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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Kat26 on December 29, 2001, at 14:15:45
Hello all
A good friend of mine has suffered for many years from anorexia and depression. The doctors put her on SSRIs but she has trouble sleeping as it is and even low doses make her insomnia worse. At the moment she is taking Surmontil, which she says helps her sleep, but doesn't do much for her depression, and it also makes her drowsy during the daytime. She asked me if she should stay with it, and I thought I'd ask some opinions?
She is also very compulsive, I mean she follows a rigid schedule especially for meals, but I think also for other things. And worries all the time about a lot of different things. I thought since it does sound a bit like OCD an SSRI would be good (since I got so much help from prozac for OCD, and I have had an eating disorder too), but then the side effects seem to be just too much... or maybe if she just toughed them out, they would diminish, but she is so anxious...Kat26
Posted by Cam W. on December 30, 2001, at 3:59:16
In reply to Question - anorexia, depression, sleeping problems, posted by Kat26 on December 29, 2001, at 14:15:45
Kat - Which SSRIs was your friend taking and for how long? I have found that insomnia is a fairly common start-up side effect of most SSRIs, especially Prozac™ (fluoxetine) and Zoloft™ (sertraline). The insomnia (and the other start-up side effects) usually disappears between 2 to 4 weeks after a stable dose is reached.
Since your friend has already started taking the Surmontil™ (trimipramine), she should at least wait to see if it works for her. An adequate trial for any antidepressant is about 8 weeks (eg. to obtain a good effect, and to wait out any start-up side effects - eg. daytime drowsiness).
An alternative antidepressant that works quite well for OCD symptoms is Anafranil™ (clomipramine). This antidepressant may not cause as much daytime sedation (ie."hangover effect") as the Surmontil, but it may not help with the insomnia, especially when when starting the drug. Have your friend ask her doc about this antidepressant, if the Surmontil doesn't pan out.
If your friend decides to retry a SSRI (eg. Paxil - paroxetine) there are reasonably safe ways to treat the insomnia (which should decrease with time on the drug, anyway). Some people with persistent insomnia have been helped with a low dose (25mg to 100mg - 50mg bedtime dose is most common) of Desyrel™ (trazodone). This drug was used as an antidepressant about 15 years ago, but it caused too much sedation in most people at the antidepressant dose (450mg to 600mg per day in divided doses).
Have your friend talk to her doc about the options I have mentioned, so he/she can decide if any are suitable for her, if the Surmontil doesn't end up working. - Cam
Posted by Kat26 on December 30, 2001, at 15:13:32
In reply to Re: Question - anorexia, depression, sleeping problems » Kat26, posted by Cam W. on December 30, 2001, at 3:59:16
Cam, thank you so much for these good ideas, I will certainly pass them on!
Kat26
This is the end of the thread.
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