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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by dlevine on September 30, 2002, at 22:32:15
I've been taking Nardil for several years for SP and depression with great success, but have NEVER been able to sleep well on it.
Currently I'm taking .5mg Klonopin & 50mg Trazadone every night and I still barely manage to get 5 solid hours of sleep. I love the antidepressant benefits of Nardil--but the insomnia is killing me.
Nardil vets, any secret sleeping tips?
Posted by cosis on September 30, 2002, at 22:42:04
In reply to Nardil veterans...how do you sleep?, posted by dlevine on September 30, 2002, at 22:32:15
Sorry I don't have any tips but I sleep the same amount of hours every night, which is 7.. It is like clockwork.. I wake up with tons of energy but I also get tired at certain times during the evening.
Posted by SLS on October 1, 2002, at 15:23:43
In reply to Nardil veterans...how do you sleep?, posted by dlevine on September 30, 2002, at 22:32:15
> I've been taking Nardil for several years for SP and depression with great success, but have NEVER been able to sleep well on it.
>
> Currently I'm taking .5mg Klonopin & 50mg Trazadone every night and I still barely manage to get 5 solid hours of sleep. I love the antidepressant benefits of Nardil--but the insomnia is killing me.
>
> Nardil vets, any secret sleeping tips?
Hi.How much Nardil are you taking?
I have had bouts of total insomnia with Nardil in the past. The things that have worked best with me have been combining a powerful, short-acting drug like Halcion or Sonata with a longer-acting one like Ativan or Restoril. The former helps put you to sleep while the latter helps to keep you asleep. I think the regimen I used years ago included Halcion 1.0mg + Ativan 4.0mg. Many doctors are uncomfortable with prescribing Halcion, but it is the strongest of the benzodiazepines for sleep, and I have never had any side-effects or memory problems with it. I can't offer you any realistic idea as to how prevalent these occur in real life. Perhaps Sonata would provide the necessary impact.
I don't think Klonopin is as effective a hypnotic as these other drugs. Are you sure you need it to treat your SP? How often is Ativan effective for SP? Do you think substituting Ativan for Klonopin and adding one of the short-acting drugs might be worth considering?
Good luck.
I'm not having very much of my own in trying to treat bipolar depression. Are you taking Nardil by itself? What drugs or drug combinations have you tried in the past?
Thanks for any input.
- Scott
Posted by dlevine on October 1, 2002, at 22:46:12
In reply to Re: Nardil veterans...how do you sleep? » dlevine, posted by SLS on October 1, 2002, at 15:23:43
> How much Nardil are you taking?
> I have had bouts of total insomnia with Nardil in the past. The things that have worked best with me have been combining a powerful, short-acting drug like Halcion or Sonata with a longer-acting one like Ativan or Restoril. The former helps put you to sleep while the latter helps to keep you asleep. I think the regimen I used years ago included Halcion 1.0mg + Ativan 4.0mg. Many doctors are uncomfortable with prescribing Halcion, but it is the strongest of the benzodiazepines for sleep, and I have never had any side-effects or memory problems with it. I can't offer you any realistic idea as to how prevalent these occur in real life. Perhaps Sonata would provide the necessary impact.
>
> I don't think Klonopin is as effective a hypnotic as these other drugs. Are you sure you need it to treat your SP? How often is Ativan effective for SP? Do you think substituting Ativan for Klonopin and adding one of the short-acting drugs might be worth considering?
>
> Good luck.
>
> I'm not having very much of my own in trying to >treat bipolar depression. Are you taking Nardil >by itself? What drugs or drug combinations have >you tried in the past?
Thanks for the info. I'm currently taking about 42mg of Nardil (I cut the pills to get that dosage). That's as low as I can go and still have a therapeutic effect.My biggest problem is not falling asleep, but STAYING asleep. I rarely ever sleep more than 3 hours straight using my current sleep meds.
I take the Klonopin (and Trazadone) to fall asleep only--not to treat my SP. My Pdoc says that Klonopin is the safest benzo to use for sleep(it has a long half-life). I've never tried anything other than Trazadone & Klonopin for my insomnia. Maybe I should consider something else?
I fear taking more benzos for such a long time frame (it may be forever). Am I wrong to? What are my non-benzo alternatives other than Trazadone?
BTW, I also take a small dose (50mg) of Depakote to minimze any manic symptoms caused by Nardil. It works well. Maybe you should consider that for use in your bipolar treatment.
Any other advice related to Nardil and what to take for sleep would be GREATLY appreciated...
Posted by SLS on October 4, 2002, at 12:16:25
In reply to Re: Nardil veterans...how do you sleep? » SLS, posted by dlevine on October 1, 2002, at 22:46:12
Hi.
> > I don't think Klonopin is as effective a hypnotic as these other drugs. Are you sure you need it to treat your SP? How often is Ativan effective for SP? Do you think substituting Ativan for Klonopin and adding one of the short-acting drugs might be worth considering?> My biggest problem is not falling asleep, but STAYING asleep. I rarely ever sleep more than 3 hours straight using my current sleep meds.
> I take the Klonopin (and Trazadone) to fall asleep only--not to treat my SP. My Pdoc says that Klonopin is the safest benzo to use for sleep(it has a long half-life). I've never tried anything other than Trazadone & Klonopin for my insomnia. Maybe I should consider something else?
I think the half-life of Klonopin (clonazepam) is far too long to be used routinely as a hypnotic to treat insomnia. It stays with you all day long. This is why I questioned as to whether it was a critical component to your SP treatment. Being in your position a few times, I have favored using either Ativan (lorazepam), which also has significant anxiolytic properties, or Restoril (temazepam). Both have medium half-lives.
--------------------------------------
Drug Name (generic name)
Half-Life
Klonopin (clonazepam)
30 to 40 hoursAtivan (lorazepam)
12 to 18 hoursRestoril (temazepam)
3.5 to 18.4 hours (mean 8.8 hours)Halcion (triazolam)
1.5 to 5.5 hoursAmbien (zolpidem)
1.4 to 4.5 hoursSonata (zaleplon)
1 hour
--------------------------------------
> I fear taking more benzos for such a long time frame (it may be forever). Am I wrong to? What are my non-benzo alternatives other than Trazadone?
I think there is still quite a bit of debate about this. My opinion at this point is that the benzodiazepines have proven themselves safe for long-term use. I hope others offer their own opinions here. It is an important issue. You should be able to find related threads using the 'Search' function at the top of page.
> BTW, I also take a small dose (50mg) of Depakote to minimze any manic symptoms caused by Nardil. It works well. Maybe you should consider that for use in your bipolar treatment.
Thanks for the suggestion. Depakote has worked well for me during the few times I've had manic reactions to antidepressants. I might still consider it as an adjunct to antidepressants for the depression itself.I'm pretty sure you'll be able to improve your sleep somehow. I think it might be worth trying Neurontin (gabapentin). It can be a great help for sleep and is often very helpful for social anxiety.
Good luck.
- Scott
Posted by chad_3 on October 5, 2002, at 14:43:55
In reply to Re: Nardil veterans...how do you sleep? » dlevine, posted by SLS on October 4, 2002, at 12:16:25
I never had sleep problem with Nardil monotherapy at high dose - but ....
I know that sometimes trazodone (I don't really recommend it) is used.
Ambien is often used.
Klonopin I believe is excellent to try because if it works for you it may work very well without any undue negative effect.However I think the best solution is to avoid drugs to make you sleep unless unavoidable. If there anyway to keep yourself very alert during the day ... also good sleep habits ... well maybe nothing of great insight here ... but sometimes daytime sedation or napping can aggrevate insomnia ...
just a thought...
Chad
http://www.socialfear.com/
> Hi.
>
>
> > > I don't think Klonopin is as effective a hypnotic as these other drugs. Are you sure you need it to treat your SP? How often is Ativan effective for SP? Do you think substituting Ativan for Klonopin and adding one of the short-acting drugs might be worth considering?
>
> > My biggest problem is not falling asleep, but STAYING asleep. I rarely ever sleep more than 3 hours straight using my current sleep meds.
>
> > I take the Klonopin (and Trazadone) to fall asleep only--not to treat my SP. My Pdoc says that Klonopin is the safest benzo to use for sleep(it has a long half-life). I've never tried anything other than Trazadone & Klonopin for my insomnia. Maybe I should consider something else?
>
>
> I think the half-life of Klonopin (clonazepam) is far too long to be used routinely as a hypnotic to treat insomnia. It stays with you all day long. This is why I questioned as to whether it was a critical component to your SP treatment. Being in your position a few times, I have favored using either Ativan (lorazepam), which also has significant anxiolytic properties, or Restoril (temazepam). Both have medium half-lives.
>
>
> --------------------------------------
>
>
> Drug Name (generic name)
> Half-Life
>
>
> Klonopin (clonazepam)
> 30 to 40 hours
>
> Ativan (lorazepam)
> 12 to 18 hours
>
> Restoril (temazepam)
> 3.5 to 18.4 hours (mean 8.8 hours)
>
> Halcion (triazolam)
> 1.5 to 5.5 hours
>
> Ambien (zolpidem)
> 1.4 to 4.5 hours
>
> Sonata (zaleplon)
> 1 hour
>
>
> --------------------------------------
>
>
> > I fear taking more benzos for such a long time frame (it may be forever). Am I wrong to? What are my non-benzo alternatives other than Trazadone?
>
>
> I think there is still quite a bit of debate about this. My opinion at this point is that the benzodiazepines have proven themselves safe for long-term use. I hope others offer their own opinions here. It is an important issue. You should be able to find related threads using the 'Search' function at the top of page.
>
>
> > BTW, I also take a small dose (50mg) of Depakote to minimze any manic symptoms caused by Nardil. It works well. Maybe you should consider that for use in your bipolar treatment.
>
>
> Thanks for the suggestion. Depakote has worked well for me during the few times I've had manic reactions to antidepressants. I might still consider it as an adjunct to antidepressants for the depression itself.
>
> I'm pretty sure you'll be able to improve your sleep somehow. I think it might be worth trying Neurontin (gabapentin). It can be a great help for sleep and is often very helpful for social anxiety.
>
> Good luck.
>
>
> - Scott
>
Posted by dlevine on October 6, 2002, at 21:47:33
In reply to Re: Nardil veterans...how do you sleep? » dlevine, posted by SLS on October 4, 2002, at 12:16:25
> > > I don't think Klonopin is as effective a hypnotic as these other drugs. Are you sure you need it to treat your SP?
I don't need Klonopin for treatment of SP. Nardil works great on the SP. It's just the inability that sleep that requires me to take Klonopin on a nightly basis (with Trazadone). This combo is becoming less effective after taking it for several years, which is why I'm now looking for alternatives.
> ? Do you think substituting Ativan for Klonopin and adding one of the short-acting drugs might be worth considering?
Ativan might be very helpful as a hypnotic. But with the short half-life I am concerned with the greater potential for dependence, as well as short-term memory problems that long-term use of all benzos may cause.
> I think the half-life of Klonopin (clonazepam) is far too long to be used routinely as a hypnotic to treat insomnia. It stays with you all day long.
Right, Klonopin has a half-life of around 30 to 40 hours. For this reason it seems to hold less addictive potential than some of the shorter lasting benzos that you mentioned. That and memory loss is a major concern for me...although I'm not sure how much it is based on scientific studies as much as my own worries. I will need to get to sleep somewhow...
>This is why I questioned as to whether it was a critical component to your SP treatment. Being in your position a few times, I have favored using either Ativan (lorazepam), which also has significant anxiolytic properties, or Restoril (temazepam). Both have medium half-lives.
These are interesting suggestions.
> I'm pretty sure you'll be able to improve your sleep somehow. I think it might be worth trying Neurontin (gabapentin). It can be a great help for sleep and is often very helpful for social anxiety.
Thanks, I was considering Neurontin. But the cost (I have no insurance) is a little daunting.
Thanks again for all the info and advice.
-DL
Posted by dlevine on October 6, 2002, at 22:03:55
In reply to Is Sleep only main problem with Nardil?, posted by chad_3 on October 5, 2002, at 14:43:55
> I never had sleep problem with Nardil monotherapy at high dose - but ....
It's interesting how people can react so differently to MAOIs--insomnia has been my most troublesome side effect by far and hypotension has never been a problem for me.
> I know that sometimes trazodone (I don't really recommend it) is used.
Why don't you recommend Trazadone? I've used Trazadone & Klonopin as a hypnotic every night for several years. I simply cannot sleep without taking some kind of hypnotic. I've tried everything: lowering my Nardil dose, taking it at different times in the day, exercise, etc., and nothing works. As it is, I only get 3-5 hours of broken sleep each night--and that is WITH my Klonopin & Trazadone!
> Ambien is often used.
I've considered Ambien. But how safe & effective is Ambien over the long-term?
Again, my biggest problem is staying--not falling--asleep.
> Klonopin I believe is excellent to try because if it works for you it may work very well without any undue negative effect.
Yup, Klonopin has been my old standby for use as a hypnotic.
> However I think the best solution is to avoid drugs to make you sleep unless unavoidable. If there anyway to keep yourself very alert during the day ... also good sleep habits ... well maybe nothing of great insight here ... but sometimes daytime sedation or napping can aggrevate insomnia ..
Unfortunately, it is unavoidable. In a perfect world I wouldn't have this terrible side-effect of insomnia, but I've tried all the "natural" alternatives and nothing works.
Thanks for all the info and suggestions.
-DL
Posted by jsarirose on October 8, 2002, at 21:44:50
In reply to Re: Is Sleep only main problem with Nardil? » chad_3, posted by dlevine on October 6, 2002, at 22:03:55
> > I know that sometimes trazodone (I don't really recommend it) is used.
>
> Why don't you recommend Trazadone? I've used Trazadone & Klonopin as a hypnotic every night for several years. I simply cannot sleep without taking some kind of hypnotic. I've tried everything: lowering my Nardil dose, taking it at different times in the day, exercise, etc., and nothing works. As it is, I only get 3-5 hours of broken sleep each night--and that is WITH my Klonopin & Trazadone!I take Parnate (another MAOI) and Trazodone for sleep. I've tried numerous anti-depressents and every time I have insomnia with one I use Trazodone. I've tried Klonopin and others, but I've had the most success with Trazodone. The dosage varies from as little as 25mg to as much as 150mg depending on the other drugs I'm taking.
>
> > Ambien is often used.
>
> I've considered Ambien. But how safe & effective is Ambien over the long-term?I really don't recommend Ambien or Sonata. They are both sleeping pills and their effectiveness will wane over time causing you to need to keep increasing the dosage. They are really made for short-term sleep problems, not long term need. And they are addictive. I know Klonopin can be addictive too, but from what I've heard if it's used as a sleep aid it shouldn't really be too addictive. I've never heard if Trazodone is considered addictive, but I don't believe it is.
-Jessica
This is the end of the thread.
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