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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by AnalyticalChemist on March 31, 2009, at 14:27:47
This post is a bit lengthy, but my medical history is somewhat convoluted, so please bear with me.
I am currently taking 10mg of Prozac (fluoxetine) along with 300mg of Wellbutrin XL (bupropion) for dysthymia. I have been on the Wellbutrin for over two years and the Prozac for ten months.
The Wellbutrin has treated me very well, with no noticeable side effects. I had taken this to alleviate problems with concentration and cognitive slowing, as well as to bring me out of my first major episode of depression in the fall of 2006. It has worked very well. For about six months I was only on 300 mg of the Wellbutrin.
Although out of the depressive episode and more mentally alert, at that time I was still socially anxious and withdrawn, as I had always been--my psychiatrist, myself, and others close to me toyed with the idea that I had mild Asperger's. A trial on Citalopram (standard starting dose) dispelled this, making me much more sociable, but left me lethargic during the day and sleeping 10+ hours per night.
I switched to Escitalopram (standard starting dose) after about 6 weeks, and although I was less tired during the day, I was still sleeping 10+ hours per night.
We then tried 20mg of Prozac (standard starting dose), and for a while I was back to sleeping a normal 7-8 hours a night. After several weeks I began to vary in my length of sleep from 7-11 hours a night, and slept VERY soundly (gunshot practically needed to wake me up on some days). My motion sickness (cars, buses, boats, etc.) also intensified. This was the situation for 7 months. I cut the Prozac dosage to 10mg, and I felt a bit more energetic during the day but still slept from 7-11 hours a night.
I should also mention that I had been on Paxil and Ritalin as a child and teenager, having been misdiagnosed for ADHD with comorbid obsessive compulsive disorder. The Paxil hammered me on my weight (50-60 pound weight gain), and I was off all medication it during my undergraduate years and for the first year of graduate school.
So, am I hypersensitive to SSRIs? Should I cut my Prozac to 5mg a day (switching to the liquid form), or should I try something else to normalize my sleep patterns? I have no plans to alter the 300mg of Wellbutrin XL that I am currently taking.
Posted by desolationrower on April 1, 2009, at 20:34:33
In reply to SSRI-induced Hypersomnia, posted by AnalyticalChemist on March 31, 2009, at 14:27:47
hi. your posts made me think of various things, but i can't really come up with any great ideas. Perhaps the ssris are keeping you from really getting effective sleep. one of the short-halflie drugs that improves deep sleep might help, maybe cyproheptadine, gabapentin. i wonder if having a sleep test for sleep apnea would be worht doing.
-d/r
Posted by AnalyticalChemist on April 1, 2009, at 20:57:45
In reply to Re: SSRI-induced Hypersomnia, posted by desolationrower on April 1, 2009, at 20:34:33
Thanks for the suggestions. I have a doctor's appointment on Monday, so I will raise that point along with others.
Posted by sowhysosad on April 3, 2009, at 2:09:52
In reply to SSRI-induced Hypersomnia, posted by AnalyticalChemist on March 31, 2009, at 14:27:47
That's really interesting, as I'm switching between extreme insomnia and hypersomnia - but definitely favouring hypersomnia - on a tricyclic. One particular night/day earlier this week I was in bed for 16 hours.
Ironically I might ask about Prozac next as that usually fixes it for me.
I'm putting it down to a chronic dopamine deficiency. Could that also be your problem? Perhaps your Wellbutrin isn't delivering in that respect?
Posted by EakinsOxley on April 2, 2011, at 20:26:03
In reply to Re: SSRI-induced Hypersomnia » AnalyticalChemist, posted by sowhysosad on April 3, 2009, at 2:09:52
What ended up happening for you? I've been on SSRI Paxil for the last 6 years and have had hypersomnia for the last 5 ... it's so bad now that I sleep 20 hours a day without a dopamine medication modafinil.
I've always suspected a link but no one seems to pay attention when I bring it up...
Posted by AnalyticalChemist on April 3, 2011, at 21:55:22
In reply to Re: SSRI-induced Hypersomnia, posted by EakinsOxley on April 2, 2011, at 20:26:03
> What ended up happening for you? I've been on SSRI Paxil for the last 6 years and have had hypersomnia for the last 5 ... it's so bad now that I sleep 20 hours a day without a dopamine medication modafinil.
>
> I've always suspected a link but no one seems to pay attention when I bring it up...I ended up dropping the Prozac entirely and replacing it with the SNRI Pristiq (an isomer of Effexor). I now have normal sleep patterns (7-9 hours per night) and have sufficient energy during the day.
Maybe a non-SSRI like Wellbutrin or Effexor/Pristiq would be right for you? Have you tried other SSRIs?
Posted by EakinsOxley on April 3, 2011, at 22:01:43
In reply to Re: SSRI-induced Hypersomnia, posted by AnalyticalChemist on April 3, 2011, at 21:55:22
My problem is anxiety disorder, so I'm not sure about switching to a different anti depressant.
I need to do Cognitive Behavioral Therapy, really, so I can get off all these meds, period.
Posted by desolationrower on April 4, 2011, at 3:38:36
In reply to Re: SSRI-induced Hypersomnia, posted by EakinsOxley on April 2, 2011, at 20:26:03
> What ended up happening for you? I've been on SSRI Paxil for the last 6 years and have had hypersomnia for the last 5 ... it's so bad now that I sleep 20 hours a day without a dopamine medication modafinil.
>
> I've always suspected a link but no one seems to pay attention when I bring it up...have you had a sleep test?
-d/r
Posted by Neuroscientist on July 15, 2011, at 0:41:00
In reply to Re: SSRI-induced Hypersomnia, posted by desolationrower on April 4, 2011, at 3:38:36
Hi all,
Not sure if anyone is still having issues with the sleep issues and SSRIs, but I just wanted to add my own 2 cents to the discussion both with personal experience and possible scientific explanation.
Ok, so like many others, I have been on SSRI for few years now (Escitalopram/Lexapro) and have also noticed my sleep needs increased.
My hypothesis about a mechanism for this is that SSRI's and some other antidepressants (and other medications) have an impact on sleep architecture. Some reduce REM sleep, but pertinent to this discussion is that SSRIs decrease SWS (Slow Wave Sleep). This is the 'deep sleep' where there is no dreaming, and it is responsible for much of the 'restorative' properties of sleep. People who get plenty of REM sleep and stage 1-2 but no SWS feel tired even after long nights sleep.
The options are as you did, switch to SSNRI which seemed to help. Also, for those who can't do this, there are various medications which are known to enhance SWS. This is discussed in Dr. Stahl's Essential Psychopharmacology. Basically, Gabapentin (neurontin), Lyrica (same class as gabapentin), Trazadone, and Tiagabine. All of these but Trazadone interact with the GABA system. Trazodone in low doses in often prescribed for insomnia. It is possible that taking one of these medications at bedtime could be benefitial. Of course the problem is adjusting the dose. Too much can lead to daytime sedation, too little no effect. Also, all of these medications also have next-day sleepiness as a possible side effect. So it is possible that their residual sedation negates their restorative properties from increasing SWS. Also make sure that none of these agents would interact with any other medications you are taking (if you are taking any others that is). If none of these meds is an option, then I would advise doing your own research on SWS and see if 1.) it would be of benefit to you and 2.) if there are other non-drug ways to increase SWS.
Of course one last option is to take a stimulant/dopaminergic during the day to counter any fatigue, if only on the days when you don't get enough sleep. Hope some of this helps.
Posted by desolationrower on July 30, 2011, at 22:49:48
In reply to Re: SSRI-induced Hypersomnia, posted by Neuroscientist on July 15, 2011, at 0:41:00
> Hi all,
>
> Not sure if anyone is still having issues with the sleep issues and SSRIs, but I just wanted to add my own 2 cents to the discussion both with personal experience and possible scientific explanation.
>
> Ok, so like many others, I have been on SSRI for few years now (Escitalopram/Lexapro) and have also noticed my sleep needs increased.
>
> My hypothesis about a mechanism for this is that SSRI's and some other antidepressants (and other medications) have an impact on sleep architecture. Some reduce REM sleep, but pertinent to this discussion is that SSRIs decrease SWS (Slow Wave Sleep). This is the 'deep sleep' where there is no dreaming, and it is responsible for much of the 'restorative' properties of sleep. People who get plenty of REM sleep and stage 1-2 but no SWS feel tired even after long nights sleep.
>
> The options are as you did, switch to SSNRI which seemed to help. Also, for those who can't do this, there are various medications which are known to enhance SWS. This is discussed in Dr. Stahl's Essential Psychopharmacology. Basically, Gabapentin (neurontin), Lyrica (same class as gabapentin), Trazadone, and Tiagabine. All of these but Trazadone interact with the GABA system. Trazodone in low doses in often prescribed for insomnia. It is possible that taking one of these medications at bedtime could be benefitial. Of course the problem is adjusting the dose. Too much can lead to daytime sedation, too little no effect. Also, all of these medications also have next-day sleepiness as a possible side effect. So it is possible that their residual sedation negates their restorative properties from increasing SWS. Also make sure that none of these agents would interact with any other medications you are taking (if you are taking any others that is). If none of these meds is an option, then I would advise doing your own research on SWS and see if 1.) it would be of benefit to you and 2.) if there are other non-drug ways to increase SWS.
>
> Of course one last option is to take a stimulant/dopaminergic during the day to counter any fatigue, if only on the days when you don't get enough sleep. Hope some of this helps.if an sri is decreasing, sws, its probably through 5ht2 agonism; a 5ht2 antagonist would be the logical choice to counteract this.
-d/r
Posted by Neuroscientist on August 1, 2011, at 18:49:52
In reply to Re: SSRI-induced Hypersomnia, posted by desolationrower on July 30, 2011, at 22:49:48
> > Hi all,
> >
> > Not sure if anyone is still having issues with the sleep issues and SSRIs, but I just wanted to add my own 2 cents to the discussion both with personal experience and possible scientific explanation.
> >
> > Ok, so like many others, I have been on SSRI for few years now (Escitalopram/Lexapro) and have also noticed my sleep needs increased.
> >
> > My hypothesis about a mechanism for this is that SSRI's and some other antidepressants (and other medications) have an impact on sleep architecture. Some reduce REM sleep, but pertinent to this discussion is that SSRIs decrease SWS (Slow Wave Sleep). This is the 'deep sleep' where there is no dreaming, and it is responsible for much of the 'restorative' properties of sleep. People who get plenty of REM sleep and stage 1-2 but no SWS feel tired even after long nights sleep.
> >
> > The options are as you did, switch to SSNRI which seemed to help. Also, for those who can't do this, there are various medications which are known to enhance SWS. This is discussed in Dr. Stahl's Essential Psychopharmacology. Basically, Gabapentin (neurontin), Lyrica (same class as gabapentin), Trazadone, and Tiagabine. All of these but Trazadone interact with the GABA system. Trazodone in low doses in often prescribed for insomnia. It is possible that taking one of these medications at bedtime could be benefitial. Of course the problem is adjusting the dose. Too much can lead to daytime sedation, too little no effect. Also, all of these medications also have next-day sleepiness as a possible side effect. So it is possible that their residual sedation negates their restorative properties from increasing SWS. Also make sure that none of these agents would interact with any other medications you are taking (if you are taking any others that is). If none of these meds is an option, then I would advise doing your own research on SWS and see if 1.) it would be of benefit to you and 2.) if there are other non-drug ways to increase SWS.
> >
> > Of course one last option is to take a stimulant/dopaminergic during the day to counter any fatigue, if only on the days when you don't get enough sleep. Hope some of this helps.
>
> if an sri is decreasing, sws, its probably through 5ht2 agonism; a 5ht2 antagonist would be the logical choice to counteract this.
>
> -d/rYeah, I think that is one of Trazadone's main mechanism of action at the lower dose range...
Posted by desolationrower on August 10, 2011, at 23:50:25
In reply to Re: SSRI-induced Hypersomnia, posted by Neuroscientist on August 1, 2011, at 18:49:52
> > > Hi all,
> > >
> > > Not sure if anyone is still having issues with the sleep issues and SSRIs, but I just wanted to add my own 2 cents to the discussion both with personal experience and possible scientific explanation.
> > >
> > > Ok, so like many others, I have been on SSRI for few years now (Escitalopram/Lexapro) and have also noticed my sleep needs increased.
> > >
> > > My hypothesis about a mechanism for this is that SSRI's and some other antidepressants (and other medications) have an impact on sleep architecture. Some reduce REM sleep, but pertinent to this discussion is that SSRIs decrease SWS (Slow Wave Sleep). This is the 'deep sleep' where there is no dreaming, and it is responsible for much of the 'restorative' properties of sleep. People who get plenty of REM sleep and stage 1-2 but no SWS feel tired even after long nights sleep.
> > >
> > > The options are as you did, switch to SSNRI which seemed to help. Also, for those who can't do this, there are various medications which are known to enhance SWS. This is discussed in Dr. Stahl's Essential Psychopharmacology. Basically, Gabapentin (neurontin), Lyrica (same class as gabapentin), Trazadone, and Tiagabine. All of these but Trazadone interact with the GABA system. Trazodone in low doses in often prescribed for insomnia. It is possible that taking one of these medications at bedtime could be benefitial. Of course the problem is adjusting the dose. Too much can lead to daytime sedation, too little no effect. Also, all of these medications also have next-day sleepiness as a possible side effect. So it is possible that their residual sedation negates their restorative properties from increasing SWS. Also make sure that none of these agents would interact with any other medications you are taking (if you are taking any others that is). If none of these meds is an option, then I would advise doing your own research on SWS and see if 1.) it would be of benefit to you and 2.) if there are other non-drug ways to increase SWS.
> > >
> > > Of course one last option is to take a stimulant/dopaminergic during the day to counter any fatigue, if only on the days when you don't get enough sleep. Hope some of this helps.
> >
> > if an sri is decreasing, sws, its probably through 5ht2 agonism; a 5ht2 antagonist would be the logical choice to counteract this.
> >
> > -d/r
>
> Yeah, I think that is one of Trazadone's main mechanism of action at the lower dose range...highfive. the antihistaminergic is helpful too, at least for sleep.
-d/r
This is the end of the thread.
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