New Shrink: Seroquel and Prozac for Insomnia & Anxiety?

[toobent]

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.

And that's the dichotomy I was hoping a Psychiatrist would be able to determine.

It's a circuitous dilemma, that those such as myself, will never be able to solve. Classic chicken & egg scenario.

The problem with this shrink is his neither his diagnoses, nor his prescribed medication answer which came first: The chicken (insomnia), or the egg (anxiety)?

And that's what I need to learn. In my subjective opinion (often the best indicator in these situations) I believe my insomnia causes my anxiety, as I have suffered insomnia way back when - years before anxiety ever presented.

 

[Thorns Have Roses]

Quetiapine is quite effective for insomnia, people are unjustifiably leery of it because it's a neuroleptic. SSRIs are frequently used for anxiety, give them a shot, and weaning off fluoxetine should be a lot easier than quitting a benzo habit. Try taking your medication as prescribed. Doses can be adjusted, or medication changed, upon further consultation with your doctor.

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.

What you think is that you're more qualified than your psychiatrist, and you're seeking support to undermine his choice of therapeutic tools, so you can seek the drugs you want. I know a lot of drug users basically don't trust medication that doesn't have an abuse potential, might this be a big part of the issue here (with a helping of common, unqualified prejudice against certain classes of medication)?

 

[Blind Melon]

I was recently prescribed Celexa (SSRI class, anti-depressant) for extreme anxiety/insomnia. It did absolutely zero for my anxiety. It made me rain sweat (which made me even more anxiety), and it made my mental state completely vacant. Didn't really care about anything... plus all the side effects of SSRIs and the extreme dependency that develops... don't know why people take them. I hate off-label prescriptions.

I was finally prescribed Gabapentin for my anxiety and insomnia, and it works OK. Not great, but still worth taking.

I'd love a benzo regiment, maybe 2mg clonazepam x2 a day. But doctors are very hesitant to prescribe benzos now, you kinda have to go through the ringer, trying out all kinds of anti-depressants/mood stabalizers/anti-psychotics. It's bulshit. But if you let them test all those drugs on you you'll eventually be prescribed benzos (that is if you aren't just drug-seeking, most docs are pretty decent at spotting that).

Best of luck to you and for your sake continue refusing SSRIs. Yuck. Hang in there man, and give Gabapentin a shot, it might help.

 

[Psychedelic Jay]

My thing about certain drugs prescribed off label is that some drugs can have very negative effects on the psych of people who are outside of the range of mind that these drugs need to treat.

 

[J.Wallace]

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.

What a dick response. Get off your high horse, bro.

SSRI's ARE shitty drugs. Also, your opinion means jack shit. This is a message board, nobody cares what you, I or anyone else here has to say.

OP, I highly recommend you avoid SSRI's. I was on them for almost 2 whole years from the age of 17 to 19. Zoloft and later Lexapro. Both made me a zombie, destroyed my sex drive and libido and did absolutely nothing for my anxiety and depression. I can't speak for anti-psychotics, but to give you rediculous drugs for off-label uses is absurd. Get a new doctor asap.

For Insomnia I'd recommend 5mg of Ambien (Zolpidem) and as for the depression I'd simply recommend therapy, no medication needed.

 

[toobent]

Quetiapine is quite effective for insomnia, people are unjustifiably leery of it because it's a neuroleptic. SSRIs are frequently used for anxiety, give them a shot, and weaning off fluoxetine should be a lot easier than quitting a benzo habit. Try taking your medication as prescribed. Doses can be adjusted, or medication changed, upon further consultation with your doctor.

I disagree with your "unjustifiably" adjective. I'm sure it is, according to the research I've done since his prescription I've come to learn that inmates at prisons fake psychosis to get prescribed this drug so they can sleep their sentences away.

Prozac has a very real potential for suicidal ideation. SSRIs also have many alarming side-effects, are also potentially capable of permanently altering neurological synapses and inducing withdrawal symptoms comparable to benzo WD through the devastating dependence SSRIs cause, but sure we can recommend them away because there's no abuse potential. Just like there is no scientific correlation between serotonin deficiencies exclusively causing depression, and that "messing with your head" by interfering with the common neurotransmitter that plays numerous roles and whose significant purpose to brain function is still barely vaguely understood, or that allowing this "messing with your head" will net any positive result in my case. But you're right, just like you've presumptuously drawn inaccurate conclusions of my character, intent, and motivation from 5 minutes of reading my thread, you know me better than myself just like my Psychiatrist knows me better in his one and only 30 minute consult.

I hear pissing on a cut will disinfect an open wound, so even though I have Betadine in the medicine cabinet, I may as well just piss on this here paper cut to treat my condition because why use something specifically designed for antiseptic purposes when I need to take a piss anyway? And hell it just might work.

I also discovered that insomnia treatment is off-label for this anti-psychotic, and according to other physicians and aggregate data 150 mg is an unusually high dose for off-label treatment of insomnia.

What you think is that you're more qualified than your psychiatrist, and you're seeking support to undermine his choice of therapeutic tools, so you can seek the drugs you want. I know a lot of drug users basically don't trust medication that doesn't have an abuse potential, might this be a big part of the issue here (with a helping of common, unqualified prejudice against certain classes of medication)?

No. I think I have more of a vested interest than my Psych, and more concern, in my own mental health. And no, I'm not seeking support to undermine his unusual off-label prescription to obtain the drugs I want. I have never had the Z-drugs I mentioned. My research concluded that they're the most effective for short-term treatment of insomnia - not Seroquel. And my research also led me to research-supported theories that it takes 21 days to form a new habit. Three weeks is within the recommended range of Ambien/Stilnox treatment, and there is no off-label prescribing of Ambien for insomnia. That's precisely what the drug is designed for, but you know what? Maybe we should start prescribing schizophrenics and those afflicted with schizoaffective disorder Ambien.

I know a lot of intelligent, well-informed people who have concerns regarding unusual prescribing of off-label drugs - particularly anti-psychotic drugs at seemingly high doses for insomnia. Two of the aforementioned people being physicians, and one being a 30 year practising Psychologist, another a 2nd year med student - all who have known me longer than this shrink's 30 minute discussion with me. A couple of those mentioned I've known for over 10 years now.
I think I am more aware of my mental state than my Psychiatrist, especially after one 30 minute session with him, and I know I am not suffering depression, nor am I suffering psychosis.

What you think is that you know me, my intent and motivation from reading a few of my posts. You don't know my history, you don't know my current state; physical, mental, spiritual, and emotional - not to mention social and financial status; the whole milieu of factors which makes us who we are. You don't know how smart I am, how disciplined I am, and how much more I know about myself than you do. But you're pompous and presumptuous enough to make asinine (implications) accusations, with no positive contribution - only your zeal to declare any and all who show concern regarding a high dose, off-label prescription of an anti-psychotic drug as drug abusers and losers who only share the common desire to get high off a preferable substance, which happens to not be Prozac or Seroquel.

The only thing you've got right is your username.

I was recently prescribed Celexa (SSRI class, anti-depressant) for extreme anxiety/insomnia. It did absolutely zero for my anxiety. It made me rain sweat (which made me even more anxiety), and it made my mental state completely vacant. Didn't really care about anything... plus all the side effects of SSRIs and the extreme dependency that develops... don't know why people take them. I hate off-label prescriptions.

I was finally prescribed Gabapentin for my anxiety and insomnia, and it works OK. Not great, but still worth taking.

I'd love a benzo regiment, maybe 2mg clonazepam x2 a day. But doctors are very hesitant to prescribe benzos now, you kinda have to go through the ringer, trying out all kinds of anti-depressants/mood stabalizers/anti-psychotics. It's bulshit. But if you let them test all those drugs on you you'll eventually be prescribed benzos (that is if you aren't just drug-seeking, most docs are pretty decent at spotting that).

Best of luck to you and for your sake continue refusing SSRIs. Yuck. Hang in there man, and give Gabapentin a shot, it might help.

Thanks for sharing your experience. And your strong recommendation against SSRIs reflects the vast majority of empirical evidence I've researched and is consistent with the aggregate data from the studies I've been reading - they're bad business. Probably worse than benzodiazepines.

My thing about certain drugs prescribed off label is that some drugs can have very negative effects on the psych of people who are outside of the range of mind that these drugs need to treat.

That's my huge concern. I am most certainly not depressed, nor psychotic. What if I blindly run into filling these scripts, begin treatment, and weeks or months down the track we observe adverse reactions. We cease treatment, and before you know it, I now am depressed, and suffering psychosis. Very real scenario, and records indicate this exact effect resulting from poor diagnoses, and malfeasance through off-label prescriptions scribbled off on a whim.

I can refer you to someone who Never Knows Best if you would like to find yourself in this devastating, life-altering position.

What a dick response. Get off your high horse, bro.

SSRI's ARE shitty drugs. Also, your opinion means jack shit. This is a message board, nobody cares what you, I or anyone else here has to say.

I've found someone on an even higher horse with even more "dickish" statements.

OP, I highly recommend you avoid SSRI's. I was on them for almost 2 whole years from the age of 17 to 19. Zoloft and later Lexapro. Both made me a zombie, destroyed my sex drive and libido and did absolutely nothing for my anxiety and depression. I can't speak for anti-psychotics, but to give you rediculous drugs for off-label uses is absurd. Get a new doctor asap.

Keep preaching, son! After 24 hours of steady research I've come to the same conclusion. Glad to see there are some whose experienced backed opinion is consistent with others' intelligent critical thinking cognitive ability, and scientific literature that all draw the same conclusion. But did you know we're really all just drug-seeking addicts? At least according to someone who Never Knows Best. Ironic.

For Insomnia I'd recommend 5mg of Ambien (Zolpidem) and as for the depression I'd simply recommend therapy, no medication needed.

I don't suffer depression. This Pysch decided that I did after I admitted I suffered depression for a period of nearly 2 years as a teenager over 14 years ago now. I agree with you on the Ambien.

I'm a high level athlete, first year med student, IN LOVE with life right now. Sure due to my competitive sport and desire to excel in school I can be anxious, BUT this is only either instigated when I am in severe sleep deficit due to my insomnia, or at the very least exacerbated by my insomnia. Either way, there's no depression to be found.

Through my own subjective measures and recollection of events. I would say the insomnia came before the anxiety, and the anxiety is exacerbated by my insomnia. Treat the cause, not the symptom. But no, lets prescribe off-label anti-psychotics and SSRIs to...I don't know what end. I honestly can't fathom his prescription.

 

[J.Wallace]

Yeah, my bad. Through responding to above posts and reading replies I lost track of the fact that the depression you spoke of was in the past and not present.

Best of luck to ya, OP. I'm glad to hear you are doing some research before taking said drugs, I personally wasn't smart enough to do so back when I was prescribed Zoloft and Lexapro, I simply took them with the idea "Hey, he's a doctor, he knows whats best!" but ironically he didn't know best, just like Never Knows Best!

 

[Thorns Have Roses]

^I just think BL goes a bit too far with it's SSRI loathing sometimes (let's not forget the old TCAs were SNRIs, amongst other things, and people wouldn't look down on those...though they're not first line medications for obvious reasons). I still maintain the quetiapine is an interesting script (the doc did give an explanation as to why the dose is what it was) and its efficacy as a hypnotic is well established.

All in all the prescribed regimen appeared to be based around killing the insomnia problem outright, while giving more generalized (minor) treatment for anxiety, something I would expect if the pharmaceutical treatment were to be accompanied by more extensive therapy (CBT, talk, both, who knows?). I think this is a pretty good idea for getting a more long-term handle on the anxiety problems (and I'd also like to remind everyone that depression isn't just acute negative feelings/dysphoria...and given the length of the consultation I don't blame the doc for assuming it before another disorder which could be established during followups).

Benzos for anxiety plus more benzos for insomnia presents a bigger risk for tolerance/dependence than receiving abenzo for either condition alone, though they would be appropriate for both.

Also, toobent, a little politeness goes a long way in these parts. Just saying, gettin' some vibes off ya.

 

[J.Wallace]

I fail to see how anybody could possibly advocate the use of SSRI's knowing the mechanism of action it creates when used. As far as I'm concerned, any compound that works on serotonin is ultimately not one that should be taken often. SSRI's are taken daily, sometimes for years on end. This causes irreversible damage to serotonin receptors and the brains ability to produce said chemical on it's own without months if not years of recovery. It took me a good year to feel 100% again.

Not to mention they simply don't work as advertised, instead they are mood blunters. While they may lessen depressive thoughts, they also ruin positive natural highs and turn you in to a zombie with no emotions whatsoever.

 

[hatrix]

Yea I'm going to ride the SSRI hate train too. They cause much more damage than good. They are just plain risky to use long term, and probably will want have you stopping them after only a week or so because of bad side effects. They cause PERMANENT changes in the brain. I certainly wouldn't want to go through that.

They definitely aren't very effective for anxiety treatment. I think it's bullshit they are prescribed for it. It may work for some people, but I think it's pretty rare. If you have real anxiety problems, a benzodiazepine is what is really going to help you. Of course, they carry risks too and can be addictive. If you have frequent panic attacks though, not just GAD like myself, you definitely need a benzo as an SSRI isn't going to do shit for them.

Seroquel seems fine for insomnia. Just note what others mentioned about it being an anti-psychotic. Talk to your doctor about the prozac. My doctor tried me on 3-4 different SSRIs before he finally put me on Xanax. Switched to Klonopin, then now I'm currently prescribed Valium for my anxiety and it's the best so far. Plus my new psych gave me 90x 5mg a month which is great since I sometimes use for comedowns and other drug combos, and want some to spare for actual prescribed use.

 

[toobent]

^I just think BL goes a bit too far with it's SSRI loathing sometimes (let's not forget the old TCAs were SNRIs, amongst other things, and people wouldn't look down on those...though they're not first line medications for obvious reasons). I still maintain the quetiapine is an interesting script (the doc did give an explanation as to why the dose is what it was) and its efficacy as a hypnotic is well established.

He didn't really give any explanation for the dose or the decision to prescribe an anti-psychotic off label at all. Keep in mind the actually bizarreness of this decision after his first 30 minute consult with me. Combined with his decision to prescribe Prozac - and I really should be running in the opposite direction as fast as I can.

All in all the prescribed regimen appeared to be based around killing the insomnia problem outright, while giving more generalized (minor) treatment for anxiety, something I would expect if the pharmaceutical treatment were to be accompanied by more extensive therapy (CBT, talk, both, who knows?). I think this is a pretty good idea for getting a more long-term handle on the anxiety problems (and I'd also like to remind everyone that depression isn't just acute negative feelings/dysphoria...and given the length of the consultation I don't blame the doc for assuming it before another disorder which could be established during followups).

No. In his own words the combination prescribed are to treat my depression, which he believes is the source of my insomnia and anxiety/panic attacks. He came to this conclusion in 30 minutes where I spent most of my time describing the recent and most influential experiences/conditions. And after answering one question about my adolescence where I admitted I suffered depression for nearly 2 years, which I NEVER have since.

The CENTRAL issue here is my insomnia. This is the source of the other existing condition; anxiety and panic attacks. The insomnia has been the one persistent condition for several years. Not the GAD, not the panic attacks, and the depression hasn't reared its ugly head in over a decade.

Prozac and Seroquel are not standard protocol treatments for my condition. He's taking huge discretionary privileges to appeal to his own delusions. There is no necessity to get a long-term handle on the anxiety if the insomnia gets treated.

I'd also like to remind everyone that when you are suffering depression - YOU KNOW YOU'RE SUFFERING DEPRESSION. It's acute, it's chronic, it's inescapable, it's undeniable. It's DEPRESSION, and you know when you have it.

Benzos for anxiety plus more benzos for insomnia presents a bigger risk for tolerance/dependence than receiving abenzo for either condition alone, though they would be appropriate for both.

I never asked for benzos, I never asked for Z-drugs, I asked for help for my main concerns in this order:

1. Insomnia: It's chronic, it's escalating and it's impairing my academic and athletic performance. Hrm...I wonder what consequential results this would have?
2. Panic attacks: They scared the hell out of me at first. Now I can almost sense them coming and am more proficient at dealing with them.
3. GAD: It makes life a little uneasy at times. But I can live with it.

And SSRIs for no good reason can have terrible sides and permanently alter the brain in a big-time negative way affecting the rest of your life - for the worst.

Also, toobent, a little politeness goes a long way in these parts. Just saying, gettin' some vibes off ya.

I don't appreciate presumptuous, condescending douche bags who make indirect postulations like they think they know someone after scan reading a couple of their posts. In fact, IRL I Clean & Jerk them then escort them to their vehicle to ensure they're able to arrive home safely before someone less tolerant and more inebriated than me (I don't drink) punches holes in their presumptuous pie hole.

I'm extremely respectful. It's a big value that forms a big part of me. When my credibility and character are unjustifiably misrepresented. My demand and fervour for respect will well be known.

I fail to see how anybody could possibly advocate the use of SSRI's knowing the mechanism of action it creates when used. As far as I'm concerned, any compound that works on serotonin is ultimately not one that should be taken often. SSRI's are taken daily, sometimes for years on end. This causes irreversible damage to serotonin receptors and the brains ability to produce said chemical on it's own without months if not years of recovery. It took me a good year to feel 100% again.

Not to mention they simply don't work as advertised, instead they are mood blunters. While they may lessen depressive thoughts, they also ruin positive natural highs and turn you in to a zombie with no emotions whatsoever.

Amen, brother. You may as well smoke meth daily for several years. You'll feel great and productivity will increase beyond your wildest dreams. But just wait and see how those dopamine and serotonin receptors function when you stop. For many many years after you stop.

Yea I'm going to ride the SSRI hate train too. They cause much more damage than good. They are just plain risky to use long term, and probably will want have you stopping them after only a week or so because of bad side effects. They cause PERMANENT changes in the brain. I certainly wouldn't want to go through that.

They definitely aren't very effective for anxiety treatment. I think it's bullshit they are prescribed for it. It may work for some people, but I think it's pretty rare. If you have real anxiety problems, a benzodiazepine is what is really going to help you. Of course, they carry risks too and can be addictive. If you have frequent panic attacks though, not just GAD like myself, you definitely need a benzo as an SSRI isn't going to do shit for them.

Seroquel seems fine for insomnia. Just note what others mentioned about it being an anti-psychotic. Talk to your doctor about the prozac. My doctor tried me on 3-4 different SSRIs before he finally put me on Xanax. Switched to Klonopin, then now I'm currently prescribed Valium for my anxiety and it's the best so far. Plus my new psych gave me 90x 5mg a month which is great since I sometimes use for comedowns and other drug combos, and want some to spare for actual prescribed use.

Amen, once again!

I'm still extremely sceptical of the Seroquel even, especially 150 mg. I've no doubt it will knock me out, and leave me feeling like a zombie the following day too - wow, that's sure to not impair my academic and athletic performance nearly as bad as the insomnia itself!

 

[Thorns Have Roses]

He didn't really give any explanation for the dose or the decision to prescribe an anti-psychotic off label at all.

Oh, I apologize then, it's just that this sounded an awful lot like an explanation.

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.

The CENTRAL issue here is my insomnia. This is the source of the other existing condition; anxiety and panic attacks. The insomnia has been the one persistent condition for several years. Not the GAD, not the panic attacks, and the depression hasn't reared its ugly head in over a decade.

Self-diagnoses are very rarely accurate. But if you are sure of this, shouldn't you be able to get insomnia meds from an M.D.? Going to a psychiatric professional is a waste of your and his time if you refuse to listen to any explanation that contradicts your a priori assumptions.

Prozac and Seroquel are not standard protocol treatments for my condition.

They're not uncommon either. Off-label use of drugs is pretty standard.

YOU KNOW YOU'RE SUFFERING DEPRESSION

That is a common misconception. ^{1 2} I'll believe you if you say you're not depressed, but what the hell do you expect a psych to figure if you give them 30min-1 hour to diagnose and prescribe treatment? I think his conclusions are very reasonable, given the limited information presented so far, a better look may well change that. If you want them to be thorough, set up with someone who can provide therapy and go more in depth before attempting any pharmacological treatment.

I never asked for benzos, I never asked for Z-drugs

The following goes along with my inkling that you are only prepared to listen to what you want to hear (see: confirmation bias), that is not an indictment of your character, it's what most people do, and is perfectly natural. It's something we have to actively try not to do, and will still fail at sometimes. But anyway:

I think I just need some Zolpidem...And maybe some Valium

I know a lot of drug users basically don't trust medication that doesn't have an abuse potential

You may as well smoke meth daily for several years. You'll feel great and productivity will increase beyond your wildest dreams.

Vaporized meth does not work that way, and implying the dangers of chronic methamphetamine use are equivalent to those of SSRIs is ludicrous. Maybe it's just hyperbole, but as I said, it is indicative of excessive contempt for these medications.

I'm extremely respectful

I don't appreciate presumptuous, condescending douche bags

What a dick response. Get off your high horse, bro.

SSRI's ARE shitty drugs. Also, your opinion means jack shit.

Pretty harsh treatment of persons who disagree with you (and agree with the established opinions of the medical community), and are only trying to help. I'm not trying to be mean or condescending, if you feel I am, say so and I'll walk away from this thread.

Not to mention they simply don't work as advertised, instead they are mood blunters. While they may lessen depressive thoughts, they also ruin positive natural highs and turn you in to a zombie with no emotions whatsoever.

Most persons who take them are not "turned into emotionless zombies", and their blunting of emotions is precisely why they're desirable medications. As someone who is all over the emotional spectrum within a given day, I can tell you natural highs can be pathological and prevent one being functional just as much as the lows. They are generally used like crutches, a temporary aid to help one while they're problems are being addressed, and they can be quite effective at this (though certainly not as effective as big pharma would like us to believe).

Just because some people have negative reactions to a drug doesn't mean no one should use it (or that they shouldn't be a first-line option), I figured a drug forum would be pretty hot on that idea, but I guess not.

I would actually love to get into a proper discussion about their benefits/detriments, but at another time and place. You have inspired me to do a bit more research into these medications, and I might make a thread on the subject within say two months time when I can explain (with proper citations and statistics) why they are (not) evil as BL's stigma would have them.

 

[sonicwhite]

I am dependent on my zoloft.....Thats proof enough that the OP is considering not wanting to go down that road.....I have tried to get off of it but, I have the worst nightmares....cold sweats and my flesh feeling like it's on fire....Also I have only been taking my klonopin as needed since last month I ran out early and had to withdrawal....I ain't doing that again....And well gabapentin is a good drug...but, I think it's withdrawals are worse then the benzo's in my opinion......I really think the OP is just wanting answers.....I mean there could be some of it where he wants peace and ya I wanted a klonopin when I first began my 8 yr plan with doctors but had to wait....But, my doc now is like a pain management patiet so he knows what it feels like to get ripped by a doctor....

 

[toobent]

Oh, I apologize then, it's just that this sounded an awful lot like an explanation.

That's not an explanation as to why he's opted to prescribe an anti-psychotic for off-label treatment instead of a variety of alternative, standard protocol treatments. He also elected to attempt describing what it should do, while not explaining what the drug is designed to do.

Self-diagnoses are very rarely accurate. But if you are sure of this, shouldn't you be able to get insomnia meds from an M.D.? Going to a psychiatric professional is a waste of your and his time if you refuse to listen to any explanation that contradicts your a priori assumptions.

That's the diagnosis of my GP, and shrink. My referral from my GP explicitly states, "...patient suffers from chronic insomnia, GAD, and panic attacks..."
This unorthodox shrink's first diagnosis made in our first consult was my chronic insomnia.
My subjective input enabling pertinent insight evidences that the insomnia was present well before the other pathologies.

They're not uncommon either. Off-label use of drugs is pretty standard.

Perhaps, but not commonly used prior to established inefficacy of standard protocol treatments first, and hence their place as off-label use. I wouldn't call it standard practice to opt for off-label use as the first course of treatment.

That is a common misconception. ^{1 2} I'll believe you if you say you're not depressed, but what the hell do you expect a psych to figure if you give them 30min-1 hour to diagnose and prescribe treatment? I think his conclusions are very reasonable, given the limited information presented so far, a better look may well change that. If you want them to be thorough, set up with someone who can provide therapy and go more in depth before attempting any pharmacological treatment.

You may well be correct, I did not read your references, but I daresay for every cited source supporting your belief of it being a misconception there would be another study concluding the contrary. Notwithstanding that the fact is that in this thread, in this context I am the subject and there is no doubt that I am cognizant of when I am and am not suffering depression. There is no doubt I have not suffered depression in well over a decade. This is axiomatic to me and all who know me (including my physician and psychologist).

What I want the Psych to do is not jump to conclusions in 30 minutes. Lets treat the well established pathological condition first. How you find his conclusions reasonable are amusing when 1. you were not there; you have no comprehensive record of the consult and dialogue exchanged, and 2. your opinion is contrary to every piece of professional advice I've sought post this bizarre experience and I believe every other opinion in this thread alone - opinions of those with similar (or dissimilar) pathologies treated with SSRIs and their horrible experiences and damage suffered as a result. Not to mention the strange acceptance of treating insomnia that impairs an athlete's and student's performance with 150 mg of Seroquel which will undoubtedly knock me out but leave me with impaired cognitive function the following day. I would be laughing, in good taste, if it weren't me suffering the folly of this Doctor.

The following goes along with my inkling that you are only prepared to listen to what you want to hear, that is not an indictment of your character, it's what most people do, and is perfectly natural. It's something we have to actively try not to do, and will still fail at sometimes. But:

I don't know how I "never asked for benzos, I never asked for Z-drugs..." to this Psych has anything to do with your incorrect intuition that I'm only prepared to listen to what I want to hear, however natural it is. In this instance I want to hear what 1. sounds logical, 2. comports with standard protocol and 3. is backed by scientific research concluding benefit outweighs risk. And me "think(ing) I just need some Zolpidem...And maybe some Valium" comes after my subsequent research from the bizarre treatment chosen by this unorthodox shrink. And both thoughts meet the aforementioned criteria 1. 2. & 3. for my pathologies.

See, I'm a med student and a competitive athlete. We seldom only listen to what we want to hear, because under my first hat I am compelled to apply the scientific method to everything where we're drilled to detach ourselves from the folly of confirmation, belief, and cognitive bias. And under my second hat I never only listen to what I want to hear because 1. if I did that I would never achieve what I have as an athlete (National Champion) and I've still achieved nothing in my eyes because I know I can always do better and 2. I'd soon get dropped from the National squad. These qualities are what separate the few (me) from the many (you).

And Seroquel has abuse potential, I don't know what importance you think that quote of yours holds.

Vaporized meth does not work that way, and implying the dangers of chronic methamphetamine use are equivalent to those of SSRIs is ludicrous. Maybe it's just hyperbole, but as I said, it is indicative of excessive contempt for these medications.

Does not work what way? Does not make depression abate, increase your work capacity and does not adversely effect numerous neurotransmitter uptake and production long-term?

And yes, I was being dramatic. Nevertheless my analogous rhetoric is still very relevant. It is indicative and foolish means to wanted ends.

What a dick response. Get off your high horse, bro.

SSRI's ARE shitty drugs. Also, your opinion means jack shit.

That was not me --^

Looks like I'm not the only one who finds your posts portray you as a condescending douche bag.

Pretty harsh treatment of persons who disagree with you (and agree with the established opinions of the medical community), and are only trying to help. I'm not trying to be mean or condescending, if you feel I am, say so and I'll walk away from this thread.

I found your first post in this thread full of presumptuous, patronizing, false assumptions most likely attributable to your own belief bias, which compelled you to take a stand! This placed you straight in the wrong and after having made snide remarks regarding my motives and character, the following

I don't appreciate presumptuous, condescending douche bags

was warranted, and about as far from harsh as the truth is from wrong. But they say the truth hurts.


[quoteMost persons who take them are not "turned into emotionless zombies", and their blunting of emotions is precisely why they're desirable medications. As someone who is all over the emotional spectrum within a given day, I can tell you natural highs can be pathological and prevent one being functional just as much as the lows. They are generally used like crutches, a temporary aid to help one while they're problems are being addressed, and they can be quite effective at this (though certainly not as effective as big pharma would like us to believe).[/quote]

You have data confirming this or you're just making this statement from your own anecdotal experience. In our own minds our n=1 confirmation really amounts to believing the Earth is the centre of the universe, and everything revolves around it, or you more precisely.

So defying natural highs is productive? SSRIs are a temporary aid?

“We act as though comfort and luxury were the chief requirements of life. All that we need to make us happy is something to be enthusiastic about.”

Just because some people have negative reactions to a drug doesn't mean no one should use it (or that they shouldn't be a first-line option), I figured a drug forum would be pretty hot on that idea, but I guess not.

Absolutely absolutists suck.

"Just because some people have negative reactions to a drug doesn't mean no one should use it" doesn't rationalize a poor off-label treatment decision. And absolutely when there are medications designed specifically for the pathology of topic with much less severe side-effects or long-term damage than they (off-labels) most definitely shouldn't be a first course of treatment! That's simply absurd to say otherwise.

You'd figure you're going to find some valuable discourse, mostly anecdote and how to get high(er), but not defending indefensible treatment bordering on malfeasance.

I would actually love to get into a proper discussion about their benefits/detriments, but at another time and place. You have inspired me to do a bit more research into these medications, and I might make a thread on the subject within say two months time when I can explain (with proper citations and statistics) why they are (not) evil as BL's stigma would have them.

To me it's not a matter of the stigma you believe they have attached, or whether they're evil or not. It's a matter of them not being the right first course of treatment prescribed me. Plain and simple, and only a fool would be contrarian, or just looking for notoriety. So I've no interest in your recent inspiration to properly research SSRIs - though I strongly suggest that as a Moderator you should, for your own good too and everybody else to avoid further dissemination of misinformation - just care about you acting a role beyond your ability when it encroached into my personal space; my character and my motives. You have/had no business there, and in future you can refrain from placing yourself there, and everything else is dandy.

There is no way I can reconcile the decision to prescribe Seroquel (anti-psychotic), for my insomnia when there are multiple more suitable and standard protocol treatment options not yet prescribed me, and Prozac (SSRI) for my "undiagnosed", or certainly subjectively not felt, depression, when all evidence and subjective measures indicate that apart from my insomnia I am at a high point in my life. A fact supported by friends, family, academic and athletic results, social and relationship status, etc. It's funny, I remember as a teenager when I suffered depression all I did was sleep. Now I can't sleep no matter how hard I try, but according to Mr Shrink and his 30 minute consult, I'm depressed

Look out...sad face! He must be depressed.

Anyone here a new parent? You know those consecutive nights of little to no sleep, and even though the high from being a new mum or dad keeps you smiling and chirpy, you eventually start feeling like crap; run-down, irrational - emotionality takes over and you're crying over spilt milk. It's not your accumulated sleep debt causing you these problems - you're just actually depressed but aren't cognizant of it. It's true, Never Knows Best, ask him.

"Few people are capable of expressing with equanimity opinions which differ from the prejudices of their social environment. Most people are even incapable of forming such opinions."

 

[Thorns Have Roses]

Alright, alright, I'll admit to overreaching here. I just think the best option is to try what the doc ordered, then when you see him in a month tell him you'd like to try something different. And I'm sorry for the misquote. (Now get ready for some tough love)

However, I emphatically stand by my conclusions, especially since you've been less than honest in this thread. I just looked at your other created threads, namely Help Benzo Withdrawals Hell.

Why didn't your docs consider benzos...hmm...maybe it has something to do with:

Although I am prescribed them for therapeutic treatment, I have a tendency to indulge in recreational use.

You also admit to concurrently using oxycodone (to help with w/d in that thread and had it because of injury, but you have other threads about how to best get high on it, in combo with supra-therapeutic doses benzos no less).

Any and all advice will be greatly appreciated. I am in a state of despair right now, fellow BLers.

I now find myself taking OC absent pain

I've still achieved nothing in my eyes because I know I can always do better

Kinda changes the situation, doesn't it?

So I will say it one more time, depression is a plausible diagnosis. You are a student and an athlete and have a social life, but you may have emtional/psychological issues that are not being dealt with. So while your life appears to be at a high point to you, from where I'm sitting it looks like it's on the verge of falling apart. My life has long since fallen apart and I do not want this to happen to you.

You have dug yourself into a pretty deep hole, and if getting yourself out of it means you have to lay off the sports and have impaired academic performance for a while, it will be well worth the temporary setbacks. If you're dead set against SSRIs I can respect that, even if I disagree, but give the quetiapine a chance, get some sleep. It's Saturday so maybe you can afford to see how it impaired it leaves you tomorrow, hopefully being pretty decent by Monday?

Maybe you can handle it all and just need the right Rx to facilitate this, but going all in means you risk losing it all too. Your decision, as you pointed out, my conclusions are based off of incomplete information and the biases I have accumulated in my time on this board.

You've limited your slip into abuse of these compounds, and that's better than I'd be able to accomplish in your situation. Work some more downtime into your life, being busy all the time can be harmful. Don't force yourself to achieve, especially with those injuries (I assume sports related? Hope they got better quickly).

Too continue with our digressive quibbles:

Does not work what way? Does not make depression abate, increase your work capacity and does not adversely effect numerous neurotransmitter uptake and production long-term?

If it be the only qualified statement I make in this entire thread, smoking meth will not abate depression and increase work capacity for very long, it'll just result in those negative effects. Low oral doses might be used to those positive effects though, certainly.

You know those consecutive nights of little to no sleep, and even though the high from being a new mum or dad keeps you smiling and chirpy, you eventually start feeling like crap; run-down, irrational - emotionality takes over and you're crying over spilt milk. It's not your accumulated sleep debt causing you these problems - you're just actually depressed but aren't cognizant of it

It's totally possible too big a workload/burnout can cause this sort of thing in absence of sleep problems, some parents can't handle parenthood very well, makes for broken families.


Edit: I have been unnecessarily emotional in my last few posts. I don't know why. Too indirect too with my hypotheticals and devil's advocate playing.

I'll retract it all if you just listen to this. I've been thinking about your problems for the last 24 hours now more or less, and I just have a gut feeling that something is not right about your explanation of your problems. It doesn't gel together. While blaming the issues solely on insomnia is most convenient (and hopefully true), it probably runs a lot deeper than that. That frightens me for your sake. My time here, particularly in PD, in addition to my own experiences has shown me that the problems we have in our conscious lives are often just effusions from more systemic subconscious ones. Good luck, and take care.

 

[Oxy Blues]

fuck that shit. benzodiazepines are designed to treat anxiety and insomnia. And considering that your insomnia lasts for quite a while then i would recommend a long-acting benzo like Clonazepam, Diazepam or Chlordiazepoxide (if you are benzo-naiive). 1mg of Clonazepam (Klonopin) every 8-12 hrs (assuming that you have no benzo tolerance) or 15-20mg of Diazepam (valium) every 24 hrs should be a good starting dose and entirely take care of your anxiety and your insomnia. Prozac is an ssri and Seroquel is an antipsychotic and these two classes of drugs really fuck ur brain up in the long term; at least with benzos once you stop they wouldn't have done any damage in you brain unless you abuse 'em in which case it is even unlikely that the brain damage you developed will even be noticeable, yes you will suffer from serious withdrawal symptoms if you quit benzodiazepines cold turkey but you can taper and let's not forget that ssri's and antipsychotics have serious withdrawal symptoms too . just my two cents.

 

[Oxy Blues]

fuck that shit. benzodiazepines are designed to treat anxiety and insomnia. And considering that your insomnia lasts for quite a while then i would recommend a long-acting benzo like Clonazepam, Diazepam or Chlordiazepoxide (if you are benzo-naiive). 1mg of Clonazepam (Klonopin) every 8-12 hrs (assuming that you have no benzo tolerance) or 15-20mg of Diazepam (valium) every 24 hrs should be a good starting dose and entirely take care of your anxiety and your insomnia. Prozac is an ssri and Seroquel is an antipsychotic and these two classes of drugs really fuck ur brain up in the long term; at least with benzos once you stop they wouldn't have done any damage in you brain unless you abuse 'em in which case it is even unlikely that the brain damage you developed will even be noticeable, yes you will suffer from serious withdrawal symptoms if you quit benzodiazepines cold turkey but you can taper and let's not forget that ssri's and antipsychotics have serious withdrawal symptoms too benzos also take care of depression if you have serious anxiety just by providing a unique sense of euphoria that comes from the feeling of 'no anxiety'. just my two cents

 

[toobent]

Alright, alright, I'll admit to overreaching here. I just think the best option is to try what the doc ordered, then when you see him in a month tell him you'd like to try something different. And I'm sorry for the misquote. (Now get ready for some tough love)

It need not be described as over-reaching, just opining when well misinformed and influenced by your own biases. And we're all emphatic when it comes to that. I disagree that the best option is to try what the Dr. ordered - maybe agree on the Seroquel as it is term break so I can live with the zombie hangover, miss morning training and just perform afternoon session, and I can't see it - despite being a high dose anti-psychotic - altering nerual pathways in a month!

However, I emphatically stand by my conclusions, especially since you've been less than honest in this thread. I just looked at your other created threads, namely Help Benzo Withdrawals Hell.

I was not dishonest at any point in this thread. My combined posting represents the reality of my situation, my recreational (ab)use of Alprazolam over a 5 week period (Wow...benzo junkie!), which I have already addressed and have well under control - without clinical input (by the way, just as a tangent, albeit it entirely relevant; I wasn't suffering acute benzo withdrawal syndrome when I made that thread - I had gastroenteritis. Lol. Look it up, the symptoms are identical.)

My admitted benzo binge has no bearing on this thread whatsoever.

Why didn't your docs consider benzos...hmm...maybe it has something to do with:

Without him knowing this? He's not a Psychiatrist...he's a Psychic?

You also admit to concurrently using oxycodone (to help with w/d in that thread and had it because of injury, but you have other threads about how to best get high on it, in combo with supra-therapeutic doses benzos no less).

Being in unbearable pain.
Popping pain killers to alleviate pain.
Yes. Poor judgement there. I must agree. [/sarcasm]

And yes, an opiate high is my one true love (also mentioned once or twice in the threads I post in). So I made enquiries as to how to enhance the OC effect when I wanted a day of not just being able to function pain free, but function with my head in the clouds. I have no desire to conceal my addictive personality and ability to act on it. I'm also well aware of how over the last decade I've learned to focus this trait toward positive goals, while being capable of indulging on an infrequent basis without it extending to addiction.

I'll confess to something else. Remember how I just said heroin is my one true love? I was an addict at the age of 14 - about the same time I ran away from home to escape physical abuse - and continued my addiction till about 17 when I was drawn to a local boxing gym that somehow maintained my interest. Anyway, within a month I'd kicked the H, began fighting and replaced one addiction; heroin, with another; athletic performance. But you now what. Every single year since I kicked the harry, I score a couple points and spot the whole thing up in one night. It's my annual indulgence. And it's never extended beyond that. See, I posses discipline, I possess mental fortitude, and I know what I want, and I do what needs to be done to get it.

I have two disc herniations, a medial protrusion and dorsal extrusion. I'm always scripted pain killers - the good ones. The majority of the time I take them as needed. Sometimes I don't. This doesn't impair my academic or athletic performance, but you know what does? Insomnia. Sleep deprivation - I won't bother looking up the data - is responsible for that many negative results from productivity to fatalities it's no joke.

I've still achieved nothing in my eyes because I know I can always do better

I've no idea what that quote is supposed to elucidate or how it relates to our discussion. But I've more important things to do right now like catch up on 5 days of missed lectures to dig back through my posts to try and get your point.

Kinda changes the situation, doesn't it?

Nothing you've just said changes my situation in the slightest. I have insomnia. A pathological condition that requires no precursor to present. A chronic condition which I have not properly been treated for. Instead I've been prescribed anti-psychotic medication, which you somehow agree with.

So I will say it one more time, depression is a plausible diagnosis. You are a student and an athlete and have a social life, but you may have emtional/psychological issues that are not being dealt with. So while your life appears to be at a high point to you, from where I'm sitting it looks like it's on the verge of falling apart. My life has long since fallen apart and I do not want this to happen to you.

Depression is not a plausible diagnosis (made in half an hour) for me. I have tremendous emotional scarring. If I told you of my childhood and teenage years you'd most likely wonder how I'm not a statistic but a high level athlete and med student. However, my issues have been dealt with. I now have a great relationship with my mother, father, and stepfather. I forgave them years ago. I received counselling and saw a psychologist years ago. I turned my addictive personality and aggression into academic and athletic improvement and focus years ago. My life right now, apart from not being able to sleep, is at an all time high. I have some of the best friends anyone could ask for, a girlfriend who lets me fuck her in the ass over the kitchen bench while she (tries) to prepare our dinner, or tops me off while we're cruising down the freeway. I am one of the best athletes on our squad. I maintain a ridiculous GPA and my professors love me. My life is on the verge of accumulating such an extensive sleep debt, I may well fall apart. That's what sleep deprivation does; you know it's a torture tactic still employed by the CIA?

So from where you're sitting, which is behind a PC screen with absolutely no knowledge of my daily life, accomplishments, feelings, motivations, relationships, activities, your view and perception is beyond obscured. It's asinine to even hold one.

I'm sorry your life fell apart, and I hope it's now back together. If not, perhaps focus on some more of what's tangible - your own life.

You have dug yourself into a pretty deep hole, and if getting yourself out of it means you have to lay off the sports and have impaired academic performance for a while, it will be well worth the temporary setbacks. If you're dead set against SSRIs I can respect that, even if I disagree, but give the quetiapine a chance, get some sleep. It's Saturday so maybe you can afford to see how it impaired it leaves you tomorrow, hopefully being pretty decent by Monday?

Insomnia is the hole I'm held in, and getting out of it requires appropriate treatment. Not SSRIs and anti-psychotics. You might have a valid option there regarding the Seroquel. I'm considering it while it's term break.

Maybe you can handle it all and just need the right Rx to facilitate this, but going all in means you risk losing it all too. Your decision, as you pointed out, my conclusions are based off of incomplete information and the biases I have accumulated in my time on this board.

I appreciate your humility to acknowledge your error. I believe I do just need the right Rx. A month of getting knocked out at 10pm every night will result in enabling me 8 hours of sleep which will dramatically improve everything.

You've limited your slip into abuse of these compounds, and that's better than I'd be able to accomplish in your situation. Work some more downtime into your life, being busy all the time can be harmful. Don't force yourself to achieve, especially with those injuries (I assume sports related? Hope they got better quickly).

Because I've been there, done that - when I was a kid. I have too much to live and be happy and grateful for to allow a recreational binge turn into full blown addiction and throw my blessed life away.

The bold is very much appreciated advice, and something I would do well to heed. I'm your classic Type A personality who sometimes (okay, most of the time) pushes myself too hard. But you know what, hard work works. So does working smart, and realizing when a reduction in intensity is necessary (something my coach is finally getting through to me - you'd be amazed at how comparable training and the processes involved are with actual life) is paramount to continued improvement and avoiding collapse.

Yes, sports related. Part of the game, which I accept. And thank you for your well wishes but they're injuries (vertebral disc herniations) that remain with you for life.

Too continue with our digressive quibbles:


If it be the only qualified statement I make in this entire thread, smoking meth will not abate depression and increase work capacity for very long, it'll just result in those negative effects. Low oral doses might be used to those positive effects though, certainly.

You missed the sarcastic analogy. Yes meth will mask the depression transiently. And productivity will increase, for a time. Eventually your dose either reaches a point where there is not enough time to maintain any productivity, but the depression might still be concealed. In any sense it was a sarcastic analogous response.
Please note in no way do I endorse meth or any drug use!

It's totally possible too big a workload/burnout can cause this sort of thing in absence of sleep problems, some parents can't handle parenthood very well, makes for broken families.

There's always an exception that proves the rule. Every new parent I've ever known has fallen victim to sleep deprivation and this is the rule, though I do know one mother who unfortunately suffered post-natal depression.

Edit: I have been unnecessarily emotional in my last few posts. I don't know why. Too indirect too with my hypotheticals and devil's advocate playing.

I'll retract it all if you just listen to this. I've been thinking about your problems for the last 24 hours now more or less, and I just have a gut feeling that something is not right about your explanation of your problems. It doesn't gel together. While blaming the issues solely on insomnia is most convenient (and hopefully true), it probably runs a lot deeper than that. That frightens me for your sake. My time here, particularly in PD, in addition to my own experiences has shown me that the problems we have in our conscious lives are often just effusions from more systemic subconscious ones. Good luck, and take care.

Don't worry. I'm Mr. Emotionality. It defines us. I think you just took an (in your eyes) honourable stance in defending SSRIs, which is fine. Only you made some presumptions about me in the process. All that aside, I have no regard for SSRIs one way or the other to be frank. I do know they're not optimal treatment, neither are anti-psychotics, for my pathological condition impairing my life: insomnia.

Thanks for your concern, but you're way off with your intuition. I have no explanation. I have a problem - insomnia. Insomnia is a pathology requiring no precursor, just a chemical imbalance perhaps. It could be endocrinological, neurophysiological, whatever. It's not emotional. Everything we are is a result of ectodermic output responding to exogenous (afferent), and endogenous (ANS) stimuli effecting a change first in our ectoderm, which elicits adaptations on a mesodermic level.

Usually the simplest answer, is the answer. Insomnia might not be some convoluted, exciting, many years in the making problem, so it lacks appeal to those who like drama, mystery and intrigue because it's too simple. Unfortunately in this case, the simple answer is my answer.

God bless you, my friend.

fuck that shit. benzodiazepines are designed to treat anxiety and insomnia. And considering that your insomnia lasts for quite a while then i would recommend a long-acting benzo like Clonazepam, Diazepam or Chlordiazepoxide (if you are benzo-naiive). 1mg of Clonazepam (Klonopin) every 8-12 hrs (assuming that you have no benzo tolerance) or 15-20mg of Diazepam (valium) every 24 hrs should be a good starting dose and entirely take care of your anxiety and your insomnia. Prozac is an ssri and Seroquel is an antipsychotic and these two classes of drugs really fuck ur brain up in the long term; at least with benzos once you stop they wouldn't have done any damage in you brain unless you abuse 'em in which case it is even unlikely that the brain damage you developed will even be noticeable, yes you will suffer from serious withdrawal symptoms if you quit benzodiazepines cold turkey but you can taper and let's not forget that ssri's and antipsychotics have serious withdrawal symptoms too benzos also take care of depression if you have serious anxiety just by providing a unique sense of euphoria that comes from the feeling of 'no anxiety'. just my two cents

Amen, brother. You're preaching to the choir.

You have a blessed day too, sir.

 

[Crazy Matt]

My wife is getting drug tested (urine), do tests look for quetiapine fumarate or, show up as something else? She cannot piss hot but needs these, even before resuming a doctor's script