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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by tonyz on May 5, 2010, at 16:29:31
I'm worried about sleep of which I've gotten very little during the past 4 months. My current meds are 1.5mg clonazepam, 125mg Amitriptyline (going up to 150 tonight) and 30mg of temazepam, 300mg Li
Unfortunately, I am pretty much a basket case now, I have terrible memory problems, trouble reading, etc. I force myself to exercise every day, but beyond that and checking this forum I don't do very much.
Sorry for the long introduction just giving you some background. I've been on the benzos for about 3-4 months now and other antidepressant medications. My question is since the benzos are known to cause temporary memory and cognitive problems, I would like to get off as quickly as I can, but I also need to sleep. Last night was decent at about 6.5hours. I'm afraid to tweak things too much because of the sleep issues. What do you suggest?
Doc I'm seeing just says take as needed.
I know the clonazepam disrupts rem sleep, temazepam supposedly allows rem sleep but consolidates phase 3 and 4 or something like that. So although I am sleeping now, I don't know the quality of the sleep?
I had been on as much as 400mg of seroquel, and clonazepam and trileptal and sometimes as little as 2 hours sleep. This is when I was in hospital as an outpatient earlier in the year.
The problem I believe is that the hospital doc was insisting that I was bipolar even though he never said that directly, so I've not had a decent antidepressant on board.
What would you do?
What is a good augmentation strategy for the amitriptyline?
Amitriptyline has pulled me out before but it took some pretty large dosages.
Posted by linkadge on May 5, 2010, at 17:00:11
In reply to Question for Blueberry and others, posted by tonyz on May 5, 2010, at 16:29:31
What is your underlying diagnosis? Do you think the amitriptyline is treating that effectively?
Were you on the benzos before the amitriptyline?
A z drug like zopiclone might be more effective for sleep than a benzo. You might try and consolidate the benzos in to one.
If the core issue is insomnia, something like melatonin might help. It tends to reduce benzo tollerance too which may help.
If the core issue is depression or anxiety, perhps adding a low dose of paroxetine or citalopram might help.
You might try doxapine too. Amitriptyline is good for sleep (in general), but doxapin or trimipramine are better. Sometimes too, the sedating AD's are good for sleep in lower doses, but promote insomnia at higher doses. Higher doses of amitriptyline might not be as sedating as the lower doses.
Perhaps trying an SSRI with lower doses of a sedating tca. Ie citalopram + doxapin, or paroxetine + trimipramine. The problem with TCA's is that in higher doses, you get substantial norepinephrine reuptake inhibition. This tends to reduce deep sleep.
If there is any hint of bipolar, or perhaps unresolved agitated which is promoting the insomnia, a drug like perphenazine (low dose) might help.
Changing the lithium to the morning (if you are taking it at night) might also improve sleep disturbance. Lithium tends to calm you down but it can induce sleep disturbances.
Tryptophan augmentation might be ok, but watch for syptoms of serotonin syndrome.
Linkadge
Posted by linkadge on May 5, 2010, at 17:01:15
In reply to Question for Blueberry and others, posted by tonyz on May 5, 2010, at 16:29:31
oh sorry tony, I didn't realize it was you before I started posting. Sorry if my ideas are redunant.
Linkadge
Posted by tonyz on May 5, 2010, at 19:18:31
In reply to Re: Question for Blueberry and others, posted by linkadge on May 5, 2010, at 17:00:11
Linkadge,
Thanks for your reply. Had tried paxil before w/ another drug - didn't work. Haven't tried celexa but tried lexapro and it may have been coincidental but my anxiety shot through the roof on a very low dosage.zopiclone is something I've not heard of before, ah I see it is similar to lunesta which doesn't work for me. ambien, lunesta, sonata - no effect.
I was taking the benzos before the amitriptyline. It's a long story and a lot of med changes but the clonazepam has been fairly constant. I try the restoril first if it doesn't work after an hour I take the clonazepam.
I'm just worried about taking the clonazepam as it reduces rem sleep.
amitriptyline is only now getting to the point where it might have some effect, but it will take a few weeks probably.
Anyway thanks for your ideas. I wish there were an easy way through this.
Posted by Hombre on May 5, 2010, at 20:04:38
In reply to Question for Blueberry and others, posted by tonyz on May 5, 2010, at 16:29:31
I used to take zopiclone, 1mg lorazepam, and Seroquel and I still wasn't getting enough sleep.
I was getting like 4-5 hours a night until I added magnesium citrate supplementation (~200mg BID, no calcium), 100mg B6 and ~250mg niacin every night along with Seroquel and Remeron. Adding the supplements allowed me to reduce Seroquel from 100 to 50mg. I dropped the zopliclone and the lorazepam. I also had to find the right level of niacin. Any more and I am too sedated the next day. The magnesium provides mood stabilizing and anti-anxiety functions as well as augmenting the antidepressants. I found that lithium, even at 400mg, was exacerbating anxiety and sleeplessness.I know it sounds mild, but magnesium has a profound effect (on me). Give it a try.
Posted by tonyz on May 5, 2010, at 20:32:29
In reply to Re: Question for Blueberry and others, posted by Hombre on May 5, 2010, at 20:04:38
Before all this started I was starting to take Niacin but I experienced the Niacin flush which was rather dramatic in my case. I think I started with 500 and then switched to 250mg.
Morgan also suggested the magnesium, I will give it a try.
It is interesting because I have psoriasis and have been taking lithium which has been causing the psoriasis to flare. I met with my pdoc yesterday and he agreed to lower the lithium. I had started taking magnesium in the mornings but didn't take it today and was feeling more anxious. I assumed it was the lithium but maybe it was the magnesium.
As I understand Niacin expands the capillaries and increase blood to all the cells and is supposed to have a cleansing effect. It's possible that it increases the blood flow to the brain which would explain why lower dosages were needed. I'm just guessing; I don't have a medical background so I could be way off base.
Thanks.
Posted by Phillipa on May 5, 2010, at 21:05:44
In reply to Re: Question for Blueberry and others, posted by tonyz on May 5, 2010, at 20:32:29
Niacinamide will prevent the flushing. Phillipa
Posted by Hombre on May 6, 2010, at 2:39:59
In reply to Re: Question for Blueberry and others, posted by tonyz on May 5, 2010, at 20:32:29
Magnesium seems to have a general calming effect without being sedative. Niacin and folic acid seem to interact with the meds to create too much serotonin, so I feel kinda blunted and tired, but really anxiety free. I sometimes get the flush, but since I'm in bed already it doesn't matter. I feel nice and warm and cozy. Again, dosage is important and it just might not sit right with you and your personal chemistry.
There's a sports supplement called ZMA that is basically zinc, magnesium, and B6. It is supposed to promote good sleep and maybe increase testosterone. I have read that deep sleep is needed for human growth hormone to be released properly. I take zinc, B6 and mag together at night and although I sometimes get some intense dreams the sleep has improved lots. Your mileage may vary, of course.
Since I went back down to 50mg Seroquel, I've also been losing some of the weight I put on over several months on lithium and now seroquel.
Posted by tonyz on May 6, 2010, at 10:31:42
In reply to Re: Question for Blueberry and others, posted by Hombre on May 6, 2010, at 2:39:59
Thanks Hombre.
Posted by Hombre on May 11, 2010, at 20:13:25
In reply to Question for Blueberry and others, posted by tonyz on May 5, 2010, at 16:29:31
tonyz - any luck with the sleep?
For me, I've decided to go back to 100mg Seroquel. I'm starting to look for work and I was starting to get some unnecessary anxiety that was making it hard to think straight. I am some kind of bipolar, although only drugs or antidepressants will make me go hypomanic, so Seroquel is the cap on the high end.
I used to take 400mg lithium, but that was interacting with the antidepressants and causing insomnia, flat mood, anxiety. I sort of went with a gut feeling and dropped the lithium for a few days, felt better, then went on Seroquel.
I'd like to reiterate that sleep has been much improved since adding magnesium citrate in small doses throughout the day. A little calcium (not too much) may also help. B6 and zinc may also help with sleep quality. I've tested them on someone who was not sleeping well but without a diagnosis of depression or whatever, and she is sleeping much better.
Posted by tonyz on May 12, 2010, at 13:22:02
In reply to Re: Question for Blueberry and others, posted by Hombre on May 11, 2010, at 20:13:25
Thanks for asking Hombre. Getting some sleep but generally need to take 30mg restoril and 2mg of clonazepam. I tried adding seroquel last night and reduced the clonazepam and I got maybe 5 1/2 hours. I'm taking amitriptyline at 150mg, and 300 LI
Plan for tonight is to increase the seroquel to 75mg and add one of the sleep meds trazodone, clonazepam, restoril.
I'm a wreck am nervous during the day and can't think straight and memory is going down fast.
So the current cocktail is:
300 LI in the am150 amitriptyline at bedtime
75 mg seroquel
and my choice of a 3rd sleep med.(trazodone, clonazepam, or restoril)I just feel I'm not getting restorative sleep and am not thinking clearly during the day. I basically stare at the walls.
This is the end of the thread.
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