# Antipsychotics for insomnia



## korey (Apr 25, 2006)

I know a fair amount of people who use antipsychotics like Seroquel for treating their insomnia. I am considering trying an antipsychotic for my insomnia as well. Seroquel acts like a potent antihistamine, from the way I understand it. It would be a good candidate for me in treating insomnia, but it is a little too expensive. I have been trying regular immediate-release generic Ambien 10mg this past month, but it only seems to work at higher-than-prescribed doses, and it also has a funny side-effect of causing me to hallucinate. I can live without the hallucinations :b so I think it is a safe choice for me to drop the Ambien and move on to something else. This leaves me with either tricyclic antidepressants or antipsychotics as possibilities for treating my sleeping problems. I've read about Doxepin, a TCA with very potent antihistamine qualities, but the heart irregularity that can happen with TCAs just scares me, so I am somewhat turned away from them. Antipsychotics seem to be the last area to explore before giving up.

As I said, Seroquel and newer antipsychotics like it are too expensive for me. This led me to consider an older medication that I've had some minimal experience with in the past: Thorazine. I tried it once at 10mg per day for a month to see if it had any appreciable effects on my anxiety, and it did at first, but then those effects seemed to just disappear. With Thorazine being such an old antipsychotic, it is very cheap, so cost would not be a problem. Anyway, I was reading about the dosage levels for treating restlessness and anxiety before having surgery (it was the closest indication to insomnia that I could find), and it suggests a single dose between 25mg and 50mg is best. I think it might be difficult to talk my psychiatrist into prescribing Thorazine 50mg PRN for insomnia, but with newer antipsychotics like Seroquel being prescribed for insomnia, I honestly don't see what the big fuss is over.

Anyway, what do you make of this prevalent usage of antipsychotics in the treatment of insomnia? Have any of you ever used an antipsychotic for insomnia? If so, which one was it and which dose were you taking before you gained control over your insomnia (if any)? I have a feeling that some people might want to comment about my suggestion of Thorazine for insomnia being as it's a rather stigmatized and "terrible" drug, but I am in search of what an antipsychotic basically does - it slows the mind and body. Let me know what you think about any of this, and please feel free to make any productive suggestions.

Things I have tried to control my insomnia:
-Ambien
-Ambien CR
-Rozerem
-melatonin tablets
-every OTC antihistamine I could find
-trazodone
-Valium (which works great, but my psychiatrist would explode if I hinted at him prescribing two benzos for me - the other is Xanax)
-promethazine (a cousin of Thorazine...it works well being as it is a particularly potent antihistamine, but it usually works _too_ well being as it makes me an unwakeable zombie the following day)

I have also tried improving my "sleep hygeine", but that was a no-go. Even if I stay away from my bed all day and only lie in it when I intend to go to sleep, I still stare at the ceiling for hours and hours.

Replies are appreciated. Thanks!


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## mserychic (Oct 2, 2004)

Just in my opinion having been through a few antipsychotics.. I wouldn't mess with them unless necessary. I can't believe drs prescribe Seroquel for just insomnia. Sure it knocks you out but tolerance builds fast, leaves most people a zombie the next day and the side effects aren't worth it. Why not try some other rx sleeping pills first? or get a giant mallet :b


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## korey (Apr 25, 2006)

*Re: re: Antipsychotics for insomnia*



mserychic said:


> Just in my opinion having been through a few antipsychotics.. I wouldn't mess with them unless necessary. I can't believe drs prescribe Seroquel for just insomnia. Sure it knocks you out but tolerance builds fast, leaves most people a zombie the next day and the side effects aren't worth it. Why not try some other rx sleeping pills first? or get a giant mallet :b


We have similar names! Neat.

I agree with the suggestion to stay away from antipsychotics unless they are deemed necessary, but in my case, I can't really think of anything else. The only other Rx sleep aid that I haven't tried is Lunesta, but it's just another fancy GABA modulator like Ambien (not to mention that Lunesta is still under patent, which gives it a hefty pricetag). There are barbiturates out there that are still used for sleeping problems, but if my psychiatrist won't go for prescribing Valium for sleep alongside Xanax for anxiety, then I seriously doubt he would give any thought to prescribing a barbiturate for sleep (particularly in a patient with a history of suicidality like myself ops). If anyone can think of any other prescription sleep aids that have gone generic (that I haven't already tried or ruled out), then please post them!

The giant mallet might work, but I don't want to wake up covered in blood and suddenly retarded. :b


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## nothing to fear (Mar 23, 2005)

antipsychotics seem to have a bad rap, because of their name... 'antipsychotics'. they are not as strong as you think. they have many other uses other than treating mania and psychosis (look it up - http://en.wikipedia.org/wiki/Seroquel) . seroquel is basically a tranquilizer. i take 300mg and it usually knocks me out after an hour or so, but it is hard getting up if i don't take it early enough although you adapt after a while. it has not make me a zombie or clouded the next day, and so far i have not had any unpleasant side effects. my father also takes it at the same dose and hasn't had a problem with it.

i go through periods of insomnia, and it didn't really work then... i'd wake up several times during the night, but on the other hand i was on a lower dose and the insomnia gradually got better as the dose was raised. i would reccomend it, if sleeping aids haven't worked for you (none have worked for me either).


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## Noca (Jun 24, 2005)

zopiclone, trazodone, klonopin, and zyprexa will knock me out for sure.


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## Speak Easy (Jun 27, 2006)

I wouldn't wanna be on an antipsychotic for anything but psychosis or schizophrenia. If there were an identifiable precipitant such as the death of a loved one, then benzos could be used for about a month. However, Ambien and Sonata have less potential for tolerance and less daytime sedation. Then there is Lunesta, a benzo receptor agonist with a 6-hour elimination half-life, which is quite effective. If daytime sedation isn't a problem and you can get your hands on a benzo as a sleep-aid, then get Dalmane, which has an extremely long half-life.

_Possible treatments_:

Insomnia agents: Ambien, Sonata, Lunesta, Halcion, Restoril, and Dalmane

ADs: Trazodone, Sinequan, Elavil, and Remeron

Antihistamines: Benadryl


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## a ibrahim (Oct 29, 2004)

You didnt mentioned what is your diagnosis and medication.
old antipsychotics are contraindicated for SA and depression,take care.
Atypical antipsychotics have the ability to slow down the intensity and the continuity of thinking, so they may enable you to sleep,I find 1 mg of risperdal to help me sleep easy without side effects.
Tricyclic antidepressants have more side effects than others,but it does not mean to escape from them if they can help,I have tried most of TCA,and I think most patients can tolerate them at moderate doses,amitriptiline and clomipramine have sedative effects and help sleep.

Good luck


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## Speak Easy (Jun 27, 2006)

*Re: re: Antipsychotics for insomnia*



a ibrahim said:


> You didnt mentioned what is your diagnosis and medication.


His meds are in his sig


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## a ibrahim (Oct 29, 2004)

Yes,lithium combined with paxil,I am on lithium and celexa,both are stimulant to the level that i cannot sleep without risperdal ,celexa and lithium causes the insomnia for me,I think he can add risperdal to lithium and paxil,lithium is a mood stabilizer when added to SSRI it augments it,adding risperdal you may get double augmentation,at least this is what I find.
I am in doubt about adding TCA as a sleep aid,to lithium and paxil,the combination may be not safe,at least theoritically.


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## Speak Easy (Jun 27, 2006)

Lithium, Paxil, and a TCA wouldn't have any special contraindications, I don't think. However, it would be pointless to add a TCA as a sleep-aid after the long list of alternatives above. There are numerous other sleep-aids that one could try before even thinking about resorting to TCAs and/or antipsychotics for secondary sleep treatment


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## korey (Apr 25, 2006)

*Re: re: Antipsychotics for insomnia*



Speak Easy said:


> I wouldn't wanna be on an antipsychotic for anything but psychosis or schizophrenia. If there were an identifiable precipitant such as the death of a loved one, then benzos could be used for about a month. However, Ambien and Sonata have less potential for tolerance and less daytime sedation. Then there is Lunesta, a benzo receptor agonist with a 6-hour elimination half-life, which is quite effective. If daytime sedation isn't a problem and you can get your hands on a benzo as a sleep-aid, then get Dalmane, which has an extremely long half-life.
> 
> _Possible treatments_:
> 
> ...


I already listed Ambien and trazodone on my list of things that didn't work. I also said that my psychiatrist is not willing to prescribe Valium as a sleep aid, so he probably is not willing ot prescribe any of the other older sleep benzos (I asked him about Restoril once, and he pretty much dodged it like a bullet). Sinequan is aka doxepin, right? That is the TCA I was thinking about when I wrote about TCAs in my original post. The can cause heart irregularity, from what I've read. I don't particularly want that. I had considered Remeron, but I've read that it causes weight gain worse than the stuff I'm taking now. It's just a giant antihistamine, anyway. Just like Sinequan and Elavil and Seroquel. On a final note, OTC antihistamines don't work for me anymore.


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## korey (Apr 25, 2006)

*Re: re: Antipsychotics for insomnia*



a ibrahim said:


> You didnt mentioned what is your diagnosis and medication.
> old antipsychotics are contraindicated for SA and depression,take care.
> Atypical antipsychotics have the ability to slow down the intensity and the continuity of thinking, so they may enable you to sleep,I find 1 mg of risperdal to help me sleep easy without side effects.
> Tricyclic antidepressants have more side effects than others,but it does not mean to escape from them if they can help,I have tried most of TCA,and I think most patients can tolerate them at moderate doses,amitriptiline and clomipramine have sedative effects and help sleep.
> ...


My diagnosis is major depressive disorder, social anxiety disorder, and "bipolar tendencies."

I have been on a small dose of Thorazine once before to see if it would affect my anxiety any. It did for a while, but then it stopped. It did provide some relief from physical and mental stress when I was going to sleep, though.

Risperdal is available as generic risperidone, but both are still more expensive than a generic drug should be.


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## korey (Apr 25, 2006)

*Re: re: Antipsychotics for insomnia*



Speak Easy said:


> Lithium, Paxil, and a TCA wouldn't have any special contraindications, I don't think. However, it would be pointless to add a TCA as a sleep-aid after the long list of alternatives above. There are numerous other sleep-aids that one could try before even thinking about resorting to TCAs and/or antipsychotics for secondary sleep treatment


The insomnia relief I'm seeking wouldn't be secondary, I don't think. I've tried Valium (a full-blown benzo) as a sleep aid. It works great, but there's no way I'm going to get a Rx for it just for sleep. I've tried Ambien (a mini-benzo) as a sleep aid. It works, but only a high doses, and it comes with the side effect of making me hallucinate. I've tried trazodone (an antidepressant) as a sleep aid. It worked for a while, but then it quit. Even at doses up to 450mg, I wasn't feeling any sedation. I've tried Rozerem (a melatonin modulator) as a sleep aid, but it didn't do anything. Melatonin tablets from the pharmacy (OTC) work well, but only when taken in excess, and I usually wake up with a very unpleasant headache after sleeping through them. OTC antihistamines generally don't work. Benadryl hasn't made me sleepy since I was 10. Not in normal doses, at least. Unisom (doxylamine succinate) works well for me, but it takes forever to kick in and leaves me with those morning-after side effects that antihistamines are known for (dry mouth, stuffy nose, blotshot eyes, etc.)

So, I would say that the treatment I'm looking for is tertiery at least. I've tried the benzos, the semi-benzos, the antihistamines, and the homones.

I don't really see what's left besides neuroleptics. :?


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## Speak Easy (Jun 27, 2006)

:stu Sorry, Korey, I'm all out of ideas. I hope you find something, though. I've never had trouble sleeping, so I'm a little shady in the area of sleep-aids, but after reading your post, it has made me that more grateful that I don't have problems falling asleep. I hope you feel better soon and find something that works for you! Maybe your doc wouldn't be so against prescribing you Dalmane, which although a benzo, it's usually best for only insomnia. It's not even listed under anti-anxiety agents. Only problem would be the morning after drowsiness, but I'm sure the Ritalin you take and the Prozac, which you might be switching to, should probably take care of it. Good luck buddy


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## korey (Apr 25, 2006)

I've come to the conclusion that the effects Thorazine would probably lapse into the following day, which would leave me a braindead zombie during class and work (if I ever get another job, that is).

So, I've got it down to one of the sedating antidepressants. Out of Elavil, doxepin, and Remeron, which do you think would be more effective? I am learning towards Remeron because it is a relatively newer antidepressant than the TCAs (I think), plus it is in its own class of antidepressants. Something that turns me away from TCAs is the acetylcholine antagonism, which I think is what causes all of the unpleasant side effects (dry mouth, urinary retention, etc). I did not see that for Remeron on a list of affected chemicals by different medications.

Any comments?


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## UltraShy (Nov 8, 2003)

Chloral hydrate -- used by Anna Nicole Smith. Not exactly fancy and new. I think it's been around since something like 1830. CIV just like benzos, though I haven't personally come across anyone who takes it.


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## UltraShy (Nov 8, 2003)

As for TCAs, I wouldn't expect you to get urinary retention unless you were taking it in larger doses (as used for depression) on a daily basis. I remember praying to pee while on imipramine, but the dose was high and I was on it for 4 weeks till I couldn't take it any more.

Amitriptyline & Doxepin just gave me a dry mouth when I attempted to use them for insomnia -- they failed to sedate me, even when I pushed the dose up the the max recommended level for depression. Due to risk of heart rhythm problems, I wasn't going to go over the recommended max as I've done with relatively harmless drugs that aren't going to possibly kill me if I take too much.

I'm aware that TCAs were popular suicide drugs back before SSRIs, so I recognize the obvious risk of taking too much.


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## korey (Apr 25, 2006)

*Re: re: Antipsychotics for insomnia*



UltraShy said:


> Chloral hydrate -- used by Anna Nicole Smith. Not exactly fancy and new. I think it's been around since something like 1830. CIV just like benzos, though I haven't personally come across anyone who takes it.


My doctor won't write me a prescription for Valium to take for sleep. If I mentioned chloral hydrate, he'd probably explode. Even though chloral hydrate is CIV just like benzos, it is supposedly much more effective at putting people to sleep. Isn't it also called "knock out drops"?

I wish there were information somewhere comparing the effectiveness of the antihistaminic sedative properties of TCAs to something like Benadryl. I want an idea of how sedating they really are without having to wait a whole month should they prove ineffective.

I know you've tried a truckload of different meds, Karl, but have you tried Remeron? If not, what types of things have you heard about it? I know it generally makes people sleepy at the lower end of its dose range, but that's about all I know. Personal accounts of it would be nice.


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## UltraShy (Nov 8, 2003)

*Re: re: Antipsychotics for insomnia*



korey said:


> Even though chloral hydrate is CIV just like benzos, it is supposedly much more effective at putting people to sleep. Isn't it also called "knock out drops"?


I've never heard of it called "knock out drops", probably because it's something you basically never hear about period. Other than Anna Nicole Smith where have you ever heard of it? Know anybody who uses it? I was aware of this sedative/hypnotic for years before it came up with Smith, but then I'm odd and research stuff like that online.



korey said:


> I wish there were information somewhere comparing the effectiveness of the antihistaminic sedative properties of TCAs to something like Benadryl. I want an idea of how sedating they really are without having to wait a whole month should they prove ineffective.


You certainly don't need to wait a month. Take a TCA and either it makes you sleepy or not. Question can be answered in as little as one dose. Perhaps another dose if you want to see if more would make it work, or work better. You might need a month to see what, if anything, it does for depression, but drowsiness is a side effect you would see immediately if it actually does sedate you. TCAs don't sedate me. This can be determined almost as quickly as "Does alcohol make you drunk?"



korey said:


> I know you've tried a truckload of different meds, Karl, but have you tried Remeron? If not, what types of things have you heard about it? I know it generally makes people sleepy at the lower end of its dose range, but that's about all I know. Personal accounts of it would be nice.


Yeah, I've tried Remeron as a sleep aid at 15 mg. The story goes that this is an odd drug that actually has more side effects -- one of them being drowsiness -- at lower doses. Odd, since almost every other drug has more side effects at higher doses. It did little, if anything, to sedate me. Though its FDA label does indicated that 54% of patients in a clinical trial reported drowsiness on it. I even saw some material that compared it to amitriptyline with it being just a bit less sedating than that TCA.


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## korey (Apr 25, 2006)

*Re: re: Antipsychotics for insomnia*



UltraShy said:


> korey said:
> 
> 
> > Even though chloral hydrate is CIV just like benzos, it is supposedly much more effective at putting people to sleep. Isn't it also called "knock out drops"?
> ...


Oh, sorry. It's only chloral hydrate dissolved in alcohol that can be called knockout drops. They're also called Mickeys, which I suppose were the Rohypnols of the early to late 1900s. The only reason I know about their co-term of knockout drops is because I remember hearing Fred tell Ricky to slip Lucy a Mickey on "I Love Lucy" once, and so I looked it up to find chloral hydrate. :b



> korey said:
> 
> 
> > I wish there were information somewhere comparing the effectiveness of the antihistaminic sedative properties of TCAs to something like Benadryl. I want an idea of how sedating they really are without having to wait a whole month should they prove ineffective.
> ...


Well, when I say that I have to wait a month, I'm referring to the fact that I can only get a prescription for one sleep aid from my psychiatrist per month, and then I have an entire month to wait until our next appointment. So, if I get prescribed something ineffective or with too many side effects, I have to ditch it and live with insomnia.



> korey said:
> 
> 
> > I know you've tried a truckload of different meds, Karl, but have you tried Remeron? If not, what types of things have you heard about it? I know it generally makes people sleepy at the lower end of its dose range, but that's about all I know. Personal accounts of it would be nice.
> ...


I looked into the strange bit about sedation at the lower end of the Remeron dosing scale. I think it has to do with the fact that Remeron acts somewhat like an NRI at higher doses, which sort of cancels out the sedating effects being as norepinephrine usually makes people jittery and jumpy.

The only thing that makes me somewhat apprehensive about taking a TCA is the fact that TCAs affect acetylcholine more notably than something like Remeron. At least that's what I've read from drug comparison charts. Their affinity for acetylcholine is what produces the dry mouth, the blurry vision, the urinary retention, and most of the other unpleasant side effects.


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## foxtrot (Feb 17, 2007)

I PM'd you my personal account of remeron (with special regard to sleep) as I've typed it out on the meds page so many times I didn't want to bore others...

but still think it's well worth giving a go for sleep esp now that you say you can only try one thing out for a month. I'd say that there is a huge chance that for that first month it would work well as a sleep aid then you could decide whether you think it's gonna keep working for another month or if you want to try something else (like a TCA). The lack of acetylcholine side effects maybe lend to it being a good one to give a shot first?


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## korey (Apr 25, 2006)

*Re: re: Antipsychotics for insomnia*



foxtrot said:


> I PM'd you my personal account of remeron (with special regard to sleep) as I've typed it out on the meds page so many times I didn't want to bore others...


Yes, I got your message. Thank you for it!



> ...The lack of acetylcholine side effects maybe lend to it being a good one to give a shot first?


That's what draws me to Remeron more than TCAs. I really don't like waking up feeling like I died at some point during sleep :b I can deal with carry-over sleepiness, but dry mouth, urinary retention, blurry/bloodshot eyes, and all the other unpleasant things that come with acetylcholine antagonism are not worth it, IMO. Trazodone had those effects, and after its sedation effects wore off, those effects were all I got. It was very nasty.


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## Noca (Jun 24, 2005)

*Re: re: Antipsychotics for insomnia*



korey said:


> foxtrot said:
> 
> 
> > I PM'd you my personal account of remeron (with special regard to sleep) as I've typed it out on the meds page so many times I didn't want to bore others...
> ...


i dont get those side effects you talk of from trazodone.


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## korey (Apr 25, 2006)

Everyone's different, Keith :b Some experience them more than others, I guess. Especially since I was taking like 150mg to 450mg per night. Aren't you at 50mg or 100mg? Dosage plays a role, obviously.


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## Caedmon (Dec 14, 2003)

> single dose between 25mg and 50mg is best.


Yes that sounds right.



> Anyway, what do you make of this prevalent usage of antipsychotics in the treatment of insomnia?


Oh, I don't care. If it works, it's safe, and the patient likes it, then have at it. They're too expensive and sedating as a hypnotic, for my taste



> Have any of you ever used an antipsychotic for insomnia? If so, which one was it and which dose were you taking before you gained control over your insomnia (if any)?


I tried Seroquel for insomnia but I felt yucky and hung over on it. I think the half-life was too long. This invariably happens to me with hypnotics with long half lives (e.g. trazodone)



> I have also tried improving my "sleep hygeine", but that was a no-go. Even if I stay away from my bed all day and only lie in it when I intend to go to sleep, I still stare at the ceiling for hours and hours.


Not that you said this, but even if you take a drug for sleep I would not jettison good _behavioral _management of sleep-wake cycles. The human race has been managing to go to sleep for thousands of years without medications. (haha, funny sentence! you get the idea though  )


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## Speak Easy (Jun 27, 2006)

It's important to understand that antipsychotics like Seroquel, Geodon, Risperdal, Zyprexa, etc, etc, don't work as antipsychotics until certain doses. If you take 25mg Seroquel it's not working as an antipsychotic. I think I talked about this elsewhere, but I should have probably posted it under this thread since it seems to be more appropriate. 

When you take 25-50mg Seroquel it's working as an antihistamine, like Benadryl (an OTC you can pick up at your nearest drugstore for a fraction of the price of an atypical). Antispychotics work by blocking 3 main neurotransmitters: dopamine (D2), alpha 1 (a1), and histamine (H1). 

In a nutshell, psychosis/schizophrenia is a result of too much dopamine. So, what needs to be done? Block the dopamine (D2). But D2 blockage does not occur until higher doses, which are as follow (70% D2 blockade):

10mg Zyprexa = 3mg Risperdal = 120mg Geodon = 500mg Seroquel

At these doses, all of the antipsychotics block the same % of D2 (70%), and will begin to work as effective antipsychotics, across a population. 

The majority of the drowsiness isn't actually occuring from the antipyschotic part of the drug (the D2 blockade), but actually, from the histamine blockade (i.e., antihistamine), which happens in the initial stages of titration, and somewhat in the a1 blockade, too. From 25-50mg you will feel the greatest change in sedation with Seroquel, and you will sleep like a baby. This might not last because of tolerance, but raising the dose by hundreds of mgs isn't going to change this. The antipsychotics work in this order: 1st, they start by blocking H1 (and are antihistamines), then they move on to a1 (and cause a little further drowsiness), and then, after a lot of titration, they move on to D2 (and become antipsychotics). Once you've moved from H1 to a1, though, it doesn't matter how much more of the drug you take, because it won't affect H1 anymore than it is, because it has already filled it up to the most it can take: 

IT CAN'T BLOCK ANY MORE H1, THEREFORE, IT MOVES ON TO A1, AND ONCE IT CAN'T BLOCK ANYMORE A1, IT WILL MOVE ONTO BLOCKING D2. 

Interestingly enough, 'most comparator trials done-- which look at symptom responses-- show these same equivalences. For example, ZEUS Geodon vs. Zyprexa trial: 126mg Geodon=11mg Zyprexa. This shouldn't be surprising since THAT'S HOW THE DRUGS ARE WORKING.

Second, no drug company can claim their drug has superior efficacy, because, again, they're all working through the same mechanism. Certainly, people tolerate each drug differently, but that's not efficacy, is it? Certainly an individual might respond to one better, but you have no way of predicting that. You simply cannot tell, by looking at someone, which drug will work and which won't.

Since there are a finite number of D2 receptors in your skull, if you are on 6mg or Risperdal-- which blocks 90% of them, and the doctor decides to augment with some Zyprexa, where's the Zyprexa going to go? Answer: your thighs. 

It's not going to D2 receptors, because they're all already blocked with Risperdal. So it's just going to go around to other receptors-- H1, a1, M1, etc-- all of which have nothing to do with bipolar or psychosis. Issues of tolerability aside, mixing two antipychotics is no different than giving more of just one antipsychotic.

For instance, "Abiliquel"- taking Abilify and adding Seroquel- is pointless. Motrin + Advil might do the same thing. You give the patient 15mg Abilify-- that's acting as a D2 blocker. 25mg Seroquel isn't even a D2 blocker, it's an H1 blocker, you're paying for an antipsychotic and getting Benadryl. You can get the exact same effect by giving Abilify and Benadryl+trazodone- which would be cheaper, and safer; or giving simply 500mg Seroquel alone, which would have gotten you both antipsychotic effect and sedative effect, thus reducing the cost by half, etc, etc'


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## Maslow (Dec 24, 2003)

Try Paxil and the practice of mindfulness. It's the only thing that has ever worked for my insomnia.


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## korey (Apr 25, 2006)

*Re: re: Antipsychotics for insomnia*



Maslow said:


> Try Paxil and the practice of mindfulness. It's the only thing that has ever worked for my insomnia.


I didn't experience the agonizing sleepiness from Paxil that it is acclaimed for. All I got was the uncontrollable weight gain, so I ditched it.



Caedmon said:


> > I have also tried improving my "sleep hygeine", but that was a no-go. Even if I stay away from my bed all day and only lie in it when I intend to go to sleep, I still stare at the ceiling for hours and hours.
> 
> 
> Not that you said this, but even if you take a drug for sleep I would not jettison good _behavioral _management of sleep-wake cycles. The human race has been managing to go to sleep for thousands of years without medications. (haha, funny sentence! you get the idea though  )


That's very true, but with my psychiatrist's recent proposal that my sleeping problems might be more bipolar-related than anything (and his suggestion for me to consider something like Thorazine - he actually mentioned Thorazine in a suggestive sense! - as a sleep aid), I am wondering if an antipsychotic would be a better choice for my sleeping problems than anything else.

The Remeron I am currently taking as both an antidepressant and a sleep aid is working decently as a sleep aid, but I fear that my psychiatrist might be correct about Remeron's weight gain being worse than Paxil's and lithium's.

I am considering dropping the Remeron and Adderall (Adderall isn't something I have found to be appreciable), switching back to Celexa as a mediator antidepressant until I can find something else to take its place (I would ditch the antidepressant aspect altogether, but I found that going without Prozac, even though it had seemingly no effect on me, caused me to become more blue than when I was taking it. So, I wouldn't mind taking Celexa for a while until something else shows up. I've read somewhere that Celexa is a good mediator AD when switching from one to another, plus it's dirt cheap as generic.), going back to my previous dose of Ritalin, adding 50mg of Thorazine PRN for insomnia, and calling it a day.

I figure the Thorazine should counteract the gagging and nausea that contributed to my discontinuation of Ritalin, and it will also hopefully keep the Ritalin's dopaminergic qualities from making me crazier.

So, my proposed cocktail (with special care for insomnia :b) is:
(per day)

40mg Celexa
40mg Ritalin
4mg Xanax
50mg Thorazine (prn)

What do you think of this combination, particularly how Thorazine fits in?

I was actually considering ditching the serotonin antidepressants because they all seem to come with the weight gain probability, and instead going for something like Wellbutrin SR (again). I realize that Wellbutrin+Ritalin might possibly result in an explosion, but with Thorazine's relatively long half-life and its rather non-selective nature about bashing dopamine receptors, I could remain "in check" while on such a combination.

I'm slowly realizing that my psychiatrist's call to stop taking lithium might be making me a bit ... mentally scattered. :afr


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## Speak Easy (Jun 27, 2006)

*Re: re: Antipsychotics for insomnia*



korey said:


> So, my proposed cocktail (with special care for insomnia :b) is:
> (per day)
> 
> 40mg Celexa
> ...


If you're worried about weigh-gain, I'm not sure how the Thorazine is going to help, since it's known to cause weight-gain. And if you have bipolar tendencies, you should be on some sort of mood stabilizer. I think you need to pick something out and stick it out to see if it works. You can't keep switching meds every other week. I think you should keep thte Ritalin and the Xanax, since apparently, those seem to important for you for everyday functioning.

Let's break it down into specific disorders.

BIPOLAR:

How have your moods been recently? If they've been ok, then maybe you'll be alright without a mood stabilizer, although it's a bit early to tell since you recently stopped your Lithium. Yes, at a high enough dose, you could use an antipsychotic and this could also help you with the insomnia, but apparently, nothing has really worked for you in that aspect. Maybe the Thorazine could work well for both of those aspects, however, keep in mind that the Thorazine has a reputation for weight-gain. I'm not sure if we talked about Loxitane, but it seems to be on the higher end for D2 blockade (mood stabilization), and very high for the H1 blockade (sleeping) and even pretty good for the serotonergic effect (depression). You may wanna look into that since I don't know the side-effects (i.e., weight gain).

UNIPOLAR:

Unless you're planning on taking Lamictal, which I don't think is an option right now, you're probably going to need an AD supplement for whatever you're gonna take for your depression. I don't understand if it's bipolar depression or unipolar depression you're suffering from, so if it's the latter, then you're gonna need to look into an AD. Celexa can result in weight-gain. How about Prozac? It's stimulating and it's actually known for weight-LOSS. And if you take Prozac, maybe you could even drop the amphetamines/methyphenidrate since maybe the Prozac will do the job all by itself. Also, you'd think the Ritalin would somehow work towards the weight-loss. But in the end, what it really comes down to, is diet and exercise, so I hope you're incorporating that into your lifestyle.

ANXIETY:

If the Xanax is working, then stick with it.

INSOMNIA:

If none of the other antipsychotics you've tried have worked, then maybe you should simply try altering some of your other meds (I mean, you are on a stimulant, and looking into Wellbutrin). I think there are definitely other things that could play a part into your insomnia (and I agree with your psych that it could be your bipolar).

I think in terms of importance, you should treat your bipolar, then your anxiety, and then your insomnia. IMO.

Ideally, I think the best approach would be Lamictal (stimulating but not too stimulating), Xanax, and if you still have insomnia, then try the Thorazaine (it's a low-potency agent so it works extremely well with the H1 blockage, or in other words, sedation. It produces a much higher instance of anticholinergic side-effects and sedation than high-potency antipsychotics). Taking it at night will make it work as a sleep-aid, and will eliminate chances of daytime drowsiness). I know you love your Ritalin, but I think it might be contributing to your lack of sleep. There's a reason stimulants are contraindicated in anxiety patients. But if you feel the Thorazine is working, the obviously keep the Ritalin and try to use it as an AD supplement as you have been using it in the past

You're gonna need a mood-stablizer, though, if your moods aren't totally regular, because the Thorazine isn't a great high-potency mood-stabilizer, It's a much better sleep-aid than it is a mood-stabilizer, but it could definitely do the trick for the insomnia


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## korey (Apr 25, 2006)

I agree that switching meds every month can’t be a good thing.

Xanax and Ritalin are both consistently helpful for their indications, and their side-effects are tolerable (and sometimes even helpful).

Since I stopped taking lithium, my mood has been somewhat jittery, but it really is too early to tell anything for sure. It seems, however, to be jumping around again, which I don’t like, so I might start taking it again at a lower dose. The side-effects of weight gain, excessive urination, and headaches were what caused my psychiatrist to take me off it in the first place. Thorazine does have a reputation for weight gain, but I would only be using it PRN, and again, hopefully the dopaminergic effects of the Ritalin will be enough to offset the weight gain potential of Thorazine. Loxitane isn’t generic, so it’s out automatically (sad, isn’t it?). 

I have been considering Lamictal as both a mood stabilizer and an antidepressant, but it is a little pricey and still under patent, so I can’t give it any serious consideration until I get a job. Being as I have “bipolar tendencies” according to my psychiatrist, I would assume that my depression is bipolar depression. The only reason I don’t like Prozac is because it causes heart burn, and besides, I have more than an entire bottle of Celexa left over from when I was taking it, so it would be a convenient choice. I don’t think I’ll be dropping the stimulant meds anytime soon. I don’t take Ritalin exclusively as an antidepressant augmenter. I have some (presumably anxiety-related) attention problems. I don’t think dopamine has much effect on my appetite and weight. If it does, then I’ve gotten used to it by now. Wellbutrin was the only med that took my appetite away completely, and it’s the one with the notable NE action, so I assume that NE is responsible for my appetite more than dopamine. I haven’t been exercising much (read: at all) since I found out that my weight gain could be coming from the Paxil and lithium, which would’ve made exercise pointless in the quest for weight loss. I actually gained weight when I began exercising (I’m aware that muscle weighs more than fat, and I wasn’t doing any intense strength training, so that’s not to blame), so I’m assuming it was the Paxil and lithium that caused the weight gain. Now that I’m off of them, it’s just a matter of making myself wake up early enough to go exercise.

I actually take the Ritalin PRN, and its half-life is so short that my morning and occasional afternoon doses are out of my system by bedtime. That’s why I specifically asked for Ritalin immediate release. I didn’t want the time release version to impact my sleeping any.

I agree that keeping my mood stable is the most important thing. My anxiety is getting a bit out of control lately being as summer is coming to an end, and school is going to start soon. I might have to go back up to my daily Xanax dose of 4mg soon.

I would enjoy for Lamictal to be an actual option for me, but it’s not at the moment, so I don’t think wishing on a star is going to help any right now. I do enjoy having Ritalin at my disposal because it is so helpful, but I don’t “love” it :b As I explained above, Ritalin is metabolized completely by bedtime, so I don’t think it’s a factor in my sleeping problems.


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## Caedmon (Dec 14, 2003)

*Re: re: Antipsychotics for insomnia*



Speak Easy said:


> It's important to understand that antipsychotics like Seroquel, Geodon, Risperdal, Zyprexa, etc, etc, don't work as antipsychotics until certain doses. If you take 25mg Seroquel it's not working as an antipsychotic. I think I talked about this elsewhere, but I should have probably posted it under this thread since it seems to be more appropriate.


THANK YOU for explaining this, your explanation is concise and readable.


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## CopadoMexicano (Aug 21, 2004)

well from bringing back the dead but why not try second generation atypical antipsychotics i noticed you list a lot of first generation antipsychotics.


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## DeeperUnderstanding (May 19, 2007)

I was going to suggest melatonin, but it looks like you've already tried it.  It worked great for me, though.


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## UltraShy (Nov 8, 2003)

Winters Tale said:


> I was going to suggest melanin...


I bought some melatonin as suggested by my psychiatrist. So far I have not been impressed. I personally think it does nothing. I don't need a substance that *might* help me sleep; I need a drug that will totally knock me unconscious. Unfortunately, the DEA isn't fond of drugs that will literally knock you out.


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## angelgail (Dec 1, 2006)

I was on Elavil and it really helped me sleep.. It does cause weight gain but just eat good and stay away from junk food. My Mom is on it and will not go off of it for nothing it is the only thing that helps her sleep. Good luck I know it's hard to get to sleep and stay a sleep I have tried everything too now I just have a drink before bed and I am out. I don't sleep all night but that's because I have two kids who sometimes wake me up. Take care.

Angel

I am on: Abilify 5mg, Zoloft, 200mg and klonopin 2mg


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