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Suggest Treatment For Chronic Insomnia

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Posted on Fri, 28 Nov 2014
Question: I have been struggling with depression and anxiety for 9 years. On 10-1-13, I had a panic attack. Depression has been much worse this year. Anxiety has been better have being prescribed Xanax. Upto .5mg a day. Chronic insomnia the past year. Any wyas. The past week or so, I have been slowing experimenting with L- tryptophan. Yesterday I took my meds 200 mg zooloft and . 5mf of Xanax. Stressed out the whole day, but got thru. Broke down in tears several times. Eventually I took a 500mg pill of the tryptophan. It seemed to calm me and put me in a better mood. What should I do? My last Psychiatrist closed his practice, so I don't see a mental health doctor until 12-15-14. I star counseling next week. I just want some sleep. I have been awake for over 48 hours, and I am not tired. Need some advice!!I forgot. I am also on lisinopril.
doctor
Answered by Dr. Ravi Soni (42 minutes later)
Brief Answer:
L-tryptophan is somewhat risky to take

Detailed Answer:
Hi, thanks for your query. Welcome to HCM.

I have read your concerns and shall answer accordingly.

You are taking right drug in effective dose that will help for your anxiety and depressive symptoms. Continue these drugs and do not stop without advice from your psychiatrist.

I want to ask a question here. Whether you have any episode in past in which, you have became extremely happy, cheerful, overfamiliar, excessive money spending, feeling high energy, increased sexual activity and desire, decreased need for sleep? etc.. These are the symptoms of mania that is apart of bipolar disorder.

L-tryptophan is not well researched and approved drug for your problems. Yeah, It can help you with anxiety and depression. It can also help you with sleep but there are some serious side effects of it. Side effects can be eosinophilia myalgia syndrome [EMS] which can present with following symptoms:
- severe muscle pain (most often in the shoulders, back, or legs)
- weakness, numbness, tingling, or burning pain (especially at night)
- tremors or twitching muscle movements
- swelling in any part of your body
- skin changes (dryness, yellowing, hardening)
- breathing difficulty or
- uneven heartbeat

You are hypertensive and diabetic also. You are at higher risk of side effects.

Less serious side effects can be:
- dry mouth, heartburn, burping, gas
- nausea, vomiting, diarrhea
- feeling drowsy or light-headed
- blurred vision
- weakness, lack of coordination
- headache or
- lost appetite

Apart from this L-tryptophan actually increases the level of serotonin which the same mechanism by which antidepressant drugs act. Zoloft is a SSRI drug which increases the serotonin in brain. If you combine both together there can be serotonin syndrome which is a serious side effects that develops due to high serotonin level in brain.

So In my opinion you should not take L-tryptophan without the advice from a doctor.

It is good that you will attend the psychotherapy and counselling sessions. For sleep you can follow sleep hygiene measures and take lunesta. If the dose of lunesta is not enough then you can double the dose. Avoid day time naps if any.

Hope I have answered your query. If you have further query then feel free to ask. Wish you good health.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ravi Soni (18 hours later)
Thanks for your reply. Ysterday, before I received your reply. Despite no sleep for over 48 hours a was able to run 1.5 miles. I also lifted weights with my friend for an hour or so. I did take the 500mg of Trypthophan at 3pm or so. I also received some essential oils in the mail. I soaked in a hot bath with some "relaxation" of the oil. I did like the smell and it seemed to make me drowsy. I also have a diffuser in my room Been using lavender oil for a little over a month. These seemed to help as well. I sleep so so. * hours or so, but it was not continuous. Times of being up for 30 min or so. I did have a lot of dreams though.

I have also been using the Fischer Wallace Brain stimulator on a regular basis the past month or so. It seems to relax me also. I got it about 7 months ago. But stopped using it after about 2 months. I did not tell my doctor about this. Embarrassed, I guess.

My last doctor said I was not Bipolar. The first 8 years of this I had no sex drive and was very frugal with money. I did not experience many times of happiness, but I could sleep. I was basically afraid of my own shadow. I had trouble driving on certain roads that I had driven for years.

About a year ago, the doctor had me on I believe 200 mg of Trazodone as well as the Zoloft. In December of last year. I would not be thinking about sex, and then the slightest movement would trigger a sensation in my testicles. Probably masterbated about 5 times a day for a month or so. I told my doc what was going on. We stopped the Traz and added the Xanax. Those sensations in my testicles stopped within two days. I still have a high sex drive at times. Masterbate 4 times a week.

The addition of the Xanax has made me able to drive. It has also enabled me to work and do my job like I use to. I am a corrections officer, the first eight years of this episode I had trouble enforcing basic rules and limits for the inmates. I called in sick frequently. I have also been able to interact with my friends better. The Xanax scares me because it is addictive. But that is the only thing that has helped so far. I don't think the Zoloft is doing much.

I also both a blue light therapy device. I have not used it much, seemed like I got a little more nervous when I tried it. So I stopped. I both this because this past summer I went golfing on a bright XXXXXXX day. I was tired. Anyways the next 3 days or so I slept really well.

Not sure if my doc was right on the bipolar diagnoses. I like him as a doc a lot. But when my panic attack occurred, my hands and feet went numb several days later. He thought this could be signs of diabetes. Diabetes levels are very good. 5.4 or so. Numbness stopped when Xanax was added.

I will stop the Tryptophan. Vitamin D level was at 40 as of last month. Should I get any blood work done before I go to see my mental health prescriber in December?

I will also print this out to give to my new health care practioners. I just want things to change for the better. Thank you.

doctor
Answered by Dr. Ravi Soni (3 hours later)
Brief Answer:
Possibility of Bipolar is there

Detailed Answer:
Hi, thanks for writing again.

Your energy of running for miles and lifting weight produces doubt in my mind about your diagnosis. whether this high energy level has developed after taking L-tryptophan? It is possible that antidepressant drugs can cause switch from depression to mania.

Whether you have mood fluctuation? Frequency of everyday? Even within day, whether sometimes morning is worst and evening is good for you?

For anxiety, another good antidepressant is mirtazapine which can decrease your anxiety and produces sedation so, it will help with sleep also. You can discuss about the possibility of taking mirtazapine with your doctor in next visit.

It is very important to sleep for you, otherwise I fear that you can go into full blown mania. So, try to take medication so that you can sleep properly. If you have sleeping pills then take it properly and take good night sleep until you meet your doctor.

I will prefer combination of zoloft, mirtazapine, lunesta, klonopin for you. Discuss this with your doctor.

If you are a person with bipolar disorder then your treatment plan will change completely in which you will be given a mood stabilizer like sodium valproate which decreases the fluctuation in your mood.

Diagnosis should be confirmed if possible in this visit and you must tell about your feelings of high energy that has developed recently.

Hope I have answered your query. If you do not have further query then close the discussion and rate the answer. Wish you good health.



Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Ravi Soni

Psychiatrist

Practicing since :2010

Answered : 538 Questions

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Suggest Treatment For Chronic Insomnia

Brief Answer: L-tryptophan is somewhat risky to take Detailed Answer: Hi, thanks for your query. Welcome to HCM. I have read your concerns and shall answer accordingly. You are taking right drug in effective dose that will help for your anxiety and depressive symptoms. Continue these drugs and do not stop without advice from your psychiatrist. I want to ask a question here. Whether you have any episode in past in which, you have became extremely happy, cheerful, overfamiliar, excessive money spending, feeling high energy, increased sexual activity and desire, decreased need for sleep? etc.. These are the symptoms of mania that is apart of bipolar disorder. L-tryptophan is not well researched and approved drug for your problems. Yeah, It can help you with anxiety and depression. It can also help you with sleep but there are some serious side effects of it. Side effects can be eosinophilia myalgia syndrome [EMS] which can present with following symptoms: - severe muscle pain (most often in the shoulders, back, or legs) - weakness, numbness, tingling, or burning pain (especially at night) - tremors or twitching muscle movements - swelling in any part of your body - skin changes (dryness, yellowing, hardening) - breathing difficulty or - uneven heartbeat You are hypertensive and diabetic also. You are at higher risk of side effects. Less serious side effects can be: - dry mouth, heartburn, burping, gas - nausea, vomiting, diarrhea - feeling drowsy or light-headed - blurred vision - weakness, lack of coordination - headache or - lost appetite Apart from this L-tryptophan actually increases the level of serotonin which the same mechanism by which antidepressant drugs act. Zoloft is a SSRI drug which increases the serotonin in brain. If you combine both together there can be serotonin syndrome which is a serious side effects that develops due to high serotonin level in brain. So In my opinion you should not take L-tryptophan without the advice from a doctor. It is good that you will attend the psychotherapy and counselling sessions. For sleep you can follow sleep hygiene measures and take lunesta. If the dose of lunesta is not enough then you can double the dose. Avoid day time naps if any. Hope I have answered your query. If you have further query then feel free to ask. Wish you good health.