fishy: Trazodone for Sleep?

[fishy]

I'm new so don't have my med history in my signature yet. Basically my docs tried me on every SSRI to the point where I developed chronic insomnia. Currently I am on

 

12.5 mg Zoloft, 150 mg Trazodone, 2.0 mg Clonazepam/day

 

I get 3-4 hrs/night sleep on this. I have been on the clonazepam for 2 years and am addicted, but doubt it is helping my sleep (is probably hurting it). Without the trazodone, I doubt I would sleep at all. but I have a feeling 150 mg may be too much...I feel groggy all day. Anyone have experice with Trazodone? How quickly should you wean? I've heard it is not strictly an SSRI (it is an SARI) but you still must wean...although most people can wean off of it faster than SSRIs.

[compsports]

I'm new so don't have my med history in my signature yet. Basically my docs tried me on every SSRI to the point where I developed chronic insomnia. Currently I am on

 

12.5 mg Zoloft, 150 mg Trazodone, 2.0 mg Clonazepam/day

 

I get 3-4 hrs/night sleep on this. I have been on the clonazepam for 2 years and am addicted, but doubt it is helping my sleep (is probably hurting it). Without the trazodone, I doubt I would sleep at all. but I have a feeling 150 mg may be too much...I feel groggy all day. Anyone have experice with Trazodone? How quickly should you wean? I've heard it is not strictly an SSRI (it is an SARI) but you still must wean...although most people can wean off of it faster than SSRIs.

 

Hi Fishy,

 

Welcome! Just as an FYI, I was Palm on PP.

 

You haven't been on Trazadone long, right? Can you refresh my memory?

 

I am so sorry to hear about your sleep difficulties. Trust me, I feel your pain.

 

CS

[ajay]

Hi fishy! Welcome!

 

My doctor just suggested Trazadone to me as well (for sleep) so I'm really interested to see what folks here have to say.

 

I don't know much about it. I've had insomnia for about a year now, and I'd love to have some sleep... on the other hand, I'm now getting about 5 hours of sleep fairly often and my anxiety is usually under reasonable control and I'm not sure I want to mess with more meds...

 

I know we'll be interested in your history when you get a chance to write it up - context can be very helpful.

[Barbarannamated]

Hi Fishy and CS and ajay~

ive been on 75 traz qhs for many years -too many to remember -and Klonopin qhs for bruxism that was likely caused by Zoloft~ the traz still seems to work for sleep although going thru rough patch recently •

I had hoped to DC both but I'm having trouble just getting thru each day right now so not trying any changes ~

I recall that traz does have a wicked hangover and dry mouth/eyes/difficulty swallowing (anticholinergic I assume) at higher doses ~i cut from 150 to 75 before I knew anything about tapering and dont recall probs but wouldn't suggest that knowing what I do now ~

FWIW-I respond MUCH better to certain generics than others -Pliva is a big chunky hexagonal monster that sucks and whoever had the bright idea to make a HUGE pill with angles should be shot

The ones that seem to be better for me are Mutual and a flat oval (150) - the mfg are all merging and hard to keep track of

The brand Desyrel is not made anymore although there is a new XR formulation available under another name -i think it's being sold as antidepressant

[compsports]

I know Fishy won't mind my temporarily hijacking his thread.

 

I wanted to mention that when I was on Trazadone, I had to be very careful in going from a sitting position to a standing or I would get dizzy. One time, because I got up too quickly, I ended up falling on my kitchen floor and severely bruising my knee. I am lucky I didn't fall on my head.

 

Ajay, tread very carefully although an insomnia veteran for other other reasons besides psych med withdrawal, I do understand that lack of sleep is a killer.

 

CS

 

PS - Barbara, I remember those hangover days.

[fishy]

 

I'm new so don't have my med history in my signature yet. Basically my docs tried me on every SSRI to the point where I developed chronic insomnia. Currently I am on

 

12.5 mg Zoloft, 150 mg Trazodone, 2.0 mg Clonazepam/day

 

I get 3-4 hrs/night sleep on this. I have been on the clonazepam for 2 years and am addicted, but doubt it is helping my sleep (is probably hurting it). Without the trazodone, I doubt I would sleep at all. but I have a feeling 150 mg may be too much...I feel groggy all day. Anyone have experice with Trazodone? How quickly should you wean? I've heard it is not strictly an SSRI (it is an SARI) but you still must wean...although most people can wean off of it faster than SSRIs.

 

Hi Fishy,

 

Welcome! Just as an FYI, I was Palm on PP.

 

You haven't been on Trazadone long, right? Can you refresh my memory?

 

I am so sorry to hear about your sleep difficulties. Trust me, I feel your pain.

 

CS

 

Hey Palm! well, it seems I've tried just about every SSRI. I can gt sleep on a dose once I start but it seems to only last about 3 weeks then my sleep goes to 0. Now I am getting no sleep with clonazepam AND 150 mg Trazodone. I didn't know SSRI WD could be so vicious. I can go about a week on 0 sleep, but then I become a basket case. I'm not sure where to go from here. Do I stick with the current meds and try to get through? Or do I updose and HOPE to reach some stability. I haven't been stable on any SSRI in a long time, so I think staying put is the right thing...but I NEED SLEEP! I'm so desperate right now, I don't know what to do.

[compsports]

 

 

I'm new so don't have my med history in my signature yet. Basically my docs tried me on every SSRI to the point where I developed chronic insomnia. Currently I am on

 

12.5 mg Zoloft, 150 mg Trazodone, 2.0 mg Clonazepam/day

 

I get 3-4 hrs/night sleep on this. I have been on the clonazepam for 2 years and am addicted, but doubt it is helping my sleep (is probably hurting it). Without the trazodone, I doubt I would sleep at all. but I have a feeling 150 mg may be too much...I feel groggy all day. Anyone have experice with Trazodone? How quickly should you wean? I've heard it is not strictly an SSRI (it is an SARI) but you still must wean...although most people can wean off of it faster than SSRIs.

 

Hi Fishy,

 

Welcome! Just as an FYI, I was Palm on PP.

 

You haven't been on Trazadone long, right? Can you refresh my memory?

 

I am so sorry to hear about your sleep difficulties. Trust me, I feel your pain.

 

CS

 

Hey Palm! well, it seems I've tried just about every SSRI. I can gt sleep on a dose once I start but it seems to only last about 3 weeks then my sleep goes to 0. Now I am getting no sleep with clonazepam AND 150 mg Trazodone. I didn't know SSRI WD could be so vicious. I can go about a week on 0 sleep, but then I become a basket case. I'm not sure where to go from here. Do I stick with the current meds and try to get through? Or do I updose and HOPE to reach some stability. I haven't been stable on any SSRI in a long time, so I think staying put is the right thing...but I NEED SLEEP! I'm so desperate right now, I don't know what to do.

 

Hi Fishy,

 

Again, I understand the desperation.

 

I don't know why this took me so long to figure this out but personally, I would taper the Zoloft or the Clonazepam first. Pick one and do it at the 10% rate or slower. I think these drugs could possibly be causing your insomnia although of course, I don't know for sure.

 

Save the Trazadone for last.

 

Unfortunately, I fear it is going to be impossible for you to achieve any stability on these meds as your system has gone haywire. So you might as well get off the drugs.

 

When I was going through insomnia h-ll when tapering, I tried various supplements. But nothing really worked for too long or never did.

 

Comp Sports

[Altostrata]

Hi, Fishy. I moved your topic here as it introduces your situation.

 

Thank you for joining us.

 

My take is the same as CompSports's, I would taper the Zoloft first, then the trazodone.

 

I guess if the traz hangover is too much for you, you could try taking a tiny bit less.

 

Traz itself has a half-life of about 3-6 hours, which means your body may recover from it during the day. It is also a serotonin receptor antagonist, which means it may be easier to quit.

 

But traz has a nasty metabolite, mCPP, which can increase anxiety, panic, and sleeplessness. mCPP's half-life is 2-6 hours.

 

You might get the effect of the trazodone at night; the traz changes into mCPP, then you get the effect of mCPP during the day.

 

mCPP is metabolized via the liver enzyme cyp 2D6. Zoloft is partially metabolized by the same enzyme. This means that as you reduce Zoloft, you may be enhancing the metabolization of mCPP (a good thing).

[fishy]

My pdoc recommended getting dumping the Trazodone and trying Restoril (a benzo). I'm already addicted to one benzo so I really don't want to be on 2. On the other hand, Trazodone is serotonergic so she may be wanting to get all the serotonergic drugs out of my system. She said I didn't have to taper the trazodone, but I've read you do (but can do so faster than SSRIs). Any thoughts?

[Barbarannamated]

Alto~

Q: What about the clonazepam

[Altostrata]

Why did she make those recommendations, fishy?

 

For what symptoms are you taking the benzo?

[fishy]

Hi, Fishy. I moved your topic here as it introduces your situation.

 

Thank you for joining us.

 

My take is the same as CompSports's, I would taper the Zoloft first, then the trazodone.

 

I guess if the traz hangover is too much for you, you could try taking a tiny bit less.

 

Traz itself has a half-life of about 3-6 hours, which means your body may recover from it during the day. It is also a serotonin receptor antagonist, which means it may be easier to quit.

 

But traz has a nasty metabolite, mCPP, which can increase anxiety, panic, and sleeplessness. mCPP's half-life is 2-6 hours.

 

You might get the effect of the trazodone at night; the traz changes into mCPP, then you get the effect of mCPP during the day.

 

mCPP is metabolized via the liver enzyme cyp 2D6. Zoloft is partially metabolized by the same enzyme. This means that as you reduce Zoloft, you may be enhancing the metabolization of mCPP (a good thing).

 

Nice to meet you ALTO. You are the admin here no? Anyway, I think CS said I should do the zoloft then the clonazepam and save the trazodone for last. I don't think weaning off the zoloft will help my sleep - but it is the next logical step. Again, any thoughts on going to a second benzo or just getting rid of all the serotonergics? Should I wean the traz? If so, how fast? lack of sleep sleep seems to be my major issue at this point.

[fishy]

Why did she make those recommendations, fishy?

 

For what symptoms are you taking the benzo?

 

I was originally prescibed clonazepam 2 years ago when the SSRIs pooped out...I couldn't sleep. The pdoc I had at the time, said my lack of sleep was due to anxiety and clonazepam would allow me to sleep. It did, but I am now tolerant, addicted, and don't know if the clonazepam is doing anything. My current pdoc and a sleep specialist both recommended Restoril on top of the clonazepam for sleep. Benzos are bad news...but so is not sleeping at all for a week.

[Altostrata]

My guess is to taper Zoloft, then trazodone, then clonazepam.

 

(I personally feel trazodone is a very nasty drug, prone to paradoxical effects, and I wouldn't take it.)

 

It appears to me that you have adverse reactions to SSRIs. The SSRIs themselves might be too activating for you, causing insomnia, and all the switching you've done over the years has probably sensitized your nervous system further.

 

Your doctor should have given up on the SSRIs a long time ago, when you had your first adverse reaction.

 

Sleeplessness is a common and very difficult withdrawal symptom. 4-5 hours of sleep a night isn't bad, comparatively.

 

If I were you, I'd stop experimenting with psych drugs and very systematically minimize whatever it is you're taking. You're not going to correct hypersensitivity by adding more drugs.

 

Why are you taking clonazepam?

[Barbarannamated]

I cant imagine -- I go bonkers if I dont sleep for 1 nite ~

can you function at all„ fishy

[fishy]

My guess is to taper Zoloft, then trazodone, then clonazepam.

 

(I personally feel trazodone is a very nasty drug, prone to paradoxical effects, and I wouldn't take it.)

 

It appears to me that you have adverse reactions to SSRIs. The SSRIs themselves might be too activating for you, causing insomnia, and all the switching you've done over the years has probably sensitized your nervous system further.

 

Your doctor should have given up on the SSRIs a long time ago, when you had your first adverse reaction.

 

Sleeplessness is a common and very difficult withdrawal symptom. 4-5 hours of sleep a night isn't bad, comparatively.

 

If I were you, I'd stop experimenting with psych drugs and very systematically minimize whatever it is you're taking. You're not going to correct hypersensitivity by adding more drugs.

 

Why are you taking clonazepam?

 

see above for why I'm on the clonazpam. BTW I am no longer getting 4-5 hrs sleep. I am getting 1-2 now

[Altostrata]

Beats me, fishy. Any of your drug switches, or all of them cumulatively, may have sensitized your nervous system to psychiatric drugs.

 

What we see with hypersensitivity is that psych medications go paradoxical.

 

I would expect the same with more drug switches. At some point, you're going to have to get off the merry-go-round. You're not going to be able to solve hypersensitivity with more drugs that trigger it.

 

The benzo alone might cause the sleeplessness -- a paradoxical reaction.

 

Why don't you discuss paradoxical reactions with your doctors and see if either has a clue?

[fishy]

Unfortnately, I've done that. To them a benzo is always sedating. Neither eould consider weaning me off the benzo. I'm gonna let things ride a few days. I will start reducing the zoloft. The trazodone, I might go to 100 mg and see what that does.

[Altostrata]

It's a medical fact that benzos can go paradoxical. That might give you an idea of the quality of advice you're getting from your doctors.

 

Adjust the Zoloft dose and the trazodone dose at different times. Give your nervous system a chance to adapt to the change and then change the other.

[fishy]

Well, my main symptom is insomnia. Should I wait to see if my sleep gets better or just start weaning on the Zoloft? I have been on my current dose for almost 3 weeks, but it was a 50% drop from my previous dose (which I was only on 1 week). Like I said, I do not remember the last time I was "stable" on any SSRI. I think I am basically in a C/T mode. I could go up, but may never find a stable point. I may just need to ride this out. So do I just wait a week and go 10% taper on the zoloft, or should I just drop it?

[Altostrata]

You've been doing a rapid taper off Zoloft. Has your insomnia increased as you've decreased? Do you get any other withdrawal symptoms?

[fishy]

At first, my doc wanted to put me on 150 mg. We started at 50 mg, but my insomnia got worse. We cut it to 25 mg and my insomnia got better, so we reduced it to 12.5 thinking that would help, but my insomnia got worse again. For 3 weeks I was able to get 3-5 hrs sleep/night on 12.5 mg. Then it went to hell and now I am getting 1-3 hrs/night (all with Trazodone). I'm afraid if I increase to 25 mg, I may see the same effect, 3 good weeks, then a drastic fall off. I saw that when I tried to re-instate Lexapro at 5 mg as well. If I go to 50 mg of Zoloft, it stimulates me. Kinda in a bind as to what to do. I don't have any other W/D symptoms except anxiety and crying spells - but these usually come as a result of many days with little to no sleep.

[Altostrata]

fishy, I get the feeling you're trying to find the right drug cocktail for your situation.

 

Your doctor or doctors may subscribe to this myth. There is no perfect cocktail. Once the situation goes south, all bets are off. Your nervous system is more like Humpty Dumpty than it is like a rubber band.

 

As I've said before, it sounds to me like serotonergics are too activating for you. The initial decrease in Zoloft worked because your nervous system was relieved of the stimulation. My guess is whatever Zoloft you're taking is still too stimulating for you.

 

And that goes for the mCPP from trazodone, too.

 

Insomnia is a common symptom of nervous systems that have been sensitized by psychiatric drugs. Once one's system is sensitized, nothing is going to work. Anything is going to go paradoxical after a short time.

 

Here's another concept to discuss with your doctors: "kindling."

 

I'm sorry you've been put in this situation. Patients should not have to make these decisions by themselves. But the fact is, doctors are clueless about the adverse effects of these drugs. Judging from your history, at least one and maybe both of your doctors suffers from this. (I can see the one jerked you around with Lamictal and Risperdal within one week in December.)

 

I feel like I'm repeating myself, and you want a definite answer about what you should do. I can't tell you. You need to make your own decisions.

 

One of them, in my opinion, should be whether you want to keep working with a doctor who's put you on 5 different drugs within a few months, and keeps on making you worse.

[compsports]

Fishy,

 

I wanted to completely 2nd what Alto said.

 

Before I started tapering off of meds in 2006, I started not being able to sleep in spite of being on three meds, which included Remeron. I now realize I was in poopout.

 

Like you, I searched for the elusive med so I could sleep. I was working in special ed and was obviously frantic as I couldn't do my job properly without sleep. Fortunately, after several attempts, when Doxepin was added, it worked. But there is no doubt in my mind that I was on borrowed time and if I had continued this path, I would have had the same experience as you are having. Anyway, I started tapering about 6 months later.

 

By the way, I think I have tried to find the perfect supplement combination like you have tried to find the perfect drug cocktail. That mentality just doesn't work.

 

Again, I realize lack of sleep is a horrible thing. But the way I look at it is you're going to experience this whether you stay on meds or during withdrawal. So you might as well start tapering if your goal is to be drug free.

 

Personally, I would taper the Zoloft at the 10% rate since you have been on several SSRIs. Your call.

 

As far as dealing with your doctors, personally, I would try to find someone else as Alto makes a great point about them making you worse. But if you can't, then you have to take charge and tell them that this is what you are going to do regarding tapering.

 

I did this with my former psychiatrist. He didn't support my getting off of meds but because I knew exactly how I wanted to taper, he had no choice but to cooperate with what I wanted to do and he did to his credit.

 

Comp Sports

[compsports]

Fishy,

 

I wanted to expand on my previous points. When I felt my psych med cocktail was causing horrific side effects and starting to lose effectiveness, I realized that if I stayed on meds, the next step according to my psychiatrist was going to be trycylics since like you, I had had horrible reactions to SSRIS. After he said that, alarm bells went off and I realized this was amounted to what I felt was an escalation regarding taking meds. If they didn't work, what was next, mood stabalizers or antipsychotics?

 

If you stay on meds, I fear that is what will happen to you in your attempt to find the elusive perfect drug combination that will give you stability. It may happen Fishy for a few weeks, or if you are lucky, a few months. But as you have learned, they go south on you.

 

Of course, you have to weigh the factors and make the decision as to how to proceed. As Alto said, it is your call.

 

CS

[Altostrata]

fishy, if you're research-minded, you might look into this:

 

SSRIs destroy sleep architecture. There is an extensive amount of documentation about this.

 

For example: http://www.ncbi.nlm.nih.gov/pubmed/10940762

 

(If you find any especially interesting papers, please post them in our Journals section following the established format.)

 

Many studies of how antidepressants affect sleep were conducted about 20 years ago at Baylor, in Texas, showing that antidepressants destroy sleep architecture, leading to numerous "micro-wakings" during dream periods.

 

Clearly, you do not have primary insomnia. Your insomnia is not caused by depression. Your sleep was normal before prolonged exposure to SSRIs. Your sleep problems are a consequence of antidepressant use, they are iatrogenic.

 

(cs, here's one for you: http://www.ncbi.nlm.nih.gov/pubmed/18787037 )

[compsports]

[(cs, here's one for you: http://www.ncbi.nlm.nih.gov/pubmed/18787037 )

 

Thanks Alto