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Dr. Bob is Robert Hsiung, MD,
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Posted by Twinleaf on December 2, 2013, at 9:42:01
In reply to Nightmares + Meds are they Connected?, posted by Phillipa on December 2, 2013, at 9:19:02
Nightmares are often related to past emotional trauma. Have you considered a low night-time dose of prazosin? It would be a safe med to take at 2 mg. or so, and could interrupt the cycle of nightmares.
Posted by SLS on December 2, 2013, at 10:32:09
In reply to Re: Nightmares + Meds are they Connected? » Phillipa, posted by Twinleaf on December 2, 2013, at 9:42:01
> Nightmares are often related to past emotional trauma. Have you considered a low night-time dose of prazosin? It would be a safe med to take at 2 mg. or so, and could interrupt the cycle of nightmares.
It is good to begin prazosin treatment as a single 1 mg dose at bedtime for the first day. This is just to prevent a syncope. Once treatment is initiated, you can then move up in dosage rapidly. When prazosin was first being looked at for treating PTSD nightmares, dosages of 3 - 6 given at night was evaluated. More recently, dosages of 20 - 30 mg/day given in divided doses is being studied. Multiple doses is most effective because the half-life of prazosin is short. Once higher dosages of prazosin were given throughout the day, it was discovered that it significantly reduced daytime depression and anxiety. It should be understood that the study population chosen was comprised of people with PTSD. I have not seen any studies looking at prazosin to treat depression and anxiety in the absence of PTSD, chronic physical or emotional abuse, or childhood neglect. A related drug, doxazosin, has a long half-life, but does not seem to be clinically effective.
- Scott
Posted by johnLA on December 2, 2013, at 11:39:34
In reply to Re: Nightmares + Meds are they Connected?, posted by SLS on December 2, 2013, at 10:32:09
twinleaf and sls-
you two may be absolutely right. but...
why must a drug side-effect be treated by yet another drug? causing most likely, more side-effects?
not trying to start a fight/debate here. i'm still relatively new to this game. but, i feel better on LESS drugs. i am still in depression, but my mind is clearer. i'll take that for now.
i am not sure if my depression is causing my nightmares or the psych meds i was on.
i'll repeat my experience here again;
since i have stopped my antidepressant i no longer have the constant vivid dreams i was having. i am curious what will happen if i can get off the last bit of klonopin i'm on. will the miracle of my first 47 years happen; just wake-up not remembering my dreams?
i have also started twice weekly talk therapy. i wonder if this helps too?
just my 2 cents.
john
Posted by ed_uk2010 on December 2, 2013, at 12:31:10
In reply to Nightmares + Meds are they Connected?, posted by Phillipa on December 2, 2013, at 9:19:02
> This is getting ridiculous. I feel okay other than being tired when go to bed at night to read some first. I take my meds then also. Usually 5mg of lexpro, 25mg of luvox, 2.5mg of valium, and a third of a lmg of Xanax. I fall asleep immediatedly but wake most nights with horrible dreams.
Have you always had these strange dreams on this med combo, or is it fairly new? That's the main clue as to the cause.
Posted by alexandra_k on December 2, 2013, at 13:34:45
In reply to Re: Nightmares + Meds are they Connected?, posted by ed_uk2010 on December 2, 2013, at 12:31:10
> > This is getting ridiculous. I feel okay other than being tired when go to bed at night to read some first. I take my meds then also. Usually 5mg of lexpro, 25mg of luvox, 2.5mg of valium, and a third of a lmg of Xanax. I fall asleep immediatedly but wake most nights with horrible dreams.
>
> Have you always had these strange dreams on this med combo, or is it fairly new? That's the main clue as to the cause.yep. also anything else that might have changed recently. how about snacks? something... maybe dairy? seems to result in nightmares for some people.
Posted by Twinleaf on December 2, 2013, at 14:39:18
In reply to Re: Nightmares + Meds are they Connected?, posted by alexandra_k on December 2, 2013, at 13:34:45
Last year, I began having very disturbing nightmares which I knew were related to past trauma. I took low-dose Prazosin at bed-time, combined with on-going psychotherapy. The dreams cleared up right away on Prazosin, and after 10 months, I was able to discontinue Prazosin without the nightmares recurring -presumably because of longer-term help from the therapy.
I mentioned this because you have described several sources of trauma, including your mother's very difficult illness and death, as well as more recent interpersonal trauma in your family and marriage. Personally, I am not a big medication-user (tianeptine and maintenance TMS only) but I am very glad I gave Prazosin a try.
I have Scott to thank for helping my pdoc be willing to give me Prazosin!
Posted by Jeroen on December 2, 2013, at 16:56:40
In reply to yes!, posted by johnLA on December 2, 2013, at 9:38:30
since i started anti psychotic
nightmares where i cant do sh*t and everybody else in my dreams acts normal going on for years now ;(
Posted by Twinleaf on December 2, 2013, at 17:01:50
In reply to i am having this..., posted by Jeroen on December 2, 2013, at 16:56:40
It's my impression that many people experience disturbing dreams on APs. So sorry this happened to you, especially as I'm assuming stopping them may not be an option.
Posted by Twinleaf on December 2, 2013, at 17:34:11
In reply to Re: Nightmares + Meds are they Connected?, posted by SLS on December 2, 2013, at 10:32:09
Scott, do you mind my asking if you are presently taking high doses of Prazosin during the day as well as the night? (i think you posted that you were, but I'm not sure) I have read one or two of the studies about its benefits for PTSD- related depression and anxiety, but do not know of anyone actually taking it around the clock. You must be one of the first!
How often is it optimal to take in order to feel a steady improvement? How helpful do you feel it is?
Posted by SLS on December 2, 2013, at 18:08:10
In reply to Re: Nightmares + Meds are they Connected? » SLS, posted by Twinleaf on December 2, 2013, at 17:34:11
> Scott, do you mind my asking if you are presently taking high doses of Prazosin during the day as well as the night? (i think you posted that you were, but I'm not sure) I have read one or two of the studies about its benefits for PTSD- related depression and anxiety, but do not know of anyone actually taking it around the clock. You must be one of the first!
>
> How often is it optimal to take in order to feel a steady improvement? How helpful do you feel it is?Hi Twinleaf.
I take prazosin t.i.d. as 10 mg morning / 5 mg afternoon /10 mg evening. Prazosin "feels" like a clean and robust antidepressant. For me, its clinical effects are unambiguous. I guess you could try b.i.d. dosing, but the half-life is 3 hours. One study weighted the dosing of prazosin as 5 mg morning and 10 mg evening. It is sad to know how long it took scientists to try using prazosin during the day when daytime anxiety and depression are such problems with PTSD.
The only side effect I experience with prazosin is a reduction of sex-drive. This is a rather common side complaint. The plumbing still works, but I don't often feel like opening the valve.
- Scott
Posted by Twinleaf on December 2, 2013, at 19:24:05
In reply to Re: Nightmares + Meds are they Connected? » Twinleaf, posted by SLS on December 2, 2013, at 18:08:10
Thanks Scott - that's very helpful. Very sorry about the side effect, but at least it seems moderate in degree!
Posted by Phillipa on December 2, 2013, at 20:20:00
In reply to Re: Nightmares + Meds are they Connected? » SLS, posted by johnLA on December 2, 2013, at 11:39:34
John exactly no more meds for me. I was doing the best on the least amount. Will continue to try to get off this merry go round of meds. How the heck did you get off the ad? I find them much more addicting than any benzo ever was. Thanks Phillipa
Posted by Phillipa on December 2, 2013, at 20:25:23
In reply to Re: Nightmares + Meds are they Connected?, posted by ed_uk2010 on December 2, 2013, at 12:31:10
Ed I agree no didn't. And yes fairly new. I attribute it to getting older as mortality is closer and fear death. I saw recently a family member of husband in wheelchair and then a 40 something year old guy from the family across the street also in wheelchair. Since my back is so bad and only option is to continue PT and experience pain which I do as must be active and also ride bike. Or get fused and be like a rod. I know that I block this during the day and it comes out at night. No med can change the future. It is what it is. But I can't accept it so fighting it at night. At least this is my thought. Trauma earlier in life is long forgiven and forgotten. I want my health more than anything. PJ
Posted by Twinleaf on December 2, 2013, at 21:37:53
In reply to Re: Nightmares + Meds are they Connected? » ed_uk2010, posted by Phillipa on December 2, 2013, at 20:25:23
Phillipa, please do consider what Scott and I have said, in different ways, about dealing with trauma, anxiety, and moderate depression- whether of old or recent cause, with Prazosin and a therapeutic relationship. Even an occasional therapy session can be very helpful, and Scott and I are both proof of the helpfulness of Prazosin. Don't feel there's nothing that can be done about the fears you have. It could well be that you will do better on little or no medication, as I found I did, (Scott has found the opposite) but you have been letting us know for several years that there are unresolved issues also.
Posted by johnLA on December 3, 2013, at 0:14:24
In reply to Re: Nightmares + Meds are they Connected? » johnLA, posted by Phillipa on December 2, 2013, at 20:20:00
dear phillips-
i am not a doctor. but, i just started talk therapy with a new therapist...
one thing she told me; i know myself best. i know this is not the case with all of us here. we all have varying degrees of mental conditions. i have straight depression with a bit of anxiety.
i will not go into my history, but i never had a suicidal thought until i was put on psych meds. had a terrible first pdoc. guy lost his practice. i have mentioned before i had unbelievable akathisia which i knew nothing about at the time. i was literally losing my mind. this was totally induced by a medication. not one person told or asked me about it. all he did was keep upping the dose.
i have mentioned this all before.
2 months into my depression i was receiving ect at ucla. the doc couldn't even look me in the eye when he was explaining it. i look back now and wonder wtf? i realize i was freaking-out due to medication. i was so anxious i would have agreed to anything to make it stop. load me up on benzos for a few months for example. they sure work for anxiety for me which was what i was really suffering from. the depression was secondary at that point.
it's been 3 years now. i am ever so slowly getting better. it's some small things that i am noticing that makes me say this. this may be as good as it gets for me. compared to my 1st year, due to 'treatment' by pdocs i actually feel better on my own and with less drugs.
i am far from well. but, i am better. like i said before; for now i will take that. i am still looking at other meds, therapies, etc. i am not ruling out anything for the future.
i want to try no meds for a bit. i have the benzos just in case. i will reevaluate in the new year.
you asked how i got off ad's. some were easy (prozac and remeron) and some were brutal. (don't want to say which ones cus i don't want to influence anybody negatively.)
again, i am not a doctor. please talk with them about what you are thinking/feeling.
and, again; for some us we are our own best chance at knowing what is right for us. that may or may not include a medication(s).
john
Posted by johnLA on December 3, 2013, at 0:19:00
In reply to Re: Nightmares + Meds are they Connected? » Phillipa, posted by Twinleaf on December 2, 2013, at 21:37:53
hey guys-
hope i didn't come-off combative towards your point of views on this thread.
you have much more experience with all this than i do...
but, sometimes it can take a pair of 'new eyes' to see or look at things differently and just possibly have a new/positive result.
i respect your generosity in your posts towards trying to help us all here.
john
Posted by Twinleaf on December 3, 2013, at 0:58:26
In reply to sls/twinleaf :), posted by johnLA on December 3, 2013, at 0:19:00
Not at all! I had similiar poor reactions to almost every medication I tried.Therapy has been the biggest help in my feeling better, with a few low-dose medications playing a less important part. I hope your therapy goes really well. It is slow, and sometimes you don't really know how much you are growing and changing until a few years have passed.
Posted by ed_uk2010 on December 3, 2013, at 3:47:38
In reply to Re: Nightmares + Meds are they Connected? » ed_uk2010, posted by Phillipa on December 2, 2013, at 20:25:23
>...only option is to continue PT and experience pain which I do as must be active and also ride bike. Or get fused and be like a rod. I know that I block this during the day and it comes out at night. No med can change the future. It is what it is. But I can't accept it so fighting it at night. At least this is my thought. Trauma earlier in life is long forgiven and forgotten. I want my health more than anything.
PJ, the PT and bike riding must do you a world of good. Also, lots of exercise during the day should improve your sleep, although I believe they say you shouldn't exercise too close to bed time. You are already doing the right things to maintain your health, which I think will continue for many years to come. Anxiety makes you feel that you're in worse shape physically than you actually are.
Posted by ed_uk2010 on December 3, 2013, at 3:50:56
In reply to Re: Nightmares + Meds are they Connected? » ed_uk2010, posted by Phillipa on December 2, 2013, at 20:25:23
>Ed I agree no didn't. And yes fairly new. I attribute it to getting older as mortality is closer and fear death.
Benzos can cause strange dreams for sure, but since you've taken them for many years, they are unlikely to be the cause if the dreams are new. I think you're right that the dreams are due to anxiety emerging at night, a time when there are so few distractions.
Posted by Phillipa on December 3, 2013, at 17:40:47
In reply to Re: Nightmares + Meds are they Connected? » Phillipa, posted by ed_uk2010 on December 3, 2013, at 3:50:56
Ed MRI scans don't lie. When I see my back twisted in the shape of an S from sclerosis, and the fact that MRI shows neck discs fused on own. Other discs are unable to be moved. PT guy can't push hard on them due to fear of them breaking. So far I have said no three times the the neurosurgeon for pain medication. He's suggested opiods now at each visit. My feeling is that if I were to do more damage to back I might not be aware of this. So I refuse them. Get on the matt at night and go through the PT excercises designed to give me more time before surgery is inevitable. And I will not be fused at the doc said from bottom of spine to top. If a simple disc could have it replaced. Bone spurs hopefully will not impringe on a nerve. As if this were to happen I'd need it then. So there is no cure. And I do agree that that anxiety of possibly being in a wheelchair comes out. Now that's a scary thought. PJ
Posted by Phillipa on December 3, 2013, at 17:42:21
In reply to Re: Nightmares + Meds are they Connected?, posted by johnLA on December 3, 2013, at 0:14:24
John I sincerely am so glad that your condition is improving. I do hope you can discontinue all your meds and continue your career as I know you are a very super Teacher!!! Phillipa
Posted by ed_uk2010 on December 3, 2013, at 18:00:36
In reply to Re: Nightmares + Meds are they Connected? » ed_uk2010, posted by Phillipa on December 3, 2013, at 17:40:47
Hello PJ,
I'm sorry to hear about your MRI results. Are you also on meds for osteoporosis?
>My feeling is that if I were to do more damage to back I might not be aware of this. So I refuse them.
No pain medication is so effective that you wouldn't notice further damage. Do you not take any pain meds at all?
xx
Posted by Phillipa on December 3, 2013, at 20:28:47
In reply to Re: Nightmares + Meds are they Connected? » Phillipa, posted by ed_uk2010 on December 3, 2013, at 18:00:36
Ed no meds of osteoporosis as the only one the endo says builds bone is forteo and can only take for 2 years and risk is osteo sarcoma. No take no pain meds at all. PJ
Posted by ed_uk2010 on December 4, 2013, at 3:42:53
In reply to Re: Nightmares + Meds are they Connected? » ed_uk2010, posted by Phillipa on December 3, 2013, at 20:28:47
> Ed no meds of osteoporosis as the only one the endo says builds bone is forteo and can only take for 2 years and risk is osteo sarcoma. No take no pain meds at all. PJ
Not even Tylenol? Other osteoporosis meds can certainly prevent worsening and reduce the risk of fractures, so why not consider one? Most people tolerate them well, you can always stop if it doesn't agree with you. Calcium/mineral supplements are not very effective unless used alongside meds. Personally, I would be a lot more scared of the osteoporosis than its treatment.
Have you ever considered replacing your Lexapro with Cymbalta for the pain? It helped you before.
Posted by SLS on December 4, 2013, at 6:21:26
In reply to Re: Nightmares + Meds are they Connected? » Phillipa, posted by Twinleaf on December 2, 2013, at 21:37:53
> Phillipa, please do consider what Scott and I have said, in different ways, about dealing with trauma, anxiety, and moderate depression- whether of old or recent cause, with Prazosin and a therapeutic relationship. Even an occasional therapy session can be very helpful, and Scott and I are both proof of the helpfulness of Prazosin. Don't feel there's nothing that can be done about the fears you have. It could well be that you will do better on little or no medication, as I found I did, (Scott has found the opposite) but you have been letting us know for several years that there are unresolved issues also.
Phillipa,
I have also used psychotherapy to help me process issues of childhood and adulthood. I was determined to work hard to be as mentally healthy as possible.
Do you sometimes feel as if the world is closing in around you with no escape? Does your marriage leave you feeling trapped? I have experienced both of these.
1. If environmental stressors produce anxiety and depression, and
2. that anxiety and depression causes a further deterioration of your environment as you become less able to manage it,
3. how do you treat both the biological and psychological when they appear to go around in circles? *
It is much easier to process one's history and transform one's psyche through psychotherapy when one's brain is functioning nominally, or at least as close to it as possible. The brain has an easier time responding to biological treatments when one's psyche does not interfere with this process.
* Ideally, one will use medication and psychotherapy at the same time.
Get busy living or get busy dying. ("The Shawshank Redemption")
- Scott
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