Medication and sleep

[Dying_Swan]

Wasn't sure where to put this so putting it in general meds forum.

I'm currently on 400mg quetiapine, 75mg venlafaxine and 7.5mg mirtazapine. At first, mirtazapine was incredible for sleep, and it was upped to 15mg. Then when I started quetiapine I was taken off mirtazapine, but quickly put back on it because the quetiapine didn't make me sleep, and just caused agitation.

Mirtazapine stopped making me sleep so I tried 50mg trazodone instead for about a month, but that didn't work so I went back to 7.5mg mirtazapine. It's not working though. Once I'm asleep, it's fine, but often I'm awake a long time, and then the side effects of quetiapine kick in (horrible restlessness) and it's a vicious circle.

So I figured I might as well stop mirtazapine since it's not working and making me crave sugar, but this idea didn't go down too well with the CPN. I'm not sure why because I'm only on it for sleep.

Does anyone know of any other sleep aids I could try? I'm keen to avoid benzos or zopiclone. Might it be worth trying to split the mirtazapine to 3.75mg?

Thank you

[lebonvin]

If yous reduce Quetiapine to 50mg it will help you sleep but dunno if they'll let you do that unless you raise venlafaxine to say 150

[WiseMonkey]

With your Dr knowledge, if might be better to come off all these meds and just try a low dose tricylic like Doxepin or Amitryptiline.

[panic_down_under]

Does anyone know of any other sleep aids I could try? I'm keen to avoid benzos or zopiclone. Might it be worth trying to split the mirtazapine to 3.75mg?

I don't think BZDs, or zopiclone are the answer either as tolerance to their sedation build quickly, often within a week or two. Doxepin might work as it is a little more sedating than mirtazapine, but I suspect that won't last long either.

Imho, the real issue is you're taking 3 meds, none of which seems to be helping much and arguably are probably making things worse and just throwing more and more meds into the mix in the hope of either stumbling onto some miracle combination, or to reduce the side-effects of the others is nutz.

If memory serves, you started on venlafaxine which proved inadequate even at high doses and the mirtazapine was added to counter the SNRI induced insomnia. Then quetiapine was added in the hope it might either boost the venlafaxine, or be the answer on its own. So my first question for the CPN is why you're still on venlafaxine when it is doing bugger all? The second question is why are you still on quetiapine when it seems to be mostly just causing agitation and possibly the insomnia too? And the third question should be why are you still on mirtazapine for insomnia when it isn't helping you sleep?

I really think your med regime needs to be reviewed by a psychiatrist. I don't see the point in taking 3 ineffective meds when another might do the trick on its own if given the chance. Poly-pharmacy is sometimes necessary, but it should be among the last options tried, not the first.

</soapbox>

[Dying_Swan]

Thank you all for your replies. I've not heard of doxepin so maybe that's an option. I've got reviews with both my private psychiatrist and the NHS one coming up, but I don't think they'll let me reduce quetiapine. If anything I reckon they'll increase it. It seemed to work for a couple of weeks but then stopped. I think the private psych is likely to take me off venlafaxine, but I haven't met the NHS one yet so don't know what he will do. I've not taken the mirtazapine for the last two nights and I've slept as well as if I took it. It's just disheartening as it was working so well. Thanks again guys. Some things for me to mull over.

[panic_down_under]

I've not heard of doxepin so maybe that's an option.

Doxepin is a TCA, or at least that is what it says on the box, but whether it has any real antidepressant activity is debatable. Mostly it is just another very potent sedating antihistamine vying with mirtazapine as to which is the more powerful. It might be a little more sedating, but how long this will last is the question. The problem is quetiapine is also a strong antihistamine so is probably adding to tolerance building.

[Quinn1]

I was put on Doxepin a few years back i didn’t like it,it was like Zoloft I had suicidal thoughts whilst on them

[Dying_Swan]

Thanks PDU and Quinn. I will ask one or both psychiatrists what they think I guess. I get a bit fed up when they start on about sleep hygiene, having had this problem nearly 20 years. Mirtazapine was such a miracle, but quetiapine never got close in terms of sleep. I think it perhaps keeps me asleep though, it's just falling asleep that's the problem. I have read of people taking a really tiny dose of mirtazapine and wondered whether that might work. Sorry to hear you felt so awful on doxepin Quinn. Sounds like it's one to be careful of.

[WiseMonkey]

Doxepin is one of the older tricyclic antidepressants but it works well for sleep at a low dose (10 mgs). It can be used specifically for this. At this dose it doesn't have a antidepressant effect. Doxepin and Amitryptiline both have an antihistamine effect, they are also used for some painful conditions at this low level.

[Dying_Swan]

Thank you WM. I will definitely ask about it. I don't think 7.5mg mirtazapine is enough for an antidepressant effect either so they might be willing to let me try it. It's a relief to at least know there's something else I could try. Thank you