I was previously on 30mg of Remeron, then on feb 20th went to 15mg Remeron, 10mg Lexapro, then on the 27th stopped the Remeron and have just been on 10mg Lexapro (taken in the morning first thing). I woke up last night with an anxiety attack at 3:30 am and couldn't get back to sleep, I felt like I was losing my mind. I have had problems with chronic insomnia in the recent past and it is coming back.

I have GAD--sorry if this is coming out weird--I am just worrying about everything now; my anxiety has come back since starting the Lex. I know that anxiety is common on Lexapro startup--how long did it take to go away? If you have insomnia, what drugs do you take for it--ambien, trazodone (I have some of both in my medicine cabinet), I can also continue to take 15mg Remeron at night for sedation--anyone else take this with Lexapro? Did the insomnia get better with time as you got used to Lexapro?

I go to the tribal clinic for treatment--have a psychologist for talk therapy/cbt and a family nurse practitioner for meds. I am asking for advice now from you guys about the Lex stuff because as a family np handles my meds and not a pdoc, I would like to get advice from people out there on the home front.

Thank you!!!

Hi Croser --

I'm sorry to hear that you had such a rough night a couple nights ago. An increase in anxiety and insomnia are common start up SEs for Lexapro (and many other ADs), as a you well know -- I know that doesn't make it any easier! Feeling like you're "losing it" -- unfortunately, that's common too for many during this phase. Don't despair. You won't lose it. The start-up phase can be frustrating, but most (if not all) of your SEs should pass within the first couple weeks. Hang in there!

I had insomnia while adjusting to Lex and took Ambien CR for the first 7 or 8 weeks. Like you, I had a preexisting insomnia issue, but I'm sleeping better now that my body's accustomed to Lex. I've heard that Trazedone can help too. I don't know anything about Remeron (sorry). Do be careful with taking sleep aids long term -- they can contribute to depression. But don't hesitate to talk to your doc about it if you need something to get you over the hump.

Hang in there, Croser!
HopefulOne

Thank you for all the replies, Hopefulone! I appreciate it. I saw my doctor today and told her about the anxiety/sleeping, and she said to move up to 20mg Lex so I'll see how that goes. Yes the startup phase is very frustrating--especially when the symptoms that you want to treat get worse!!! Thanks for the encouragement.

I really don't like using Ambien, because of the addiction factor. I didn't know that sleep aids could increase depression, though--do you know why that happens? Is it only hypnotics (like Ambien)? I just started a new job this week, though, so I definitely need sleep, so I'll take it if I need it.

Thanks for the advice!!!

Hi Croser-

Like HopefulOne, I had start-up anxiety with Lex that lasted a few weeks -- it was really upsetting to me -- but it's different for everyone. It went away as the body/brain adjusted to the Lex. I'm now on 20mg taken at bedtime, which seems to work fine. After two months, I added Wellbutrin in the mornings, which really helps a lot with energy. (Lex can be sedating, while WB is often activating. But, again, everyone is different. Lex could turn out to be activating for you.)

And, yes, be real careful if you opt for Ambien (technically called a 'hypnotic,' like Sonata) or any of the benzos (clonazepam, Valium, Ativan, etc), which are known technically as 'tranquilizers.' Both of these families of drugs work similarly on the brain. And studies show that most people start seeing signs of tolerance/addiction after just a few weeks, as well as memory problems.

Also, the reasons these medicines (benzos, as well as Ambien and its ilk) can cause or aggravate depression is that they are 'central nervous system depressants.' Specifically, they work to enhance GABA, a neurotransmitter whose role is to send 'inhibitory' messages from one brain cell to another. What scientists suspect they are doing (it's still not entirely certain) is this: In some way, directly or indirectly, these meds are telling the neurons to slow down or stop firing (which quiets down the brain). This is done electrically in a way that 'supercharges' the neuron. But it also makes the neuron LESS RESPONSIVE to other neurotransmitters that would normally excite it. Result: The brain's output of the excitatory neurotransmitters (i.e. serotonin, noradrenaline, dopamine, etc) are reduced! And you know what happens when those things get reduced, right? DEPRESSION!

That's why you really have to use those meds sparingly! When starting on Lex, I held off a long time before taking a little clonazepam for the anxiety, because of the risk of aggravating depression. That said, I'm really glad I finally took some (!) for a few weeks (okay, one month- I admit it). But I'm equally glad I stopped.

If you do go that route, here's my two cents: Go with clonazepam. Its half-life is much, much less than valium (meaning it exits the body sooner). And while its half-life is longer than xanax, I think the consensus among docs is that it's less addictive than xanax.

You asked about trazodone and remeron. These are antidepressants, and so there's no evidence of the risks that the benzos and hypnotics have (memory loss, addiction, etc). But since both tend to be very sedating, they can help a lot with sleep and anxiety.

All that said, here's an idea you might want to at least consider: Just following the body's lead in terms of sleep. Worst-case scenario: You go to work on just an hour or two of sleep, but so what? Then you'll be good and tired when you get home and can naturally sleep again. I know it's easier said than done, but it's always seemed to me that people (myself included!!) worry too much about getting a good night's sleep EVERY SINGLE night -- as if some horrible tragedy will unfold if they just follow the body's lead and sleep when their body is ready to. And it WILL eventually be ready to, much sooner than you think!

Hang in there!!!

Cheers.

This post has been edited by MichaelBlue: Mar 5 2008, 06:51 PM

Hi MichaelBlue!

Thank you for your thoughtful reply; I found it very informative. I understand now why hypnotics and benzos can aggravate depression--I've heard that a few times before but I always like to know the WHY behind these things. Thank you for explaining it to me.

I've been prescribed clonazepam in the past, a few months ago when I had really awful insomnia/anxiety and felt like this: But I don't plan on asking for/accepting it in the future unless the situation is absolutely dire again.

I've hidden the Ambien away--for use only if I REALLY need it. "Just following the body's lead in terms of sleep"--good advice, I will keep that in mind and at least try it for a few nights (I have Tylenol PMs otherwise). I know that I should do that and a lot of this sleep problem is "in my head," but I have really bad (recent) memories of months spent in sleep deprivation and eventual breakdown from insomnia (I was also off my anti-d's then, so that was probably a major contributing factor ... anyway ...).

Thank you again, MichaelBlue!

Croser