Psycho-Babble Medication Thread 943564

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Mix of meds - don't seem to be working

Posted by tonyz on April 16, 2010, at 11:32:57

I'm on the following meds: 1mg clonazepam (for about 3 months now), 100mg seroquel (had been up to 400mg), 125mg Nortriptyline, 600 Lithium, 15mg remeron. I take everything at bedtime with the exception of the lithium of which I take half in the morning and half at bedtime.

I'm sleeping very poorly and I don't know what to do. Occasionally, I'll take 30mg of restoril in the middle of the night and that seems to relax me and I get some sleep.

I don't know what is going on, normally 7.5 of remeron would knock me out and I would sleep well. Now I feel no effect. My mind is very slowed from being depressed I guess but my body is racing and I don't know how to calm myself.

Current doc added the remeron, but he is not inspiring me with a lot of confidence. I know if I go up on the seroquel or clonazepam I will probably sleep better - but those are 2 drugs I am trying to eliminate.

Just looking for some suggestions I can discuss with my doc and an opinion if taking the 30mg of restoril with this combination is a bad idea

 

Re: Mix of meds - don't seem to be working » tonyz

Posted by Phillipa on April 16, 2010, at 12:52:15

In reply to Mix of meds - don't seem to be working, posted by tonyz on April 16, 2010, at 11:32:57

Tony have you been cutting down on those two meds? If so could be some withdrawal if not maybe raising temporarily to see if it helps? Phillipa

 

Re: Mix of meds - don't seem to be working

Posted by tonyz on April 16, 2010, at 14:37:04

In reply to Re: Mix of meds - don't seem to be working » tonyz, posted by Phillipa on April 16, 2010, at 12:52:15

Cut back on the seroquel, also on the lithium, clonazepam had been pretty much the same - occasionally I would wake up and take some more to try to get to sleep.

The seroquel is not something I can tolerate long term, lithium I don't know it has some effects but it seems when it was at 900mg I was doing better.

Problem is I don't like taking any meds and I go off them and am stable for maybe 6 months and then have a relapse - this one is particularly difficult.

I have a lot of anxiety over the combinations of drugs. Everyone reacts differently and it becomes guesswork and experimentation.

 

Re: Mix of meds - don't seem to be working

Posted by linkadge on April 16, 2010, at 16:11:25

In reply to Mix of meds - don't seem to be working, posted by tonyz on April 16, 2010, at 11:32:57

Not sure if I mentioned it before, but the meds you are taking are highly noradrenergic.

Nortriptyline (NRI), remeron (alpha-2 antagonist), seroquel (noradrenergic metabolite). Have you ever tried a serotonergic drug?

Amitriptyline might be better than nortriptyline in terms of mood and sleep.

Linkadge

 

Re: Mix of meds - don't seem to be working

Posted by tonyz on April 17, 2010, at 14:19:28

In reply to Re: Mix of meds - don't seem to be working, posted by linkadge on April 16, 2010, at 16:11:25

Thanks linkage. I have been on amitriptyline in the past and it has been effective - problem is more severe side effects. Not sure what I'm going to do at this point.

 

Re: Mix of meds - don't seem to be working

Posted by linkadge on April 17, 2010, at 15:41:21

In reply to Re: Mix of meds - don't seem to be working, posted by tonyz on April 17, 2010, at 14:19:28

I hear you with side effects. When I was taking nortriptyline it didn't provide the same emotional support as amitriptyline did. It did help with energy but not so much insomnia.

I had too many side effects with amitriptyline so I lowered the dose and added cipralex (lexapro) which seems to work well with the TCA.

Linkadge

 

Re: Mix of meds - don't seem to be working » linkadge

Posted by tonyz on April 17, 2010, at 18:17:08

In reply to Re: Mix of meds - don't seem to be working, posted by linkadge on April 17, 2010, at 15:41:21

Hi Linkadge - thanks for your last posting. This current depression started in early January. I started with Lexapro and Buspar. I had a huge panic attack- can't specifically relate it to the medication, and I only started at 5mg. The buspar was stopped thinking that it might be causing the insomnia. Then the lexapro was stopped, and later restarted at a higher dosage 10mg and for a brief period I felt 100% better, but I guess anxiety and panic must have started up and it has been a struggle to find something that works.

It is hard to say if the lexapro/buspar caused the anxiety or if that was just something that happened.

I see my pdoc next week; I just wish I could get my sleep under control and feel like I was making some progress.

Remeron doesn't seem to be helping with sleep. I'm taking restoril and clonazepam - both of which I hate, but nothing else seems to be working.

 

Re: Mix of meds - don't seem to be working

Posted by linkadge on April 17, 2010, at 20:59:52

In reply to Mix of meds - don't seem to be working, posted by tonyz on April 16, 2010, at 11:32:57

Hmm. I've always wanted to try a nortriptyline / cipralex combination. I've heard this is particularly effective.

It sounds like you are on a lot of meds. What is the lithium for? Depression? Lithium can sometimes cause insomnia (believe it or not)

You might experiement with 7.5mg of remeron. Some people find that 7.5 was actually more sedating than 15mg.

The other thing too is that you are on 3 meds that (rem,ser,nor) which have 5-ht2 antagonist / antihistamine effects. It could be that this pathway for sedation is exhausted. Sometimes too much 5-ht2 antagonism can cause paradoxical excitation and or obsessive thought patterns.

Some thoughts.

1) to pick the best of nortriptyline, seroquel, or remeron.

2) reevaluate the use of lithium (unless bipolar disorder is present). Or try lower doses earlier in the day.

3) possibly add a SSRI (lower dose?) with a few extra benzo's as needed for startup anxiety?

4) Additionally, 5-htp might be a useful adjunct. 25-50mg in the midday.


Say.....seroquel + lexapro + benzo's (or)
nortriptyline + lexapro + benzo's (or)
nortriptyline + 5-htp + benzo's


If you can get something to help nail the depression, usually the insomnia lifts on its own.

The mood and insomnia are always a catch 22. It just seems that you are on a lot of sedating / depressing type of antidepressant medications. Remeron made my depression worse and its sleep inducing effect wore off. Same with seroquel. Nortriptyline wasn't bad, but it didn't help the core syptoms of my depression.

Linkadge

 

Re: Mix of meds - don't seem to be working

Posted by tonyz on April 18, 2010, at 12:21:39

In reply to Re: Mix of meds - don't seem to be working, posted by linkadge on April 17, 2010, at 20:59:52

Thanks again Linkadge for all the info. I know there are some studies that have shown lithium to be very effective with a TCA. In my case there is also some suspicion of bipolar. When I'm in a normal state (not depressed) and just a bit agitated 7.5mg of remeron would knock me out - now it does not seem to be doing much. Doc said to do 15mg. Since I am taking the restoril now maybe I will try a lower dosage of the remeron one night and see what happens.

I've heard of cases where Lithium can cause insomnia. Maybe I will lower it for one day and see what happens.

You have given me a lot to discuss with my pdoc. Thanks again. I'll post how things go.

 

Re: Mix of meds - don't seem to be working

Posted by Meltingpot on April 23, 2010, at 15:28:59

In reply to Re: Mix of meds - don't seem to be working » linkadge, posted by tonyz on April 17, 2010, at 18:17:08

Hi,

I was on lexapro for almost two years and it helped a bit, kept me working. Then after two years I started getting very bad break through anxiety and suicidal thought. After sleeping (all most too much for two years) I stopped being able to sleep at all (that was a first for me as I've never had problems with sleep before). I came off the lexapro and went on Clomipramine and then my sleep was back to normal again.

Just an idea for you.

Denise

 

Re: Mix of meds - don't seem to be working

Posted by tonyz on April 24, 2010, at 17:34:52

In reply to Re: Mix of meds - don't seem to be working, posted by Meltingpot on April 23, 2010, at 15:28:59

Hi Denise,
Thanks for your comments. Originally I started with lexapro and had massive anxiety was taking it along with buspar. Even though I am a low dose of luvox, I find myself taking 30mg of Restoril and 2mg of clonazepam (not at the same time to get some sleep).

I am not crazy about the combination that I am on, but I'm not sure what to do at this point.

The person that originally prescribed the lexapro had told me that it was the least stimulating of all the ssris.

I'm sure amitriptyline would work, but the side effects are not pleasant.

It is a strange combination now none of the drugs are at any level where they can do anything.

At least with clomipramine you can have coffee - I'm assuming that's the case anyway.

I'm rambling here, thanks for your post I hope the clomipramine continues to work for you.


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