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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Emme on September 20, 2005, at 7:10:14
Hi All,
I fall alseep but I wake up too early without getting in enough hours. So I feel drugged a lot and my brain won't hold a coherent thought now. I also suspect the quality of my sleep may not be all that good. My doctor and I came up with options to try to make me stay alseep longer: klonopin, seroquel, keppra. I can at least tolerate all three. But I need to figure out which of the three will cause the least hangover and cognitive effects with my current mixture. Of course I know I have to try them myself one by one. But I'm curious about others' experiences about which makes them the least spacey.
Lamictal 100, memantine 2.5, abilify 2.5 every other day. Xanax as needed (though less likely to be needed if I end up using klonopin, seroquel, or keppra).
Thanks,
emme
Posted by SLS on September 20, 2005, at 7:57:51
In reply to No zzzzz's for me, posted by Emme on September 20, 2005, at 7:10:14
I have not found Keppra 2000mg to be effective at promoting sleep or maintaining sleep.
Some people really like Seroquel at 25mg when it is used as a hypnotic. I guess part of your decision-making process would include what other benefits you might find in using Klonopin over Seroquel. For instance, if chronic anxiety, social phobia or panic attacks are problems, Klonopin might be the logical choice. However, in the absence of anxiety disorders, perhaps Seroquel makes sense. Since Seroquel treats everyone so differently, you might want to plan on the possibility that there will be residual sedation for the first few days.
- Scott
Posted by Emme on September 20, 2005, at 14:36:03
In reply to Re: No zzzzz's for me, posted by SLS on September 20, 2005, at 7:57:51
> I have not found Keppra 2000mg to be effective at promoting sleep or maintaining sleep.
>
> Some people really like Seroquel at 25mg when it is used as a hypnotic.
> guess part of your decision-making process would include what other benefits you might find in using Klonopin over Seroquel. For instance, if chronic anxiety, social phobia or panic attacks are problems, Klonopin might be the logical choice. However, in the absence of anxiety disorders, perhaps Seroquel makes sense. Since Seroquel treats everyone so differently, you might want to plan on the possibility that there will be residual sedation for the first few days.
>
>
> - ScottHi Scott,
I've used Seroquel at 6.25 mg for sleep before, but not with this combination. I tend to have generalized anxiety problems, but seroquel would do the trick for that also. It sounds like perhaps seroquel should be the first thing I try out and then maybe klonopin the second.
The reason I'm feeling uneasy about my choice of sleeping med is b/c I'm pretty upset at the dizzy/spacey feeling I'm *already* walking around with. My brain is mush. Wanna help me speculate on why?
1) Just the effects of consistently not getting enough sleep. That may be part of it, but I really feel awfully spacey. Something's wrong.
2) This combination of medications is screwing up not just quantity but quality of sleep in ways I'm not even aware of.
4) Fatigue and cognitive impairment as a yet-unresolved symptom of the illness.3) Do you think there's any way the addition of abilify might intensify the effects of memantine, leading to the drunk feeling? I haven't thought through how this could be so.... There's so little clinical experience with memantine at this point.....
em
Lamictal 100, memantine 2.5, abilify 2.5 every other day...xanax when needed.
Posted by Declan on September 20, 2005, at 15:10:27
In reply to Re: No zzzzz's for me » SLS, posted by Emme on September 20, 2005, at 14:36:03
Emme, you said you wake not having enough sleep. Do you think your sleep is too light and that you are not getting deep restorative sleep? Do you awaken repeatedly?
Don't some people say that Seroquel can make them a little restless, physically? Maybe it's a common practice is to combine Seroquel with a benzo for this reason.
Declan
Posted by Emme on September 20, 2005, at 15:34:17
In reply to Re: No zzzzz's for me, posted by Declan on September 20, 2005, at 15:10:27
Hi Declan,
> Emme, you said you wake not having enough sleep. Do you think your sleep is too light and that you are not getting deep restorative sleep? Do you awaken repeatedly?
I've been wondering about that. I'm really not sure. If I accidentally fall asleep somewhere and have to move to my bedroom, that's one awakening. Other than that, I think I'm sleeping straight through. Unless I'm waking up and having no recollection of it. But one can have poor quality sleep w/o repeatedly waking up, right?
Strangely, I feel decent when I wake up in the morning. Then about two hours later...whammo. I've just started taking meds at night in case morning doses were zoning me out. It's not clear that it's helping.
> Don't some people say that Seroquel can make them a little restless, physically?
I have not heard that about seroquel, but anything is possible. Abilify does seem to do that to people.
emme
Posted by UgottaHaveHOPE` on September 20, 2005, at 17:49:07
In reply to No zzzzz's for me, posted by Emme on September 20, 2005, at 7:10:14
u might have to experiment with 25mg and what time of the day to take it
Posted by Phillipa on September 20, 2005, at 18:43:12
In reply to Re: seroquel is great, but it can cause grogginess, posted by UgottaHaveHOPE` on September 20, 2005, at 17:49:07
All of a sudden I'm sleeping too much could that mean my depression or thyroid are out ot wack? Still taking l5mg of valium at night. Fondly, Phillipa
Posted by SLS on September 20, 2005, at 22:54:33
In reply to Re: No zzzzz's for me » SLS, posted by Emme on September 20, 2005, at 14:36:03
Hi Emme.
Off hand, I would say that there might be some pharmacodynamic interaction between the Lamictal and memantine. Both are antiglutamatergic. However, there is no pharmacokinetic interaction. The level of each remains unaffected by the other. Lamictal is also an inhibitor of sodium channels. I would expect this type of drug to have negative effects on cognition at higher dosages. You could try to back off the Lamictal to 50mg for a few days to evaluate its effects on cognition.
I guess anything is possible.
Why are you taking Abilify every other day? I take 10mg every day, but could probably do just as well with 5.0mg.
- Scott
Posted by Tom Twilight on September 21, 2005, at 5:27:18
In reply to No zzzzz's for me, posted by Emme on September 20, 2005, at 7:10:14
> I fall alseep but I wake up too early without getting in enough hours. So I feel drugged a lot and my brain won't hold a coherent thought now.
Funnily enough I have exactly the same problem now I'm on Marplan
I'm wondering if you've ever tried a sedating AD like Remeron/Mirtazapine, or a TCA like Amytriptaline.
I find both these meds better for maintaining sleep than Zopiclone.
Its strange because I don't find Amytriptaline very sedating, but I don't seem to "Snap Awake" at 4 AM like I usually do.Clonazepam is also good for keeping one asleep
Sorry for bad spelling-I'm Dyslexic
Posted by Emme on September 21, 2005, at 14:42:06
In reply to Re: No zzzzz's for me » Emme, posted by SLS on September 20, 2005, at 22:54:33
Hi Scott,
> Off hand, I would say that there might be some pharmacodynamic interaction between the Lamictal and memantine. Both are antiglutamatergic.
I'd wondered about that....
> However, there is no pharmacokinetic interaction...... I would expect this type of drug to have negative effects on cognition at higher dosages.
Thanks. I'm curious about interaction between the memantine and the abilify. I can't think of any reason why there should be, but my pharmacology isn't superb, so I might be missing something.
> You could try to back off the Lamictal to 50mg for a few days to evaluate its effects on cognition.
I'll bring that idea up when I see my doctor. We've been trying to scootch my meds down as low as we can get away with. But I think she might be leery. My mood dipped a lot (and undipped again) in the last week or so.
> Why are you taking Abilify every other day?Because taking it every day was too much and the half life is long enough to permit skipping days. I guess I could also take 1.25 mg every day. I'm not sure it would matter either way.
I am grateful for the improvements, but I'd like to lose the drunken feeling. I remembered your comment about feeling drunk on too much memantine, which made me wonder if the abilify was intensifying the effects of the memantine.
I tried Seroquel last night and I'm going to give it several nights.
> I take 10mg every day, but could probably do just as well with 5.0mg.
How is it working for you?
emme
Posted by Emme on September 21, 2005, at 14:48:58
In reply to Re: No zzzzz's for me, posted by Tom Twilight on September 21, 2005, at 5:27:18
Hi Tom,
> I'm wondering if you've ever tried a sedating AD like Remeron/Mirtazapine,
I used to take it. It pooped out.
> or a TCA like Amytriptaline.
My doctor and I have talked about tricyclics, but she's got a few reasons for not wanting to prescribe them for me.
So at the moment, it's a trial of Seroquel for a few days, with Klonopin/clonazepam next in the queue.
> Sorry for bad spelling-I'm DyslexicI've seen worse. :)
emme
Posted by SLS on September 21, 2005, at 18:11:20
In reply to Re: No zzzzz's for me, posted by Tom Twilight on September 21, 2005, at 5:27:18
Hi Tom.
> > Sorry for bad spelling-I'm Dyslexic
> I've seen worse. :)
Me too. Perhaps it is not so necessary to apologize for. I would never have known. That is not to say that I don't have an appreciation for the intense focus it must require to compose a letter. I am happy that you shared with us your difficulties. It must be a relief of sorts for you to feel safe enough to disclose your handicap. Hopefully, with time, you will feel less and less need to.
I like seeing your name on the board. Keep posting!
- Scott
Posted by Emme on September 21, 2005, at 21:52:22
In reply to Re: No zzzzz's for me » Tom Twilight, posted by SLS on September 21, 2005, at 18:11:20
> Me too. Perhaps it is not so necessary to apologize for. I would never have known. That is not to say that I don't have an appreciation for the intense focus it must require to compose a letter. I am happy that you shared with us your difficulties. It must be a relief of sorts for you to feel safe enough to disclose your handicap. Hopefully, with time, you will feel less and less need to.Tom, I second what Scott said.
Scott and Tom, thanks for the brainstorming.
This is the end of the thread.
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