release and [3H]GABA uptake in primary cerebral cortical cultures. In normal cells, electrical stimulation (10 Hz, 2 min) increased [3H]GABA release (FR-NER St1 = 0.77+/-0.14; St2/St1 ratio = 0.94+/-0.02). The exposure of sister cells to glutamate, reduced electrically evoked [3H]GABA release (FR-NER St1 = 0.40+/-0.05; St2/St1 ratio = 0.60+/-0.08). Modafinil (0.3-1 microM) prevented the glutamate-induced reduction of the St2/St1 ratio (0.85+/-0.11; 0.88+/-0.05, respectively). A similar protective effect was observed for [3H]GABA uptake. These findings suggest that modafinil may be neuroprotective in that it attenuates glutamate-induced excitotoxicity in cortical neurons.
it would be comforting to think that this was conclusive.
-z
> Linkadge
Posted by linkadge on August 28, 2005, at 20:15:32
In reply to Re: modafinil » linkadge, posted by zeugma on August 28, 2005, at 17:00:36
When I asked for a study, didn't mean to sound like a dweeb, was really just curious.
The study is interesting.
I had one doctor tell me that if a stimulant causes euphoria, then at that point it is neurotoxic. Anything below that level is safe.
Of course I don't know how he came to this conclusion.
Linkadge
Posted by Dave001 on August 29, 2005, at 3:52:06
In reply to Re: modafinil, posted by linkadge on August 28, 2005, at 16:52:59
> I'd like to see an article supporting its protection againts
> glutamate excitotoxicity. After all, does't the drug work primarily
> through enhancement of glutamatergic function ??What I've seen of evidence for neuroprotection from modafinil has come
up incidentally in reading. One example: it partially reversed symptoms
of degeneration in a mouse model of Huntington's disease when
administered in combination with creatine monohydrate and another
substance (the name of which escapes me at the moment).I haven't evaluated the evidence enough to have formed any opinion on
the matter; I had mentioned the possible neuroprotective properties to
assuage the poster's concern that he was causing himself harm, because
if anything, the evidence points in the opposite direction.Here are several citations from a quick PubMed search:
Aguirre, J. A., A. Cintra, et al. (1999). "A stereological study on the
neuroprotective actions of acute modafinil treatment on
1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced nigral lesions of
the male black mouse." Neuroscience Letters 275(3): 215-8.Antonelli, T., L. Ferraro, et al. (1998). "Modafinil prevents glutamate
cytotoxicity in cultured cortical neurons." Neuroreport 9(18): 4209-13.Jenner, P., B. Y. Zeng, et al. (2000). "Antiparkinsonian and
neuroprotective effects of modafinil in the mptp-treated common
marmoset." Experimental Brain Research 133(2): 178-88.Xiao, Y.-l., J.-m. Fu, et al. (2004). "Neuroprotective mechanism of
modafinil on Parkinson disease induced by
1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine." Acta Pharmacol Sin 25(3):
301-5.*Zeng, B. Y., L. A. Smith, et al. (2004). "Modafinil prevents the
MPTP-induced increase in GABAA receptor binding in the internal globus
pallidus of MPTP-treated common marmosets." Neuroscience Letters 354(1):
6-9.* You can download the full text to the corresponding study here for free:
http://www.chinaphar.com/1671-4083/25/301.pdfI'm sure there are plenty more if you want to track them down.
This is the end of the thread.
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