Zoloft For Anxiety With Insomnia?

[lilylola]

So, I went to my pdoc today, who wants to get me started on an ultra-low dose of Zoloft and titrate me up very slowly, since I've had funky reactions to SSRIs (You know, those side effects the first little while).

My main issue my entire life has been anxiety, and then insomnia resulting from anxiety.

I took Xanax for a year, and it helped, until it stopped working. Then, when getting off, I had rebound insomnia for a month. Then I went on Seroquel to deal with that, and it was great for 5 months, but then that caused REALLY bad rebound insomnia lasting 6 months. Now in month 7 off Seroquel, and my sleep still sucks donkey walnuts. Meaning, while it wasn't awesome before, it is now way worse & never returned to baseline.

This last week I went back on Xanax. (As an aside, I have tried nearly EVERY sleep aid, natural, not natural, and the benzos & Seroquel were the only thing that worked without causing next day anxiety & depression, and I don't drink & I have good sleep HYGIENE).

When I went to the doc today, he suggested I stay on the Xanax, since that is helping me sleep really well, and in a week, start a very, very small dose (half the normal starting dose) of Zoloft. (When I took it in my early 20s, it made me sleepy). When the side effects of the Zoloft are over, then I am to titrate off the Xanax. Lord knows how that will go, but I will only have been on Xanax again for a month, at that point.

Anyone with insomnia and anxiety take Zoloft with good results that they can share with me? Or any results?

Thanks!

[TheMoon]

@Lily ola

I have taken Zoloft in the past but I did not experience drowsiness and I was not experiencing insomnia at the time. However, I remember feeling anxiety when I first started on Zoloft.

Until early this year I had been on Prozac for a long time and suffered both anxiety and insomnia. Both of those drugs list insomnia as a side effect that occurred in 16% of depression patients treated in clinical trials. As you mentioned, Zoloft can also cause drowsiness in some patients (13% in clinical trials). I experienced tremor and anxiety on both of those medications and was given low-dose Valium to help get through the initial stages.

This past February I went to a doctor complaining of increasing anxiety and he switched me to Cymbalta which is approved for both depression and anxiety. I have to admit that I was surprised at how well it has worked for me and my anxiety. It does not cause drowsiness or tremor or insomnia and I have been able to function normally.

The bad news is that there is no generic for Cymbalta so it is more expensive but it worked for me when the other two did not. The thing about Xanax is that it has such a short half-life that rebound anxiety is a possibility, especially if you have been using it for a while.

I find that longer acting (Valium) or intermediate acting (Klonopin) benzodiazepines work better for me and help me relax at night to sleep.

So I guess the bottom line for me is that Zoloft and Prozac both caused anxiety and sometimes tremors when I used them. Cymbalta does not have those effects and it works on anxiety quite well. With Cymbalta, you could function during the day without Xanax, only taking it at night for relaxation and sleep. I have also used temazepam (Restoril) for sleep with good results at a low dose.

I will also add that titrating off of benzodiazepines like Xanax is much easier if you switch to an equivalent dose of Valium and then titrate of of Valium. I've tried titrating off of Xanax and it was very hard because of the cravings in-between doses.

That is my experience anyway. Other PR members may have more experiences to share with you.

[lilylola]

Thanks for feedback! I know that there could be a worsening of insomnia initially, and that concerns me. But I also want to get on the right SSRI at this point, because the insomnia is caused by anxiety. I did feel sleepy on Zoloft, and totally speedy on Paxil, so everyone is different. I'll just have to see how I feel. As far as Xanax vs. Klons...

I just need something that packs a punch at bedtime, and Xanax packs a bigger punch for me than Klonopin. If I notice that I have daytime anxiety, too, I will think about switching benzos during this initial period. Great feedback!!!

[TheMoon]

Xanax definitely works faster than many other benzodiazepines (1-2 hrs) so I always feel the punch when I take it - Klonopin takes its time though like you say. Valium has an onset of 1-1.5 hours though and its metabolites linger in the body to help with the daytime anxiety. Xanax is definitely the favorite benzo for most people because of its quick onset and strong initial effects. I have always experienced quick relief with it too.

Valium is my favorite not only because it has a quick onset but because it handles anxiety over a longer period of time. I wonder if Xanax extended release would be a good choice for you? It comes in a generic but I don't know how commonly it is prescribed anymore.

You are right though about getting the right antidepressant for you. If you find one that works well for you then maybe some of your other symptoms will resolve.

Best of luck to you!

[notredame]

Ativan isn't at all bad--you don't feel the sudden sense of relief that Xanax gives you, but you do get the feeling of well being and calm after about 45 minutes after taking one 1mg pill.

[lilylola]

My pdoc prefers Ativan, and would have prescribed it, but I let him know that I already had about 35 Xanax 2mg bars in my possession. He now wants me to just take them if they work for me, never dosing more than 2mg in a night. That's fine, because 1mg an hour before bed works really nicely for me.

When I was taking Xanax before for sleep, I never had inter-dosing anxiety symptoms. The only problem for me was rebound insomnia when I stopped, some tinnitus (ear ringing) and some rebound anxiety that was dramatically worsened by taking Ambien
(AKA Satan pills).

I will likely be on Xanax for about 4-6 weeks for sleep purposes, depending on how long the adjustment period is to get past the initial yuckiness of Zoloft. My concern is what m sleep will be like when I titrate off the Xanax after that period of time. I guess it cant be worse than when I was on it for a year. Or can it???

[TheMoon]

I had the tinnitus too, and it still comes and goes. I also had Ambien once and that was the last time for me - it works great for many people but I just don't tolerate it very well. If you were on Xanax for a year and managed to quit, I would think a month or more wouldn't be so bad, as long as it's titrated slowly. Once the Xanax is gone you can better assess how the Zoloft is affecting you at night. But really after that amount of time you should be stable and the Zoloft side-effects will have passed. That's the theory anyway. Maybe your doc will give you a few Xanax or Ativan to use as needed until you begin to sleep regularly.

The other positive aspect of your situation is that you only take the Xanax at night for sleep as opposed to taking it throughout the day, so it should be easier to ween off of it. Hopefully the Zoloft will work for you and you will eventually sleep normally.

I suffered terrible insomnia as a teenager and young adult. It wasn't until later that I figured out it was depression the whole time. Once I got that under control it was much easier to sleep normally.

[lilylola]

Thank you so much! That is really helpful info! Would I need to titrate off of the Xanax onto Klons or Valium, as I've been taking klonopin for 6 months 2-3x a week, at night only, .25-1mg?

I mean, I guess my pdoc will advise, but wondering...

[TheMoon]

Well that depends on your ultimate goal. Are you trying to come off of benzodiazepines completely? If you are taking Klonopin as well as Xanax, you may not need to titrate as carefully off of Xanax since your body already has Klonopin in it. Klonopin has a longer half-life so it stays in the body for a while. A modest increase in Klonopin dosage while discontinuing the Xanax might be all that is required. Since they are both in the same family it is possible to convert between them based on equivalent doses.

The standard method in many parts of the world is to convert the combined doses of any other benzodiazepines the patient is taking into an equivalent Valium dose, and then titrate the Valium down slowly - that method was developed in the UK: benzo.org.uk : Benzodiazepines: How They Work & How to Withdraw, Prof C H Ashton DM, FRCP, 2002

But doctors in the US don't all follow that approach, in fact I think Klonopin is used more in the US than Valium for titrating from what I have seen and read. In addition, your doctor may have more experience with Ativan and prefer to use it. I think the Valium method makes the most sense because it has a long half-life and comes in 2mg tablets for when you finally get the dose lowered. You can break them in halves then quarters as you titrate down.

I guess I should add that I am not a physician and that these are my opinions based on reading and personal experience. US physicians seem to do their own thing when it comes to benzodiazepines. It might be worth asking your doctor about switching to just Klonopin or Valium though. After all, it is easier to titrate of of one drug versus many drugs. If you still like the punch that Xanax delivers, then Valium may be a better choice since it acts quickly.


By the way, here is a chart of benzodiazepine equivalent doses and half-lives: http://www.benzo.org.uk/bzequiv.htm

[lilylola]

I am trying to get off of benzos completely. I was taking Klons 2-3x a week for 6 mos, then I ran out, and Xanax was available, so I have been on that for a week, and need to remain on a benzo I guess until the side effects of the Zoloft wear off. I haven't started Zoloft, but I think I am going to next week. So to be clear, you are saying I shouldn't just stop the Xanax, but should taper onto Valium?

Also, I have been taking the Xanax nightly. .5-1mg for a week...

[mdavis6565]

Although I have never been through benzo withdrawal myself it may be useful to see if picamilon can help at all. Basically it is regular gaba attached to niacin - this allows it to cross the blood brain barrier where it is then metabolized into gaba and niacin. I imagine it would help as your body learns to make its own GABA again but honestly I have not read anything or heard anything about it being used for this purpose. All I know is that it is considered to be very safe.

[lilylola]

Interesting. One reviewer on Amazon for picamilon said that he had used it to withdraw from years and years of Xanax use, but he wasn't sure about its efficacy. I will totally keep it in mind!

[TheMoon]

I am trying to get off of benzos completely. I was taking Klons 2-3x a week for 6 mos, then I ran out, and Xanax was available, so I have been on that for a week, and need to remain on a benzo I guess until the side effects of the Zoloft wear off. I haven't started Zoloft, but I think I am going to next week. So to be clear, you are saying I shouldn't just stop the Xanax, but should taper onto Valium?

Also, I have been taking the Xanax nightly. .5-1mg for a week...

Yes, that is one safe way to do it without suffering withdrawal. If you have been on benzos for a while your body has adapted to them and stopping them completely will most likely precipitate withdrawals and rebound insomnia (one of the worst parts of withdrawal for me). Valium's long half-life makes it a good candidate but some psychiatrists prefer Klonopin for tapering and might add baclofen (a GABA analog and muscle relaxant) and valproic acid (anti seizure med) at the end of the taper.

I have never heard of picamilon, that sounds interesting, I will have to look into it. Although the niacin might cause some side-effects.

And again, I'm not a physician just someone who has been through benzo withdrawals and read up on it. From my experience and listening to others, the most popular method of tapering is to switch to a longer acting benzodiazepine like Valium then lower the dose in small increments. Since you are only using Xanax right now it might be a good time to start tapering. The Valium will insure that you have a smooth landing when you finally stop, because it will linger in your body for a while after you last dose. Also, once you have finished tapering, the Zoloft side-effects will have decreased and you will probably be feeling better.

Your doc seems reasonable about these medications. If you tell your doctor that you want to get off of Xanax and Klonopin altogether, he/she will probably be open to tapering you off gradually so you have the least amount of side-effects. If you stop without tapering you will probably have the rebound insomnia again and want to go back on the Xanax.

Just my opinion of course. Your doc has probably done this before and will hopefully have some ideas for your particular situation.

[lilylola]

All of this sounds very reasonable. My doc seems to be a fan of Ativan, so I think he will taper me onto that. The rebound insomnia piece is the hard piece for me that I want to avoid. That's why I got mixed up with benzos in the first place. If I had known ANYTHING about rebound insomnia, I would have been way too scared to ever take them.

[lilylola]

Alright. I just totally changed my mind. I don't want to feel weirder than I already do from benzo use. I'm opting not to go on the Zoloft, and I hope to return to taking Klonopin 2-3x a week at a low dose. Combined with Somatomax, and lack of stress, that has been my best sleep situation. Daily Xanax use, while it works for a solid 7 hours of sleep, leaves me feeling fuzzy brained all effing day at work.

Also, I'd like to add that because of the long half life, I don't have to use Klonopin on a daily basis, only for sleep emergencies. Whereas with Xanax, I sleep like poo if I don't take it daily. I've only been on the Xanax daily for 9 days, so I imagine it's not going to be dramatic if I stop taking it. Just some bad sleep again.

[TheMoon]

If it's not broke don't fix it No reason to start Zoloft if using Klonopin a few times a week works for you. Besides Zoloft and other drugs like it are difficult to get off of once you've been on them long-term. I know these meds have other uses, and Cymbalta has helped both my depression and anxiety, but why start unless you have an immediate need that only an ant-depressant will help with.

I looked up Somatomax and now I'm intrigued. I see that it has phenibut which I have never tried but it has been discussed on the boards if you ever want/need more information and personal accounts.

Glad it worked out for you with fewer meds instead of more.

[lilylola]

Are you sure it has phenibut? Because when you stop taking it, nothing much happens.

[mdavis6565]

I have been taking Phenibut. The stuff is really fabulous and definitely helps you sleep. I take it two or three times a week and have not had a problem with withdrawal or physical addiction using it at the rate. I use it when I see my girl because it is a strong aphrodisiac affect.

[cashman1]

So, I went to my pdoc today, who wants to get me started on an ultra-low dose of Zoloft and titrate me up very slowly, since I've had funky reactions to SSRIs (You know, those side effects the first little while).

My main issue my entire life has been anxiety, and then insomnia resulting from anxiety.

I took Xanax for a year, and it helped, until it stopped working. Then, when getting off, I had rebound insomnia for a month. Then I went on Seroquel to deal with that, and it was great for 5 months, but then that caused REALLY bad rebound insomnia lasting 6 months. Now in month 7 off Seroquel, and my sleep still sucks donkey walnuts. Meaning, while it wasn't awesome before, it is now way worse & never returned to baseline.

This last week I went back on Xanax. (As an aside, I have tried nearly EVERY sleep aid, natural, not natural, and the benzos & Seroquel were the only thing that worked without causing next day anxiety & depression, and I don't drink & I have good sleep HYGIENE).

When I went to the doc today, he suggested I stay on the Xanax, since that is helping me sleep really well, and in a week, start a very, very small dose (half the normal starting dose) of Zoloft. (When I took it in my early 20s, it made me sleepy). When the side effects of the Zoloft are over, then I am to titrate off the Xanax. Lord knows how that will go, but I will only have been on Xanax again for a month, at that point.

Anyone with insomnia and anxiety take Zoloft with good results that they can share with me? Or any results?

Thanks!

Are you sure it has phenibut? Because when you stop taking it, nothing much happens.

In my personal experience seroquel has been the go to medicine for sleep both depth and length.

I was on zoloft for several years - best A/D ever - but I stopped zoloft because of ED problems that I believe were associated with medication. Interesting that you say the zoloft makes you drowsy. I always took it first thing in the morning with my coffee so who knows.

One thing that I practice is staying away from taking anymore than one type of benzo during a prescrition cycle. Hope this post was of some use and lots of luck - insomnia & anxiety suck.

[csrao]

You can try ‘Focusing on breathing’ to get get relief from insomnia and get quality sleep. This technique reduces the flow of thoughts, calms the mind and relaxes the muscles, inducing sleep. It rarely fails, has no side effects and can be combined with any other treatment or medication. Try the following technique lying in the bed when you need to sleep.

‘Triple segment mode’: Every finger has 2 cross lines, dividing it into 3 parts. We call them segments. Place the tip of the thumb at the top segment of the little finger and breathe three times. Move the thumb to the middle segment and breathe three times. Move to the bottom segment and breathe three times. Repeat these steps at the next 3 fingers. At the thumb, place the tip of the index finger on its segments and follow the same steps. Then switch to the other hand and repeat the process all over. Continue to practice, switching the hands. If you realize that you lost track of the breathing, start immediately from the top segment of the little finger of any hand. Some days it may take longer time to get sleep. Simply keep on practicing rather than worrying about sleep.
When you wake up in the morning, you will be surprised how you slept so well last night!

The detailed article on insomnia can be seen in my web site.