Hope for sleepless brain
May 31, 2011 6:32 AM   Subscribe

You are not my doctor, but I'm writing in the hope that someone has had a similar experience and might be able to help me see my way through this difficult situation. I've had a month of extremely strange experiences with psychoactive drugs, and I'm wondering if someone might reassure me that this situation is reversible. (Warning: long, messy situation ahead.)

About three weeks ago, I decided to see a psychiatrist for severe insomnia. I was also experiencing some depression, probably due to sleep deprivation. He prescribed Ativan, a sedative, and I took it for a few nights. I then did some research about benzodiazopines, which made me very alarmed-- they cause a variety of negative cognitive effects, and I tried tapering off the drug. When I tapered, I couldn't sleep at all, so I had to keep taking it. I also felt increasingly foggy, and had poor memory and concentration, and a really low mood during this time. My shrink wasn't worried about these things-- he said when weighed against not sleeping, it's more important to sleep. He also suggested we'd add Wellbutrin for mood, which I did after a week.

After a week on these drugs, my mood and focus got bad enough that I went home for a week to stay with my parents. At this time, I saw another shrink, who prescribed another sleeping med (Silenor/doxepin 6mg), which I took along with the Ativan. It worked the first night, and not at all the next few nights. My dad (a doc) then prescribed Trazadone, which I tried for a night after I came home, and the original shrink gave me Rozerem, which I tried the next night. The original shrink was kept apprised of these meds, and kept suggesting additional meds. I wasn't sleeping well, no matter what medication or combination I tried, so I decided to taper off the Ativan once and for all (the shrink said I could probably just taper slowly). The night I stopped taking it, I got a raging headache, went to the ER (they sent me home and said to take tylenol), and slept no (zero) hours. Things continued this way for the next three days (four days total without sleep)-- more headaches, pressure behind eyes, etc. My original shrink was out of town; I saw another shrink and explained the situation. He prescribed Lunesta, and also Seroquel (which I haven't taken yet), and I have been sleeping with the help of that med for the last few days. Unfortunately, I didn't really trust him and don't want to see him again.

Looking back, this drug blitz feels insane. I am a person who doesn't even use recreational drugs! I had poor judgment at the time, and wasn't making great decisions, and got some lousy advice, I think. Over the course of this, I'm afraid I've caused some permanent damage to my brain-- my eyes hurt, my head hurts, I feel like my brain is empty, and I can't sleep except w/ Lunesta. I've spoken about this with the psychiatrists, as well as a neurologist, and they seem to suggest that these physical problems are due to sleep deprivation and just keep prescribing additional medications (Seroquel, recently). I feel that the meds have caused lots of problems, and I'm hesitant to keep adding more to the mix. I'm currently looking for a psychiatrist I feel I might be able to trust more. One ray of hope: I had an acupuncture treatment last week that made me feel, briefly, normal again. But that was also the night I got the raging headache. Subsequent acu treatments haven't worked as well.

My question is: is the amount of medication and sleep deprivation I've experienced over the last month enough to cause permanent damage? Can the brain heal itself again? Have you or someone you know come through a similar situation and bounced back? I realize this all sounds insane-- believe me, it's uncharacteristically chaotic. I'm pretty terrified that I've done real harm here. I know the responses will be "see a doctor!" I'm going to try to see a regular physician this week. Is there a doctor or clinic in NYC you'd recommend to help deal with these issues? Psychiatrists seem to downplay the physical effects of medication. I've been frustrated so far with the medical advice I've received.
posted by anonymous to Health & Fitness (12 answers total)
You've seen four of five doctors (and an acupuncturist!) in a three week period and taken a number of different drugs and had a totally out of whack sleep.

I don't think that there is any way you're going to feel normal right now. You sound really really, totally understandably, stressed out and anxious.

You need though to keep in mind that lots of those drugs have side effects and some of them take some time to get used to and that this in combination with getting no sleep or inconsistent sleep and high anxiety over the situation is probably why you feel like crap.

You need to find a doctor you trust and stop jumping all over the map. I'm not a doctor but I've had sleep problems in the past and psychiatrists can be heavy handed with the sleeping medicine because sleep deprecation can be a really bad thing for you.

I don't think, from my totally non medical opinion, that you've done major harm to yourself but I do think you've gotten yourself overtired and stressed out. You should probably spend a couple of weeks working on getting decent sleep and doing things that reduce anxiety before making any dire predictions about the state of your brain. I bet after a few weeks of good sleep/less stress you'll feel much better.
posted by SpaceWarp13 at 7:00 AM on May 31, 2011 [5 favorites]

IANAD, but I'm a little confused as to what you are currently taking. Hopefully you can update us via a mod. What are you taking now? Are you still taking the Wellbutrin? Trazodone? Were you drinking with any of these meds? Were you on any other meds (non psych) that could be interfering? What was the dosage of these meds? When your head is hurting, what is your blood pressure? Could the headache be from high blood pressure perhaps? Are you taking HTP-5 or St John's Wort with any of these (don't do that!)?

Sounds like the Ativan wasn't the right med for you...that's OK, it happens. The headache may be some residual withdrawal from the Ativan. While you weren't on it long enough to establish a serious physical dependence on it, meds can affect everyone differently and it's possible your body needed a longer tapering period. It shouldn't have caused permanent damage in the short time you took it. Wellbutrin could be the problem...it causes some off the wall side effects in people who are too sensitive to it. Most people can either tolerate Wellbutrin or can't...there seems to be very little "in between" there.

Depression can cause insomnia and poor judgement, so the depression may not be a side effect of the insomnia...the insomnia may be a side effect of the depression. Finding the right anti depressant unfortunately takes some time and trial. Wellbutrin can cause insomnia and headaches, so that may be your culprit right now. In the psych hospital we would often give trazodone for sleep and for chronic headaches...it is an older antidepressant that I've seen combined with other meds before. My grandfather was given trazodone for headaches and sleep problems when he was having issues related to Parkinson's. It helped him, and also helped his tremors somewhat. Does the trazodone help with headaches?

I'm curious about the Seroquel prescription. I've heard of it being prescribed along with antidepressants to "boost" the effectiveness of the antidepressants, but not with Wellbutrin. Honestly, I wouldn't try it along with the Wellbutrin...I've heard of so many people who just simply can't tolerate the Wellbutrin so they can't take it. I would talk to a doc about tapering off that first before you start adding other things to the mix. And TAPER the right way! Antidepressants are meant to build up in your body over time (which is why they say you have to take it for 4 weeks before you really know how effective it will be) which means you have to taper back down over a period of weeks. You can't just cut the dose in half one day and quit the next. Benzodiazepines are shorter acting, so you can taper those off more quickly (based on how long you've been taking them).

In short...I seriously doubt you did any permanent damage. I think you've got some drug interactions going on, and that you probably need an antidepressant but haven't found the right one yet. The next doctor visit you have with a psychiatrist you should take a list of all the meds you've tried, along with when you started and stopped them and the side effects of them. That will probably help narrow down the type of meds you need. If it were me, I'd lean more toward the Lunesta for sleep (it's not a benzo and acts differently in the body, so as long as you get a full 8 hours of sleep and take it correctly it should be easier to adjust to) and then try a different antidepressant (I've had good experiences with Celexa/Citalopram in the past but you have to give it a solid 4 weeks before deciding if it's making a difference or not).

In short, be wary of a doc that just wants to keep adding meds on top of what you are taking without stopping other meds. If you are in crisis and really need to sleep, a benzo or even a muscle relaxer is OK for one or two nights, but I wouldn't want to start stacking them all together.

Remember, IANAD, and IANYD or Psychiatrist or anything official (just worked in a psych hospital and absorbed a lot of knowledge from the doctors there).
posted by MultiFaceted at 7:08 AM on May 31, 2011

No, you haven't experienced permanent damage. Stop reading about benzodiazepines on the internet. Throw out the Seroquel. Take the Lunesta every night until you have had so many solid nights of sleep that sleep is no longer a scary prospect, and you are functioning well during the day. Then decide how you'd like to proceed, as far as tapering off Lunesta and/or addressing whatever issues sent you down this little path. Don't worry; you'll be fine.
posted by kmennie at 7:16 AM on May 31, 2011 [3 favorites]

Damn, that does seem to be quite a bit of medication to use within a month.
I have insomnia due to my pain and have tried pretty much all the drugs you've listed.
The brain is very plastic when it comes to bouncing back from medications/trama. I would be more concerned about sleep depravation as you'd be more prone to accidents.
Personally, I would try to find anything that helps sleep, narcotics. Also try exercise if you can to try and wear yourself out.
IANAD, but I wouldn't be to concerned with the medications as long as you take them as directed.
posted by handbanana at 7:17 AM on May 31, 2011

Your brain is not broken.

Ativan is not really appropriate for treating sleep disturbances, unless it's specifically anxiety that's keeping you from sleeping. Even in that case, it should only be used for a period of weeks. Lunesta and other so-called z-drugs should not be mixed with benzodiazepines like Ativan. Lunesta is not ideal for taking every night, as many people develop tolerance to it, as well as rebound insomnia upon cessation.

Trazedone is an antidepressant sometimes used as a sleep aid, and is relatively easy to tolerate. Since you mention headaches, I will note that it can cause temporary swelling of the sinuses and other areas. Dozepine is a tricyclic antidepressant, which tend to have a fair number of side effects, but it is sometimes used for the treatment of insomnia. I'd say there are better options, but a low dose won't do you much harm.

I remain unconvinced that Rozerem actually does anything, but in any case the side effects should be minimal.

Do not take the Seroquel. It's an antipsychotic and is truly not meant to be used as a sleep aid, though some misinformed doctors do so anyway. Toss it.

Stay off of all caffeine and other stimulants. Wellbutrin can definitely contribute to insomnia, so avoid it. If you want a light OTC sleep aid, go with 25-50mg of benadryl.
posted by dephlogisticated at 7:39 AM on May 31, 2011

My (terrible terrible) former Dr put me on a very low dose of Seroquel once - it turned me into a zombie. I did not need to be on it, and I took it because she told me to. Do not take it.

I hope you can get some sleep soon. And I was going to suggest benadryl, too.
posted by bibliogrrl at 7:54 AM on May 31, 2011

Are you still taking the Wellbutrin? I'm on 100mg/day, and anything higher than that gives me crazy insomnia.
posted by telophase at 9:22 AM on May 31, 2011

Doctors and therapists are great, but I think it's a good time to collect all your bottles, walk down to a pharmacy, and talk to a PHARMACIST. They can't prescribe, but their job is to know about drugs, side effects, interactions, etc. They can get you more informed, and that ought to help you feel less frightened as you figure out what comes next.

They can also do this by phone, but I find people are kinder with their time when you are standing in front of them, plus, with this many prescriptions, visual aids may be helpful.
posted by Ys at 9:55 AM on May 31, 2011 [1 favorite]

Wellbutrin caused me to have severe insomnia for the first 2-3 weeks I was on it, but that side effect eventually went away. If you are still taking it, do you take it first thing in the morning? If you take it later in the day that could definitely be contributing to your inability to sleep.
posted by FormerMermaid at 12:07 PM on May 31, 2011

I'm just guessing here based on the tone of your post, but do you think your original problem of difficulty sleeping might have some connection to more general feelings of anxiety? Seeing a therapist, rather than just a psychiatrist, could be very helpful.
posted by so_gracefully at 1:58 PM on May 31, 2011 [1 favorite]

You probably haven't hurt your brain. Have you been taking Tylenol for the headache? Tylenol can result in a killer rebound headache. Try to go off your pain meds if you can stand it, stay hydrated, and stay fed.

Don't panic about the Lunesta. You're not going to get addicted to it, and you need the sleep so you can make good decisions for yourself.

And yes, I would talk to a regular doctor in addition to a psychiatrist. It sounds like sleep deprivation to me (which can be think-I'm-gonna-die horrible) but you need to go about this in a systematic way.
posted by thinkingwoman at 3:28 PM on May 31, 2011

Holy shit.

That's a lot of different meds of that kind to go through in *six* months, much less one. Still, you haven't screwed yourself up permanently. Long term sleep deprivation has been shown to damage metabolism and cognitive function in a way that's difficult to recover from - but that's for decades of sleep deprivation, not a few weeks or months.

Don't ever (ever) just go cold-turkey on these kinds of medications, unless you *really* want to feel horrible. Some will also have more serious withdrawal side-effects than simple headaches, pain, shakes, or insomnia, especially in combination.

Also, be patient. It takes weeks for antidepressants to kick in properly, for the side effects to die down, for you to adjust to them - and that's *if* you started on the right dosage. Go slowly. You can't hurry this process without feeling really messed up, as you've just discovered. Slowly on, slowly off.

Sleep-wise: I assume you've tried all the normal sleep hygiene things - no sugar for a couple hours before bed, no entertainment or bright lights an hour before bed, doing nothing in bed except sex and sleep, no caffeine at all, no alcohol, warm drink before bed, comfortable temperature in the bedroom, all that stuff? Keeping a sleep diary so you know your sleep efficiency rate? If you are lying in bed stressing about sleeping, get up, do something relaxing but boring - no TV, computers, books, internet, phone. Daily morning exercise to get sunshine. Good diet (whatever that means for your body). Enough water.

Don't stress about changing things all at once, either. Just make small changes, incrementally.
posted by ysabet at 6:51 PM on June 1, 2011

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