![[dr. bob]](/dr-bob-sm.gif)
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 brynb on September 18, 2012, at 12:01:08
I started an earlier thread about insomnia, and this is pretty similar, but I'd love some feedback on a good med that I can use temporarily and as a PRN for some insomnia and anxiety I'm currently experiencing. I'd like to use it temporarily as I feel like I'm in a bit of rut, but not a severe depressive episode. If someone knows of something that can help mood as well, great.
Also, it takes a lot to knock me out (even though I'm only 105 lbs). I can't use a benzo--I use these sparingly as I had addiction issues in the past. Z drugs are probably not my answer either. Vistaril used to kind of help, but no longer works. I don't like how I feel on Seroquel (or any APs, really), but I was thinking of possibly using Risperdal.
Thoughts?
Many thanks.
Posted by Phillipa on September 18, 2012, at 12:49:04
In reply to Non-benzo PRN for sleep/anxiety, posted by brynb on September 18, 2012, at 12:01:08
My pharmacist said abilify is a good med. As for dosing those I know online for sleep take tiny doses. Phillipa
Posted by linkadge on September 18, 2012, at 14:43:30
In reply to Re: Non-benzo PRN for sleep/anxiety » brynb, posted by Phillipa on September 18, 2012, at 12:49:04
I've been using remeron lately and its doing the trick. There is some hangover, but I keep the dose as low as possible.
Linkadge
Posted by Beckett on September 18, 2012, at 15:18:34
In reply to Non-benzo PRN for sleep/anxiety, posted by brynb on September 18, 2012, at 12:01:08
I found Abilify activating. Risperdal not much of a soporific. Saphris knocked me out more reliably. But you may not like it any more than Seroquel.
Posted by brynb on September 18, 2012, at 18:19:06
In reply to Re: Non-benzo PRN for sleep/anxiety, posted by Beckett on September 18, 2012, at 15:18:34
Thanks for your responses. My pdoc gave me Seroquel (only 10 tablets until I see him next). Despite not loving the med, I do think it's a good choice. He also wants me to go up on my lithium dose (but after trying Seroquel in order to distinguish what's working). He thinks that my insomnia and anxiety will resolve subsequent to getting my mood in a better place.
Thanks again.
Posted by jono_in_adelaide on September 18, 2012, at 18:47:20
In reply to Re: Non-benzo PRN for sleep/anxiety, posted by Beckett on September 18, 2012, at 15:18:34
Doxepin might be a goer, dose range 10-50mg at bedtime.
Effective, non addictive and dirt cheap.
Risperdal isnt very sedating, so might not be a good choice.
Posted by phidippus on September 18, 2012, at 22:24:52
In reply to Non-benzo PRN for sleep/anxiety, posted by brynb on September 18, 2012, at 12:01:08
Hi, Bryn!
Risperdal can be very activating. Good for anxiety, but not so good for sleep.
Here are some suggestions for PRN insomnia/anxiety:
Cyproheptadine is a powerful antihistamine which also antagonizes 5ht2c receptors which are implicated in anxiety. It is also a sedative.
Mirtazapine is a tetracyclic antidepressant that is often prescribed to treat insomnia.
Doxepin is a TCA used to treat anxiety and insomnia
Gabitril is an anticonvulsant that can be used to treat both anxiety and insomnia. It improves sleep quality
Lyrica is an anticonvulsant that has been used to treat anxiety. It knocks me out.
Thorazine is a typical anti psychotic that is a strong sedative and anxiolytic.
Clonidine is prescribed to treat insomnia and anxiety.
Hope this helps.
Eric
Posted by brynb on September 19, 2012, at 8:36:39
In reply to Re: Non-benzo PRN for sleep/anxiety » brynb, posted by phidippus on September 18, 2012, at 22:24:52
Hi Eric,
Thanks! Good suggestions. Remeron made me gain a ton of weight, and Doxepin was just weird. I wanted something that would work immediately as an anxiolytic, so my pdoc and I went with a low dose of Seroquel (not my favorite, but it does help me sleep, and if it's temporary, I can deal).
Cyproheptadine sounds like an interesting antihistamine. I never tried it, but as someone who suffers from allergies and headaches, it sounds like it could be good. I'm going to talk to my pdoc about it at our next appt.
By the way, I'm realizing that Tramadol has been making me speedy/hypomanic. It's amazing how I lack insight while I'm going through something. It brings me back to our conversation about whether I'm ever energetic, to which my initial response was no. But, that's not true; I do get high energy, just not in a euphoric or "good" way.
Thanks again, Eric.
-Bryn
Posted by bleauberry on September 19, 2012, at 13:47:40
In reply to Non-benzo PRN for sleep/anxiety, posted by brynb on September 18, 2012, at 12:01:08
If wanting meds, I would probably consider low dose remeron, as in 2mg to 7.5mg, no higher than that. Much more sedating that way. Even a tiny crumb can work.
Other than that, I dunno, I tend to feel meds for insomnia should be PRN, as you are thinking of doing. Remeron for that. On a regular basis, savella can make very good sleep, but not in a sedative way. It just does something to quiet down excess adrenaline stuff, probably through feedback loops, best guess. The first few days can have worsened sleep.
I personally prefer the use of plant medicines prior to synthetic ones. Their power to improve symptoms and disease are not well known in our society. In your case, the primary herb to take control of your symptoms, all of them, would be rhodiola rosea. You may not even need anything for sleep after it has had a few days or a couple weeks to start doing its stuff. Good for sleep, energy, depression, endurance, anxiety. For PRN usage, I like Lemon Balm, Skullcap, Passionflower, and Valerian Root. They aren't really potent sedatives, but through a variety of mechanisms they calm everything down so sleep can happen. That said, they all do have some immediate sedative quality to them, probably Skullcap the most. Lemon balm is more relaxing, calming, soothing, with only a hint of sedation. But in the background as part of a cocktail, it works to turbocharge the others.
Just some ideas. Been there done that, so I'm just sharing what I have noticed over the years.
Posted by brynb on September 19, 2012, at 13:58:22
In reply to Re: Non-benzo PRN for sleep/anxiety, posted by bleauberry on September 19, 2012, at 13:47:40
> If wanting meds, I would probably consider low dose remeron, as in 2mg to 7.5mg, no higher than that. Much more sedating that way. Even a tiny crumb can work.
>
> Other than that, I dunno, I tend to feel meds for insomnia should be PRN, as you are thinking of doing. Remeron for that. On a regular basis, savella can make very good sleep, but not in a sedative way. It just does something to quiet down excess adrenaline stuff, probably through feedback loops, best guess. The first few days can have worsened sleep.
>
> I personally prefer the use of plant medicines prior to synthetic ones. Their power to improve symptoms and disease are not well known in our society. In your case, the primary herb to take control of your symptoms, all of them, would be rhodiola rosea. You may not even need anything for sleep after it has had a few days or a couple weeks to start doing its stuff. Good for sleep, energy, depression, endurance, anxiety. For PRN usage, I like Lemon Balm, Skullcap, Passionflower, and Valerian Root. They aren't really potent sedatives, but through a variety of mechanisms they calm everything down so sleep can happen. That said, they all do have some immediate sedative quality to them, probably Skullcap the most. Lemon balm is more relaxing, calming, soothing, with only a hint of sedation. But in the background as part of a cocktail, it works to turbocharge the others.
>
> Just some ideas. Been there done that, so I'm just sharing what I have noticed over the years.Thanks, bleauberry. I appreciate the input. We went with Seroquel, which I can deal with right now. And yes, I'm definitely thinking just a PRN right now, as both my pdoc and I agree that when my mood gets better, ideally, so will the anxiety and insomnia. I gained a lot of weight from Remeron. Do you think this is still likely at that low of a dose? Curious.
I like your alternative ideas. I'm very interested in holistic/alternative medicine, but I haven't had much success with supplements. I'll have to revisit.
Thanks again.
-b
Posted by ChicagoKat on September 19, 2012, at 16:15:56
In reply to Non-benzo PRN for sleep/anxiety, posted by brynb on September 18, 2012, at 12:01:08
> I started an earlier thread about insomnia, and this is pretty similar, but I'd love some feedback on a good med that I can use temporarily and as a PRN for some insomnia and anxiety I'm currently experiencing. I'd like to use it temporarily as I feel like I'm in a bit of rut, but not a severe depressive episode. If someone knows of something that can help mood as well, great.
>
> Also, it takes a lot to knock me out (even though I'm only 105 lbs). I can't use a benzo--I use these sparingly as I had addiction issues in the past. Z drugs are probably not my answer either. Vistaril used to kind of help, but no longer works. I don't like how I feel on Seroquel (or any APs, really), but I was thinking of possibly using Risperdal.
>
> Thoughts?
>
> Many thanks.Hi Bryn,
I found Neurontin to be a lifesaver. I am like you, can no longer take benzos, have grown too tolerant to tthem. But the Neurontin knocked me right out, and I've noticed no side effects. I like it MUCH better than Lyrica, which seemed to make my depression worse. Also, with Neurontin, there's lots of room to go up on the dose if necessary, and still be in the therapeutic range.
I was on Tramadol, like you, but I couldn't tolerate it; it made me way too irritable and made my BP high, but unresponsive to antihypertensives. I quit it after 2 days. So much for the "miralce" cure for depression. :(
Posted by brynb on September 19, 2012, at 16:31:09
In reply to Re: Non-benzo PRN for sleep/anxiety » brynb, posted by ChicagoKat on September 19, 2012, at 16:15:56
> Hi Bryn,
>
> I found Neurontin to be a lifesaver. I am like you, can no longer take benzos, have grown too tolerant to tthem. But the Neurontin knocked me right out, and I've noticed no side effects. I like it MUCH better than Lyrica, which seemed to make my depression worse. Also, with Neurontin, there's lots of room to go up on the dose if necessary, and still be in the therapeutic range.
>
> I was on Tramadol, like you, but I couldn't tolerate it; it made me way too irritable and made my BP high, but unresponsive to antihypertensives. I quit it after 2 days. So much for the "miralce" cure for depression. :(
>
>Thanks, Kat. It's crazy--I feel like I've tried almost everything, but, naturally, that's not true, and I've had great suggestions on this board (and reminders of meds I forgot about).
Tramadol is still working for me as an AD. It gets me going in the morning. But, it's been making me hypomanic later, so we'll see. Sorry to here it didn't work for you. Is it possible your depression is within the bipolar spectrum (being treatment resistant and getting irritable from ADs)?
Unfortunately, I can't take Neurontin; I used to, and at first, it was good. Initially it was activating and would lift my mood within a few hours (gave me sort of a high). But, after being on it (even at low doses) off and on for two years, the last several times I took it, it made me manic.
So, it's Seroquel for now.Hope you're feeling better,
-b
Posted by jono_in_adelaide on September 19, 2012, at 21:32:33
In reply to Re: Non-benzo PRN for sleep/anxiety » ChicagoKat, posted by brynb on September 19, 2012, at 16:31:09
There are realy only three options for sleep
Those that work through the GABA receptor (benzos, z drugs and a few oddball others)
Those that work through the histamine and seretonin receptors (most antidepressants, periactin, phenergan, sparine, atypical antipsychotics)
Those that work through the adrenalin receptors (clonidine, tianzidine, trazodone)
I often wonder wether it might be worth rotating sleep meds to prevent tolorance, taking (say) a benzo one night, Seroquel the next night, Clonidine the third night, then back to your benzo on the 4th night and so on. Theoreticaly it would make sense, I wonder if it works out well in practice?
Posted by SLS on September 20, 2012, at 0:56:47
In reply to Re: Non-benzo PRN for sleep/anxiety, posted by jono_in_adelaide on September 19, 2012, at 21:32:33
What about promethazine (Phenergan)? I've never tried it, but I have seen it help someone who had to discontinue Zyprexa due to metabolic concerns. I was surprised it worked as well as it did.
- Scott
Posted by jono_in_adelaide on September 20, 2012, at 1:08:29
In reply to Re: Non-benzo PRN for sleep/anxiety, posted by SLS on September 20, 2012, at 0:56:47
Yeah, Phenergan can be very helpful, especialy as its avaliable over the counter in Australia and the UK
Great med to have at home, its a potent antihistamine, great for nausea, and it is effective against insomnia
Posted by phidippus on September 20, 2012, at 8:58:47
In reply to Re: Non-benzo PRN for sleep/anxiety » phidippus, posted by brynb on September 19, 2012, at 8:36:39
Seroquel is not a bad choice if you can tolerate it. It can help with anxiety, insomnia, mood stability and depression.
If you up your lithium, the Tramadol won't make you hypomanic.
High energy does not always mean euphoric, it can also come in the form of anxiety, pressured feelings and irritability.
Do you get racing thoughts?
Eric
Posted by rjlockhart37 on September 20, 2012, at 22:35:49
In reply to Non-benzo PRN for sleep/anxiety, posted by brynb on September 18, 2012, at 12:01:08
NUERONTIN!! i used to always take that PRN during anxiety attacks when they discontinued alprazolam.
hydroxyine...its a anithistimine that is widely used with public mental health psychiatrists.
Posted by brynb on September 20, 2012, at 22:46:08
In reply to Re: Non-benzo PRN for sleep/anxiety, posted by rjlockhart37 on September 20, 2012, at 22:35:49
Neurontin makes me manic. I've been using hydroxyine for a while, so it no longer works...
Frustrating, as I'm kind of limited here. Actually, my response to Seroquel has been positive the past few days, so we'll see...
Posted by ChicagoKat on September 22, 2012, at 23:16:06
In reply to Re: Non-benzo PRN for sleep/anxiety » ChicagoKat, posted by brynb on September 19, 2012, at 16:31:09
>
> > Hi Bryn,
> >
> > I found Neurontin to be a lifesaver. I am like you, can no longer take benzos, have grown too tolerant to tthem. But the Neurontin knocked me right out, and I've noticed no side effects. I like it MUCH better than Lyrica, which seemed to make my depression worse. Also, with Neurontin, there's lots of room to go up on the dose if necessary, and still be in the therapeutic range.
> >
> > I was on Tramadol, like you, but I couldn't tolerate it; it made me way too irritable and made my BP high, but unresponsive to antihypertensives. I quit it after 2 days. So much for the "miralce" cure for depression. :(
> >
> >
>
> Thanks, Kat. It's crazy--I feel like I've tried almost everything, but, naturally, that's not true, and I've had great suggestions on this board (and reminders of meds I forgot about).
>
> Tramadol is still working for me as an AD. It gets me going in the morning. But, it's been making me hypomanic later, so we'll see. Sorry to here it didn't work for you. Is it possible your depression is within the bipolar spectrum (being treatment resistant and getting irritable from ADs)?
>
> Unfortunately, I can't take Neurontin; I used to, and at first, it was good. Initially it was activating and would lift my mood within a few hours (gave me sort of a high). But, after being on it (even at low doses) off and on for two years, the last several times I took it, it made me manic.
> So, it's Seroquel for now.
>
> Hope you're feeling better,
> -bHi Bryn,
Sorry I missed your post, I've been going through a washout so I can start Nardil and have not been my best of late. Thanks for your kind words. I've often wondered if I have a Bipolar II issue b/c I often get irritable and get racing thoughts and have to talk a lot. But all my docs say no, it's just severe uniipolar deepression with accompaning anxieety. I must admit I was tried on Lithium and it did nothing for me, so maybe they are right. Sorry to hear the Neurontin no longer helps you. It does the opposite for me - it knocks me out, which I love.. I sometimes with I could be put in a coma until some new fabulous treatment comes out :) I'm sorry to hear you are starting to have trouble with Tramadol too. Overall, I hope you find the right treatment for you and feel better soon.
Thanks again,
Kat
>
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.