Every AD gives me terrible nightmares & night sweats!

[Mikey1]

Hi guys,

I'm new to the forum and was hoping to seek out some advice. I am a 31 year old male and have suffered from GAD for over 7 years. I have looked into all sorts of alternative therapy but it has become clear that I definitely need to be on some sort of antidepressant. The problems is EVERY AD I have tried in the past 7 years gives me intolerable nightmares and night sweats. All other side effects I can handle but this problem leaves me almost incapacitated by the morning.

I have tried fluoxetine, escitalopram, sertraline, venlafaxine, paroxatine and now need to to discontinue from imipramine for the same reason. I have also tried to add other drugs like buspirone, pregabalin and sleeping aids but they make no difference.

Has anyone else had this problem and found a way to manage it? Please help!

Many thanks.

[alankay]

Mike, I've read about Lyrica(anticonvulsant) used off label for GAD. It's approved in Europe for that. If all the ssri types(serotonergics) do that, talk to your doc about Lyrica.

http://www.medicalnewstoday.com/releases/40404.php

Research trazodone as well.
Message me any time. Alankay

[Mikey1]

Thanks for the reply Alan. Lyrica is trade name for pregabalin which I have tried and did work well for a month before losing its effect. When I increased the dosage, it made me feel very sleepy during the day which somewhat defeated the objective!

I think trazadone is going to be my next move. Will discuss with the doc.

[alankay]

Yeah, that's the one. I'm sorry about that. That kinda leaves just Wellbutrin and Fluvoxamine from the current group of what doc like to try. So nightmares and night sweats are the main issues, right?

[Mikey1]

Alan - Wellbutrin (bupropion) does sound like a good idea especially as it has the added benefit of helping as a smoking cessation drug but the doc seems reluctant on that one - can't remember why. Will discuss when I see him on Thursday. Fluvoxamine has not come up for some reason. Nightmares and sweating are really the only issues. Most drugs are effective in treating the GAD.

Thanks for the post, Kev. Going for an earlier trycyclic drug is what I have just tried with the imipramine but that has been probably the least effective for me and with the worst side effects but saying that, I have only tried the one so far. Maybe i should try another. I was prescribed synthetic saliva for the dry mouth which helped on that front.

[alankay]

Mike, assuming you have given all those ssri's long enough trials, another suggestion is Remeron(Mirtazapine). I believe sleepiness is a common side effect when starting as well dizziness but you know how those sides vary and many pass. Many TCA's that cause drowsiness are dosed at night for that reason. I seems that meds that act on serotonin cause your the sleep issues. The TCAs are believed to act via the same neurotransmitter(serotonin) but still sometimes switching classes help. I could not find Forwells kind mention of prothdien in the US/Canada(did find it Internationally though so ask your doc or pharmacist) but here's the wiki article on it http://en.wikipedia.org/wiki/Dosulepin
Wellbutrin isn't used so much for GAD but it is a different class of AD to review with your doc.
I had sleep issues(broken sleep) with celexa but even that passed after 3 months like my pharmacist said it would. If an ssri worked well otherwise the sleep issue might pass but if it were that bad might take just too long.:( If your doc really feels the sleep issue will pass(likely would) perhaps he can prescribe a few long acting benzodiazepines tabs like Tranxene(clorazepate) short term since it would help your sleep and have a low potential for problems(dependence, etc). With it's very long half life(also would help with GAD) JUST until the ssri side effects diminish(or just use before bed a few nights a week). Just another thought. Alankay

[Mikey1]

Thanks very much for the input. Just went to the doc and he has prescribed me 600mg trazodone. I am a little worried about its sedative properties but will give it a go. If that doesn't work, mirtazipine. Turns out bupropion is not licensed in the uk as an AD. Clorazepate is also not licensed here but I already take 1mg clonazapam each night (which I fear I am already dependant on). I fear this won't be the end of it so shall keep everyone updated in the hope we find a 'solution'... Eventually :)

[alankay]

Mike, cool. Keep me posted. Fret not, I used to use lorazepam on all school days during college but know I take diazepam only once a month or so you use the clonazepam just to help you for "where you are now" anxiety wise. In time you'll might be able to reduce/eliminate the clonazepam(or not, depending on how you're feeling) as you get better with both med and non-med means at managing things.
The side effect of drowsiness might pass if you give it a good trial. But if it ended the nightmares I bet that would be great just in that alone. Time will tell.
I used clonazepam for a while and found it a very good med. I was having trouble sleeping on 60 mg fluoxetine for anxiety and it indeed helped me sleep all night. I'm glad you seem to have a Dr. that is open to suggestions, etc. Some forget the patient has a vote too and are really rigid.:) Or so it seems. Alankay

[Mikey1]

Had an awful reaction to trazodone... I was started at 300mg and felt absolutely dreadful the next day. In 7 years, no drug has made me feel so bad after a single dose - tiredness, dizziness, nausea and migraine... Anyone prescribed this drug should be warned!! Start on a very low dose to test your reaction. I've been totally put off and have switched over to mirtazipine. Hope this proves a better choice!

[alankay]

Yikes. I hope you get better results with the remeron. If not I'd wonder about the GAD diagnoses or have them rehash your old symptoms and just kind of verify that's the proper diagnoses.

[alankay]

Mike, anyway all those you've tried have acted primarily on serotonin. I wonder if something that acts on another neurotransmitter like wellbutrin might be worth a try if not alone but in augmentation of your "best tolerated" SSRI.
Doxepine is another TCA and is often used for those with sleep issues but I wonder about that one since the bad reaction to trazodone(another TCA).
Well I know you need to give remeron it's go so hope the best comes of it. In the mean time keep me/us posted and I'll keep thinking about other things to run by the doc.
I hate to ask but have you seen a counselor(I know you mentioned all alternative therapies so just have to ask)? Just to make sure there's not some underlying experience/emotion, etc, bugging the crap out of you that you never have gotten off your chest, etc. Just asking.
Now, could it be you're sensitive to SSRI's(all serotonin antagonists) and need a low dose. I was on lexapro 20mg and feeling anxious/irritable more so that when at 10mg, or 15mg so I skipped a day and started taking 10mg and have felt much, much better. I have been on other(prozac, 40mg and 60mg without that issue). But am much better on 10mg of lexapro and figure perhaps for me, with that med needed a lower dose than most(sensitive to lexapro). I just wonder if you pull back on the dose abit instead of starting high to give your body time to adjust to the med., see how it effects you and make slow changes after that. I wonder if your system is just very sensitive to all the serotonin antagonists and you need less than the usual dose. Some symptoms you mention are similar too(NOT the same) as Serotonin Syndrome, see below(I'm JUST referring to shaking/tremor and sweating).
The symptoms are often described as a clinical triad of abnormalities:[1][5]
Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma
Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea.
Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.

Could this be a "touch", some "low grade" Serotonin Syndrome and you just need a lower dose(who said the syndrome is "all or nothing")? NOT saying it is just thinking outside the box a bit and using some logic. Think it over. Message me any time. Alankay