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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Enigma on April 11, 2006, at 15:25:00
I have severe atypical depression and am on disability (for almost a year now).
After a million other meds, I finally tried MAOI's. Parnate was a side-effect nightmare, so I had to quit it.
I was then on Nardil for 3-4 months? Side-effects were bad, but not nearly to the degree of Parnate.
The worse side-effect was the insomnia and disrupted sleep. I would wake up with mania-type symptoms ever 1-2 hours, sometimes every 30 mins. Sleep aids didn't help much. Nardil DID help my depression, where SOOO many other drugs failed, so I just lived with the sleep problems for as long as I could.
Then I got ECT felt a considerable amount better and finally quit the Nardil, mainly because I couldn't stand not getting a decent nights sleep for months at a time AND wanted to gauge how effective the ECT was.
I slept a little "better", as in, not waking up ever 1-2 hours, BUT, it still takes me 1-3 hours to get to sleep at night. I just sit there and toss and turn and my brain goes into overdrive, racing thoughts, anxiety, worry, and other things I don't want to talk about (rage-related).
I play this game every single night. It doesn't matter when I try to go to bed.
I've tried seroquel at night, which gets me to sleep, but makes it VERY hard to get up in the morning.
Klonopin is the same. I wake up exhausted, and I think the Celexa is keeping me "down", tired, as well.
I haven't gone to bed and woken up "refreshed" in longer than I can remember, which I'm sure is based on more than just the MAOI's.
I tried a couple OTC sleeping pils and prescription. Same thing. I wake up exhausted, and that's IF I can even get out of bed.
Question is.. most of this stated with the MAOI's.
Will I EVER sleep normally again?
I used to be able to get to sleep in 15-20 mins after hitting the pillow. Now it's a battle, each and every night and it's driving me crazy. (Crazier than normal I should say).
Posted by linkadge on April 11, 2006, at 18:27:19
In reply to MAOI's and permanent sleep problems???, posted by Enigma on April 11, 2006, at 15:25:00
This may sound simple, but have you tried melatonin?
Most OTC stuff doesn't work for me, but melatonin did.
Linkadge
Posted by Caedmon on April 11, 2006, at 19:32:50
In reply to Re: MAOI's and permanent sleep problems???, posted by linkadge on April 11, 2006, at 18:27:19
My insomnia patterns often follow that same course.
I agree, melatonin works great for me too.
There is that new Rx drug, Rozarem, which is a melatonin agonist I think. Although I am not interested in it since the regular OTC hormone works just fine for me.
I respond pretty well to amitriptyline too.
- C
Posted by djmmm on April 11, 2006, at 20:26:53
In reply to MAOI's and permanent sleep problems???, posted by Enigma on April 11, 2006, at 15:25:00
I agree with the others...melatonin works for me, as does a high dose of benadryl... Most "sleeping pills" cause horrible rebound insomnia for me... I try to alternate between melatonin and benadryl...(I take Parnate, BTW)
good luck
Posted by Phillipa on April 11, 2006, at 22:50:07
In reply to Re: MAOI's and permanent sleep problems???, posted by djmmm on April 11, 2006, at 20:26:53
I guess lunesta and ambien are no no's with the MAOI's but I think you can take klonopin. Love Phillipa
Posted by Don_Bristol on April 11, 2006, at 23:04:26
In reply to Re: MAOI's and permanent sleep problems???, posted by Phillipa on April 11, 2006, at 22:50:07
> I guess lunesta and ambien are no no's with the MAOI's but I think you can take klonopin. Love Phillipa<
No, it's alright to take any of the new style "z-sleepers" (including Lunesta or Ambien) with an MAOI. There is no contra-indication which I am aware of and in fact I do take that combination myself quite frequently.
Posted by Don_Bristol on April 11, 2006, at 23:35:08
In reply to MAOI's and permanent sleep problems???, posted by Enigma on April 11, 2006, at 15:25:00
Enigma, please excuse typos below.
I have just posted to say how little sleep I can get (if I try specifically not to sleep much) while taking Parnate.
In my case I find it useful to have the extra time because unlike you I do not feel tired, exhausted, drained, and the sorts of things you describe.
You and I clearly do not have the same response to meds. However I too did experience the weirdest periods of sleepiness and wakefulness during the night while on Nardil.
Many of the antidepressants (eg Prozac) are reckoned to help with sleep because they improve low mood and anxiety which are preventing proper sleep. However Prozac. for example, is generally seen as a med which reduces the quality of sleep. So I guess it's mainly to do with whether the better sleep from mood improvement outweighs the reduced quality of sleep.
I guess it is perfectly possible that an MAOI has created irreversible changes but I must say I feel the odds are very much against it.
I sense that what is preventing you from sleeping is largely psychological disturbances. I found meditation (at any time in he day) helped me learn how to still the mind a little and gave me better sleep. I also found that relaxation tapes immediately before bedtime really did help a lot.
But maybe you feel too low to try this sort of stuff. I think you may be feeling zonked in the morning after seroquel or klonopin because, in part, you have so much sleep to catch up on and partly because those meds are known, on average, to still be in the system for longer than the 7 or 8 or 9 hours sleep you might get.
If you are not working (you are on disability) then why not give yourself a week of these meds and sleep in as long as you need to. A week is so that you can overcome the sleep deficit you have accumulated. (Yes, I know sleep and recovery from its deprivation does not really work in that way but I am sure you get the idea.)
Watch out though because over the course of a week the sleeping meds will start to reach higher levels in you. The med from the day before will not all have gone when you take the next med and you may have to adjust the dose accordingly. OTOH don't micromanage the dose by splitting tabs into seven-eights or any other such obsessional behavior.
Personally I prefer benzodiazepines but they are harder and harder to get. A couple of shorter acting ones are Lormetazepam and Lorazepam but they are not so short and you would still need to take them a few hours before going to bed.
Another alternative would be to take one of the old tricyclic antidepressants. Unlike the SSRIs these do not affect sleep architecture and are themselves sedating to a lesser or greater degree depending on which one you take. However they can give side effects (blurred vision, dry mouth, etc etc) which trouble some people. The antidepressant effect from these would be useful for you and help your sleep too but that would not kick in for a few weeks which I sense is to long for someone as restless as you currently seem to be to wait - and the AD effect may not occur in all people.
So you must take your choice. The "weird" stuff like relaxation and meditation has no side effects and will not affect you the next morning and can give benefit within a day or so of starting - so I would do those if you can. After that the choice of med is yours but do not overlook the underlying rage related problems which you allude to as they sound as if they are likely to be the root of almost all the trouble you experience. Therapy (such as CBT or even psychodynamic if a trauma is persisting) could be very useful for that - again no side effects, no morning hang overs.
best wishes.
Posted by JaclinHyde on April 12, 2006, at 1:28:46
In reply to Re: MAOI's and permanent sleep problems??? » Enigma, posted by Don_Bristol on April 11, 2006, at 23:35:08
Both Lunesta and Ambien CR (the controlled release version) are just fine with an MAOI. I take one or the other every nigh.
JH
Posted by TylerJ on April 12, 2006, at 11:16:34
In reply to MAOI's and permanent sleep problems???, posted by Enigma on April 11, 2006, at 15:25:00
> I have severe atypical depression and am on disability (for almost a year now).
>
> After a million other meds, I finally tried MAOI's. Parnate was a side-effect nightmare, so I had to quit it.
>
> I was then on Nardil for 3-4 months? Side-effects were bad, but not nearly to the degree of Parnate.
>
> The worse side-effect was the insomnia and disrupted sleep. I would wake up with mania-type symptoms ever 1-2 hours, sometimes every 30 mins. Sleep aids didn't help much. Nardil DID help my depression, where SOOO many other drugs failed, so I just lived with the sleep problems for as long as I could.
>
> Then I got ECT felt a considerable amount better and finally quit the Nardil, mainly because I couldn't stand not getting a decent nights sleep for months at a time AND wanted to gauge how effective the ECT was.
>
> I slept a little "better", as in, not waking up ever 1-2 hours, BUT, it still takes me 1-3 hours to get to sleep at night. I just sit there and toss and turn and my brain goes into overdrive, racing thoughts, anxiety, worry, and other things I don't want to talk about (rage-related).
>
> I play this game every single night. It doesn't matter when I try to go to bed.
>
> I've tried seroquel at night, which gets me to sleep, but makes it VERY hard to get up in the morning.
>
> Klonopin is the same. I wake up exhausted, and I think the Celexa is keeping me "down", tired, as well.
>
> I haven't gone to bed and woken up "refreshed" in longer than I can remember, which I'm sure is based on more than just the MAOI's.
>
> I tried a couple OTC sleeping pils and prescription. Same thing. I wake up exhausted, and that's IF I can even get out of bed.
>
> Question is.. most of this stated with the MAOI's.
>
> Will I EVER sleep normally again?
>
> I used to be able to get to sleep in 15-20 mins after hitting the pillow. Now it's a battle, each and every night and it's driving me crazy. (Crazier than normal I should say).
>
>
> I've been on Parnate for a little over 2 mos. and have experienced some pretty bad insomnia myself. I have tried Lunesta, Ambien cr, lorazapam, benadryl and Trazodone. A lot of pdocs use Trazodone for maoi induced insomnia. A lot of people don't like it, but when you find the right dose and it's not too high ( 150 mgs. for me ) it works great. At this dose I fall asleep quickly, stay asleep, and awaken around 7:00 a.m. feeling refreshed. Different things work for different people. Good Luck to you whatever you try..insomnia sucks!Tyler
Posted by Enigma on April 12, 2006, at 11:52:49
In reply to Re: MAOI's and permanent sleep problems???, posted by linkadge on April 11, 2006, at 18:27:19
> This may sound simple, but have you tried melatonin?
>
> Most OTC stuff doesn't work for me, but melatonin did.
>
> LinkadgeI tried it a very long time ago, and could barely get out of bed afterwards. A friend with sleep problems said I was taking too much - saying that the dosage they put in each pill (some brands) is WAY too high, and specifically told me to find a brand with a super low dose. I don't recall if I was ever able to find one with such a low dose. I don't recall the specifics. But hey, I'll try it again.
Posted by Enigma on April 12, 2006, at 13:15:58
In reply to Re: MAOI's and permanent sleep problems??? » Enigma, posted by Don_Bristol on April 11, 2006, at 23:35:08
Thanks for all the info.
Unfortunately, the rage stuff, violent fantasies and the like, have been with me for many, many years. Started a little after puberty, after having violent arguments with my so-called parents, and troubles with other kids in school, etc. It's like the beast I keep "at bay", not acting on the impulses in any way. I don't even spank my children, ever. :)
I use my family (wife and kids) to control anything stupid I might "want" to do... In other words, say I want to hurt someone (and it's ALWAYS someone who, let's say "wronged" me), I don't, as I don't want to go to jail, throw my life away, hurt my family in any way, and so on. It's under control - unfortunately the depression isn't.
I've had therapy a number of times, over the years, and it has never helped me rid myself of these violent fantasies. Honestly, in any of my latest therapy sessions, I don't even bring up the subject. Most people I know don't know about them, and I probably shouldn't be sharing this on-line either. But, I'm just "Enigma" right? ;)
I have NO current or future plans on hurting anyone, no matter how much I might want to.
I really hope I didn't spook anyone. Unlike others, I'm actually "used to" these thoughts, as I've had them for so many years, and I've just learned to live with them.
I still think these are the least of my worries. First and foremost, I need to be depression free so I can enjoy life again, then, go back to making a living. This is what I most of all. Who here doesn't?
Posted by gardenergirl on April 12, 2006, at 13:29:14
In reply to Lunesta/Ambien CR, posted by JaclinHyde on April 12, 2006, at 1:28:46
> Both Lunesta and Ambien CR (the controlled release version) are just fine with an MAOI. I take one or the other every nigh.
I take Ambien or Ambien CR. I've wondered if alternating nights with Lunesta and one of the Ambiens would reduce the rebound insomnia? Occasionally I need to stay up too late to comfortably take a sleep aid, but then I have a terrible time getting any sleep at all.
What has been your experience with taking one or the other?
Thanks,
gg
Posted by Don_Bristol on April 12, 2006, at 19:54:07
In reply to Re: MAOI's and permanent sleep problems???, posted by Enigma on April 12, 2006, at 13:15:58
On April 12, 2006, at 13:15:5 ENIGMA wrote:
----------------------------------------------------------
-- trimmed --Unfortunately, the rage stuff, violent fantasies and the like, have been with me for many, many years. Started a little after puberty, after having violent arguments with my so-called parents, and troubles with other kids in school, etc.
-- snip --
hurt my family in any way, and so on. It's under control - unfortunately the depression isn't.
I've had therapy a number of times, over the years, and it has never helped me rid myself of these violent fantasies.
Honestly, in any of my latest therapy sessions, I don't even bring up the subject. Most people I know don't know about them, and I probably shouldn't be sharing this on-line either. But, I'm just "Enigma" right? ;)
I really hope I didn't spook anyone. Unlike others, I'm actually "used to" these thoughts, as I've had them for so many years, and I've just learned to live with them.
---------------------------------------------------------------
Enigma, you say you hope you "didn't spook anyone". Hey! Many of us here have problems which would spook others. So you are not at all unusual in this respect.
On this board I have come across so many things which would spook me out if I didn't know better. These things would spook me out if I was expecting to hear about normality.
But this board is not supposed to be a slice of what passes for normality. Instead, it has people who are trying to reach that normality but who, for the time being, think and behave outside that normality.
I think you will find a genuine warm welcome here. I for one, welcome you. Step aboard. Stay as long as you like.
---
As for your posting, I can't help but sense overtones of OCD there in your make-up.
First there is the fear from having unwanted thoughts of doing harm. This is very typical of OCD.
Secondly is the outcome of never actually doing what the frightening intrusive thoughts describe - this too is very true of OCD. In fact it is sometimes jokingingly said that OCD people with intrusive thoughts of harming are the safest people to be with those whom the thoughts describe. If you see what I mean. And this is because a typical OCDer will never execute the intrusive thoughts he or she has.See the section Fears Of Harming Others at <http://tinyurl.com/rgcra>;
Thirdly, the depression. Many OCDers have depression in the adult life. There seesm to be a relatively high likelihood of that happenin
Sad to hear you didn't share your intrusive thoughts of harm with your therapist. Maybe you did not feel you had the trust which allowed you to speak freely. That happens. If you can manage it, it might be well worth dicussing it.
Don
Posted by Crazy Horse on April 13, 2006, at 6:38:27
In reply to Was: SLEEP. Now: INTRUSIVE THOUGHTS OF HARM » Enigma, posted by Don_Bristol on April 12, 2006, at 19:54:07
> On April 12, 2006, at 13:15:5 ENIGMA wrote:
>
> ----------------------------------------------------------
> -- trimmed --
>
> Unfortunately, the rage stuff, violent fantasies and the like, have been with me for many, many years. Started a little after puberty, after having violent arguments with my so-called parents, and troubles with other kids in school, etc.
>
> -- snip --
>
> hurt my family in any way, and so on. It's under control - unfortunately the depression isn't.
>
> I've had therapy a number of times, over the years, and it has never helped me rid myself of these violent fantasies.
>
> Honestly, in any of my latest therapy sessions, I don't even bring up the subject. Most people I know don't know about them, and I probably shouldn't be sharing this on-line either. But, I'm just "Enigma" right? ;)
>
> I really hope I didn't spook anyone. Unlike others, I'm actually "used to" these thoughts, as I've had them for so many years, and I've just learned to live with them.
>
> ---------------------------------------------------------------
>
> Enigma, you say you hope you "didn't spook anyone". Hey! Many of us here have problems which would spook others. So you are not at all unusual in this respect.
>
> On this board I have come across so many things which would spook me out if I didn't know better. These things would spook me out if I was expecting to hear about normality.
>
> But this board is not supposed to be a slice of what passes for normality. Instead, it has people who are trying to reach that normality but who, for the time being, think and behave outside that normality.
>
> I think you will find a genuine warm welcome here. I for one, welcome you. Step aboard. Stay as long as you like.
>
> ---
>
> As for your posting, I can't help but sense overtones of OCD there in your make-up.
>
> First there is the fear from having unwanted thoughts of doing harm. This is very typical of OCD.
>
>
> Secondly is the outcome of never actually doing what the frightening intrusive thoughts describe - this too is very true of OCD. In fact it is sometimes jokingingly said that OCD people with intrusive thoughts of harming are the safest people to be with those whom the thoughts describe. If you see what I mean. And this is because a typical OCDer will never execute the intrusive thoughts he or she has.
>
> See the section Fears Of Harming Others at <http://tinyurl.com/rgcra>;
>
> Thirdly, the depression. Many OCDers have depression in the adult life. There seesm to be a relatively high likelihood of that happenin
>
> Sad to hear you didn't share your intrusive thoughts of harm with your therapist. Maybe you did not feel you had the trust which allowed you to speak freely. That happens. If you can manage it, it might be well worth dicussing it.
>
> DonEnigma,
I'm with Don..I to welcome you with open arms. I've got OCD, and Don described it perfectly for me, "Intrusive Thoughts"..I've never acted out even one in 25yrs of this illness. Seems like a lot of worrying for nothing. Both meds and counciling have helped me. Talking to friends here helps too. Take care and please come around often. :)-Crazy Horse (Tyler)
Posted by JaclinHyde on April 13, 2006, at 16:39:11
In reply to Re: Lunesta/Ambien CR » JaclinHyde, posted by gardenergirl on April 12, 2006, at 13:29:14
I have found that both are great with a little edge for the ambien CR because it lasts longer.
JH
> > Both Lunesta and Ambien CR (the controlled I release version) are just fine with an MAOI. I take one or the other every nigh.
>
> I take Ambien or Ambien CR. I've wondered if alternating nights with Lunesta and one of the Ambiens would reduce the rebound insomnia? Occasionally I need to stay up too late to comfortably take a sleep aid, but then I have a terrible time getting any sleep at all.
>
> What has been your experience with taking one or the other?
>
> Thanks,
> gg
>
Posted by Enigma on April 14, 2006, at 15:29:58
In reply to Was: SLEEP. Now: INTRUSIVE THOUGHTS OF HARM » Enigma, posted by Don_Bristol on April 12, 2006, at 19:54:07
Thanks for the warm welcome. Actually, I've been around for a couple years now I think, off and on. I might have had a different username before. Not sure...
Hmm, don't feel like typing much today, but I'll just say this..
The reason I don't bring up everything with a therapist is because I feel it isn't going to make a difference. Before reacting to that, read this too. ;) --> I basically perform trial and error and test each doc and therapist I see. I get infuriated when they don't listen, and/or upset when they are unable to help me (or don't even try).. then I feel like I've spilled my guts for no benefit to myself and wasted my time. I really hate that. ;)
Soooo, I try out "lesser" problems and test their ability to help me. If they can/do help, or, I feel they are *really* listening AND using that info to HELP me, then I tell them a little more, and so forth.
I've pretty much lost hope in the medical field in general, so I really limit how much I say. I've just had too many disappointments, failures, etc, etc. Too many to be a coincidence. I'm including doctors, therapists, even the health care field in general, such as insurance carriers, fighting for disability, yada yada.
Out of the lot of them, I've had pretty dismal experiences, to say the least. The ONLY saving grace are nurses. I've found a good? number of them to be very kind and genuinely caring, which I highly admire, respect, and desire. I did have ONE good PCP, but he retired early. :(
Oh well, said more than I wanted.. heh..
take care..
The real test will be to see if my current "doctor" will prescribe EMSAM for me. Her never having heard of the MAOI patch, really worries me. I've known about it for over 1.5 years. Pathetic.
Posted by nel11 on April 21, 2006, at 8:11:17
In reply to MAOI's and permanent sleep problems???, posted by Enigma on April 11, 2006, at 15:25:00
Hi:
Klonopin has worked for me, but melatonin seems
to really knock me out for the night, and no
script needed...Has anyone noticed that 1mg of melatonin is WAY too
much now on a maoi (parnate for me)
Posted by Crazy Horse on April 21, 2006, at 8:28:27
In reply to Re: MAOI's and permanent sleep problems???, posted by nel11 on April 21, 2006, at 8:11:17
> Hi:
> Klonopin has worked for me, but melatonin seems
> to really knock me out for the night, and no
> script needed...
>
> Has anyone noticed that 1mg of melatonin is WAY too
> much now on a maoi (parnate for me)
>
>
So melatonin is safe to take with parnate? I've never tried it. So, are you actually sleeping well every night while taking parnate. I'm on Parnate and sleep well most of the time, but about one night a week i don't sleep at all...happened last night..yawn. :) I can handle one night a week.-Crazy Horse
This is the end of the thread.
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