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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Guy on May 21, 2005, at 18:14:43
I've been taking clonazepam and Remeron on and off for eight years, but my insomnia always creeps back, and I end up back on 10 mg Zyprexa, which lets me sleep but makes me feel like crap. I'm so fed up with this med merry-go-round and all I want is to be med free. The only problem is the insomnia...I just can't tolerate it (I get super agitated and suicidal), but it is my number one syptom whenever I try to wean off meds. Right now I want to get free of the benzo, and then get onto something that is easier to wean off of than the Zyprexa. My pdoc is totally against any plans to withdraw and says I should just keep increasing the clonazepam, to 4 mg and then to 6 mg if necessary. This, despite the fact that I tell him I develop tolerance to increased doses within a couple of weeks. I think I have to find a doctor who will help me out of this mess. In the past I've ended up in emergency after going ten days with no sleep...the only response from docs is meds and more meds. How can I taper when I have already developed tolerance to an existing dose??? It's so hard and seemingly hopeless!
Posted by SLS on May 21, 2005, at 21:26:44
In reply to Defeated by insomnia, posted by Guy on May 21, 2005, at 18:14:43
For now, I think you should leave the benzodiazepine (clonazepam) in place and work on maximizing another sleep strategy first. I would recommend trying small doses of Seroquel (25-50mg) at bedtime and see if you can discontinue the Zyprexa. If successful, you can then begin working on discontinuing the clonazepam.
- Scott
Posted by Guy on May 22, 2005, at 0:26:53
In reply to Defeated by insomnia, posted by Guy on May 21, 2005, at 18:14:43
Thanks for the suggestion, but I can't tolerate Seroquel...makes me extremely ill right away. I have, however, had some success with Doxepin, a TCA, in the past. Unfortunately, it, too, causes severe insomnia when discontinued. If you go to the sleep forums on the net, you will learn that Zyprexa has absolutely the worst rebound insomnia of any drug on the market. Some people claim they didn't sleep at all for a whole month after discontinuation. How that's possible, I don't know.
Posted by EarthLover on May 22, 2005, at 17:35:10
In reply to Re: Defeated by insomnia, posted by Guy on May 22, 2005, at 0:26:53
Guy, please keep us posted on your progress. Your story sounds like mine, only more advanced, so it's slightly scary. Notwithstanding that, I feel two things strongly: there is a way out, and it won't be easy. Good luck.
> Thanks for the suggestion, but I can't tolerate Seroquel...
Posted by SLS on May 22, 2005, at 20:56:57
In reply to Defeated by insomnia, posted by Guy on May 21, 2005, at 18:14:43
> I've been taking clonazepam and Remeron on and off for eight years, but my insomnia always creeps back, and I end up back on 10 mg Zyprexa, which lets me sleep but makes me feel like crap. I'm so fed up with this med merry-go-round and all I want is to be med free. The only problem is the insomnia...I just can't tolerate it (I get super agitated and suicidal), but it is my number one syptom whenever I try to wean off meds. Right now I want to get free of the benzo, and then get onto something that is easier to wean off of than the Zyprexa. My pdoc is totally against any plans to withdraw and says I should just keep increasing the clonazepam, to 4 mg and then to 6 mg if necessary. This, despite the fact that I tell him I develop tolerance to increased doses within a couple of weeks. I think I have to find a doctor who will help me out of this mess. In the past I've ended up in emergency after going ten days with no sleep...the only response from docs is meds and more meds. How can I taper when I have already developed tolerance to an existing dose??? It's so hard and seemingly hopeless!
It might be an interesting experiment to use one of several anticonvulsants.1. Neurontin
2. Depakote
3. Gabitril
4. Lyrica
- Scott
Posted by 4WD on May 27, 2005, at 21:33:10
In reply to Defeated by insomnia, posted by Guy on May 21, 2005, at 18:14:43
> I've been taking clonazepam and Remeron on and off for eight years, but my insomnia always creeps back, and I end up back on 10 mg Zyprexa, which lets me sleep but makes me feel like crap. I'm so fed up with this med merry-go-round and all I want is to be med free. The only problem is the insomnia...I just can't tolerate it (I get super agitated and suicidal), but it is my number one syptom whenever I try to wean off meds. Right now I want to get free of the benzo, and then get onto something that is easier to wean off of than the Zyprexa. My pdoc is totally against any plans to withdraw and says I should just keep increasing the clonazepam, to 4 mg and then to 6 mg if necessary. This, despite the fact that I tell him I develop tolerance to increased doses within a couple of weeks. I think I have to find a doctor who will help me out of this mess. In the past I've ended up in emergency after going ten days with no sleep...the only response from docs is meds and more meds. How can I taper when I have already developed tolerance to an existing dose??? It's so hard and seemingly hopeless!
Trazodone knocked me out.
Marsha
Posted by Elroy on June 3, 2005, at 15:49:01
In reply to Defeated by insomnia, posted by Guy on May 21, 2005, at 18:14:43
Only thing that I could suggest would be that of the other poster who suggested similarly, and that would be to give Lyrica a try - if it is available whevever you are (Europe). It has been approved in US by FDA, but not released by Pfizer yet (was approved several months ago, so not sure what the hold up is).
Wish we would get more input on Lyrica from European reviewers of this site, but what input I have seen has been quite favorable.
Also, I wonder if possibly switching over from clonazepam to the extended release version of Xanax might be more beneficial? Pros and cons each way I guess. I don't know which would be easier to wean off of eventually. Maybe going from Klono to Xanax XR to something like BusPar and then a total wean?
Of course the unanswered question is that of whether the core problem causing the anxiety has been addressed, and, if not, that weaning might not be the thing to do at this time. Or does the anxiety just appear when the insomnia is present?
Let's see... have you had your cortisol levels checked? Elevated cortisol levels - especially if your daily cycle is off even a little bit - can cause some serious insomnia problems. That is what's going on in my case. I take Ambien and am lucky to sleep about 3 to 3 1/2 hours (Midnite to 3 - 3:30 AM). I instead I take Restoril then that time frame moves up to maybe five hours. Apparently my cortisol levels will go low enough in late evening to allow me (with some sleep aid assistance) to get to sleep but then levels start climbing too early in the early morning hours (and way too high) and it wakes me up.
Very frustrating.
My doc is prescribing me with Remeron in an effort to get around this as some recent studies have shown that Remeron is pretty effective in lowering cortisol levels (in NON Cushing's states - if you have Cushings, which should be automatically checked if you test out with elevated cortisol, then Remeron is not going to work effectively). What doses were you on? As I recall, my doc said that Remeron was more sedating at the lower doses (also created more hunger pang symptoms!) than at the medium and higher doses... she specifically mentioned taking the lower doses late at night because of that.
Elroy
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> I've been taking clonazepam and Remeron on and off for eight years, but my insomnia always creeps back, and I end up back on 10 mg Zyprexa, which lets me sleep but makes me feel like crap. I'm so fed up with this med merry-go-round and all I want is to be med free. The only problem is the insomnia...I just can't tolerate it (I get super agitated and suicidal), but it is my number one syptom whenever I try to wean off meds. Right now I want to get free of the benzo, and then get onto something that is easier to wean off of than the Zyprexa. My pdoc is totally against any plans to withdraw and says I should just keep increasing the clonazepam, to 4 mg and then to 6 mg if necessary. This, despite the fact that I tell him I develop tolerance to increased doses within a couple of weeks. I think I have to find a doctor who will help me out of this mess. In the past I've ended up in emergency after going ten days with no sleep...the only response from docs is meds and more meds. How can I taper when I have already developed tolerance to an existing dose??? It's so hard and seemingly hopeless!
Posted by TerraJo on June 8, 2005, at 9:44:13
In reply to Re: Defeated by insomnia » Guy, posted by Elroy on June 3, 2005, at 15:49:01
this is very interesting on a variety of levels.
i have the same insomnia symptoms- agitation at bedtime. i have ambien, which i wake from after 3 hours. i have restoril, which goes a little longer. i find alternating these "tricks" the body and they work better and last longer each of them. i used xanax, too. if i stop the ambien, then i can't sleep the next night. but, if i take restoril, then that stops that whole cycle.
i've just switched over to klonopin and only woke once last night.
for me, i noticed it helps to have a carb meal before bedtime. not so much that you pack on the weight because of it, but a small bowl of oatmeal or triscuits or a bagel. i am more likely to wake up if i don't do this.
exercising to exhaustion during the day helps some, but when you have insomnia with agitation it doesn't matter how tired you are. you're still agitated anyway. so, i understand.
t.
Posted by Sebastian on June 8, 2005, at 11:58:15
In reply to Re: Defeated by insomnia » Guy, posted by Elroy on June 3, 2005, at 15:49:01
I am almost off the zyprexa. I switched to geodon, which is less sedating. And I'm still having a tough time with insomnia. Sort of like I'm super awake all the time. Maybe its the wellbutrin sr too. But geodon makes a good step down from zyprexa.
Posted by Elroy on June 8, 2005, at 18:27:11
In reply to Re: Defeated by insomnia, posted by TerraJo on June 8, 2005, at 9:44:13
Well, knowing that I have highly elevated cortisol (actually diagnosed with "Pseudo Cushing's" - which is intertwined with the whole anxiety / depression problem), I spoke with my regular PCP and P-doc about trying Remeron. There are studies that show that Remeron significantly reduces cortisol levels (also that it aids with sleep in many cases and in many cases was statistically more effective than SSRIs). It has been my belief that my HPA Axis is highly dysfunctional and that the cortisol levels start rising too early and rising too highly.
Well, I have taken Remeron two nights now. I was started out on 15mg a day for two weeks and then will go to 30mg daily. I was cautioned to take the 15mg dose in late evening due to its "sedating effect". I was also advised that Remeron is one of those meds where the very noticeable side effects (sedation and hunger pangs) are more noticeable at the lower doses than at the higher doses.
First night, took 15mg pill about 10:30 PM and within about 30 minutes became extremely sleepy. Went to bed and fell immediately asleep. Woke up at 1:30 AM and went to bathroom (usually make sure and go before going to bed, but think that I was so sllepy that I forgot). Was upset at waking up so soon (note that I took no Ambien or Restoril, etc.), but realized that I was still very sleepy and went right back to sleep. Woke briefly at 5:30 AM and went right back to sleep. Then woke up at about 8:30 AM. Unfortunately still quite sleepy and slept off-and-on on the couch until about noon.
Second night (last night) almost exact duplicate, only this time I took one 10 mg Ambien just prior to going to bed... and slept straight through until 7:00 AM. Once again, still quite sleepy thru the morning and napped off-and-on until around noon. Not sure if this is the medication effect or just "catching up" on all that sleep I've missed!!! LOL Actually, felt like it probably was the medication effect as it had that "feeling" to it.
As to hunger pangs, have only noticed a very slight increase in that area.
Am hoping that upping dose to 30 mg will still provide the sleep aid at night while eliminating the daytime tiredness and the few hunger pang symptoms that there are. Beyond that, am hoping that the Remeron does prove effective in controlling the cortisol while "re-setting" the HPA Axis... and hopefully then allowing me to get off of this "Merry-Go-Round"!
Note that I do not believe this to be any type of a cure-all, that I believe that it is of primary effectiveness for those whose disorder includes having elevated levels of cortisol. From what research I have seen, that can include a fairly high percentage of people who suffer from a variety of disorders (from various anxieties to various depressions and what-all inbetween). If your problem involves a non elevated cortisol levels - and especially if it involves LOW cortisol - then this medication likely isn't for you. Cortisol testing is the key.
Anyway, will be interesting to see how this plays out over the long term.
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