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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by g_g_g_unit on March 10, 2010, at 21:52:47
hey,
so far prozac (20mg) seems to be doing an okay job of keeping the worst of my depression symptoms at bay ..
unfortunately, i'm left with two residual (and sorta intertwined) side-effects ...
1) insomnia .. with melatonin, i will awaken too early .. without it, i don't fall asleep until 4am, leaving me pretty much incapacitated the next day (and cancelling out any AD benefit). even with melatonin i am too tired and scatterbrained for anything requiring higher functioning/an attention span
2) restless legs & myoclonic jerks that are almost painful because the muscles are so taut
my guess is that changing to another SSRI won't help with the insomnia, since they all affect sleep?
amitriptyline helps the insomnia, but worsens restless leg ..
i'm seeing a neurologist tomorrow about the restless legs, since it's become such a long-standing problem
i thought about Prozac +low dose Requip + low-dose Remeron possibly. i'd rather not get stuck on a sleep med long-term (Remeron's side-effects are also a pain in the butt), but don't really know what options i have now
Posted by Phillipa on March 11, 2010, at 11:04:23
In reply to prozac - augmentation options, posted by g_g_g_unit on March 10, 2010, at 21:52:47
How did the neurologist appointment go? Phillipa
Posted by bleauberry on March 11, 2010, at 15:21:53
In reply to prozac - augmentation options, posted by g_g_g_unit on March 10, 2010, at 21:52:47
I don't know. I had the leg jerks in sleep for years while on prozac. Zyprexa definitely fixed the sleep problem and improved prozac efficacy. The final touch was a low dose of adrafinil and I was quite well for years. But, the leg jerks were there the whole time.
I think anything that shows favor to serotonin at the expense of the other neurotransmitters is prone to doing that.
From a theoretical point of view, a very low dose of a dopamine agonist would seem the most likely approach. Of course, there is no way to know how it would affect you emotionally or any other way, or what the longterm outcome would be.
Remeron made my leg jerks worse. Good sleep though, at least for a couple months until I developed tolerance.
Abilify is an option. Probably not good for sleep, but potential for the leg jerks. Anecdotally the best doses seem to be low...1mg to 5mg.
Another option is to switch to a more balanced approach, such as Zoloft+Nortriptyline.
There's no easy way out unfortunately.
This is the end of the thread.
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