Antidepressants and Sleep Questions

for me, i would be choosing between food and supplements, so i just take fish oil and vitamin d and try to eat right. i suppose I could do more for myself in taking some of these supplements, but i just cant afford it.

oak wrote:for me, i would be choosing between food and supplements, so i just take fish oil and vitamin d and try to eat right. i suppose I could do more for myself in taking some of these supplements, but i just cant afford it.

And supplements aren't side effect free. Also, while I don't have any definite proof, it seems that many people who have been on psych meds are quite sensitive and may have trouble with items that are supposedly harmless. So you may not be missing that much since the ones you are taking seem to be the most benign. Of course, your mileage will vary.

49er

mollete wrote:

kaiasgram wrote:

mollete wrote:"IMHO", the best drug to TFU your sleep is Lexapro (escitalopram).

Hi mollete, would you elaborate?

It can cause one to have tons of spontaneous arousals, and consequently fragment sleep.

It is important to note, however, that generating a lot of spontaneous arousals does not equate (necessarily) to insomnia-- rather, it would also result in a lot of stage changes (creating sleep fragmentation) and a lot of worthless NREM (NREM1).

This is not to be confusified with insomnia (to put a number on it, let's say it's a Sleep Efficiency of <85%, AND it's creating a problem). Also be aware the insomnia can be sitting in a number of places-- inability to take sleep, inability to maintain sleep, and/or early rising (which might otherwise be Toxic ASPS)(TASPS)(OK I made that up, but doesn't that sound like it should actually BE something?).

And of course, there are plenty of insomniacs out there who are so jacked up (for whatever mechanism) that besides not sleeping through the night, they don't have EDS, so it's like, "What's another hundred arousals in the big scheme of things?"

oak wrote:... i think i am going to try to talk psychiatrist into reducing the effexor at the next appt and see how it goes...

So before an attempt at Drug Wingin" (DrWing) is made, be aware that you can be running 5 variables at once. Consider these for thought:

Drugs and CBT

Drugs and More Drugs

mollete wrote:...that you can be running 5 variables at once...

Now while it's fun to find studies that can basically prove anything about anything, check out results outcomes #8 and #9 in this clinical trial, then ask me "Gee mollete (2 "l"s, one "t"), I wonder why Lunesta pulled the plug?"

http://clinicaltrials.gov/ct2/show/resu ... 5#outcome8

I quickly glanced at the article on CBT and insomnia so if I am missing something, my apologies. If the insomnia is due to the side effect of Effexor and not to the failure to adequately treat the depression, I fail to understand how CBT would be helpful.

49er

mollete wrote:

mollete wrote:

kaiasgram wrote:

mollete wrote:"IMHO", the best drug to TFU your sleep is Lexapro (escitalopram).

Hi mollete, would you elaborate?

It can cause one to have tons of spontaneous arousals, and consequently fragment sleep.

It is important to note, however, that generating a lot of spontaneous arousals does not equate (necessarily) to insomnia-- rather, it would also result in a lot of stage changes (creating sleep fragmentation) and a lot of worthless NREM (NREM1).

This is not to be confusified with insomnia (to put a number on it, let's say it's a Sleep Efficiency of <85%, AND it's creating a problem). Also be aware the insomnia can be sitting in a number of places-- inability to take sleep, inability to maintain sleep, and/or early rising (which might otherwise be Toxic ASPS)(TASPS)(OK I made that up, but doesn't that sound like it should actually BE something?).

And of course, there are plenty of insomniacs out there who are so jacked up (for whatever mechanism) that besides not sleeping through the night, they don't have EDS, so it's like, "What's another hundred arousals in the big scheme of things?"

oak wrote:... i think i am going to try to talk psychiatrist into reducing the effexor at the next appt and see how it goes...

So before an attempt at Drug Wingin" (DrWing) is made, be aware that you can be running 5 variables at once. Consider these for thought:

Drugs and CBT

Drugs and More Drugs

[quote="49er"]I quickly glanced at the article on CBT and insomnia so if I am missing something, my apologies. If the insomnia is due to the side effect of Effexor and not to the failure to adequately treat the depression, I fail to understand how CBT would be helpful.[quote]

49er



Exactly, 49er. For example, in my case,THIS problem is insomnia without anxiety. I just lay awake for 2 hours without thinking about anything in particular. The only concern with reducing the SSRI/SNRI drugs is that the daytime depression would return. CBT therapy (which I have had plenty of) is not relevant at least in this case.

oak wrote:

49er wrote:I quickly glanced at the article on CBT and insomnia so if I am missing something, my apologies. If the insomnia is due to the side effect of Effexor and not to the failure to adequately treat the depression, I fail to understand how CBT would be helpful.

49er



Exactly, 49er. For example, in my case,THIS problem is insomnia without anxiety. I just lay awake for 2 hours without thinking about anything in particular. The only concern with reducing the SSRI/SNRI drugs is that the daytime depression would return. CBT therapy (which I have had plenty of) is not relevant at least in this case.

Thanks for responding Oak. I am so sorry it takes so long for you to get to sleep.

This site might be helpful regarding Effexor tapering as it suggests 10% of current dose every 4 weeks to minimize the chances of withdrawal symptoms which include the rebound depression you are concerned about. You may find this pace too slow and many doctors look at you like you are nuts when you describe it. But take a look and see what you think. And the site is not beholden to any financial or commercial interests and depends entirely on donations.

http://survivingantidepressants.org/ind ... nlafaxine/

49er

thank you 49er! appreciate it.

49er wrote:I quickly glanced at the article on CBT and insomnia so if I am missing something, my apologies. If the insomnia is due to the side effect of Effexor and not to the failure to adequately treat the depression, I fail to understand how CBT would be helpful.

My point up there is to stress how complicated this whole thing can be.

• If you know what the problem is, the solution is easy:
  
  Patient: Doctor, it hurts when I do this.
  Physician: Then don't do that.
• So if you have "Insomnia Due to Drug or Substance", great, don't do that.
• But there's 11 different classifications of insomnia, so unless one knows which one they're working with, correcting the problem may be difficult to impossible.
• The above studies were all looking at escitalopram (SSRI) instead of venlafaxine (dual inhibitor).
• This doesn't apply to everybody. Even if some nut on the internet says "Effexor causes insomnia", and you take what the manufacturer claims (18%)(HAHAHAHAHAHA) and double it (36%) or even trple it (54%) you still have a lot of people that don't get insomnia (but one wonders if there are at least some sub-clinical effects).
• While venlafaxine causes insomnia (with the disclaimers above) escitalopram causes fragmentation (big difference).
• However, TTBOMK, no one has ever looked at the effect escitalopram on sleep architecture. Consequently, a claim that escitalopram leaves a common and distinct fingerprint is relegated to the "Some Nut on the Internet" status.
• TS, if you're on Lexapro, look at the Spontaneous Arousal Index on the NPSG, and if it's through the roof, then "you might want to pay attention" (JF).
• ADM strategy should take into account baseline characteristics of the patient. For instance, if the sleep effect of an ADM is wake-promoting, don't give it to an insomniac, get some traz or mirtz or trip or whatever.
• It's going to be a beautiful day so everybody get their DA outside and get some BLT.

OK just ONE more to prove SNOTI status and I really have to run:

http://clinicaltrials.gov/ct2/show/NCT00442481

Lundbeck.

What a BF surprise.

Mollete posts always remind me just how stupid I am. Too many abbreviations for me...

NeedHelp2 wrote:Mollete posts always remind me just how stupid I am. Too many abbreviations for me...

Well, the post above with BF is easy for me to translate Big F----king Unfortunately, the other abbreviations are not so obvious in my opinion.

Maybe Mollete needs to write an abbreviation guide for all of us dumb folks:)

49er

TTBOMK, = ___ ____ based on my knowledge

see, CPAP is working

Oh c'mon! You use these acronyms every day in normal conversation!

Anti-Depressant Medication
Bright Light Therapy
Cognitive Behavioral Therapy
Dead (Butt)
Jeff Foxworthy (OK, you need to be a JF fan to know that routine)
Nocturnal Polysomnography
Selective Serotonin Reuptake Inhibitor
Some Nut On The Internet
That (Being) Said
To The Best Of My Knowledge

Thanks for the translation!