Bad dreams: Is it the trauma or the drug to treat the trauma
August 16, 2017 9:29 PM   Subscribe

I have bad dreams, a lot. They usually revolve around trauma I experienced when I was younger and my family's reaction = woefully inadequate, hurtful, not something I can stop thinking about really. Well, all of the trauma took place within the family. So I take 20mg of Lexapro a day. I have heard that Lexapro can in fact cause bad dreams, or is really just stuff sticking around in my head that I haven't fully processed, despite having several years of therapy.

This week has been particularly bad. Not just a dream here and there, but all night, a long sequence of dreams that are usually about the same thing, and just repeating over and over. I can wake up exhausted, and depressed. Sometimes it takes me ages to get into functional mode for the day, and sometimes it doesn't happen at all. So what can I do? Do I get myself off the meds? I frequently write in a journal but that doesn't really seem to help... Btw, heavy snowflakes - my older brothers sexually assaulted me when I was young, and I lost a younger brother to suicide. My mum, whom I supported for many years after this and didn't disclose the abuse to, as I'd felt she couldn't cope with it (she accidentally found out) now has , I guess 'sided' with my brother (s). She's made various ridiculous remarks, like. 'oh boys are horny at that age' , 'you'll be okay', 'you're too angry', and more recently, 'it's harder on those unforgiven', for which I just had to cease communication with her, and these things STICK, really hard. How she has been - minimising, ignoring, and then supporting my brother (the main perpetrator) is just so painful and is often what I dream about. So, back to the main question - and it all may seem obvious, but I've had LOADS of therapy; is it the SSRI? I don't really remember having these dreams before Lexapro but then that was ages ago...
posted by summerinwinter to Health & Fitness (18 answers total)
My deepest apologies for pressing publish too soon...

I am so very sorry for what you have gone through. Uh, is there a reason you are in therapy and maintaining an active relationship with your family? Has your therapist helped you process this or discussed other options? Have they helped you fully feel and process anger and grief towards your family? I ask because in my humble experience, only the rare unicorn could actively remain in relationship with people who hurt us during any attempt to process and heal that type betrayal and abuse.

I feel like long term you have other options besides years of medication and processing abuse while maintaining a facade so your abusers and their enabler can continue to feel comfortable.

Please look into better care, think about putting together a new team to address your recovery and wellbeing. You are worth the best professional care available, go find a new team. Taking these steps might temporarily help with the nightmares, too, because taking positive action on your own behalf sends powerful messages to your subconscious. You are worth this and so much more. You have agency.

Short term, call your prescribing physician. It is this person's job to talk to you about side effects and tweaking your dose. Please call your prescribing doctor about your change in condition.
posted by jbenben at 10:00 PM on August 16, 2017 [1 favorite]

There are many different antidepressants out there and each has its own profile of side effects. If Lexapro is the problem, that doesn't mean that you have to go off all medication - your doctor may be able to find another one that works better for you.

Second, I think EMDR is a particularly good fit for this kind of very specific trauma memory that is playing over and over in your head. It's not the only modality - when I looked into it a few years ago, research showed that it was demonstrably effective although not necessarily more effective than other similar techniques without the cross-brain stimulation. But it is well known and not hard to find trained therapists if you live a big US city. Also, sometimes you can see a specialist for a limited number of EMDR sessions while continuing to work more generally with your own therapist - ask about it if that would be something that appealed to you.
posted by metahawk at 10:20 PM on August 16, 2017

Hey, I've been through similar abuse (down to my mom siding with the abuser, of course), and I am so sorry you are going through this. If you are open to it, I have found cannabis will often give me dreamless sleep (or at least I don't remember the dreams). On the woo end of things, put a black stone like obsidian or a purple one like lepidolite under your pillow for easy sleep and no nightmares. Talk to your psychiatrist because it very well may be the medication--I don't personally have experience with Lexapro. Your psychiatrist can prescribe you something that won't cause the vivid dreams. Good luck!
posted by shalom at 10:43 PM on August 16, 2017 [1 favorite]

My mother is on Lexapro, and we just went to her doctor yesterday because she's been having nightmares and hallucinations. Because mom is old and has multiple serious health problems, they're doing some tests before they decide it's the meds, but yeah, it could definitely be the Lexapro. And if so, there are many other meds you could try.
posted by MexicanYenta at 10:50 PM on August 16, 2017 [1 favorite]

For me, lexapro fixed the very vivid nightmares that I had had my whole life. However, they come back big time if I take benadryl for allergies. According to my prescribing physician, this is a very common interaction. Just flagging in case that might be the cause.
posted by BusyBusyBusy at 11:04 PM on August 16, 2017

This is maybe a different approach and I don't mean it to be an "aspirin and walking cane" remedy for something that may seem crippling. I can only tell you I cannot bear to wake up to my dreams and what seems to help me is listening to radio shows when I fall asleep, so when I wake up there's a shift in direction to whatever is playing.

There are many podcasts and radio apps - iTunes, TuneIn, and others. Stitcher is nice because it has autoplay lists of your favorite podcasts and it's what I use every night.

I understand the appeal of wanting to chemically contain the mind, and maybe we can, sometimes. But podcasts every night have helped me outmaneuver it instead, redirecting dreams toward other things.

You can't slow the car down and maybe it'll never stop but maybe each night you can take another exit instead.
posted by plexi at 11:28 PM on August 16, 2017 [1 favorite]

I take Lexapro along with other medications and I too have disturbing nightmares. I have come to terms with the fact though that for me these nightmares are 100% unresolved fears and PTSD related issues that I need to keep working on with my therapist and psychiatrist. I wonder if maybe you need an augment to the Lexapro (in addition to CBT and EMDR to help sort through your trauma). Maybe talk to your doctor about adding an anti anxiety medication since (at least for me) Lexapro is just an antidepressant?
posted by Hermione Granger at 11:58 PM on August 16, 2017

Is it worth learning to lucid dream, so you can change the ending? Start keeping a dream diary by the bed. Maybe your brain will get tired of recording the same crap every day.

Nightmares on the whole are indicative of serotonin imbalances, I hear. I sometimes go through violent dream jags myself — being stalked or harassed, or even committing crimes. On those weeks I set a little altar and light a tea candle, settling my mind and watching the flame burn. The warm light casts a protective glow. Try a ritual act to focus you.
posted by fritillary at 12:57 AM on August 17, 2017

PTSD related nightmares are not uncommon. In fact there is a medication called prazosin which, for many people, dramatically reduce their PTSD related nightmares. Maybe you can discuss the possibility that these are from PTSD with your medical practitioner.
posted by teamnap at 5:55 AM on August 17, 2017

Smoking an indica or taking an edible before bed should, over time, tamp down the vivid dreams/nightmares.
posted by Dressed to Kill at 6:33 AM on August 17, 2017 [1 favorite]

It could very well be both.

Last winter I had an exhausting bout of nightmares that replayed childhood abuse I'd experienced (and kind of forgot about). It didn't get better until I did some intensive trauma work, but I also switched up my antidepressants (though that came months after).

Like you, I've been in and out of therapy my whole life, so the self-guided work was very much grounded in that foundation. Here's what I did:
- distress tolerance (DBT) activity every day
- doing 1 kind thing for myself every day (in my case the very basics from Maslows hierarchy since I was failing to eat and even drink water)
- reading others experiences on r/cptsd and r/raisedbynarcissists
- I found workbooks, rather than journaling, helped me process my past in such a way so I wasn't ruminating.
- the workbook I used was "The Complex PTSD workbook" by Arielle Schwartz, PhD.
- I've heard great things about the book "Complex PTSD: From Surviving to Thriving" by Pete Walker.
- being patient with myself and how long the healing process will take as long as it needs.

You went through some awful things and are still being treated terribly. But having finally made it through to the other side (and I'm now 40) I can only encourage you to make your way through too - it really is better here.
posted by A hidden well at 6:40 AM on August 17, 2017 [1 favorite]

How she has been - minimising, ignoring, and then supporting my brother (the main perpetrator) is just so painful and is often what I dream about. So, back to the main question - and it all may seem obvious, but I've had LOADS of therapy; is it the SSRI?

It could be the SSRI, though I think that sometimes the dreams that come up with SSRIs can actually be part of the healing process, but you're describing current events with your mother that are triggering the dreams. I'm not sure past therapy makes a ton of difference here -- you have a current ongoing stressor that is impairing your ability to function day-to-day. I think you need a therapist trained in treating trauma to help you through this -- not necessarily to rehash all the past (though it might need some re-processing, if it's coming up now) but to help you process the present.
posted by lazuli at 6:48 AM on August 17, 2017 [2 favorites]

Datum: I take that same Lexapro dose, and have taken a higher one in the past, but do not have nightmares.
posted by radicalawyer at 9:02 AM on August 17, 2017

Have you ever been tested for sleep apnea? Once I got my CPAP machine and started actually enjoying extended deep (REM) sleep, I not only felt worlds better all around but my dreams - or at least dream recall- were cut by 90% across the board. Now I only really dream when I don't use my machine and sleep crappily as a result.
posted by gottabefunky at 10:42 AM on August 17, 2017

Hi everyone, many of your suggestions are really good. I think maybe EMDR may be a good thing to go to. I'd like to smoke cannabis, but it makes me very neurotic. My therapy in the past, which was for about 11 years was gestalt therapy. It did help me remarkably in many ways; I've gotten to a much better place and even have a fulfilling and wonderful relationship and good job and all of that. But yes, never helped with the dreams, the therapist loved to psychoanalyse them which was somewhat enlightening but that's it. I did ask my doctor about this and she suggested a bigger dose of lexapro, which i'm skeptical about. I don't have relations with my family, except for one sister (I have two older sisters, a family of 6 originally). I tried to maintain a relationship with my mum, but it just kinda tore me apart, each time she was dismissive or offensive, so I put a stop to it last year. All we did was email every month or so about nothing at all. And this for some reason I always feel guilty about, but, self-preservation... we live in different cities, thankfully. I will look into sme of the options suggested, and try some podcasts too. I do love podcasts. Thanks, all
posted by summerinwinter at 4:37 PM on August 17, 2017

Chiming in to recommend prazosin. It saved my sanity when I was having PTSD related nightmares and it really had no side effects except light headedness. I'd try that before a raise in the AD. It's just an old school blood pressure med that the VA found out helped vets with PTSD sleep better.
posted by kanata at 8:43 PM on August 17, 2017

yes, actually yes, prazosin, I will pursue that option, definitely... thank you
posted by summerinwinter at 10:30 PM on August 17, 2017

Hi, therapist here. Prazosin is definitely worth a trial - I've seen a lot of people find relief with it, thus helping you work deeper in therapy.

Gestalt can be really powerful therapy, but it's not focused on skills that help reduce the impact of trauma. I'd invite you to investigate DBT (dialectical behavior therapy) if possible. DBT is skills-based, including distress tolerance and emotional regulation under stress. EMDR is also a good way to approach disturbing memories in a controlled environment.
posted by catlet at 5:11 AM on August 18, 2017 [2 favorites]

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