Trazodone, Seroquel, Remeron

[nsauce]

My psych wants me on something for insomnia. He wrote me for 100mg Trazodone. He is also giving me the options of Seroquel 25mg or Remeron 15mg, if the Trazodone doesnt work for me. I havent picked up the trazodone from the pharmacy yet, and I just wanted to see what peoples experiences have been with these meds - experiences both good and bad.
Thanks BL .

 

[GABAking]

Trazodone should work nicely at 100 mg. If that doesn't work for you, I'd go with the Remeron. Both of those drugs are tricyclic antidepressants which were used back before SSRI's became the mainstay of treatment. some TCAs are notoriously drowsy, so they are really only used for sleep purposes nowadays.

I'd stay away from Seroquel if I were you. Antipsychotics are nasty drugs, lots and lots of side effects.

 

[BabyGurl3171]

I take Seroquel and honestly it doesn't make me tired. I'm on 300 mgs.
I also take Trazodone 100 mgs, which works nicely. But I also take Ambien with it.
My teenager is on 15 mgs Remeron and that really works for her with no hang over in the morning.
I'd try traz first then remeron. Probably avoid Seroquel if you can, imo.

 

[Geaux Tigers!]

TL;DR I suggest the TCA trimipramine as the psych drug for insomnia. Random rambling about how I'd handle sleep with a pretend patient.


Do not use quietipine; sure, it'll knock you out but it has a greater side effect profile than the ones you mentioned. (yes, I realize that D2 is not occupied by this dose)

If trazodone works for then it's definitely the best option of the three; if not, I bet mirtazapine will do something for you, but it does have bad off weight and appetite effects that are more troublesome than those associated with trazodone. Mirtazapine is a good drug and it may have some good antidepressant properties (much superior than trazodone) if that is what you're looking for. Also, it causes some really fantastic dreams! Notorious for this.

Honestly the best TCA for insomnia, in my opinion, is trimipramine. More sedating than trazodone and seems to cause, subjectively, less of a hangover effect.

I suppose a psych will want to use psych drugs to solve every problem, but if you're looking for nonaddictive things to help --> try tizanidine; nonscheduled and very underrated..

I'd try out a tizanidine first; if this works, you won't have to deal with a next day hangover like you might with these drugs.

For a patient with sleep problems, I do it like this:

First Line: tizanidine 5mg. po qhs #30/hydroxyzine 25mg. po qhs #60 /gabapentin 400mg. po qhs #30
Second Line: trimipramine 25mg. po qhs #30/ flurazepam 15mg po qhs prn #15

No sense in giving out more bullshit if ^^^ doesn't work.

Third Line: quazepam 7.5 1-2 tab po qhs #60

Time for z-drug? No way! quazepam is far superior (and still GABAa specific) It is underprescribed and superior to zolpidem; it improves sleep architecture, and drug tolerance is not as swift

I'd be hesitant to write these z-drugs. Too "wild". I'd move on to triazolam and tempazepam.

Quazepam (Doral) : http://en.wikipedia.org/wiki/Quazepam

I think the best fourth line drug would be zolpidem followed by triazolam (Halcion).

At month 6, if you still can't sleep; I think it's time for Seconal followed by chloral hydrate followed by Xyrem (GHB)

lol, if you went to me; by the 8th month you'd be on Xyrem.

 

[nsauce]

Thanks for the input. I am on a paid clinical trial therapy which inlcludes the chemo therapy-like peginterferon alpha2a, and ribavirin for Hep C and these cause increased anxiety and a number of other side effects.
I am already getting 5mg Dronabinol 2xday (yay!!) for nausea and appetite stimulation (fun stuff) which my NP prescrigbes me, but she said if I wanted benzos or other psych meds that I'd have to go to a psych. They sent me to one (all of this is 100% free to me). She told me in no uncertain terms that their goal is to "keep me happy" so that I do not quit the trial therapy program.
She writes me 1mg kpin a day now, but it doesnt help me sleep which is why we are trying the other meds. I don't want any other benzos . If Trazodone puts me to sleep ok, and doesnt leave me a drooling zombie the following day ill be happy with it. (I hear it causes awesome boners which is always a plus in my book). If I dont like Trazodone or it doesnt work for me I can choose something else, and my psych recommended the two from the first post. I'm just trying to get some input on this situation so I can make as informed of a decision as I can.
More input is certainly welcome and thanks again.

 

[NeighborhoodThreat]

Have you had trazodone before? It works very well for some people but very badly for others.

Interestingly enough, mCPP is a metabolite of trazodone.

 

[nsauce]

no, i have never had trazodone before. I wont be able to pick it up until tomorrow or tuesday.

 

[nsauce]

I tried the Trazodone and it made me feel like unwashed ass . I had my monthly appointment today with my regular (non-psych) doctor and she told me to throw that Trazodone crap in the garbage, and she wrote me for Temazepam . Problem solved. God I love it when I have a good doctor.

 

[Supeudol]

Definitely go with Trazodone. I have been on and off Trazodone numerous times since about 2008, and I find it always still continues to work well, and 100mg is a perfect dose for me. Try not to get another benzo prescription for sleep if you can help it. 1 Benzodiazepine prescribed is plenty for most people. I've been on & off and back on benzos now for over 8 years, and I get 4mg/day of Clonazepam and I barely make it by. But I am also on a high dose of Lyrica which helps quite a bit. The good thing with Trazodone is that tolerance does not build fast like with benzos.

Remeron is pretty useless, and if you care about weight gain as a side effect, Remeron is garbage then.. I'm surprised you get sleep from Temazepam. I find most benzos useless for sleep, except for the exception of Diazepam, and Flurazepam, and perhaps Etizolam.

Trazodone has worked well for me, even though I don't take it every night. It seems to work better than Zopiclone for sleep, and like I said most benzos I find as crap for sleep, and I have been on pretty much all of them available in North America.

Anyways, just my 2 cents..

 

[nsauce]

It made me feel sick and shitty, didnt make me sleep and it gave me a terrible hangover. I got Restoril.

 

[mgrady3]

^^ I'll second this.
Trazaodone gave me headaches and made me feel like shit in the morning; it also only helped me to sleep sporadically

 

[kitsunedemon]

^^ I'll second this.
Trazaodone gave me headaches and made me feel like shit in the morning; it also only helped me to sleep sporadically

I've been on Trazodone awhile, I got prescribed it due to Generalised Anxiety Disorder and Major Depressive Disorder, as well as severe Insomnia. In my personal opinion it shouldn't really be prescribed as an immediate relief from Insomnia due to it being an SARI, and as we all know SSRI's take generally AT LEAST two weeks to get used to.

After being on 200mg Trazodone every night before bed, it really helped with my anxiety and depression, and most of the time covers my insomnia. Trazodone is a useful drug, and i found it a lot more "light" in comparison to Paroxetine (SSRI), but takes a while to get used to - took me about 2 months. But some people have extreme adverse effects with it, and in the transitional stage of your body getting used to the schedule, it used to make me feel like i had been hit by a bus, and sometimes actually kept me awake (I've sometimes wondered if this is due to it being metabolized into mCPP...) And some people just can't get used to it, and i don't blame em!

But, for Anxiety/Depression/Insomnia combo it's really helped me out! Now i've reduced my dosage to 100mg

In regards to the OP i'm sure that the temazepam will work much better for you ;D

 

[nsauce]

^^ I'll second this.
Trazaodone gave me headaches and made me feel like shit in the morning; it also only helped me to sleep sporadically

About an hour after I took it and I was in bed I had to piss so i went to the restroom and standing up made me feel like I was going to die for real. Then I didnt sleep any better than normal, and I woke up with HORRiBLE coton mouth and hangover. Fuck Trazodone.

 

[mgrady3]

its a weird one.
works iike a charm for some people and not for others.

to me it was just like taking a regular 1st gen antihistamine in terms of sedation; only it wasn't as constant. sometimes it definitely knocked me out. sometimes it did nothing but give me a headache.

regardless of what ti did sleep wise it left me with all the anticholinergic hangover effects

 

[nsauce]

Thanks for all of your input.

 

[elixir1]

Trazodone works well for most and not ag all for some. Personally, I've tried it and it knocks me out ... Note that trazodone has a biphasic half-life and after the initial peak and trough, there is later another peak which causes grogginess for some in the morning. Seroquel, to me, caused poor quality of sleep, and can cause pretty bad restless leg... 300 is a lot. Usually lower doses of 25-100mg are more effective for insomnia and the high doses of up to 900mg are uses for psychosis and are typically less sedating (paradoxical). Remeron, like trazodone, is an antidepressant and seems to work for most. One undesirable side effect (for most) is weight gain which goes for Seroquel as well.

 

[paranoid android]

Id go with remeron on that one since it's the second best sleeping pill Ive had. If your doc would prescribe it a low dose of amitriptyline is perfect for sleep. It's a tricyclic anti-depressant so it's a really old med but very good for sleep.

 

[leomard]

TL;DR I suggest the TCA trimipramine as the psych drug for insomnia. Random rambling about how I'd handle sleep with a pretend patient.


Do not use quietipine; sure, it'll knock you out but it has a greater side effect profile than the ones you mentioned. (yes, I realize that D2 is not occupied by this dose)

If trazodone works for then it's definitely the best option of the three; if not, I bet mirtazapine will do something for you, but it does have bad off weight and appetite effects that are more troublesome than those associated with trazodone. Mirtazapine is a good drug and it may have some good antidepressant properties (much superior than trazodone) if that is what you're looking for. Also, it causes some really fantastic dreams! Notorious for this.

Honestly the best TCA for insomnia, in my opinion, is trimipramine. More sedating than trazodone and seems to cause, subjectively, less of a hangover effect.

I suppose a psych will want to use psych drugs to solve every problem, but if you're looking for nonaddictive things to help --> try tizanidine; nonscheduled and very underrated..

I'd try out a tizanidine first; if this works, you won't have to deal with a next day hangover like you might with these drugs.

For a patient with sleep problems, I do it like this:

First Line: tizanidine 5mg. po qhs #30/hydroxyzine 25mg. po qhs #60 /gabapentin 400mg. po qhs #30
Second Line: trimipramine 25mg. po qhs #30/ flurazepam 15mg po qhs prn #15

No sense in giving out more bullshit if ^^^ doesn't work.

Third Line: quazepam 7.5 1-2 tab po qhs #60

Time for z-drug? No way! quazepam is far superior (and still GABAa specific) It is underprescribed and superior to zolpidem; it improves sleep architecture, and drug tolerance is not as swift

I'd be hesitant to write these z-drugs. Too "wild". I'd move on to triazolam and tempazepam.

Quazepam (Doral) : http://en.wikipedia.org/wiki/Quazepam

I think the best fourth line drug would be zolpidem followed by triazolam (Halcion).

At month 6, if you still can't sleep; I think it's time for Seconal followed by chloral hydrate followed by Xyrem (GHB)

lol, if you went to me; by the 8th month you'd be on Xyrem.

What makes flurazeoam better than quazepam?

And why is zolpidem better than triazolam?

 

[Kpingod]

I think people have already covered it but trazodone at 100mg will knock you tf out while 25mg of seroquel will barely make you drowsy and just feel weird. I was on seroquel at like 150 XR and 100 IR for a while and it did ‘work’ but when my psych gave me the choice of seroquel or trazodone I took 150mg trazodone without a 2nd thought. It also has more recreational value imo, last night I mixed 75mg traz with 20mg flexeril, 1 mg klonopin and a few beers and pissed my bed lmao I was so relaxed. Trazodone can be mixed with most shit to just get more sedation and some minor anxiolysis. Not sure that’s always safe but yeah, try the trazodone and if it doesn’t work go for the remeron. Seroquel sucks ime

 

[Pissed_and_messed]

I do mirtazapine for insomnia and anxiety, mostly.

It works pretty well most nights for about 4-5 days in row.

I just have issue with 30-60 h half-life, being strong antagonist to all 5ht-2 receptors it makes psychedelics somewhat pointless and it takes time to fix the issue. Tho 5ht-2c antagonism apparently enhances knock-out. Also 24/7 presence in bloodstream desensitizes h1-receptors pretty quick. I also don't really rotate shit with anything but weed nowadays and odd pack of beer (when it comes to treating insomnia, that's what I am mostly after).

And I am not convinved this stuff couldn't cause issues along the route. My memory is what it is...

How is trazodone different?