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Sleep Issues--EMSAM, Abilify, Seroquel, Rozerem

Posted by jkshrews on April 10, 2007, at 7:28:22

In reply to Re: MAOI Diet: ginseng and fresh soy beans, posted by zana on April 9, 2007, at 18:25:14


If you have bipolar disorder, it might be really important to stick with the Abilify or the Seroquel. (But I can't figure out why you are taking them both.) Both are effective anti-manics, and Seroquel is now approved to treat bipolar depression. For a person with BD, this would be a primary treatment, and EMSAM would be only an adjunct. If you have high irritability (which is really just dysphoric hypomania) I think the Seroquel or Abilify is right on target. I don't know how well it works for euphoric types. If you are thinking of it as a sleep med, that is just a side-effect. (You could just as well take Benedryl for the same side-effect.)

These agents should not be called "atypical antipsychotics," which is why I call them "antimanics" when used in the context of BD. Better yet would be to call them by some common feature of chemical structure, as is the case with benzodiazepines, tricyclics, etc., rather than by disease conditions they are currently used to treat.

Info on the breakdown process of any drug can be found in the package insert in a section on clinical pharmacology. It assumes you know the related biochemistry. What the insert won't usually tell you is little facts such as Parnate is different from D-amphetamine by only a single chemical bond and, in addition to being an MAOI, it is active at the same receptor site as D-amphetamine.

People with BD frequently have a very fragile circadian rhythm that is easily upset by exposure to artificial lighting after sunset. In fact, the manic-depressive aspect of the disorder, i.e., mood cycling, might be caused largely by artificial lighting. Some experiments have shown that if a person with BD is placed in an environment with a purely natural day-night lighting cycle, the mood cycling aspect of the disorder trails off and goes away in about 6 months. Rozerem (rameltheon) simulates a total black-out by activating the melatonin receptors in the brain. I say it cancels the "Thomas Edison effect." So it is conceivable that it might be an effective remedy for mood cycling if taken very regularly over the long course of time. It is still important to turn off unnecessary lights in the evening, maybe wear sunglasses if you watch TV, etc. (Or don't watch TV, read email, etc., after 7 PM) A very helpful book about sleep hygiene is "The Promise of Sleep."

Rozerem does not make you go to sleep. It just makes it possible to sleep after a week or two of regular use, if you have a disturbed circadian rhythm. Although it might genuinely help you if you need it, it is not sedating and will not directly counteract the amphetamine effect of EMSAM or Parnate. It will just shut off the lights.

There is another melatonin-oriented drug called Valdoxan (agomelatine), but I don't know if it is out yet or how they intend to use it.


> ps.
> Thanx for the tip on Rozerem. It sounds like a good drug, maybe a better choice than the seroquel. I am taking soo many things and my pdoc is a real stickler for one change at a time but I'd like to give this one a try. I am not wide about the new atypical antipsychotics. Maybe it's just that I'd rather not be in that class of meds. I'm also taking abilify and would like to discontnue that. Am going to have to wait until I've finished getting used to the Emsam I think.
> Thanx again.
> Zana.
> Where did you get the infor on the metabolites? No wonder it's stimulating!




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