Mental Health Is my seroquel use for insomnia affecting my ADHD treatment?

[InsomniacMike]

I recently began taking seroquel for my insomnia and it works very well. But its causing me to sleep in way too late and causing me to miss my college classes i have in the mornings. I have tried so many other sleeping medicines, the most effective mirtazapine but that left me sedated for the entire next day. Ambien didn't really sedate me too much and I found myself out of bed doing things besides sleeping or getting ready for bed. Sonata worked alright but I was needing 20mg and sometimes it didnt even work at all. Trazodone didnt provide me with much relief from insomnia. Lunesta helps me stay asleep but gives me an amazing (not) taste for the entire next day and everything I eat taste metallic. I am prescribed Rozerem but that is a sleep medication that needs to be taken regularly at the same time, and my hectic college lifestyle doesn't allow for that. I tried xaanx 1mg for sleep but it didnt really put me to bed. I am prescribed ativan 1-2mg for sleep as needed and think it works decently, am wondering if xanax 2mg could be decent for putting me to bed.

I would like to find something different than seroquel for my insomnia because I feel like its slowing down my cognition and ability to focus/concentrate in college. It makes me sort of lethargic to a point where I can't learn information while under the influence of seroquel and the hangover the next day has the same effect.

I have noticed that my medication for ADHD is becoming less effective, and I'm wondering if me starting the seroquel recently has anything to do with the effectiveness of Vyvanse and adderall for my ADHD. My next options for sleeping medication that my insurance will approve is triazolam (halcion) and other benzo or non-benzo hypnotics. They also cover most generic medications but i am at a dead end as to what to try next for insomnia.

I liked how ambien worked, yet i eat most of my food at night and ambien required you to have an empty stomach for it to be fully absorbed. Im looking for a medication that could help me fall asleep quickly, stay asleep, and wake up with no hangover or groggy feeling. Ambien also didnt seem to cause my Vyvanse and adderall to stop being so effective. I strongly believe that Seroquel is dampening the efficacy of my ADHD medications. Any suggestions??

Dx. ADHD, Social Phobia, Insomnia
Tx. Vyvanse 70mg, Adderall 15mg prn, Paxil 25mg ER, Seroquel 50mg, Xanax 1mg prn-panic, Ativan 1-2mg prn-insomnia

 

[Toscacat]

I don't think that Seroquel is interacting with the stimulant you take for ADHD per se. Rather, Seroquel is notorious for next-day sedation, and is lousy for sleep latency (at least for me). You may want to speak with your physician about switching from Ativan to Klonopin. There's also low-dose doxepin (3 mg for sleep tops--anything more will make you overly sedated the next day).

There is Belsomra, but managed care is not a fan of the drug when cheap generics exist. It must be taken on an empty stomach or it works no better than placebo.

My insurance company would not pay for Rozerem PERIOD. (I don't know why that drug is so expensive. It has a lousy market share, no copay card, and shitty managed-care coverage. And an expensive melatonin-receptor agonist is like "yesterday's drug at tomorrow's prices.")

 

[paranoid android]

Seroquel at 50mg's would not act as a anti-psychotic at all as you have to hit around 200mg's before it even starts acting as a Serotonin antagonist let alone a Dopamine Antagonist. At 100mg's or below it's basically just a really strong anti-histamine. Usually the daytime drowsiness wears off after a week or so or it does with most people anyway.

Have you ever tried a Tricyclic for insomnia? I found Amitriptyline and Trimipramine to great for insomnia and far better then Seroquel which i find the sedation wears off rather quickly.

 

[AlphaMethylPhenyl]

In my opinion, the seroquel should be given a better chance. I'd imagine two weeks at least. A lot of the time, next-day grogginess from sleeping medication tends to dissipate after a good couple weeks or so of taking it.

I had to brush up on my literature a bit. It appears that seroquel doesn't bind very strongly to dopamine receptor subtypes in general, and that it may in fact indirectly increase adrenergic activity, which is of course is important for concentration. I believe its main metabolite also increases adrenergic activity, but through a different mechanism. I would urge you to question whether you're really not able to function well in school, or whether you may not feel that you aren't.

It's a difficult situation you're in, but, especially at that dose, it doesn't seem likely that your schoolwork would be disrupted, barring extreme sedation during an early class. And even then, giving your body and brain a few weeks to adjust is recommended after any medication change, I'd think.

Now ativan and xanax are medications that tend to dull people. You're also taking stimulants, and overall your dose is pretty high. I'm wondering whether you might be able to sleep better and feel less anxious if you were taking less amphetamine, because it does tend to cause anxiety. You also would probably be more alert if you were taking less ativan and xanax. I'd strongly urge you to consider this.

Xanax is not really known as a sleep medication.

 

[paranoid android]

^Norquetiapine which is of course Quetiapine's main and i believe only active metabolite is a fairly potent Norepinephrine reuptake inhibitor. Quetiapine itself acts as a antagonist at the α1-adrenergic and α2-adrenergic receptor sites so it's a Adrenergic antagonist hence the Hypotension that many people get when they first start treatment or stand up to quickly. Alot of Tricyclics such as Imipramine and Nortriptyline also act as potent Norepinephrine reuptake inhibitors and are used off label for treating ADHD. While Tricyclics are primarily sedating and Quetiapine certainly is there effect on Norepinephrine and possibly Quetiapines effect on Dopamine can make them useful in treating ADHD.

As far as Xanax and Ativan go they are not sleep meds they are anti-anxiety meds. They cause very little in the way of sedation in my experience and also Xanax is really too short acting to be used for that imo. Temazepam, Nitrazepam and sometimes Valium are used for sleep. However doctors these days usually prescribe a Z-hypnotic such as Zopiclone long before any benzo these days.

 

[Moreaux]

I actually found that Xanax interfered with my sleep back when I took it. I would wake up when it wore off and couldn't get back tonsleepnwothout taking another one. It was great for knocking me out initially, but too short acting. I definately found that it interfered with my sleep cycle. You may want to consider lowering your amphetamine doses and consequently your benzo doses - that should have an impact on the intensity of your insomnia. Good luck OP!

 

[InsomniacMike]

I think seroquel is the ideal medication since it would help me sleep after a long day of school and pretty much minimize any of the activating effects of my ADHD medication and eliminate insomnia as an issue. I heeded your advice and asked my psyc to drop the ativan and now I take 1mg of xanax as needed. I went down on my paxil and got prescribed temazepam for sleep. I have nothing to say but wow. I finally have found a sleep medication that allows me to eat before bed, and wake up not drowsy. I also don't feel "drugged" after taking it like ambien made me feel.

I saw my PCP today and he suggested Wellbutrin SR 100mg twice a day. Now, since it is summer I wont be relying on my adhd medication everyday, unless I enroll in summer classes or get a job.
and interesting research about the seroquel acting on norepinephrine, or its metabolites. I still have seroquel left, and I try to cycle my sleep medications so that I do not build up tolerance to the temazepam. Thank you for your advice!!

 

[InsomniacMike]

Seroquel at 50mg's would not act as a anti-psychotic at all as you have to hit around 200mg's before it even starts acting as a Serotonin antagonist let alone a Dopamine Antagonist. At 100mg's or below it's basically just a really strong anti-histamine. Usually the daytime drowsiness wears off after a week or so or it does with most people anyway.

Have you ever tried a Tricyclic for insomnia? I found Amitriptyline and Trimipramine to great for insomnia and far better then Seroquel which i find the sedation wears off rather quickly.

I think the next day drowsiness is mostly due to me not taking it every night, thus the side effect of drowsiness doesnt wear off.

I have not tried any TCAs, but i believe my father has tried Elavil. He took it at bedtime only 10mg i think and he slept great. Maybe I will ask my p.doc about that the next time I visit of the seroquel next day drowsiness does not get better. However, I am using temazepam 30mg now and i think I have finally found the right medication that eases me to sleep and allows me to wake up restful the next day.

 

[InsomniacMike]

I actually found that Xanax interfered with my sleep back when I took it. I would wake up when it wore off and couldn't get back tonsleepnwothout taking another one. It was great for knocking me out initially, but too short acting. I definately found that it interfered with my sleep cycle. You may want to consider lowering your amphetamine doses and consequently your benzo doses - that should have an impact on the intensity of your insomnia. Good luck OP!

Initially I found xanax 1mg to be great at relieving my insomnia. However, within one week that dosage no longer did the trick so I called my p.doc and asked for something else. I do believe I am on a pretty high dose of amphetamines, yet I still struggle daily with organization, time management, etc. My PCP suggested Wellbutrin, so I might give that a try.

I recently read an article about Paxil blocking to metabolism and excretion of ampheatime via the "2D"?? pipeline or something like that. If so, i would much rather get on a cleaner antidepressant that dosent affect this "2D" pipeline and allows me to be on a lower dose of amphetamine.

heres the source of that information
http://www.corepsych.com/2012/09/adhd-insights-prozac-paxil-ampehtamines/