New Shrink: Seroquel and Prozac for Insomnia & Anxiety?

[toobent]

I had a consult with a new Psychiatrist today.
I started at the most recent development of symptom causing concerns and worked back to when they first presented.
Emphasized that which concerned me the most.
Which can be summarized with the following:

1. Severe insomnia, rapidly escalating to multiple days of zero-negligible sleep that impairs my academic performance
2. Periods of anxiety culminating in my first black-out panic attack
3. Fluctuating levels of anxiety, infrequent bouts of mild to severe panic attacks aggravating my normal daily life

He listened, took notes then proceeded to ask me questions about my childhood, particularly teen years. I answered honestly. He concluded that my heightened stimulated SNS (effected way back then) is a direct result of traumatic experiences as a young adolescent that still affect me today.

He then asked if I was ever depressed. I admitted I suffered one period of depression as a teenager, about 15-17 then again briefly at about 19. He did not elaborate much on this at all. I said I've never felt depression since. Sure, I've felt down when suffering injury or illness, or the death of a loved one, but not clinical depression. In fact, apart from my insomnia I said I feel as though I'm at a high point in my life; academic and athletic pursuits being steadily accomplished.

He finished by prescribing me 150mg Seroquel to be taken every night same time (~2 hours pre-bedtime). Said it was not a medication designed to put me directly to sleep, but should make it easier for me to fall asleep and remain asleep. He said that it should also aid in treating my anxiety.

He then prescribed me Prozac (a drug I'd heard of, but knew nothing about). Before I could ask, he said this drug is an antidepressant to treat my depression. I replied that I was not depressed, to which he responded that I might soon find my feelings different after a couple weeks on Prozac. That it might enable me to look back and see that I was actually depressed. He also expanded on this by saying that it may aid in reducing my panic attacks. Which seemed like an unacceptable answer or explanation to me. I did not persist in requesting anything for my anxiety or panic attacks, as I arrived late to my appointment. I notified them, but he was generous enough to still take me in for a half hour consult (instead of the scheduled 1 hour), but most importantly I had lost some faith in him. The way he conducted himself during the consult, the questions he posed and the correlations he drew all had me developing respect for him right throughout the consult, but the medication he prescribed me and his reasons when queried about them made me lose all faith in him as being a promising, productive therapist

I'm scheduled to see him again in 4 weeks.

Thoughts?

Anyone care to share their knowledge or experience with Seroquel and Prozac in treating insomnia and anxiety?

editing...

I've had a very brief look into these drugs, and find it very strange that he prescribed these drugs for my diagnosed conditions. Am I missing something. Also, SSRI drugs seem to be very, very bad. Even worse then benzodiazepines.

 

[nAON]

Seroquel can be pretty good for knocking you out, but should keep in mind that at its core it is an antipsychotic, and thus has side effects related to this - if its IR and you're taking it at night, shouldn't be that bad, but you might still feel groggy in the morning.

SSRIs are, in my opinion, shitty drugs, even shittier if you're on them when you don't need them. Normally for panic attacks the most commonly prescribed stuff (and probably the most useful) are benzos, it's quite weird that he didn't script you that.

Get another psych?

 

[thesameoldfears]

I have taken both of these medicines before.

Seroquel was effective in getting me to sleep, but way quicker than 2 hours. If I wasn't in bed by the 30-45min mark I had a hard time even walking to bed. And that was only on 50mg. It did seem to cause weight gain for me.

Prozac was an absolute disaster, but I'm bipolar. It made me soooo manic. But I knew a lot of people who got it for anxiety and it seemed to just generally improve their function.

 

[deficiT]

I've only taken seroquel recreationally, while it did knock me out pretty quickly, I vaguely remember being in a half awake state in the middle of the night, with completely restless legs, feeling like my body was tweeking and twitching very uncomfortably. And I felt like complete shit the next day. I wouldn't recommend seroquel unless you are bipolar or some other serious mental issue.

I've taken a few SSRI's (Paxil, Zoloft, Effexor) but never Prozac. They helped my depression but not really my anxiety. While SSRI's do work for some people, they made me dangerously uncaring. It actually made me less productive because I really didn't give a shit about anything and became extremely lazy and consumed copious amounts of booze and amphetamines and sat around.

It's all up to you, if you feel your anxiety is bad enough that you want to try medication out, by all means go for it. But there are positives as well as negatives.

 

[Mass08]

I wouldn't take the prozac, SSRIs are shitty harsh drugs.

 

[toobent]

Thanks for all your responses. I've not yet had a chance to research Prozac and Seroquel as much as I would like. But briefly I've already discovered that Seroquel is prescribed to schizophrenics and bipolar patients, or major depression sufferers - none of these did he, or has any other Doctor, diagnosed me with. So where does he find it clinically acceptable to prescribe an anti-psychotic drug for off-label use to treat my diagnosed insomnia? Surely there is a more direct, safer, prudent first line of attack before resorting to off-label use of pretty hardcore drugs.

And Prozac is an antidepressant used to treat major depression, OCD, and panic disorder. He diagnosed me with depression (from my mentioning my brief period of depression as a teenager, now 14 years ago) when I told him that apart from my insomnia and salmonella poisoning I am at what I would describe one of my high points in life - I'm very happy. So perhaps his intended treatment effect of the Prozac is to address my panic disorder, which I believe is resultant of my accumulating sleep deprivation keeping me in a hyper-sympathetic state.

But my subjectively overwhelming and most debilitating pathological condition of insomnia, which I emphatically articulated as my biggest concern because of the compounding effect a continuing sleep deficit has on my whole life; study, sport, relationships, and downtime (when fortunate to have any) to participate in hobbies and other restorative activities, goes virtually untreated. At least not directly. It's devastating and I can't believe he did not prescribe a medication which as it's primary effect is treatment of chronic insomnia! He himself I have clear chronic insomnia persisting over several years now.

I don't think I'll fill the Prozac, because in my short research I've already read far too much of concern, and I know I am not depressed. I have been depressed before. It is a horrible condition I hope I or anyone else never has to endure again. And panic disorder, well I would actually label myself with GAD over that so Prozac plays no role in treating GAD. Which I believe is either a direct effect of my insomnia or at least exacerbated by it.

I will fill the Seroquel to see if it does provide some positive effect on my sleep, but I am extremely concerned about nightly 150mg dosing of an anti-psychotic drug designed for people who see and hear things that are not there (schizophrenics), or for bipolar disorder. So unless he diagnosed me in our first session, lasting 30 minutes, with bipolar and decided not to tell me but just prescribe me meds to treat it, then he's clearly using it off label to avoid using other more suitable insomnia medication, but for what reason? What could his motives be?

Can anyone offer me advice about how to go about expressing my concerns I have raised here to him? Is it advisable to do this or not? Should I schedule an appointment sooner than the 4 week one we've already pencilled in? Or should I try and see another Psychiatrist in the interim?

 

[AlphaMethylPhenyl]

SSRIs and Anti-psychotics are very capable medicines.

 

[toobent]

I've seen a few of your posts, resembling this one, in a variety of threads now. Where you make a comment that offers no contribution to the specific situation of the thread creator seeking relevant input to their situation and/or question(s).

SSRIs and Anti-psychotics are very capable medicines.

Capable of what?

Aspirin and Promethazine are very capable medicines.

See how useless and irrelevant the above factual statement is. Like yours it provides no benefit to anyone. And like yours it provides absolutely no benefit to me and my situation. It answers none of my questions or elucidates any ambiguity I may be suffering. In fact what you did was introduce ambiguity to an otherwise clear, coherent, and precise thread.

Why enter my thread and post a comment that offers absolutely no constructive advice, input or observation of my very detailed and specific situation? You've just wasted the 12 seconds it took you to type your post, because I doubt you read any of mine, including the OP. You've now actually wasted more of my time then you did of your own. Thanks, Ho.

It's a shame because I think I've seen some smart, constructive posts from you - I'm most likely confusing you with someone else though.

 

[behindblueeyes]

I'm surprised your doc chose Seroquel for insomnia and not something with less serious side effects... for example I'm scripted Remeron which helps sleep, I mean that has side effects too but not like anti-psychotics.

Remeron or trazodone would seem like a better option and they synergize well with SSRIs.

 

[AlphaMethylPhenyl]

I've seen a few of your posts, resembling this one, in a variety of threads now. Where you make a comment that offers no contribution to the specific situation of the thread creator seeking relevant input to their situation and/or question(s).

Capable of what?

Aspirin and Promethazine are very capable medicines.

See how useless and irrelevant the above factual statement is. Like yours it provides no benefit to anyone. And like yours it provides absolutely no benefit to me and my situation. It answers none of my questions or elucidates any ambiguity I may be suffering. In fact what you did was introduce ambiguity to an otherwise clear, coherent, and precise thread.

Why enter my thread and post a comment that offers absolutely no constructive advice, input or observation of my very detailed and specific situation? You've just wasted the 12 seconds it took you to type your post, because I doubt you read any of mine, including the OP. You've now actually wasted more of my time then you did of your own. Thanks, Ho.

It's a shame because I think I've seen some smart, constructive posts from you - I'm most likely confusing you with someone else though.

Maybe you're not. I had to offer my educated opinion given the people who state that they're harmful and/or useless. My reputation means something, so people can say "look, Ho-Chi-Minh, who has some good ideas every now and then, doesn't agree that "SSRIs are shitty harsh drugs" and the pejorative implication of seroquel being "an anti-psychotic", maybe I should re-evaluate what other posters stated. You obviously haven't read enough of my posts to understand just how much thought goes into my opinions. If you wanted elaboration, then say it. In fact, I would have been all too happy to elaborate. As it is, since you insist on being rude, I won't give you valuable help. I hope you learned your lesson.

 

[nAON]

Maybe start on lower dosage of the seroquel? Better to do too little than too much.

And though I don't know this psych or anything about him, I have heard too many stories of stubborn, pretentious fools to recommend giving most of them a 2nd chance, especially if it's costing you. Try and get a new psych and a second opinion imo.

And Ho-Chi - why the fuck are you posting in this thread if you're not elaborating on the subject and just self-referencing in posts? BDD is not exactly a good forum if you wanna partake in meta-discussion and social frolicking

 

[sonicwhite]

Prozac is the first line of defense for depression. They use it before they try any others. Um, well insomnia all the time....anxiety....it kinda sounds like manic but, in a way it doesn't. The serqual. Should help you sleep....I went thru a traumatic psychosis in 05 and I have residue from that event still today. Kinda derealization and panic attacks...Are you going to a clinic or a personal therapist?. Why I ask this is some have been trained to look for drug abuse patterns and others are very liberal about the meds.

 

[toobent]

Maybe you're not. I had to offer my educated opinion given the people who state that they're harmful and/or useless. My reputation means something, so people can say "look, Ho-Chi-Minh, who has some good ideas every now and then, doesn't agree that "SSRIs are shitty harsh drugs" and the pejorative implication of seroquel being "an anti-psychotic", maybe I should re-evaluate what other posters stated. You obviously haven't read enough of my posts to understand just how much thought goes into my opinions. If you wanted elaboration, then say it. In fact, I would have been all too happy to elaborate. As it is, since you insist on being rude, I won't give you valuable help. I hope you learned your lesson.

More dribble lacking substance.

I said your comment was useless, irrelevant and provided no benefit to me in this thread. Your vague ambiguity only, by your own admission, served yourself - your perception of your reputation. That's a fantastic attitude, Ho.

I made a factual observation pertaining to your post in my thread and followed it up with a question as to why you would take the time to make a comment that had no substantial potential to benefit me, first and foremost as the thread creator, or anyone else involved in this thread as either contributors offering constructive opinion or advice, or other participants who may be reading in hopes of their own benefit due to being in a similar situation.

Your educated opinion?

SSRIs and Anti-psychotics are very capable medicines.

Shows the quality and level of your education if you hold any conviction that the above quote offered any constructive contribution in this thread, all while displaying your education.

Seroquel is an anti-psychotic, that you find that fact and the stating of said fact deprecatory raises questions in my mind that are irrelevant to the thread, but nevertheless interesting enough to occupy me with some amusement for a few moments.

Maybe you should read my posts in this thread to inform and enable yourself, to become capable of offering a coherent, constructive contribution that might help in providing me a solution, instead of evaluating what other posters have said, and worrying about your reputation and perceived educated opinions.

Like I said, the majority of the posts I've seen from you are much like your initial post in this thread, so I'm not exactly eagerly anticipating reading any more of them. Fortunately I don't discern a user's intelligence, thoughtfulness, resourcefulness, or absence of the aforementioned from one post. And if I wanted you to elaborate I would have asked - strangely enough, I did; to my own folly - and it appears further useless qualities are exhibited with your second post in my thread with your evidenced ability to lie and find offence in truth, or rudeness in honesty.

With the short, albeit perpetuating uselessness, of your correspondence to me I find myself doubting you had any help to offer - valuable or otherwise. I certainly did learn something though, as I do everyday, and that's that posts from you are better left unread, to both save time and hope for humanity.

Have a great day, good sir. And ensure you maintain that perception of a good education and reputation with your vague, substance-lacking, ambiguous, aphasic comments. I'll be sure to remember good ol' Ho as a reputable character.

 

[Psychedelic Jay]

Psychiatry is evil in my opinion...

It solves nothing and will never solve anything to throw pills at anyone who can rationally elaborate on their feelings and are coherent doing so. Period.

The only pills I would give is a mood stabilizer... Then send your ass to THERAPY.

General practitioners are to take care of your general health and well-being... Insomnia is a health and well-being issue. Not a mental disease...

No one should be getting anti-psychotics for sleep, ever. Try cyproheptadine, diphenhydramine, doxycycline, zolpidem, hydroxyzine, hell even promethazine...

Find out the root of your emotion, and handle it.

Covering it up will shorten your lifespan and ruin you quality of life. Most psychiatric medications do all three of those quite easily.

 

[toobent]

I'm surprised your doc chose Seroquel for insomnia and not something with less serious side effects... for example I'm scripted Remeron which helps sleep, I mean that has side effects too but not like anti-psychotics.

Remeron or trazodone would seem like a better option and they synergize well with SSRIs.

Thanks for the info. I am surprised too. I actually know a young kid who has recently been diagnosed with schizophrenia and he's prescribed Seroquel, among other things, as treatment for his psychosis.

I find it a very strange prescription for my confirmed diagnosis; insomnia, anxiety/panic disorder, and somehow he's decided I'm suffering from depression too, when I know I'm not. And everyone who has ever suffered depression knows when they're suffering from it, and knows when they are not.

Maybe start on lower dosage of the seroquel? Better to do too little than too much.

And though I don't know this psych or anything about him, I have heard too many stories of stubborn, pretentious fools to recommend giving most of them a 2nd chance, especially if it's costing you. Try and get a new psych and a second opinion imo.

And Ho-Chi - why the fuck are you posting in this thread if you're not elaborating on the subject and just self-referencing in posts? BDD is not exactly a good forum if you wanna partake in meta-discussion and social frolicking

150mg does seem very high for a first time dose on an anti-psychotic med being prescribed off-label for insomnia.

First consult was free From now on they're $140

Prozac is the first line of defense for depression. They use it before they try any others. Um, well insomnia all the time....anxiety....it kinda sounds like manic but, in a way it doesn't. The serqual. Should help you sleep....I went thru a traumatic psychosis in 05 and I have residue from that event still today. Kinda derealization and panic attacks...Are you going to a clinic or a personal therapist?. Why I ask this is some have been trained to look for drug abuse patterns and others are very liberal about the meds.

But I don't have depression. He decided I do, after I admitted I suffered depression over 15 years ago for a couple of years. Notwithstanding that he prescribed it for me to treat my panic/anxiety disorder, which also appears as an off-label treatment and a strange one that begs questions when there are other drugs designed specifically for GAD and panic attacks. I'm not sure what you're saying with:

Um, well insomnia all the time....anxiety....it kinda sounds like manic but, in a way it doesn't.

It was a Psychiatrist at a special clinic, I'm not sure whether he was profiling me to ascertain whether certain meds were not suitable to prescribe. It didn't seem like it from the questions he was asking. He was more concerned about my teenage years. He did ask if I drank, smoke or abused drugs. I said no. I dress professionally. I was in suit paints and shirt, minus the tie.

 

[toobent]

Psychiatry is evil in my opinion...

It solves nothing and will never solve anything to throw pills at anyone who can rationally elaborate on their feelings and are coherent doing so. Period.

The only pills I would give is a mood stabilizer... Then send your ass to THERAPY.

General practitioners are to take care of your general health and well-being... Insomnia is a health and well-being issue. Not a mental disease...

No one should be getting anti-psychotics for sleep, ever. Try cyproheptadine, diphenhydramine, doxycycline, zolpidem, hydroxyzine, hell even promethazine...

Find out the root of your emotion, and handle it.

Covering it up will shorten your lifespan and ruin you quality of life. Most psychiatric medications do all three of those quite easily.

Over the years I've tried:

1. Melatonin
2. 5HTP
3. ZMA
4. Removal of ALL electrical components from the room
5. Eating high CHO just before bed
6. Ceasing prandial phase >2 hours pre-bed
7. Ceasing physical activity >4 hours pre-bed
8. Promethazine
9. Diphenhydramine

Nothing worked, not even transiently.

Keep in mind I'm an extremely physically healthy high level athlete too. Not your typical, hunched over a PC screen for 8+ hours a day who eats takeout 75% of the time and thinks exercise is a walk in the park.

I have pathological insomnia.

I'm starting to think this shrink believes it's because I'm depressed...but I'm not depressed. I'm sleep deprived, irritable, agitated, and growing increasingly angry as a result of an ever increasing sleep debt.

 

[sonicwhite]

Okay well.....I think if you have doubts...Talk to him about it. I don't see you as a drug seeker or anything. I just know when I had to get help...it was from a behavioral and substance clinic...Then I got a new shrink that doesn't really look at my past but, rather treats the symptoms I have. I'm bipolar OCD SAD GAD insomnia and some other crap. And yes the prozac is used off label for panic attacks and I guess it's too early to judge whether he is going to keep you on the soft meds instead of potent benzo's even tho I don't think your seeking that....Just some closer. I understand completly and, I have had to gone thru 8 yr's of doc's to finally come to the place where I am now......Just PM me if you have any ?'s about whats going on. Maybe I can help.

 

[toobent]

Thanks, sonic.

Honestly. I think I just need some Zolpidem for 3-4 weeks, by which stage hopefully some less potent more long-term treatment can sustain the new sleep pattern the Ambien would have effected.

And maybe some Valium, if that, to sustain low anxiety levels and prevent any occurrence of panic attacks. I think the biggest cause of my GAD and panic attacks are the fact that I'm constantly sleep deprived so my ANS is in sympathetic overdrive.

 

[Psychedelic Jay]

Over the years I've tried:

1. Melatonin
2. 5HTP
3. ZMA
4. Removal of ALL electrical components from the room
5. Eating high CHO just before bed
6. Ceasing prandial phase >2 hours pre-bed
7. Ceasing physical activity >4 hours pre-bed
8. Promethazine
9. Diphenhydramine

Nothing worked, not even transiently.

Keep in mind I'm an extremely physically healthy high level athlete too. Not your typical, hunched over a PC screen for 8+ hours a day who eats takeout 75% of the time and thinks exercise is a walk in the park.

I have pathological insomnia.

I'm starting to think this shrink believes it's because I'm depressed...but I'm not depressed. I'm sleep deprived, irritable, agitated, and growing increasingly angry as a result of an ever increasing sleep debt.

If you anxiety is as bad as it seems, of course you aren’t getting any sleep.

I would try clonidine or Guanfacine

These are perfect for anxiogenic insomnia (anxious insomnia)...

Your pathological insomnia can be because you are pathologically anxiety ridden.

 

[T. Calderone]

Hi Toobent, I was reading your thread on the benzo taper this morning. I suffer from insomnia too and it can be maddening. I havn't seen my psychiatrist since 2009 when I lost my job with insurance. (Since then, my work has been off the books with no benefits) I was diagnosed bipolar and I feel it's getting worse as I get older. I had been prescribed so many different antidepressants over the years. SSRI's, tricyclics, benzos and antipsychotics too.

I must say, I was surprised when you mentioned that this doctor wants you to take Seroquel as his first choice to help you sleep. 150 mg is a high dose if you have never taken it before. I recall 50 mg being a starting dose for me but it had many side effects I just couldn't handle. It helped my sister who is also bipolar but too strong for me. I had a hard time waking up in the morning and even into the next day left me lethargic. Initially it knocked me out but then my blood pressure went up as I gave it a couple months to "start working."

I think he could have given you something else, like mentioned earlier Remeron or Trazadone. Even Amitriptyline was useful for a while. If you filled these already, don't take 150 mg to start. Maybe 50-75 mg and see if it helps. The Prozac is not bad and like Sonic mentioned, it's sometimes prescribed for anxiety issues. But Seroquel is offered to people "off label" way too often than it should in my opinion. Did you tell him that you're trying to detox off Xanax?