Help, i feel like i can't sleep anymore..

[kaossalami]

Hey tds.. Everything is going fine right now except for my sleep patterns..and i've always suffered from severe chronic insomnia. Sometimes not being able to sleep for 3-5 days at a time. It all started when i was younger (5-7 yrs old) and it seems to have just progressively been getting worse.

I take 20mg celexa a day for extreme depression.
I take 40-60mg adderall in the MORNING, for adhd.
I also take 400MG seroquel at night for bipolar disorder.

Before anyone says to remove any of these meds, let me say this first, this has been the only combination of medication that has worked for me in the past 15 years. Paxil sent my bipolar off the wall and made me not sleep for 10 days. I've tryed less/more serouqel ranging in doses from 100-800mg daily. Seroquel only allows me to get about one or two hours of sleep at most a night. After about a week of not sleeping i do tend to fall asleep for about 10-20 hours on a random day that i will have no idea thats coming... I cant remove celexa/seroquel/adderall from my regimen. I've tryed almost all gaba drugs for sleep, tryed ambien, lunesta, trazadone, klnopin, valium, xanax, some major tranquilizers.. the list goes on and on. For example, last night, took 300MG of seroquel around 2am and slept only till 3:30am.. nothing seems to increase the duration of my sleep or help me fall asleep. These drugs even in high doses don't help.. Any ideas? Any medication ideas i can throw out to my doctor because i really need a night where i can sleep atleast 3 hours or more every other night...no sleep makes me extremely depressed daily.

 

[Lolie]

You have bipolar disorder and you're on both an SSRI and a stimulant (40mg is the maximum recommended dose of Adderall for ADHD) and that could be part of the problem. SSRIs often have a stimulant effect on people with bipolar disorder (as you found with Paxil).

You're also not on a mood stabiliser, which seems even more strange given that you're on a stimulant. It's not usual to rely solely on an antipsychotic to control bipolar disorder (in fact here Seroquel is only approved as a monotherapy for a maximum of 6 months during an acute episode - to be used as a maintenance drug it must be combined with a mood stabiliser).

I'm on the same dose of Seroquel as you and I still have random days where if I lie down during the day I'll sleep for ages, even though I didn't feel especially tired.

I know that you're saying insomnia is making you feel depressed but it's often the other way around. Insomnia is often one of the first indications of a bipolar episode and < 3 hours sleep per night is highly suggestive of a hypomanic or mixed state.

 

[Bojangles69]

Yeh like Lolie said insomnia is not actually a DSM diagnosed disorder, rather always a symptom of another disorder... or even a true sleep disorder. But I think the insomnia at this point is either a side effect of the meds you're on, or your own biological reaction as a bipolar patient to those meds.
You should obviously be taking you adderal in the mornings though and seroquel at night (which you already mentioned). But something tells me the adderal is the culprit here even with you taking it in the mornings. The celexa might just aggravate everything but I think if you got off/changed the adderal you'd start sleeping much better. If not you might want to change up the celexa.
You can't go on forever living with insomnia and at some point the drs either going to up your seroquel or give you another sedative. You should really find out which med is causing it, and its definitely not the seroquel lol.

 

[kaossalami]

I know its not the seroquel. haha.

I've also tryed taking adderall out of my daily regiment with no luck to changing my sleeping habits. I think i'm going to stop taking the celexa for a bit and ask about a mood stabalizer. Celexa was prescribed because i was very sensitive to SSRI medications and i usually am in a very depressed manic mood with my bipolar.

 

[Lolie]

I know its not the seroquel. haha.

I've also tryed taking adderall out of my daily regiment with no luck to changing my sleeping habits. I think i'm going to stop taking the celexa for a bit and ask about a mood stabalizer. Celexa was prescribed because i was very sensitive to SSRI medications and i usually am in a very depressed manic mood with my bipolar.

If you're in a mixed state (depressed and manic at the same time or in rapid succession) then you should definitely be on a mood stabiliser. The high dose of Adderall is probably making things worse, but I'm not sure why your doctor would even try the Celexa given your past response to SSRIs - there are much less risky ways to deal with the depression than using a class of drugs well known for inducing mania and mixed states and mood stabilisers are generally the very first line of treatment.

 

[hobhead]

lamotrigine (lamictal) is a mood stabilizer that, for many, is effective .
it is one of those things that one has to titrate up for weeks as it, in a small segment of the population, can cause a life threating rash .

it is thought that mood stabilization is a necessary first step when treating depression and bipolar .

lamotrigine is becoming a first line treatment .

quetiapine (seroquel) acts as an antihistamine (sleep inducing) in low doses 25<100mg
in larger doses it acts as an antipsychotic .

can you manage to get your MD to order a sleep study? i am led to believe that this is very productive in managing chronic insomnia .

 

[kaossalami]

Yeah im talking to a sleep study place near by that my dad went too.

Im pretty sure its the celexa that's not working well with me..before on paxil id be in manic moods.. alot of panic attacks and brain shocks/chest shocks every hour or so... the chest/brainshock feeling just started coming back. I guess I've taken lamictal, but years ago when I first started visiting my psychatrist. I don't remember how well it went but ill, ake an appt and talk to her about it.