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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by gadchik on October 26, 2013, at 14:10:46
Improvement of sleep quality by controlled-release melatonin in benzodiazepine-treated elderly insomniacs.
Garfinkel D, Laudon M, Zisapel N.
SourceAging Research, Day Care Unit, The E. Wolfson Medical Center, Holon 58100 and Meonot Maccabi, 7 Hanna Senech St., Bat-Yam 59303, Israel.
AbstractBenzodiazepines are widely used in the elderly population for the initiation of sleep. However, very frequently, complaints about poor sleep maintenance persist despite benzodiazepine treatment. Melatonin, a hormone produced by the pineal gland at night, is involved in the regulation of the sleep/wake cycle. Melatonin production decreases with age and can also be inhibited by benzodiazepines. We have recently reported on the association between insomnia and impaired melatonin output in the elderly. In the present study we have investigated the efficacy of melatonin replacement therapy in improving sleep in 21 elderly subjects who have been taking benzodiazepines and had low melatonin output. In a randomized, double-blind, crossover designed study the subjects were treated for three weeks with 2 mg per night of controlled-release melatonin and for 3 weeks with placebo, 2 h before desired bedtime with a 1-week washout period between treatment periods. Subjects' sleep was assessed by wrist actigraphy. Melatonin treatment significantly increased sleep efficiency and total sleep time and decreased wake after sleep onset, sleep latency, number of awakenings and fragmental index, as compared to placebo. The results of our study indicate that melatonin replacement therapy can improve sleep quality in the elderly and that the beneficial effects are augmented in the presence of benzodiazepines.
Posted by Phillipa on October 26, 2013, at 18:44:48
In reply to Pubmed Article Benzos and Melatonin, posted by gadchik on October 26, 2013, at 14:10:46
G how does one know if their melatonin level is low? Is melatonin now a script or still over the counter? Thanks P
Posted by gadchik on October 26, 2013, at 19:44:49
In reply to Re: Pubmed Article Benzos and Melatonin » gadchik, posted by Phillipa on October 26, 2013, at 18:44:48
It's over the counter. I think it can be low in anyone over 50. I don't know if they test for it. I want to try it but am afraid to.
Posted by Phillipa on October 27, 2013, at 18:01:04
In reply to Re: Pubmed Article Benzos and Melatonin, posted by gadchik on October 26, 2013, at 19:44:49
Gadchik you haven't taken it either? P
Posted by gadchik on October 27, 2013, at 19:34:42
In reply to Re: Pubmed Article Benzos and Melatonin » gadchik, posted by Phillipa on October 27, 2013, at 18:01:04
I've had friends tell me that it actually kept them up all night when they took it, others say it gives a warm mellow sleepy feeling. Some say it gives crazy dreams, so I just don't know what to expect...I don't do well when I take a new pill, get too nervous, but I think I will try a small piece eventually!
Posted by Phillipa on October 27, 2013, at 20:37:52
In reply to Re: Pubmed Article Benzos and Melatonin, posted by gadchik on October 27, 2013, at 19:34:42
Same here. Was it melatonin that was at one time taken off the market? If so I tried it once when in late 20's and got scared as I didn't want to breath. Seriously so never took it again. P
Posted by gadchik on October 28, 2013, at 6:36:48
In reply to Re: Pubmed Article Benzos and Melatonin » gadchik, posted by Phillipa on October 27, 2013, at 20:37:52
I hadnt heard about it getting taken off the mkt. But it's sold as a supplement, but its a hormone. Yeah, the not breathing thing scares me. When u take it with a benzo, u can get too sedated, but I take remeron with a benzo sometimes and it says that can cause too much sedation too. That's why I never drink alcohol now, because Im scared to combine with a benzo and stop breathing, but even my pdoc said I could have a glass of wine and be fine!
Posted by gadchik on October 28, 2013, at 9:51:34
In reply to Re: Pubmed Article Benzos and Melatonin, posted by gadchik on October 28, 2013, at 6:36:48
P, r u still taking Luvox? I did read somewhere that it is the only ad that increases melatonin in the body.
Posted by Phillipa on October 28, 2013, at 10:22:09
In reply to Re: Pubmed Article Benzos and Melatonin, posted by gadchik on October 28, 2013, at 9:51:34
Really? I wish you had the link as would explain why that time a doc took me off it and didn't sleep for two weeks even with very high doses. The minute I added back the only 25mg of luvox and low dose benzo I slept again. P
Posted by doxogenic boy on October 28, 2013, at 10:44:32
In reply to Re: Pubmed Article Benzos and Melatonin » gadchik, posted by Phillipa on October 28, 2013, at 10:22:09
> Really? I wish you had the link as would explain why that time a doc took me off it and didn't sleep for two weeks even with very high doses. The minute I added back the only 25mg of luvox and low dose benzo I slept again.
Couldn't it have been Luvox withdrawal?
- doxogenic
Posted by Phillipa on October 28, 2013, at 23:26:01
In reply to Re: Pubmed Article Benzos and Melatonin » Phillipa, posted by doxogenic boy on October 28, 2013, at 10:44:32
I feel it was but just found this also. Phillipa
Posted by Phillipa on October 28, 2013, at 23:27:25
In reply to Re: Pubmed Article Benzos and Melatonin » doxogenic boy, posted by Phillipa on October 28, 2013, at 23:26:01
Looks like you also must take melatonin with the luvox doesn't it?
Posted by gadchik on October 29, 2013, at 4:57:16
In reply to Re: Pubmed Article Benzos and Melatonin, posted by Phillipa on October 28, 2013, at 23:27:25
this study sounds that way...I thought luvox just increased the melatonin that's already produced by ur body
Posted by doxogenic boy on October 29, 2013, at 17:46:59
In reply to Re: Pubmed Article Benzos and Melatonin, posted by Phillipa on October 28, 2013, at 23:27:25
> Looks like you also must take melatonin with the luvox doesn't it?
To me it looks like you should avoid taking fluvoxamine and melatonin together.
http://www.ncbi.nlm.nih.gov/pubmed/15744215
Quote from the link above:
CNS Spectr. 2001 Jun;6(6):511-3.
Circadian rhythm sleep disorders as a possible side effect of fluvoxamine.
Hermesh H, Lemberg H, Abadi J, Dagan Y.
SourceOutpatients Department and the Anxiety Disorders and Behaviour Therapy Unit, the Geha Mental Health Center, Rabin Campus, Petach-Tiqva, Israel.
AbstractSleep problems, day somnolence, and fatigue as a result of psychotropic drugs are very common. Psychiatrists usually consider these effects a result of insomnia and treat them by prescribing sleeping pills or other benzodiazepine agents. We describe here 10 cases of circadian rhythm sleep disorders (CRSD)--and not merely insomnia--as a possible side effect of fluvoxamine (FVA). Two other serotonin reuptake inhibitors, fluoxetine and clomipramine, did not induce CRSD in any of these 10 patients. We speculate that FVA-induced CRSD is caused by the effect of FVA on serotonin and melatonin levels in the central nervous system. CRSD as a side effect of FVA can be treated by replacing the suspected FVA or adding melatonin to a beneficial FVA treatment. Thus, it is important to be aware of possible iatrogenic CRSD in order to treat appropriately. Prospective studies are needed to confirm our observation and to study the influence of other psychotropic drugs on sleep-wake schedule.
End quote.
-----------------------------
http://www.ncbi.nlm.nih.gov/pubmed/11270913
Quote from the link above:J Clin Psychopharmacol. 2001 Apr;21(2):167-74.
Differential effects of fluvoxamine and other antidepressants on the biotransformation of melatonin.
Härtter S, Wang X, Weigmann H, Friedberg T, Arand M, Oesch F, Hiemke C.
SourceDepartment of Psychiatry, University of Mainz, Germany.
AbstractMelatonin, the predominant product of the pineal gland, is involved in the maintenance of diurnal rhythms. Nocturnal blood concentrations of melatonin have been shown to be enhanced by fluvoxamine, but not by other serotonin reuptake inhibitors. Because fluvoxamine is an inhibitor of several cytochrome P450 (CYP) enzymes, the authors studied the biotransformation of melatonin and the effects of fluvoxamine on the metabolism of melatonin in vitro using human liver microsomes and recombinant human CYP isoenzymes. Melatonin was found to be almost exclusively metabolized by CYP1A2 to 6-hydroxymelatonin and N-acetylserotonin with a minimal contribution of CYP2C19. Both reactions were potently inhibited by fluvoxamine, with a Ki of 0.02 microM for the formation of 6-hydroxymelatonin and 0.05 microM for the formation of N-acetylserotonin. Other than fluvoxamine, fluoxetine, paroxetine, citalopram, imipramine, and desipramine were also tested at 2 and 20 microM. Among the other antidepressants, only paroxetine was able to affect the metabolism of melatonin at supratherapeutic concentrations of 20 microM, which did not reach by far the magnitude of the inhibitory potency of fluvoxamine. The authors concluded that fluvoxamine is a potent inhibitor of melatonin degradation. Because this inhibitory action is also found in vivo, fluvoxamine might be used as an enhancer of melatonin, which might offer new therapeutic possibilities of fluvoxamine.
End quote.
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http://www.cpnhelp.org/another_reason_to_take_meExcerpt from the article above:
Fluvoxamine (Luvox), an antidepressant, is known to increase natural melatonin production and it may also increase blood levels of melatonin if it is taken at the same time as melatonin supplementsi. If fluvoxamine and melatonin are taken together, the risk for side effects of melatonin may be increased.
End quote.
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http://www.dr-bob.org/babble/20080412/msgs/823044.htmlExcerpt from the message above:
A molecule related to fluoxetine, fluvoxamine (Luvox) naturally increases blood levels of melatonin. When fluvoxamine and melatonin are taken at the same time, blood levels of melatonin are significantly higher than if the melatonin were taken by itself. The result of this interaction is an increase in melatonin side effects (eg. headache, nausea, and increased drowsiness). Whether this results in any real danger (in most cases) is doubtful, although the literature does not recommend taking melatonin and fluvoxamine together.The drug interaction between fluvoxamine and melatonin is probably due to fluvoxamine's inhibition of the cytochrome P450 system (CYP); specifically CYP1A2 and CYP2C9 isoenzymes.
End quote.- doxogenic
Posted by Phillipa on October 29, 2013, at 21:24:29
In reply to Re: Pubmed Article Benzos and Melatonin » Phillipa, posted by doxogenic boy on October 29, 2013, at 17:46:59
I don't take it but it sounds like just the low dose of luvox could be why I sleep pretty well now. Phillipa
Posted by doxogenic boy on October 30, 2013, at 10:45:06
In reply to Re: Pubmed Article Benzos and Melatonin » doxogenic boy, posted by Phillipa on October 29, 2013, at 21:24:29
> I don't take it but it sounds like just the low dose of luvox could be why I sleep pretty well now.
Yes, this is probably due to Luvox's effect on melatonin. Do you take it in the evening/night, and are you tired in the morning?
- doxogenic
Posted by Phillipa on October 30, 2013, at 20:59:52
In reply to Re: Pubmed Article Benzos and Melatonin » Phillipa, posted by doxogenic boy on October 30, 2013, at 10:45:06
Take at bedtime with low dose benzo no not tired in am. Phillipa
Posted by Phillipa on November 9, 2013, at 21:26:08
In reply to Re: Pubmed Article Benzos and Melatonin » doxogenic boy, posted by Phillipa on October 30, 2013, at 20:59:52
I've also decided to cut out the 2.5mg of Lexapro that I was taking with it. Reason kept taking it was it caused me to wake earlier than without it. So If I do this I should be able to cut down or out the 7.5mg of valium & .5mg of Xanax I take at night. I feel the worse in the morning and as the day goes on I wake more. So I'm thinking the Lexapro is cancelling the luvox and then causing me to take the benzos. Any thoughts on this? Thanks Phillipa
Posted by doxogenic boy on November 11, 2013, at 12:18:14
In reply to Re: Pubmed Article Benzos and Melatonin » Phillipa, posted by Phillipa on November 9, 2013, at 21:26:08
> I've also decided to cut out the 2.5mg of Lexapro that I was taking with it. Reason kept taking it was it caused me to wake earlier than without it. So If I do this I should be able to cut down or out the 7.5mg of valium & .5mg of Xanax I take at night. I feel the worse in the morning and as the day goes on I wake more. So I'm thinking the Lexapro is cancelling the luvox and then causing me to take the benzos. Any thoughts on this?
----
I think it is worth trying to cut out the Lexapro, but have you tried to cut down og cut out Valium and Xanax before?- doxogenic
Posted by Phillipa on November 11, 2013, at 20:04:14
In reply to Re: Pubmed Article Benzos and Melatonin » Phillipa, posted by doxogenic boy on November 11, 2013, at 12:18:14
Since I only take at night my cutting of pills is splitting with fingers so never accurate. So the dose is always up and down. Phillipa
Posted by doxogenic boy on November 13, 2013, at 18:02:30
In reply to Re: Pubmed Article Benzos and Melatonin » doxogenic boy, posted by Phillipa on November 11, 2013, at 20:04:14
> Since I only take at night my cutting of pills is splitting with fingers so never accurate. So the dose is always up and down.
Do you feel any difference with different doses?
- doxogenic
Posted by Phillipa on November 13, 2013, at 21:31:19
In reply to Re: Pubmed Article Benzos and Melatonin » Phillipa, posted by doxogenic boy on November 13, 2013, at 18:02:30
Not really when wake each morning feel horrible. Still can't figure out if the synthroid or the meds. Thoughts? Phillipa
Posted by doxogenic boy on November 14, 2013, at 7:40:39
In reply to Re: Pubmed Article Benzos and Melatonin » doxogenic boy, posted by Phillipa on November 13, 2013, at 21:31:19
> Not really when wake each morning feel horrible. Still can't figure out if the synthroid or the meds. Thoughts?
I am not sure, but do you have any of these side effects?
http://www.synthroid.com/whatissynthroid/sideeffects.aspxQuote from the link above:
Rapid or irregular heartbeat
Chest pain or shortness of breath
Muscle weakness
Nervousness
Irritability
Sleeplessness
Tremors
Change in appetite
Weight loss
Vomiting
Frequent bowel movements
Excessive sweating
Heat intolerance
Fever
Impaired fertility
Decreased bone density
Changes in menstrual periods
Other unusual medical events
End quote.See also this site:
http://www.patient.co.uk/forums/discuss/unacceptable-side-effects-of-levothyroxine-30055- doxogenic
Posted by Phillipa on November 14, 2013, at 8:34:09
In reply to Re: Pubmed Article Benzos and Melatonin » Phillipa, posted by doxogenic boy on November 14, 2013, at 7:40:39
Only one I have is the bone density. Had osteoporosis, osteo arthritis, bone spurs, spinal stenosis and back pain no matter what I do has severely impacted my daily activities. Hence since it sounds like both synthroid and SSRI's could be involved in the bone density and feeling like I have to get doing something, anything, coud it be the 25mg of luvox, 2.5mg of Lexapro, .75 of Xanax (hard to break the lmg pill into two pices one for bed and then one when wake early) and the 7.5 mg of valium same issue with breaking meds. I think a lot is knowing I'm getting old and can't do what I could. But then look at others my age and they are perfectly fine and functioning in running and other things I used to love to do. Phillipa
Posted by doxogenic boy on November 14, 2013, at 10:26:32
In reply to Re: Pubmed Article Benzos and Melatonin » doxogenic boy, posted by Phillipa on November 14, 2013, at 8:34:09
> Only one I have is the bone density. Had osteoporosis, osteo arthritis, bone spurs, spinal stenosis and back pain no matter what I do has severely impacted my daily activities. Hence since it sounds like both synthroid and SSRI's could be involved in the bone density and feeling like I have to get doing something, anything, coud it be the 25mg of luvox, 2.5mg of Lexapro, .75 of Xanax (hard to break the lmg pill into two pices one for bed and then one when wake early) and the 7.5 mg of valium same issue with breaking meds. I think a lot is knowing I'm getting old and can't do what I could. But then look at others my age and they are perfectly fine and functioning in running and other things I used to love to do.
Maybe you find out what drug(s) that cause(s) the problems if you taper off one drug at a time.
- doxogenic
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