Do SSRIs influence sleep architecture significantly?

[BrianinTN]

I don't understand why you haven't been using a normal prescription sleep aid designed to address issues of insomnia and getting to sleep -- like Ambien or Lunesta -- rather than juicing the benzo.

I personally use a rotation of Ambien (well, its generic) and Lunesta -- when one starts losing potency, I shift over to the other. (Medical note for anyone else reading this thread: you do NOT combine them on the same night!) I, too, started using klonopin to get to sleep, but it didn't take long for me to (a) do my homework and (b) realize that I was on a fast track for ever-increasing the doses to get the same effect for me to realize that I needed a real medicine designed to treat chronic sleep problems.

I'm glad to still have the clonazepam, but I will only use it to help me sleep now if I've had an exceptionally tough day and am wound up really tight.

Oh, and FWIW, I've tried probably 7 or 8 antidepressants -- two-thirds SSRIs I guess. None have ever really worked for me. I tend to get either no effect or just side effects. None affected my sleep, other than Remeron which has already been addressed. I guess the bupropion could have, but it isn't an SSRI, and I took it in the morning anyway due to the possible activation effect.

[EricinNC]

I don't understand why you haven't been using a normal prescription sleep aid designed to address issues of insomnia and getting to sleep -- like Ambien or Lunesta -- rather than juicing the benzo.

I personally use a rotation of Ambien (well, its generic) and Lunesta -- when one starts losing potency, I shift over to the other. (Medical note for anyone else reading this thread: you do NOT combine them on the same night!) I, too, started using klonopin to get to sleep, but it didn't take long for me to (a) do my homework and (b) realize that I was on a fast track for ever-increasing the doses to get the same effect for me to realize that I needed a real medicine designed to treat chronic sleep problems.

I'm glad to still have the clonazepam, but I will only use it to help me sleep now if I've had an exceptionally tough day and am wound up really tight.

Oh, and FWIW, I've tried probably 7 or 8 antidepressants -- two-thirds SSRIs I guess. None have ever really worked for me. I tend to get either no effect or just side effects. None affected my sleep, other than Remeron which has already been addressed. I guess the bupropion could have, but it isn't an SSRI, and I took it in the morning anyway due to the possible activation effect.

You need to understand that I was on these medications long before I ever was put on CPAP. Originally my problems were treated purely as psychiatric and it took a prompt from a psychiatric nurse at a depression support group to get me to get into a sleep study many years ago. It came back positive, but because of insurance (refusal to pay), I was not put on CPAP gear until many years later.

It was those "many years before CPAP" that I was put on these meds. Most of my complaints about shortness of breath were written off as anxiety prior to CPAP, after proper CPAP the shortness of breath and uncontrolled hypertension went away. But I was stuck on klonopin, after many years of taking high doses of it.

And lately, my gear has not been cutting it anymore since major equipment changes. So a lot of old symptoms suddenly came back in spades, so in the last two or three months Ive been taking extra klonopin. The last month or so Ive stopped doing that though. Now Im at my original dose of K, but its still a high dosage.

Im in a very bad situation to be honest. Close to death, I think.

Eric

[BrianinTN]

My story is not entirely different. The CPAP/BiPAP side for me is a fairly recent development too. For years I've been treating my hypertension with a cocktail of medications (no one med alone would get the job done), and the same can be said of my depression -- hence my revolving door or SSRIs, SNRIs and NDRIs. My shrink put me on the klonopin, and while I am glad I tried it and still see a useful place for it, I feel lucky that I managed to sever the link before it got out of hand.

[socknitster]

I guess the bupropion could have, but it isn't an SSRI, and I took it in the morning anyway due to the possible activation effect.

Bupropion does not affect sleep, or so said the abstracts of the studies that I have read. Bupropion does not affect serotonin. It affects mainly norepinephrine.

Benzo's flatten sleep architecture and keep you from REM or SWS. This stuff is basically legal smack and should be avoided at all costs by anyone, but most especially someone wih a sleep disorder. Its not real sleep. Its like eating candy instead of steak and salad, dude. I have gone thru some anxious times in my life and have taken xanax. 1/4 pill and I didn't give a crap what happened next. When I realized that I was hoarding and looking forward to taking it, I let it go. I have enough problems in my life. I didn't need to add a drug problem. Talk to your doctor and make a plan for getting of of it WITH the doctor. And personally, I would have second thoughts about seeing a doc who would prescribe that long term for sleep. Its one thing to get over a death in the family or something, but there are better alternatives for both anxiety and sleep.

Lyrica, for example, if you want to take a drug, is used in the European Union as an anxiolitic and is helpful for deeper sleep and for people who have pain. It has recently come to light that Fibromyalgia, the syndrome that Lyrica is marketed for, is actually most likely a sleep disorder called UARS. Lyrica helps fibro patients to get more deep sleep and that is why they have less pain. It is the disrupted sleep that causes their pain. I tried it and it helped me some. It caused some serious edema for me, so I had to go off before I could see if it was really helping me or not.

SSRI's mainly cause arousals unrelated to respiratory events (but those can be there for other reasons like UARS). I did read an abstract of a study that stated that the negative side effects of SSRI's, particularly those on sleep, could be reversed if you took it with small doses of 5-HTP. There again--the SSRI's can't do a damn thing for you if there isn't any serotonin in the synapse to conserve. Conserving nothing equals nothing. If there is even small amounts of it available, the SSRI's can do their job. I have no idea why this isn't more well known, except for the fact that if people got wind of the fact that you could take an over the counter, natural substance, as opposed to an expensive patented drug there would be no more money for the big druggies.

In the long run, less is more. Target the underlying issues and get rid of the baggage. That is what I've been trying to do for the last 3 years. I'm so sick of trying all the band aids that the doctor can think of. I want to know why and how to fix/prevent.

If you are feeling really ramped up on days after you used cpap, there may be something more going on there. Serotonin doesn't ramp you up, it makes you feel calm. I doubt it is the SSRI causing you to feel ramped up. Do you feel your cpap prescription is accurate? It sounds like you aren't 100% compliant, you might be sending your central nervous system in a tailspin by using cpap intermittently. Best to stick to something for a while until you can really see its effects. Consistency isn't just for kids. Its for everyone.

Jen

[BernieRay]

Bupropion - I've used it twice since I started xPAP, probably for a year total. Once while I was going through a painful divorce and once to quit smoking. I had no problems with sleeping. I took 150mg SR in the morning and again in the evening.

Lyrica - I tried in several doses and schedules to deal with diabetic peripheral neuropathy. Didn't work well for the pain, but it didn't effect my sleep, though that is hard to be 100% confident in, since the pain did keep me up.

I also tried Cymbalta, 2 different dosages at 3 different times. Each time, one pill completely dealt with the pain. Each time, I didn't sleep for 3 days. It had effected my mother in the same way earlier. A co-worker, however, has been taking it for a while and says that he sleeps great taking it, though he doesn't have OSA.

10 years ago, my PCP put me on Avandia for my diabetes It worked great, but my liver enzymes kept rising and I had to quit. Turns out that I was the 1 in 10,000 for whom Avandia was hard on the liver. Funny thing is, Avandia was developed to avoid liver damage. Course, now I'm glad I had to stop it, given the deaths that have been attributed to it. Unfortunately, I've spend the preceding 10 years trying to regain control of my glucose levels. But that's another story.

What all this has taught me is that, while the literature may say one thing, and it may be true for most people, the only way to know how it will work for a given individual is to try it. If it doesn't work, it's time to stop. What makes things hard to determine, though, is when too many things are going on and too many things change at the same time. Under those circumstances, it's darn difficult to be able to tell what is causing what and what to try next.

I certainly don''t have any "keys to finding relief". I wish that I did. Sometimes, we just have to keep trying different things. But it is best to change only one thing at a time, so that a clear determination about that change can be made.

[socknitster]

I certainly don''t have any "keys to finding relief". I wish that I did. Sometimes, we just have to keep trying different things. But it is best to change only one thing at a time, so that a clear determination about that change can be made.

Absolutely.

[EricinNC]

If you are feeling really ramped up on days after you used cpap, there may be something more going on there. Serotonin doesn't ramp you up, it makes you feel calm. I doubt it is the SSRI causing you to feel ramped up. Do you feel your cpap prescription is accurate? It sounds like you aren't 100% compliant, you might be sending your central nervous system in a tailspin by using cpap intermittently. Best to stick to something for a while until you can really see its effects. Consistency isn't just for kids. Its for everyone.

Jen

Uhhhhh, no I am 100% compliant. As compliant as a sleep doctor could ask for. I use my gear every night. What makes me feel ramped up is when I increase the pressure from my originally prescribed pressure of 10. When I increase my minimum from 10 to 11, after a few days on the old S8s and after only one night on the new S9, I feel absolutely jazzed, but strangely tired at the same time. I have been diagnosed with akathisia from SSRIs before and its like increasing pressure from CPAP "reactivates" the SSRIs and its like I go thru this mini-SSRI activation thing. It becomes intolerable and I have to reset my pressure back to 10.

It has nothing to do with non compliance, more the total opposite.

Eric

[SleepingUgly]

Uhhhhh, no I am 100% compliant. As compliant as a sleep doctor could ask for. I use my gear every night. What makes me feel ramped up is when I increase the pressure from my originally prescribed pressure of 10. When I increase my minimum from 10 to 11, after a few days on the old S8s and after only one night on the new S9, I feel absolutely jazzed, but strangely tired at the same time. I have been diagnosed with akathisia from SSRIs before and its like increasing pressure from CPAP "reactivates" the SSRIs and its like I go thru this mini-SSRI activation thing. It becomes intolerable and I have to reset my pressure back to 10.

Do you take the SSRIs everyday? (And don't make me sorry for responding to you!)

[EricinNC]

I guess the bupropion could have, but it isn't an SSRI, and I took it in the morning anyway due to the possible activation effect.

Bupropion does not affect sleep, or so said the abstracts of the studies that I have read. Bupropion does not affect serotonin. It affects mainly norepinephrine.

Benzo's flatten sleep architecture and keep you from REM or SWS. This stuff is basically legal smack and should be avoided at all costs by anyone, but most especially someone wih a sleep disorder. Its not real sleep. Its like eating candy instead of steak and salad, dude. I have gone thru some anxious times in my life and have taken xanax. 1/4 pill and I didn't give a crap what happened next. When I realized that I was hoarding and looking forward to taking it, I let it go. I have enough problems in my life. I didn't need to add a drug problem. Talk to your doctor and make a plan for getting of of it WITH the doctor. And personally, I would have second thoughts about seeing a doc who would prescribe that long term for sleep. Its one thing to get over a death in the family or something, but there are better alternatives for both anxiety and sleep.

Lyrica, for example, if you want to take a drug, is used in the European Union as an anxiolitic and is helpful for deeper sleep and for people who have pain. It has recently come to light that Fibromyalgia, the syndrome that Lyrica is marketed for, is actually most likely a sleep disorder called UARS. Lyrica helps fibro patients to get more deep sleep and that is why they have less pain. It is the disrupted sleep that causes their pain. I tried it and it helped me some. It caused some serious edema for me, so I had to go off before I could see if it was really helping me or not.

SSRI's mainly cause arousals unrelated to respiratory events (but those can be there for other reasons like UARS). I did read an abstract of a study that stated that the negative side effects of SSRI's, particularly those on sleep, could be reversed if you took it with small doses of 5-HTP. There again--the SSRI's can't do a damn thing for you if there isn't any serotonin in the synapse to conserve. Conserving nothing equals nothing. If there is even small amounts of it available, the SSRI's can do their job. I have no idea why this isn't more well known, except for the fact that if people got wind of the fact that you could take an over the counter, natural substance, as opposed to an expensive patented drug there would be no more money for the big druggies.

Im well aware that benzos suppress slow wave sleep. However getting off 4 mg klonopin after youve been taking the stuff for years is a tall order. As far as SSRIs go, they have kept me alive during the period when I was not on CPAP, but now that Im on CPAP the SSRIs seem to be making me feel jazzed, mildly agitated at times even. If I pump up the pressure on the CPAP, the "jazzed" SSRI feeling gets WAAAAAYYYY worse.

Ive already discussed all of this with my psychiatrist who prescribes these medications for me. He has already given me the go ahead to cut my SSRI dose if I want or need to. I am just afraid to cut back the dose because everytime Ive gone off antidepressants, Ive fallen apart completely. However, Ive never tried increasing the pressure of the CPAP off antidepressants and I wonder if that would cause my depression to evaporate...probably a pipe dream I figure. Im skeptical and would probably land right back on the SSRI after a few weeks...hence I dont try to do it.


I really wish I had been diagnosed with and treated with CPAP many many years ago , before I was put on all these psych meds. And then treated with psych meds if still needed. I was talking about this with my family tonight and I said it seems to me that when my OSA is not properly treated, I lose my mind. And that when my OSA is properly treated, my mind follows. My shrink told me OSA can cause psychosis. Quite frankly, I feel mildly psychotic.

Eric

[EricinNC]

Uhhhhh, no I am 100% compliant. As compliant as a sleep doctor could ask for. I use my gear every night. What makes me feel ramped up is when I increase the pressure from my originally prescribed pressure of 10. When I increase my minimum from 10 to 11, after a few days on the old S8s and after only one night on the new S9, I feel absolutely jazzed, but strangely tired at the same time. I have been diagnosed with akathisia from SSRIs before and its like increasing pressure from CPAP "reactivates" the SSRIs and its like I go thru this mini-SSRI activation thing. It becomes intolerable and I have to reset my pressure back to 10.

Do you take the SSRIs everyday? (And don't make me sorry for responding to you!)

Every single day, never miss a beat. Totally 100% compliant.

Eric

[SleepingUgly]

If the SSRI is a constant, but you change the pressure on your CPAP and it makes you feel agitated, maybe it's your CPAP pressure that's the problem and not the SSRI. Weren't you supposed to have a sleep study yesterday or today or something?

Your symptoms could be symptoms of your disorders, and not necessarily side effects of the medication or the CPAP, or the medication X CPAP interaction.

If you're sleep disorders are treated, even if sub-therapeutically, and you are sleeping, I have a hard time believing you would be feeling "psychotic" (although admittedly, I don't know what YOU mean by that). But if you're feeling psychotic, you need to call your psychiatrist.

[EricinNC]

If the SSRI is a constant, but you change the pressure on your CPAP and it makes you feel agitated, maybe it's your CPAP pressure that's the problem and not the SSRI. Weren't you supposed to have a sleep study yesterday or today or something?

Your symptoms could be symptoms of your disorders, and not necessarily side effects of the medication or the CPAP, or the medication X CPAP interaction.

If you're sleep disorders are treated, even if sub-therapeutically, and you are sleeping, I have a hard time believing you would be feeling "psychotic" (although admittedly, I don't know what YOU mean by that). But if you're feeling psychotic, you need to call your psychiatrist.

Im psychotic all the time. I go around in a constant mild psychosis. As someone who for some reason, I dont know why but its obvious you, but its obvious you are interested in psychopharmacology and psychology. I am not. I think they are dead ends.

You are aware arent you, that there are people in this world who are in a constant state of psychosis? Most psychotics are not locked up in psych wards anymore. Fifty years ago? Probably I would be in a psych hospital longterm. Although I would not go but thats another story.

Not all psychotics see things, hear things, think aliens landed in their backyard or are fixated on stupid stuff that does not exist. Some psychotics are just goofy people who "cant get it together" and are mildly demented. Thats what Ive become. My shrink says so. I agree with him. The CPAP was helping a lot until recently. Even mild sleep deprivation can set off psychotic symptoms in persons pre-disposed to psychosis or worsen psychotic symptoms in already psychotic people.

I am a chronic psychotic, but not a schizophrenic. I am a mood disordered psychotic. The worst psych diagnosis I ever had was "Major depression, severe and chronic with psychotic features." I have had an ECT consultation before. I am crazy plus my mood is awful plus I have trouble breathing.

Good quality sleep is closely tied to how well psychosis is controlled...or uncontrolled. I always said if they could just get my sleep good, everything else would probably go away.

The best treatment for psychosis is electric shock treatment, clozapine and if needed if OSA is present, CPAP. I have thought about ditching the SSRI and just going with CPAP or a tracheotomy plus ECT.

Eric

[ozij]

Eric, here's what I hear you saying:
You were give pharmaceutical treatment for depression before your sleep apnea was diagnosed.
You were also given -- and have been taking -- large doses of benzodiazepines.
You were better when you started cpap therapy on a ResMed S8.
Your machine broke, you got an S9 - things are no longer so good.
You're disappointed in your doctors.
You are convinced you know everything you need to know about psychopharma.

I also conclude - I could be wrong of course - that you do realize some people have found help on this forum, and you post here in the hope of finding some yourself - despite your disappointing experiences.

Here are some thoughts / info I'd like to share with you -they may all be irrelevant to you, but on the off chance that they may help you, I'm taking the time to gather them. If they help, fine. If they don't - be that so. This is not posted in an attempt to convince you of anything, only to present options that may, possibly, help you.

Some of what you describe reminds of Jere's experience -- here's an example from Jere's posts.
Jere's experience

Yikes! This thread reminds me of the years of being on Zoloft then Serzon and then back to Zoloft, suffering from the side-effects (the ones the doctor never tells you about). The meds were supposed to relieve my anxiety and depression (not to mention chronic insomnia). Every time I tried to get off any of them, I would get the 'zaps' (my GP had no answer to that) and getting off Serzon brought me as close to suicide as I ever want to be. Yuch.

I complained and complained that none of these medicines were helping. Finally, my psych referred me to a psychopharmacologist. After maybe two visits, and a long discussion about the psychotic behavior running through my mother's family (probably bi-polar), he put me on a low dose of lithium. I was skeptical at first (I have never been manic), but the stuff has been a great help. Anxiety is manageable and depression is almost gone. Insomnia is under control and I am off Ambien altogether. Add CPAP to the equation, and I have been sleeping at night and staying awake during the day. I don't ask for much, but being able to sleep at night and to remain awake during the day - well, it's priceless.

Doctors can be very quick to put people on antidepressants. They might work for some people, but they did not work for me (actually made things worse).

For me there is no noticeable link between OSA and anxiety. My anxiety is inherited and the OSA a coincidence.

_________________

As for weaning off antidepressants, here is what works for me. First, every step/reduction takes two weeks. First, I cut 1/4 off my dose, then another 1/4, then another 1/4 (leaving me with a 1/4). I would then cut that 1/4 in half and finally - 8 weeks later - stop altogether. Still got minor zaps and some mood instability for a few weeks. The key is to GO SLOW. Never, ever go cold turkey.

If you find this intriguing, you can search Jere's other posts here: search.php?author_id=2435&sr=posts

OSA may cause depression for some people - loss of sleep plus the physical experience of repeated choking all night long are not conducive to a sense of well being.

Here is a link to a Google Scholar search on OSA and Depression. Perhaps you can find the time - and hopefully ability to concentrate despite feeling so bad - and study some of these papers.

You may also want do some some serious study of this very informative site: http://www.benzo.org.uk. I suggest you start out with this: The Ashton Manual in order to get a sense of the seriousness and professionalism of the people.
Benzo's are mis-perscribed, are probably the most physically addictive substance known, and have terrible side effects in the long range.

I'm sure you wish you had good doctors who would co-operate with each other. I won't tell you how to go about finding them and I won't argue with you about whether it's possible or impossible.

Here's a suggestion though: If you decide to read any of the links I've given you and find hope in them, try to contact the writers and ask them for recommendations of similar minded colleagues who live close enough to you to make a consultation a viable option.

Good luck.

[Alsacienne]

ozij that's an excellent post.

Eric, please listen before you bite my head off!

I have found some of your posts both here and in other threads pretty stressful reading. I can feel that you have great anger and frustration and given your history I can understand a bit better why you feel so strongly about such a lot of things.

I too suffered from undiagnosed depression. I was then treated with Deroxat (Paxil in the US) for 10 years, during which time I was also diagnosed with OSA. A lot of my excessive daytime sleepiness was due directly to the antidepressant medication which left me firing on less than all cylinders for a very long time.

CPAP therapy did help me regain equilibrium and better sleep, but it wasn't until I completed a severance programme lasting 11 months that things got substantially better on the sleep front.

I wonder if you managed to reduce your meds you would find an improvement in your sleep and also in your waking life. It might be worth a try. But if your personal circumstances force you to have to rely on antidepressant medication, please don't start tinkering with it without the support and supervision of your doctor. Maybe it might be worth investigating whether a change of medication to one with a shorter half-life might improve your sleep?

Should you decide to consider reducing your medication or coming off it completely with the minimum of undesirable side effects, you will need to do it over a long period of time and with support. My personal starting point was http://www.paxilprogress.com and it is thanks to their members and their proposed tapering plan that I have now lived a full and active life for 4 years now without antidepressant medication.

The strong feelings which are an integral part of you at present are probably more related to the antidepressant medication than your sleep problems, but I can understand that both are fair game if you are looking for reasons why life is not as you would wish it at present.

I sincerely wish you an improvement in your sleep and life. Hang on in there. ATB Alsa x

[SleepingUgly]

You're getting some good advice here. I want to reiterate that making changes to your medications, even tapering off without your doctor's help is not a good idea. Do it under supervision.