![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by JPA on January 3, 2015, at 17:32:37
I went off clomipramine, lyrical and gabitril in early December and took my last dose of remeron last night. I slept like garbage before, waking up about every hour and probably had many more micro arousals. The last week has been tough. I go to sleep and don't fall asleep right away. The anxiety then builds rapidly and I find myself wishing I was dead dead dead. At which point I take some lorazepham and sleep for three hours. That allows me to manage the next next day.
I also take some supplements that have helped heal me . Gotu Kola, Honokiol and Kava. I can be on those supplements long-term and be well. I just need to find a way to avoid the anxiety bomb if I don't fall asleep. I think for me It will involve getting out of bed and doing things like work or reading, reset the process and then try to reinitiate sleep.
My goal to keep lorazaphan for purely occasional use... Put your hand up if you think that's actually funny. Me too, but I'm finished with drugs. I've tried all of them...I exaggerate not. I'm happy to be on supplements and live reduced sleep.
btw I just went to see a sleep doctor. All she had to say to me is ho well functioning I was given the scale of my sleep problems, but had nothing to offer for supplements. She just said they don't work. Last time I waste my time with any specialist outside of my current doctor, who, by the way, would be happy to have me on heavy meds for the rest of my life just so I can maintain the veneer of a normal existence but feel like garbage all day, everyday.
I will feel the pain for the next several month, not to mention it will be our heavy time at work. I've been walking dead for the last 20 years of heavy medication use. Know I will continue being the walking dead, but will a least have a remote chance at truly being better with the help of natural supplements. At worst I'll be walking dead, but with a libido.
Posted by Guy on January 3, 2015, at 18:43:21
In reply to This time i'm done with meds, posted by JPA on January 3, 2015, at 17:32:37
JPA, I wish you luck but am wondering if the supplements will do much for your sleep given that you have been on meds for so long. I assume from what you have written that Remeron does not make you feel better. I had the same experience--very shallow sleep and felt unwell every day. Have you tried trimipramine? It promotes a better quality sleep (for me) and at 100 mg has no noticeable side effects. It is something you could stay on for years without too many problems, providing, of course, that it helps. If you are going to go the "natural" route, keep in mind that it can take a few weeks for normal sleep patterns to re-establish themselves. It takes determination to endure that type of suffering, but it can be done. The key is relaxation. If you relax enough, you will fall asleep. Send me a babble-mail if you wish to discuss and need support.
Posted by Phillipa on January 3, 2015, at 19:36:12
In reply to Re: This time i'm done with meds, posted by Guy on January 3, 2015, at 18:43:21
Pretty much had it myself with meds. They no longer work and now the bad outweighs the good according to all the studies on the internet. In my case referring to benzos
Posted by Tomatheus on January 3, 2015, at 20:16:59
In reply to This time i'm done with meds, posted by JPA on January 3, 2015, at 17:32:37
JPA,
I think that ultimately, we need to find out for ourselves which treatments work best for us. For some of us, I think that medications can be a vital part of a treatment plan that works the best, but I do think that for others, opting for other treatment options while abstaining from medications or taking them only on occasion could be the best way to go. I wish you luck with your ongoing efforts at finding the best treatment strategy for you.
Tomatheus
Posted by jpa on January 3, 2015, at 21:10:17
In reply to Re: This time i'm done with meds » JPA, posted by Tomatheus on January 3, 2015, at 20:16:59
Tomatheus,
Your thoughts convey a sense of compassion and wisdom. You are quite right, we all need to find our own path to good health. Medication may well be the answer for some. I wished it would have been for me.
Posted by Christ_empowered on January 3, 2015, at 21:56:14
In reply to well said » Tomatheus, posted by jpa on January 3, 2015, at 21:10:17
I wish you the absolute best. Meds aren't for everybody. I mean, I take a couple to stay out of a mental hospital. That's about all they can do for me, honestly. For other people...there are more options, forunately. I hope you find something that makes life more live-able.
Posted by Tomatheus on January 3, 2015, at 22:21:36
In reply to well said » Tomatheus, posted by jpa on January 3, 2015, at 21:10:17
JPA,
Thank you for your compliment, and again, may good luck be with you in your journey toward wellness.
Tomatheus
Posted by SLS on January 3, 2015, at 22:38:36
In reply to This time i'm done with meds, posted by JPA on January 3, 2015, at 17:32:37
Your sleep might improve as your system re-regulates itself in the absence of psychotropic medication. You should anticipate insomnia as a withdrawal rebound effect for discontinuing Remeron. I don't know how long this phenomenon will persist. If this effect is the result of histamine receptor upregulation, you could try using Benadryl (diphenhydramine) to promote sleep and taper the drug gradually. Of course, you would want to use the minimum effective dosage to start off with. I believe generics come in 12.5 mg pills. If not, get the tablets so that you can split them in half. You might want to start at 25 mg.
It sounds like a CBT approach would help reduce the anxiety that you experience when you don't fall asleep right away.
Magnesium?
Melatonin?
Valerian?Check out the Alternative board for more ideas.
- Scott
Posted by jpa on January 5, 2015, at 14:03:27
In reply to Re: This time i'm done with meds » JPA, posted by SLS on January 3, 2015, at 22:38:36
Wow its been rough.
I need more than 2mg of lorazepham to fall asleep. Remeron withdrawal leeds to severe sleep anxiety and insomnia. My doc will only prescribe 2mg of lorazhepam at night. I have to go to work everyday, so no sleep at all is not an option. I won't go back on Remeron....options?
Posted by SLS on January 5, 2015, at 15:35:36
In reply to well said, posted by jpa on January 5, 2015, at 14:03:27
> Wow its been rough.
>
> I need more than 2mg of lorazepham to fall asleep. Remeron withdrawal leeds to severe sleep anxiety and insomnia. My doc will only prescribe 2mg of lorazhepam at night. I have to go to work everyday, so no sleep at all is not an option. I won't go back on Remeron....options?Doxepin might be an option. It is a TCA that some people take specifically for sleep and anxiety. Low-dose Seroquel. Trimipramine is another TCA that is occasionally used for sleep. I don't think it is as powerful as doxepin, but it might feel less sedating. Low to medium dosage Trazodone. Amitriptyline was a favorite choice of doctors for quite a few years. It is perhaps the most powerful TCA for sleep. However, anticholinergic side effects can be uncomfortable. This might not be too much of a problem at the low dosages used for sleep, and they can lessen over time.
- Scott
Posted by jpa on January 5, 2015, at 16:19:14
In reply to Re: well said » jpa, posted by SLS on January 5, 2015, at 15:35:36
Hey Scott,
I'm really trying to stay off the meds, or at the very least not try new ones. At worse, I'll go back on a little remeron and see if that helps the 2mg of lorazepham. For me, meds are making things worse. I just need to get over the sleep anxiety associated withdrawal from the drugs I was on.
John
Posted by SLS on January 5, 2015, at 18:09:31
In reply to tappering » SLS, posted by jpa on January 5, 2015, at 16:19:14
> Hey Scott,
>
> I'm really trying to stay off the meds, or at the very least not try new ones. At worse, I'll go back on a little remeron and see if that helps the 2mg of lorazepham. For me, meds are making things worse. I just need to get over the sleep anxiety associated withdrawal from the drugs I was on.
>
> JohnI may have already suggested CBT.
https://www.google.com/?gws_rd=ssl#q=insomnia+cbt
- Scott
Posted by Guy on January 5, 2015, at 19:33:40
In reply to This time i'm done with meds, posted by JPA on January 3, 2015, at 17:32:37
JPA, I think you hit the nail on the head when you said "sleep anxiety". How are you going to overcome that? That is your big challenge. If Remeron helps you get through the night, why not take slivers of the med as you practise relaxation? It's still a hard med to discontinue for some, but you have to go through a period of really crap sleep before your natural sleep architecture re-establishes itself. That means getting off all meds and relying only on supplements and relaxation techniques. You are right, after many years on sleep meds you have become psychologically as well as physically addicted. Things will improve, but I know it's hard to feel sh*tty as you work towards your goal.
Posted by jpa on January 5, 2015, at 21:32:36
In reply to Re: This time i'm done with meds, posted by Guy on January 5, 2015, at 19:33:40
Not sure if I will make it because I am not sleeping right now. I will not go back on remeron, only to restart this process at a later date. I have some lorazepam I can take if things get real bad, but that too is not a long term option. Medication helped me once, but after years of searching I have finally realized that for me it will never work again. Time to move on and try to heal in some other way. I read a CBT book on sleep and anxiety recently...didn't really help. Not sure if seeing a CBT expert would help (as Scott suggested), but may try that next.
I'm about to go to bed now...I've got a long night ahead of me. When I can't sleep the anxiety builds and I just don't know how to stop it. Sometimes I get up and read, but once the anxiety is out I'm done for and won't sleep. I'm just looking at my dog sleeping right now. Man, I would trade my brains for his zzzs anytime.
Posted by SLS on January 5, 2015, at 23:36:55
In reply to tappering » Guy, posted by jpa on January 5, 2015, at 21:32:36
> I'm just looking at my dog sleeping right now. Man, I would trade my brains for his zzzs anytime.
I totally get that.
I'm sorry that the CBT book didn't help. I'm not sure how much more a CBT therapist can do for you, but I would leave that as an option. Meditation? Hypnosis?
Since part of your problem might be a protracted "withdrawal" from Remeron, perhaps you can crossover to a drug that is easier to discontinue. I am not quick to shove drugs down your throat, but you say that losing sleep right now is not an option. In an emergency, you might think about using one of the sedating TCAs at a low dosage. The order of potency might look something like this: amitriptyline > doxepin > trimipramine > nortriptyline. Like Remeron, these drugs exert antihistaminic effects, which might help with sleep. Unlike Remeron, they leave other synaptic receptors alone. (Amitriptyline and nortriptyline do block 5-HT2a receptors, which might help buffer Remeron discontinuation induced rebound anxiety). For me, personally, I would try doxepin first, mainly because it is less anticholinergic than amitriptyline, and might help with anxiety more. Look at hydroxyzine, too.
- Scott
Posted by ed_uk2010 on January 6, 2015, at 10:19:25
In reply to This time i'm done with meds, posted by JPA on January 3, 2015, at 17:32:37
>My goal to keep lorazepam for purely occasional use... Put your hand up if you think that's actually funny. Me too, but I'm finished with drugs.
Very hard to know what 'when needed' use should look like when problems occur most or all of the time!
Posted by phidippus on January 6, 2015, at 16:19:47
In reply to This time i'm done with meds, posted by JPA on January 3, 2015, at 17:32:37
Have you ever just accepted that you're not going to sleep? Its not meant for you. You better just busy yourself-you have so much extra time to burn. Stop fighting it.
Look into ACT.
Eric
Posted by baseball55 on January 6, 2015, at 19:43:58
In reply to Re: This time i'm done with meds » JPA, posted by phidippus on January 6, 2015, at 16:19:47
When I stopped drinking, I couldn't imagine how to get to sleep without alcohol and it took a while. Many sleepless nights. But my body did adjust.
The body and brain need sleep. Maybe not as much sleep as we get when we take sleep-enhancing drugs and alcohol. but we need sleep. And what I found is that, eventually, I learned to fall asleep. No particular technique. I just went enough days without sleep that I couldn't not sleep any longer.
I asked myself, what's the worst that can happen if I can't sleep?Just thinking about that question alleviated a lot of my anxiety about insomnia. What's the worst that can happen?
For me, the worst that could happen was that I could be alone, in the dark, with no defenses, reflecting on myself. And to solve this issue, all the sleep aids in the world wouldn't help. For that, I needed therapy.
Posted by ed_uk2010 on January 7, 2015, at 8:24:57
In reply to Re: This time i'm done with meds, posted by baseball55 on January 6, 2015, at 19:43:58
>When I stopped drinking, I couldn't imagine how to get to sleep without alcohol and it took a while. Many sleepless nights. But my body did adjust.
It does take time, for certain. Also, sleep is likely to be improved in the long run. Alcohol readily disrupts sleep architecture and causes 'rebound' early morning waking in the long run.
>The body and brain need sleep. Maybe not as much sleep as we get when we take sleep-enhancing drugs and alcohol. but we need sleep. And what I found is that, eventually, I learned to fall asleep. No particular technique. I just went enough days without sleep that I couldn't not sleep any longer.
Sleeping too long appears to be as bad as not sleeping enough! Also, sleep requirements decrease with age. Interestingly, elderly people who sleep less seem to live longer than those who sleep more.
>I asked myself, what's the worst that can happen if I can't sleep? Just thinking about that question alleviated a lot of my anxiety about insomnia. What's the worst that can happen?Definitely. It's important to remember that people don't die of insomnia. The body will catch little 'micro sleeps' even if you don't sleep properly. Daytime functioning can be impaired by insomnia, but it's often impaired more by sleep meds! .....even though they can make the situation temporarily less distressing.
>For me, the worst that could happen was that I could be alone, in the dark, with no defenses, reflecting on myself.That's often the worst thing - the anxiety. It's good to know that you were helped by therapy.
Posted by phidippus on January 7, 2015, at 16:12:35
In reply to Re: This time i'm done with meds, posted by baseball55 on January 6, 2015, at 19:43:58
I suffer from insomnia as well. I found that the biggest battle in going to sleep is the anxiety that accompanies not being able to go to sleep. Once you conquer that, falling asleep is easy.
If I can't sleep I just get up and do something like play a video game. Or bake cookies. Lol.
Eric
Posted by jpa on January 7, 2015, at 17:07:03
In reply to Re: This time i'm done with meds » baseball55, posted by phidippus on January 7, 2015, at 16:12:35
Are you on any meds right now?
I went three years with next to no sleep before seeking help. They put me on clomipramine and I went back to normal. Went off it, things got bad again but going back on clomipramine didn't help.
Wasted a lot of time trying other meds, which all failed. Not surprising given clomipramine is potentially the strongest anti anxiety med.
Now I'm about two weeks of all meds. I'm hoping that after they wash out of my system my sleep will be better than when I first sought treatment. Doesn't really matter though given there are no other options. As for the sleep anxiety...we have to find our own paths. At this stage, there is nothing any therapist could tell me that would improve my sleep.
Not sure if going off the meds is the right thing to do, but I feel like its the only hope at truelly being well again. My doctor has no idea what to do with me. He's a good guy, but I stopped relying on his advice long ago. He won't comit on the right path forward anyway.
Posted by phidippus on January 8, 2015, at 15:19:05
In reply to tappering » phidippus, posted by jpa on January 7, 2015, at 17:07:03
> Are you on any meds right now?
Lithium, carbamazapine, Geodon, Latuda, Vyvanse, Klonopin.
> I went three years with next to no sleep before seeking help.
Wow. How did that feel?
>things got bad again but going back on clomipramine didn't help.
How did things go bad?
>clomipramine is potentially the strongest anti anxiety med.
I think Nardil might be a bit more powerful. Clomipramine also compares to Effexor and Paxil.
>I'm hoping that after they wash out of my system my sleep will be better than when I first sought treatment.What are you going to do if your worse?
>At this stage, there is nothing any therapist could tell me that would improve my sleep.
Have you tried ACT?
> Not sure if going off the meds is the right thing to do
What were you on the meds for?
Eric
Posted by jpa on January 8, 2015, at 16:46:05
In reply to Re: tappering » jpa, posted by phidippus on January 8, 2015, at 15:19:05
Eric,
Honest question: do you feel better on these drug? Or is it the case that things would be much worse for you if you meds free?
For me, the meds kept me functioning, allowing me to work, be a husband and father. But I did it all under great durress. I was living a life of diminished expectations.
I'll take the pain and anguish of going off meds for the chance of being truelly better.I know full well that my chances of success are slim at best. I'm probably just increasing mu suffering by doing this experiment and will end up back on meds. But I'm not going down without a fight. To go back on meds that just barely keep me functioning without a hope of ever getting better...I fear would be worse fore me than the suffering I'm going through right now.
John
Posted by phidippus on January 9, 2015, at 7:10:29
In reply to tappering » phidippus, posted by jpa on January 8, 2015, at 16:46:05
That's an interesting question. Without the drugs I am a psychotic, neurotic mess. With the drugs I feel normal.
What exactly are the symptoms you battle with?
Eric
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.