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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Sunbath on August 10, 2009, at 11:22:59
Hi,
first: sorry for my bad English and my very long post!!
I was reading babble since a few months now and thought it was time to post my medstory + some questions :)
I'm 27 and am having these problems for about 3 years now:
After some very stressful events @work I got a really hard time sleeping.. waking far too early and not being able to fall asleep again.. also waking 1-3 times / night.
This happens although -since 2.5 years- I'm taking 150mg trazodone xr at night.
The trazodone has improved this condition to some extent though, it was far more severe before..Also I'm experiencing daytime anxiety with a bit of SAD and one of my biggest problems is: "not being able to relax"!
So even when I'm extremely tired and feeling sleep-deprived, I'm NOT able to sleep during the day.
Other problems are: having a constant feeling of muscle tension.. + sometimes feelings of derealizations + fear of going mad et.c.
This is even worse on days I have slept worse..
everything's stress because of feeling stressed, in a bad mood and spacy/foggy in my mind and being quite irritable when meeting ppl or even getting out of my house.So I became quite the avoiding kind of personality..
Now I'm quite desperate to get some kind of relief or maybe even remission because this really really sucks and I'd really like to study. It feels like I'd miss out whole life.
It would be really great if some of you would suggest some meds..
Medications:
<8 years ago I also had OCD (without the "C") and some kind of depression which lasted about 3 years and finally responded on paroxetine.>I already tried:
8yrs ago period:
sertraline, ssri + mirtazapine,
ssri + venlafaxine, mirtazapine + venlafaxine,
ssri+reboxetine, <combi of ultra-lowdose melitracen + flupentixol>,
risperidone + ssri, ziprasidone + ssri,
amisulprid + ssri...
and then finally got to paroxetine which helped the OCD to some noticeable degree until it "faded" more into the background (where it more or less stays)..3yrs->now period:
citalopram, escitalopram,
trazodone (still taking), mianserin (was far toooo sedated over the day, also don't want to take this since I gained about 7kg on mirtazapine),
opipramol..Since 12/2008 I'm taking the escitalopram+trazodone combo and also started psychotherapy + started exercising 3 months ago (2-3 times a week).
I didn't feel the ssri was working, but I had already given up on medications since I didn't think that anything would help (that's why I started exercising and psychotherapy feeling so desperate).
So I was taking the escitalopram für 9 months now without a noticeable effect nor response.
Now, because again I'm feeling desperate (exercising + psychotherapy not improving my somatic symptoms), I visited a new pdoc who was astound about that none of my previous medications trials seemed to work..
She's a big fan of seroquel so she prescribed sertraline 50mg (instead of my 15mg escitalopram which I reported to her as not working) + seroquel 25mg in addition to the trazodone 150mg.This was 1 week ago.. and, although I'm sleeping MUCH longer now, I feel much worse on the seroquel. My mind is/feels cloudy the whole day and I'm quite irritable and tired the whole day! When I wake up I don't feel refreshed (maybe I'm having some rebound REM and/or nightmares?)
Does anyone think that this would improve beyond the 1 week I'm taking it at sleep time? Or is seroquel simply the wrong med for me?
I was thinking about maybe trying lowdose amitriptyline instead of the seroquel?And regarding the sertraline.. I really can't imagine that any ssri nor SNRI could be of REALLY much help anymore.
Having had nothing but disapointments and having read a whole lot on psychotropical.com, especially Dr. Gillmans opinion about the "newer generation meds", I think I'd really like to try something COMPLETELY different..Would any of you think parnate would be an option (for my symptomcluster?), or would it (too much) exacerbate the restlessnes/cause more insomnia?
Also in my retarded country (Austria) no MAOI is available (except the "~" moclobemide)
and I don't know whether a pdoc was able to get it from i.e. Germany (where tranylcypromine is available).Or would you suggest to try something different before I try a MAOI anyway?
Maybe lamotrigine?
Thanks a lot for reading and again sorry for my bad English + thanks for being able to take part in the babble :)have a good time!!
Posted by X-ray on August 10, 2009, at 11:57:00
In reply to New pdoc, new meds (anxiety, trouble sleeping, ..), posted by Sunbath on August 10, 2009, at 11:22:59
Hi,
The combo of trazodone and amitriptyline will cause drowsiness in the morning.
You will probably sleep well on a low dose of amitriptyline (30-50 mg).
I think that Lyrica might help you.
I've been on amitriptyline for 37 years.
My current dosage is 70 mg.I'm on Buspar for anxiety.
Best regards,
X-ray
Posted by Sunbath on August 10, 2009, at 12:06:03
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping, ..), posted by X-ray on August 10, 2009, at 11:57:00
> Hi,
>
> The combo of trazodone and amitriptyline will cause drowsiness in the morning.
>
> You will probably sleep well on a low dose of amitriptyline (30-50 mg).
>
> I think that Lyrica might help you.
>
> I've been on amitriptyline for 37 years.
> My current dosage is 70 mg.
>
> I'm on Buspar for anxiety.
>
> Best regards,
> X-rayHi X-Ray,
thanks for your answer! Wow 37 yrs is a lot..Regarding the combo: Is there some kind of interaction between those two I'm not aware of? Or is it just that both are so powerful sedating meds (but so is Seroquel?)?
Do you think that weight gain could be a big issue at a low dose?Thank you!
Posted by Phillipa on August 10, 2009, at 12:14:16
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping, ..), posted by Sunbath on August 10, 2009, at 12:06:03
Sunbath welcome to babble and your English is great. I found seroquel sedating. I also have Gad didn't find the SSRI's worked paxil did for two years and then was switched for a med trial to celexa and that was it. I take very low doses of benzos. Heard high doses of seroquel are less sedating than low. Hopefully someone will chime in with some great personal experience. Phillipa
Posted by X-ray on August 10, 2009, at 12:48:14
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping, ..), posted by Sunbath on August 10, 2009, at 12:06:03
Hi,
Interactions trazodone and amitriptyline:
Increased sedation and reaction time due to CNS depression.Weight gain can be a side effect of amitriptyline.
However, this has never been a problem for me.I guess that you have to think about what you eat.
You can check your weight every morning.Best regards,
X-ray
Posted by floatingbridge on August 10, 2009, at 16:41:35
In reply to New pdoc, new meds (anxiety, trouble sleeping, ..), posted by Sunbath on August 10, 2009, at 11:22:59
Hi Sunbath, and welcome!
Trazodone was not good for me (I have a fatigue problem, brain fog and insomnia among my somatic symptoms). It made me very tired and dopey--yea, it knocked me out--but it was like being hit with a lead weight. I'm wondering if you or others here would suggest you reconsider that as part of your current line-up. I think 150 is a high dose (I could be wrong). Do you like it?
Posted by SLS on August 10, 2009, at 16:59:20
In reply to New pdoc, new meds (anxiety, trouble sleeping, ..), posted by Sunbath on August 10, 2009, at 11:22:59
> Does anyone think that this would improve beyond the 1 week I'm taking it at sleep time? Or is seroquel simply the wrong med for me?
I had a similar reaction to Seroquel. I didn't stay on it for more than a week, though. Do you react the same way to bupropion (Wellbutrin)?
> I was thinking about maybe trying lowdose amitriptyline instead.
Some people use doxepin (Sinequan), another TCA, for the same purposes. It is good for sleep and anxiety.
- Scott
Posted by Sunbath on August 10, 2009, at 17:10:14
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping, » Sunbath, posted by floatingbridge on August 10, 2009, at 16:41:35
thanks a lot for the welcomes Philippa and Floatingbridge! :)
Floatingbridge: I wouldn't say 150mg trazodone was a high dose, since you can go up to somewhat about 400mg-600mg (depends on being an in- or out-patient :D ) when using it as an antidepressant (what it isn't used for these days very often as I heared..)
But yes for a sleep aid I think it might be quite high reading about other babbler's dosing regimen, but I dunno.
It seems to be the right dose for me however..
I started it because at that time my pdoc gave it to me and I thought it would be a good choice.. effective and hardly any weight gain.
when I go higher than 150mg my brain is really foggy the next day and at lower doses it didn't help me much.
I don't like it though since there are days I feel I'm "besides me" cannot concentrate and feel this brain fog regardless.. I think that's related to the trazodone...
I once tried to taper it by decreasing by 25mg, but had strong rebound/withdrawal symptoms :( I hadn't realized that I had already taken it for 2 1/2 years now.. so I think I'm pretty much bound to using it a little longer till the sleep problems are gone..Since it's quite hard to stop it for me, and 150mg traz isn't enough for keeping me asleep, my pdoc told me to start lowdose seroquel as an adjunct..
That's working great for sleep, but I'm a bit like a zombie, feel tired, easy to anger and generally in a bad mood during the day since I started the 25mg seroquel at night..
I hope this is going to fade over time? Has anyone experienced effects like this which resolved over time?I'm really wondering whether seroquel was the right med for me.. how long would you wait until telling the doctor?
Also do you think that tranylcypromine (for anxiety) would be a good choice when sertraline + seroquel + trazodone failed?
Thanks and good evening to all!
Posted by Sunbath on August 10, 2009, at 17:15:48
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping, ..), posted by SLS on August 10, 2009, at 16:59:20
Hi Scott,
I cannot remember whether I reacted similar to wellbutrin or not, since it gave me bad insomnia and at that time I wasn't convinced that it was the right med for me, since it doesn't look like wellbutrin was very much effective against anxiety/insomnia, so that I quit it after the 3rd day..
Do you really think it's the NE uptake blocking?At this low dose?
What do you think about parnate for anxiety?
Posted by Sunbath on August 10, 2009, at 17:21:09
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping, ..), posted by SLS on August 10, 2009, at 16:59:20
> > I was thinking about maybe trying lowdose amitriptyline instead.
>
> Some people use doxepin (Sinequan), another TCA, for the same purposes. It is good for sleep and anxiety.
>
>
> - Scott
Thnx for the suggestion!!But I already tried doxepin once between 12,5mg and 25mg.. when I tried to wean off the trazodone ( wanted it to substitute for it). I tried 12,5mg doxepin + 100mg traz. Couldn't sleep at night but was foggy the whole next day till evening.. that's why I then stopped playing around with doxepin
Posted by floatingbridge on August 10, 2009, at 17:27:39
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping,, posted by Sunbath on August 10, 2009, at 17:10:14
Hi Sunbath,
I tried it once--and I don't remember the dose--and felt so terrible on it--I think they call the reaction akathisia. That was the first and last time I took it. Others here have had more success and tolerance. Have you discussed your reaction with your doc?
fb
Posted by Sunbath on August 11, 2009, at 3:03:24
In reply to seroquel » Sunbath, posted by floatingbridge on August 10, 2009, at 17:27:39
> Hi Sunbath,
>
> I tried it once--and I don't remember the dose--and felt so terrible on it--I think they call the reaction akathisia. That was the first and last time I took it. Others here have had more success and tolerance. Have you discussed your reaction with your doc?
>
> fbOhhh Akathisia sounds really bad :(
No I haven't called her yet.. I'm hesistant because maybe I should wait a bit more than a week before judging Seroquel?
Posted by floatingbridge on August 11, 2009, at 12:03:14
In reply to Re: seroquel » floatingbridge, posted by Sunbath on August 11, 2009, at 3:03:24
Hi Sunbath,
I'm sorry, I didn't mean to scare you--many here use seroquel to their advantage. If your reaction is tolerable, I guess give it a fair trial-- and note your start up symptoms and see if they resolve.
best,
fb
Posted by elanor roosevelt on August 11, 2009, at 23:50:59
In reply to New pdoc, new meds (anxiety, trouble sleeping, ..), posted by Sunbath on August 10, 2009, at 11:22:59
i think your reaction to the seroquel is a red flag
please talk to your doctor
perhaps sonata to sleep
it allows dreaming and dreaming is useful for sorting throughgood luck
Posted by Sunbath on August 16, 2009, at 15:06:50
In reply to Re: seroquel » Sunbath, posted by floatingbridge on August 11, 2009, at 12:03:14
Hey no reason to be sorry about anything, thank you! You didn't scare me..
But I do think that the seroquel isn't good for me so I dropped it 2 days ago.. Now I'm doing much better with 20mg amitriptyline :) Still in a very bad mood though, but I can sleep (what's GREAT!!!)
Posted by Sunbath on August 16, 2009, at 15:08:45
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping,, posted by elanor roosevelt on August 11, 2009, at 23:50:59
Thank you Elanor, that's what I wanted to hear :D
Yes I thought so too and I already dropped Seroquel for 20mg Amitriptyline 2 days ago.. it's working much better for me, though I really hope that there won't be too much weight gain..
Posted by zatar on August 17, 2009, at 10:29:47
In reply to New pdoc, new meds (anxiety, trouble sleeping, ..), posted by Sunbath on August 10, 2009, at 11:22:59
I have the same problem of disrupted sleep, constant muscle tension and suffer from anxiety and panic attacks. I have Fibromyalgia so sleep is definitely an issue, especially sleep maintenance. Low dose doxepin (10mg) kept me asleep through the night until recently when some issues increased my anxiety and I was unable to fall asleep (never a problem until now) and I started waking up 10-15 times a night.
Per my pdoc's recommendation, melatonin 3mg helps me fall asleep and raising doxepin to 40mg keeps me asleep. My pdoc is very good about writing prescriptions for flexible dosing, so I tried increasing the doxepin until I found a dose that worked.
Sleep hygiene is very important. When my anxiety and sleep issues act up, I must avoid ALL caffeine (even decaf coffee,which still contains some caffeine), alcohol and chocolate. These prevent me from falling asleep and/or cause me to wake up in the wee hours when anxiety is rearing it's ugly head. I also avoid anything containing aspartame, MSG and other excitotoxins.
Exercising past dinner also tends to disrupt my sleep, so I make sure to do it in the morning. When my anxiety and panic attacks settle down, I find that I can go back to decaf coffee and have a drink and a chocolate muffin once in awhile.
My pdoc says that usually doxepin has an anti-anxiety effect starting at around 75mg and he is a big proponent of doxepin for sleep. But I am extremely sensitive to medications and cannot tolerate higher doses of many meds, so I don't take enought to get an anti-anxiety effect. Raising the doxepin dose increases my daytime fatigue and "spaciness", so I stick to the lower dose to help my sleep.
Years ago I took trazodone (50-100mg) for sleep maintenance issues and it worked for many years until I started getting these darn panic attacks (triggered by a trial of another medication). I was switched to 10mg doxepin and slept through the night. Doxepin causes increased appetite, however, so I eventually gave trazodone another trial. This time it didn't work at all, so I'm back to doxepin and intend to stick with it. I must be constantly aware to avoid snacking and watch portion control because doxepin definitely increases appetite. I am willing to pay the price because I find doxepin to be the best med I've tried for sleep.
SSRIs and benzos all disrupted my sleep. Since sleep is so precious to me and lack of it flares up my Fibro, I'm going to stick with doxepin.
I believe the trick for any medication is to find a dose that works for you. Start low, and titrate up slow.
Good luck to you. And may you find the sleep that you need.
-zatar
Posted by floatingbridge on August 17, 2009, at 11:46:40
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping, ..), posted by zatar on August 17, 2009, at 10:29:47
Hi Zatar,
I hadn't heard of this doxepin. A TCA? No morning hangover?
Thanks for posting and glad you've got your meds working,
fb
Posted by Sunbath on August 18, 2009, at 15:20:07
In reply to Re: New pdoc, new meds (anxiety, trouble sleeping, ..), posted by zatar on August 17, 2009, at 10:29:47
Hi zatar!
Thnx for your message. I'm very sorry you have the same sleep problems plus fibromyalgia! This really sucks!Not getting enough sleep for months already drives me crazy> Low dose doxepin (10mg) kept me asleep through the night until recently when some issues increased my anxiety and I was unable to fall asleep (never a problem until now) and I started waking up 10-15 times a night.
I tried doxepine (12,5mg) once but I couldn't tolerate the daytime fatique it gave me.
Also the Trazodone isn't working anymore, or isn't enough anymore.. I tried weaning off by reducing by just 20mg for 2 weeks, but this rebound insomnia or withdrawal insomnia just didn't improve, so I'm again taking those 150mg of trazodone (xr).
I then tried Seroquel which let me feel a bit like a zombie whole day but I slept well.. now I changed it for amitriptyline which is also very sedating.. not quite as much as doxepine but right after it I suppose :)
This is working well too, but again the daytime fatique..Did you try Seroquel or amitriptyline?
To me it seems like a hunt for the right balance: good, continous sleep vs. daytime fatique..
> Per my pdoc's recommendation, melatonin 3mg helps me fall asleep and raising doxepin to 40mg keeps me asleep. My pdoc is very good about writing prescriptions for flexible dosing, so I tried increasing the doxepin until I found a dose that worked.
I never tried Melatonin, maybe I should give it a try one day too..
> Sleep hygiene is very important. When my anxiety and sleep issues act up, I must avoid ALL caffeine (even decaf coffee,which still contains some caffeine), alcohol and chocolate. These prevent me from falling asleep and/or cause me to wake up in the wee hours when anxiety is rearing it's ugly head. I also avoid anything containing aspartame, MSG and other excitotoxins.
I second that! For me it's especially alcohol and caffeine (don't eat chocolate often, but thanks for the warning ;) )
I also didn't know about aspartam in this regard! Thanks!> My pdoc says that usually doxepin has an anti-anxiety effect starting at around 75mg and he is a big proponent of doxepin for sleep. But I am extremely sensitive to medications and cannot tolerate higher doses of many meds, so I don't take enought to get an anti-anxiety effect. Raising the doxepin dose increases my daytime fatigue and "spaciness", so I stick to the lower dose to help my sleep.
Anxiety is a real problem, I also don't know if the Zoloft will help, but maybe the doxepine will still work for you although you're not taking "the full dose"? Maybe you're a slow metaboliser and don't need such a high dose?
> I believe the trick for any medication is to find a dose that works for you. Start low, and titrate up slow.
you're right! Once that were those 150mg trazodone for me.. higher than 150 > daytime fatique, lower > cannot sleep well..
> Good luck to you. And may you find the sleep that you need.
>
Thanks a lot! I wish you all the same! Luck is really what we need in this med and conditions jungle.. And don't give up hope! The day will come when we'll feel well again! Just let's hope that it will be soon :)
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