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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by clipper40 on December 7, 2007, at 5:59:33
I don't understand. Why use Seroquel, with all of the risks of a neuroleptic, when there are plenty of other sleep aids out there?
Posted by AnneL on December 7, 2007, at 11:04:58
In reply to Why is Seroquel so popular as a sleep aid?, posted by clipper40 on December 7, 2007, at 5:59:33
For myself, an extremely low dose of Seroquel 25 or 50 mg. zonks me out all night long. I believe Seroquel used at very low doses is more sedating than at "therapeutic" levels (say 800 mg. daily).
Posted by Phillipa on December 7, 2007, at 11:55:58
In reply to Re: Why is Seroquel so popular as a sleep aid? » clipper40, posted by AnneL on December 7, 2007, at 11:04:58
I don't know didn't work for me put me in another world. And didn't improve my sleep still awake in four hours. Phillipa
Posted by mav27 on December 7, 2007, at 13:28:59
In reply to Why is Seroquel so popular as a sleep aid?, posted by clipper40 on December 7, 2007, at 5:59:33
> I don't understand. Why use Seroquel, with all of the risks of a neuroleptic, when there are plenty of other sleep aids out there?
Like what?
I've tried
Alprazolam
Clonazepam
Diazepam
Flunitrazepam
Nitrazepam
Oxazepam
and Temazepam
Not a single one so much as makes me drowsy, i don't think there are any others available in australia, stilnox maybe but there is no chance in hell of me finding a gp that would prescribe that.
yet 12.5mg of seroquel knocks me out in no time and lets me sleep 6-8 hours... so i will happily use it anytime.
Posted by clipper40 on December 7, 2007, at 20:18:52
In reply to Re: Why is Seroquel so popular as a sleep aid? » clipper40, posted by mav27 on December 7, 2007, at 13:28:59
Amazing how differently we all can react to the same medication.
I was thinking in terms of alternatives like:
melatonin, agomelatine, ramelteon, low dose doxepin or amytriptyline, trazadone
Then there are drugs like Ambien and Lunesta though they're not really good for long-term use.
Does Seroquel leave you with a hangover in the morning once you've adjusted to it?
Posted by mav27 on December 7, 2007, at 21:31:45
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by clipper40 on December 7, 2007, at 20:18:52
Im not sure if those first three are prescriptions drugs or not, can't find any mention of them on aussie drug sites. The other 3 i couldn't take though as they interact with my other medication Nardil (i've tried a TCA with it before.. wasn't a fun day following that)
Seroquel doesn't leave me with any hang over feeling.> Amazing how differently we all can react to the same medication.
>
> I was thinking in terms of alternatives like:
>
> melatonin, agomelatine, ramelteon, low dose doxepin or amytriptyline, trazadone
>
> Then there are drugs like Ambien and Lunesta though they're not really good for long-term use.
>
> Does Seroquel leave you with a hangover in the morning once you've adjusted to it?
Posted by clipper40 on December 7, 2007, at 22:31:30
In reply to Re: Why is Seroquel so popular as a sleep aid? » clipper40, posted by mav27 on December 7, 2007, at 21:31:45
Melatonin is a hormone/supplement we can purchase at the health food or vitamin stores in the U.S. I mistakenly included aglomelatine because that isn't even out yet. I was confusing it with ramelteon, the third one on my list, which is a medication also available in the U.S. for sleep and it is based on the action of melatonin.
I forgot to add Neurontin and Lyrica but I think those can leave you groggy the next day.
Anyway, I can see why you would use Seroquel. I'm glad it works for you - without any hangover.
Posted by linkadge on December 7, 2007, at 23:59:24
In reply to Re: Why is Seroquel so popular as a sleep aid? » mav27, posted by clipper40 on December 7, 2007, at 22:31:30
I think it is partly a fad. I would guess that many people taking seroquel for sleep would gain a similar effect with a high potency antihistamine such as hydroxyzine.
Seroquel may be an appropriate choice if mania or significant agitation is present. I would not take seroquel for sleep unless *every* other safer alternative has been exhausted.
The anticholinergic effects of seroquel may partially mask movement related side effects, but offer no protection against the potential development of long term neurological consequences. There are also metabolic issues whos importance cannot be underscored.
I think seroquel has become a do-all drug just becasue its so dirty. You're potentially less likely to drive some on-edge patient into a suicidal murderous rampage with seroquel then by giving them say wellbutrin. Who knows, maybe the chemical you have out of whack may be one of the 500 that it messes with.
Linkadge
Posted by clipper40 on December 8, 2007, at 3:27:47
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by linkadge on December 7, 2007, at 23:59:24
Hmmm, I was thinking that it would be an advantage over doxepin and amitriptyline for sleep because it wouldn't be anticholinergic. Now that you've informed me that it does have anticholinergic effects, I'm wondering even more about its advantage(s). It probably doesn't have the cardio effects that the tricyclics have... that's one thing - though that risk is very small on low doses of TCAs for sleep purposes.
It's probably one of the few things that those on MAOIs can take for sleep but for everyone else, it doesn't seem to have that much more to offer than cheaper, and potentially safer, alternatives.
Maybe it works well and is easily tolerated so doctors have an easy time prescribing it. Perhaps you're also right that it's an "in" drug to take right now.
Posted by linkadge on December 8, 2007, at 9:44:48
In reply to Re: Why is Seroquel so popular as a sleep aid? » linkadge, posted by clipper40 on December 8, 2007, at 3:27:47
>I'm wondering even more about its advantage(s). >It probably doesn't have the cardio effects that >the tricyclics have.
It doesn't have the same cardiac problems as the TCA's do, but it has been associated with cardiovascular problems of its own.
>It's probably one of the few things that those >on MAOIs can take for sleep but for everyone >else, it doesn't seem to have that much more to >offer than cheaper, and potentially safer, >alternatives.
It is possible that by blocking monoamine activity at certain receptors, it is reducing the insomnia induced by an MAOI overstimulating such receptors.
>Maybe it works well and is easily tolerated so >doctors have an easy time prescribing it. >Perhaps you're also right that it's an "in" drug >to take right now.
I personally found low dose TCA's to be more tollerable. Seroquel makes me depressed. The neuroleptics are often prescribed in dementia (which makes absolutely zero sence outside of the goal of behavioral control), but such use has waned somewhat after studies showing lack of cognitive improvement (deterioration), as well as increased risk for stroke, falls etc.
The use in elderly is just convienient. Its not that they're necessarily the best choice, but that they can achieve some desired effect.
I think its just a convenient drug that is used because it is *newer* and hence uncontiously assumed to be better (?)
If seroquel works and nothing safer works, and you're happy, there is probably little reason to change. I'd just be cautious of doctors using it in the one side fits all category.
Linkadge
Posted by clipper40 on December 8, 2007, at 10:18:19
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by linkadge on December 8, 2007, at 9:44:48
Thanks. I'm not taking - it - just looking into various sleep aids.
Interesting that Seroquel has it's own heart issues. I'm beginning to think that there are no safe medications for the long-run.
Posted by Emme on December 8, 2007, at 11:08:15
In reply to Why is Seroquel so popular as a sleep aid?, posted by clipper40 on December 7, 2007, at 5:59:33
> I don't understand. Why use Seroquel, with all of the risks of a neuroleptic, when there are plenty of other sleep aids out there?
Because it works.
I cannot tolerate Ambien, Lunesta, or Rozerem. Trazodone leaves me a zombie the next day. Melatonin made me more depressed. Benzos aren't always enough to keep me asleep through the night. A low dose of Seroquel (6.25-12 mg) produces a natural feeling drowsiness, I stay asleep, and I'm not horribly hung over the next day.
Posted by linkadge on December 8, 2007, at 12:27:27
In reply to Re: Why is Seroquel so popular as a sleep aid? » clipper40, posted by Emme on December 8, 2007, at 11:08:15
No, no safe medications. Only, toxic, and less toxic.
Linkadge
Posted by clipper40 on December 8, 2007, at 16:31:23
In reply to Re: Why is Seroquel so popular as a sleep aid? » clipper40, posted by Emme on December 8, 2007, at 11:08:15
Ok, I guess there aren't that many alternatives that WORK and are well-tolerated by a lot of people. I'm curious, though, whether you've ever tried doxepin or trimipramine.
Posted by clipper40 on December 8, 2007, at 16:32:09
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by linkadge on December 8, 2007, at 12:27:27
Well said, unfortunately.
Posted by Emme on December 9, 2007, at 12:55:49
In reply to Re: Why is Seroquel so popular as a sleep aid? » Emme, posted by clipper40 on December 8, 2007, at 16:31:23
> Ok, I guess there aren't that many alternatives that WORK and are well-tolerated by a lot of people. I'm curious, though, whether you've ever tried doxepin or trimipramine.
Tricyclics have never been seriously considered for me for a few reasons, including my extreme sensitivity to side effects from most meds. So there's really been no reason to try a med class with a high side effect profile when we hit upon something that works well and gives me no side effects. I keep some Seroquel on hand and probably use it once or twice every few weeks if I am having trouble sleeping.
Posted by linkadge on December 9, 2007, at 13:18:36
In reply to Re: Why is Seroquel so popular as a sleep aid? » clipper40, posted by Emme on December 9, 2007, at 12:55:49
>So there's really been no reason to try a med >class with a high side effect profile
The side effects of the TCA's aren't necessarily more numerous than the side effects of other classes. The TCA's have different side effects. For many who do well on TCA's, the side effects are much more tollerable than those of other medications.
For instance, I never got akathesia, insomnia, anxiety, or apathy on a TCA.
Another thing to consider is that seroquel actually has a TCA structure itself. I believe it is a TCA derivitive. The TCA's and Seroqel have many common targets namely antihistamine, antiserotonin (5-ht2a/c). A metabolite of seroquel has affinity fo the norepinephrine reuptake pump, like the TCA antidepressants.
The sedating TCA's like doxapin, amitryptaline or trimipramine, were use for many of the same purposes that seroquel is now. It seems to me that the common mechanism between the two is likely antihistamine effects, antiserotonin effects, and possible norepinephrine reuptake inhibition.
For many people taking seroquel off lable, I don't think the dopamine blockade is necessary. It is probably a side effect that can produce apathy, reduced vitality, and or movement disorders.
As such, for primary sleep issues, I would personally recomend a sedating TCA over seroquel. I found doxapin did everything seroquel did for sleep but I woke up feeling not half bad as compared to uuugggg.
Linkadge
Posted by Emme on December 9, 2007, at 13:38:06
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by linkadge on December 9, 2007, at 13:18:36
> As such, for primary sleep issues, I would personally recomend a sedating TCA over seroquel. I found doxapin did everything seroquel did for sleep but I woke up feeling not half bad as compared to uuugggg.Thanks for the input, but as the saying goes....if it ain't broke I'm not messing with it.
Posted by linkadge on December 9, 2007, at 14:40:56
In reply to Re: Why is Seroquel so popular as a sleep aid? » linkadge, posted by Emme on December 9, 2007, at 13:38:06
>Thanks for the input, but as the saying >goes....if it ain't broke I'm not messing with >it.
Well, in a sense yes. Seeing as you are not using seroquel often, risks are low.
For somebody using it more regularly, it would be good to consider the potential risks of long term neuroleptic use.
For somebody needing a sleep aid every day, I still think that a low dose TCA would be a safer long term option.
Linkadge
Posted by Phillipa on December 9, 2007, at 18:23:38
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by linkadge on December 9, 2007, at 13:18:36
So then is nefadazone serzone the same? Phillipa still in the US.
Posted by Justherself54 on December 9, 2007, at 21:52:01
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by linkadge on December 9, 2007, at 14:40:56
The lowest dose of any TCA has put me out for a whole day and I felt just horrible..I've never been able to tolerate them for some reason..I know long term use of seroquel has its risks..because I'm on a very lose dose (25 mg) I'm hoping there won't be any bad effects down the road and now I'm on an MAOI so I've had to increase it a tad so I can sleep..insomnia was getting so bad I wasn't sure which to increase..clonazapam or zopiclone, so I chose to up the seroquel by half a 25 mg tablet and slept like a log for the first time in ages..
Posted by linkadge on December 10, 2007, at 11:42:15
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by Justherself54 on December 9, 2007, at 21:52:01
Supposedly, there is going to be a re-release of doxapin (called selanor or something) which is an ultra low dose (under 5mg) indicated for insomnia.
In terms of doxapin, doses of like 1-2mg work, but you need to open up the caps.
Of course it won't work for everbody, I just personally felt better on TCA's, so just an option to consider.
Linkadge
Posted by clipper40 on December 10, 2007, at 17:34:36
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by linkadge on December 10, 2007, at 11:42:15
Wow, that's really good news. I am currently using 12.5 mg. I open up the capsule and half it. I wonder if I took a lot lower whether it would still work for me. I still often need help to get me to sleep at this dosage but it definitely keeps me asleep. I'll have to try lowering the dosage. Hopefully that won't interfere too much with my anxiety level.
Posted by linkadge on December 11, 2007, at 9:42:08
In reply to Re: Why is Seroquel so popular as a sleep aid? » linkadge, posted by clipper40 on December 10, 2007, at 17:34:36
you can google it, its called silenor:
http://www.montreuxequity.com/sec/pr_1171411735
SILENOR™ is a low-dose (1 mg, 3 mg, 6 mg) oral tablet formulation of doxepin HCl that is patent protected for its use in insomnia. Doxepin has been prescribed for more than 35 years for the treatment of depression and anxiety at dosages typically ranging from 75 mg to 300 mg per day. At the currently prescribed high doses, doxepin is known to have a range of undesirable side effects. However, at the doses used in SILENOR™ in controlled clinical trials completed by Somaxon to date, SILENOR™ has been well tolerated.Linkadge
Posted by clipper40 on December 11, 2007, at 19:24:03
In reply to Re: Why is Seroquel so popular as a sleep aid?, posted by linkadge on December 11, 2007, at 9:42:08
That's amazing. Leave it to some entreprenuer(s) to take an old cheap drug, cut it down to very small dosages, patent it, increase the price and start making a lot of money off of it! I think I'll just open the regular doxepin capsules myself and take out small amounts.
Thanks for the link! Now I know that a really small dosage will probably work for keeping me asleep at night. Then, I'll just need to find something that will get me to sleep. If I take 25 mg. of doxepin, then it will also get me to sleep - but then I'll get the side effects too.
Actually, now that I think about it, I can take melatonin or atenolol for that. This just might work!
BTW, do you know what is responsible for early morning awakening? Is it too high cortisol or too low cortisol? I think I've read that it can be both. Is that true?
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