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1. Has anyone ever had trazodone "poop out" on them? I've been taking it for years and it doesn't seem to be helping me sleep anymore. I wake up every night between 11 and 3, no matter what time I take my meds and go to bed, and toss and turn and fall back asleep around 4. I'm groggy all the time, from lack of sleep and also, I believe, from the trazodone.

2. Can you quit trazodone cold turkey or do you need to taper? I do not have a pdoc at present bc of reasons, and my sleep meds are rx'd by my pcp, who has good intentions, but not always enough info bc she's not a psych professional.  I want to go into a conversation with her  well informed.

Appreciate whatever info you can provide. Thanks.

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Were you taking this as PRN? Or was this every night or almost every night for years?

If this was PRN,  probably don't need to taper. if this is almost to every night, taper. Trazodone hits quite a large set of receptors.

Fair warning, you'll probably hit even worse rebound insomnia when you stop taking it, assuming it was not PRN.

Can't comment on poop out. I had it about 18 years ago, but was purely PRN. Took it maybe a handful of times, but stopped.

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It stopped working for me after awhile but idk If that was the drug or the emergence of manic symptoms 

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What is your dose ? You may be able take more (300 mg is the general limit though for depression up to 600 mg was common) and regain its hypnotic ability. That would help if it is poop out or possibly just tolerance.  If a med has worked for years and then quits working a dosage adjustment is a reasonable way to try to regain its effects.

If trazodone did not make you groggy in the past I would not expect it to suddenly start making you groggy or more groggy.

It is likely tolerance, most experience tolerance to some degree with sleeping meds (antihistamines or GABA affecting meds).

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I've been on it continuously for almost exactly a year 50-100mg. I had taken it in the past for longer, but stopped somewhere along the line, for years. 

So, not being PRN, I'm assuming just adjusting dose could mess me up. This could be part of the problem, dropping from 100 mg to 50, I  assume, would give me rebound issues, thinking I  need more I go back to 100, things get better, I drop it back again, lather, rinse, repeat. Maybe I should just drop it by 25 mg, and just tough out any rebound, until I  can get off it totally if it's not actually helping me anymore. I  hate this guessing game. I  was just reading posts on another board last night from when I tapered off cymbalta. What a nightmare that was.

I  thought trazodone was completely innocuous. I should know better by now, wishful thinking. 

Thanks for the info. It helps a lot.

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3 minutes ago, notloki said:

What is your dose ?

<snip>

It is likely tolerance, most experience tolerance to some degree with sleeping meds 

I only take it as a sleep aid, and I can't tolerate more than 100 mg without becoming too groggy to function during the day.

It's ironic that it is apparently no longer helping me sleep, but I still have trouble with grogginess in the morning even at 100mg. 50 mg is not too bad in the morning,  but I re-upped to 100 to try to achieve better sleep because this waking up in the middle of the night also leaves me unable to function. 

My PCP and I have been fumbling around with this and getting nowhere. Your input is greatly appreciated. 

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Yep it is a groggy making med and I took 600 mg. I managed a few months.

The 2 obvious choices are antihistamines or GABA affecting sleeping pills. I believe trazodone induces sleep via its antihistamine effect so it is likely trying another antihistamines will produce the same result as you are getting now. That leaves GABA agents. All the benzos (Restoril is popular) or a Z drug. Ambien, Lunesta, and others. I prefer the Z drugs as for me they have less morning sedation and less cognitive problems. On benzos for sleep my dose is so high I slur my words but Lunesta at a supratherapeutic dose does not.

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Posted (edited)
2 hours ago, WytchyWoman said:

I've been on it continuously for almost exactly a year 50-100mg. I had taken it in the past for longer, but stopped somewhere along the line, for years. 

So, not being PRN, I'm assuming just adjusting dose could mess me up. This could be part of the problem, dropping from 100 mg to 50, I  assume, would give me rebound issues, thinking I  need more I go back to 100, things get better, I drop it back again, lather, rinse, repeat. Maybe I should just drop it by 25 mg, and just tough out any rebound, until I  can get off it totally if it's not actually helping me anymore. I  hate this guessing game. I  was just reading posts on another board last night from when I tapered off cymbalta. What a nightmare that was.

I  thought trazodone was completely innocuous. I should know better by now, wishful thinking. 

Thanks for the info. It helps a lot.

The SNRIs, like Cymbalta, have the reputation of being extra rough regarding withdrawls ; it, in theory, shouldn't be that bad for trazodone.

Anything that is a psych med should be tapered, just in case, as sedation is sort of a side effect, despite your reasons for taking it. Your overall mood may be affected as there's quite a bit of 5HT-* and alpha andrenergic receptor antagonism going on.

Edited by argh
affected not effected
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Posted (edited)
14 hours ago, notloki said:

antihistamines <snip> I believe trazodone induces sleep via its antihistamine effect so it is likely trying another antihistamines will produce the same result as you are getting now.

this makes  a lot of sense. benadryl used to knock me out like a light, not anymore. that would lead me to believe tolerance.

14 hours ago, notloki said:

All the benzos

i have been on benzos for sleep for 15 years now. yeah. that was too long. i've been tapering off very slowly. i can do .5mg, every 2-3 months. it's taking time, but i am down to 3.5. they stopped working forever ago. when the tradzodone was still helping.

14 hours ago, notloki said:

a Z drug. Ambien, Lunesta, and others. 

tried all of these that were currently available c. 2003, nothing helped. i believe they tried risperdal and seroquel too. this was back when i had a pdoc. finally landed on the trazodone/benzo combination as the only thing that helped at all.

my insomnia is from rumination, anxiety, fear, i wake up in mid thought worried about everything. i have to wonder if that's why nothing helps. even when i sleep, i don't rest bc my mind never stops.  and the only restful sleep comes from just knocking me out cold. 

14 hours ago, argh said:

The SNRIs, like Cymbalta, have the reputation of being extra rough regarding withdrawls ; it, in theory, shouldn't be that bad for trazodone.

this is very good to know.  i'll keep my fingers crossed. 

14 hours ago, argh said:

Your overall mood may be effected as there's quite a bit of 5HT-* and alpha andrenergic receptor antagonism going on.

i will keep that in mind and respond accordingly if things get weird. i am currently shopping for a pdoc, but it's not something i see happening soon. if things get bad, i can always, hopefully, get myself to the  ER. i'll let those close to me know that mood shifts could be a thing and to keep peeled eyes for signs of trouble.

i can't tell you how much i appreciate all the information and support.

Edited by WytchyWoman
typos

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Posted (edited)

I've taken up to 300 mg in the past. I've always found it hit or miss at "keeping" you asleep. It's best at getting you asleep. Take it with carbs/sugar to kick it in. It can be really hard to get up out of bed in the morning, but once I'm up, especially with some caffeine, the grogginess disappears quickly. Splitting the dose if you wake up in the middle of the night might help get you back to sleep but may add to the hangover.

Edited by rextasy
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8 minutes ago, Iceberg said:

@WytchyWoman Have you ever tried a typical antipsychotic? 

no, i had to look them up. i feel like they ruled them out a long time ago bc of risk of side effects of some sort due to genetic predisposition? i could be remembering wrong. i do that a lot lately.

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27 minutes ago, WytchyWoman said:

this makes  a lot of sense. benadryl used to knock me out like a light, not anymore. that would lead me to believe tolerance.

i have been on benzos for seep for 15 years now. yeah. that was too long. i've been tapering off very slowly. i can do .5mg, every 2-3 months. it's taking time, but i am down to 3.5. they stopped workign forever ago. when the tradzodone was still helping.

 

tried all of these that were currently available c. 2003, nothing helped. i believe they tried risperdal and seroquel too. this was back when i had a pdoc. finally landed on the trazodone/benzo combination as the only thing that helped at all.

my insomnia is from rumination, anxiety, fear, i wake up in mid thought worried about everything. i have to wonder if that's why nothing helps. even when i sleep, i don't rest bc my mind never stops.  and the only rest sleep comes from just knocking me out cold. 

this is very good to know.  i'll keep my fingers crossed. 

i will keep that in mind and respond accordingly if things get weird. i am currently shopping for a pdoc, but it's not something i see happening soon. if things get bad, i can always, hopefully, get myself to the  ER. i'll let those close to me know that mood shifts could be a thing and to keep peeled eyes for signs of trouble.

i can't tell you how much i appreciate all the information and support.

You are welcome.

One thing jumps out at me. Root cause.

It's not insomnia as in just can't sleep, but it's your rumination and anxiety that keeps you up and wakes you up. 

I see benzos have already been tried along with some SSRIs/SNRIs.

Have you tried Buspar?  It's not an antihistamine, gabaergic or SSRI/SNRI.

Lyrica is also said to be useful for GAD. Not exactly first line, but "Rapidly relieves anxiety..." sounds promising.

http://journals.sagepub.com/doi/10.1345/aph.1Q405

It's a gabapentinoid, which have some sort of interaction with the GABA system/calcium channels, but does not affect it like benzos do. Sedation, a side effect, is probably not as powerful as benzos or trazodone, but perhaps if this takes care of the GAD, you can fall asleep vs needing to be knocked the fuck out. Lyrica is not generic yet, so once again, my favorite drug, which is actually related to Lyrica...gabapentin, is possible.

Remeron, which is an atypical AD is also good for GAD. While at low doses it's primarily an anti-histamine..it might do the trick. My histamine receptors are probably somewhat desensitized as I take Zyrtec every day.

However, I occasionally take hydroxyzine as a PRN for sleep which is an antihistamine, though much stronger (and related too) to Zyrtec. Very gentle, not knocking me out, but helps with sleep. Isnt' any less effective than it used to be before I started taking Zyrtec regularly.

I still have left over Remeron pills that I use as a nuclear option. Even though it also is an anti-histamine at low doses...perhaps one of the strongest antihistamines ever made, it is very much a "knock me the fuck out", med. Like I start stumbling like I'm drunk and will be asleep within an hr, after taking it.

 

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39 minutes ago, WytchyWoman said:

no, i had to look them up. i feel like they ruled them out a long time ago bc of risk of side effects of some sort due to genetic predisposition? i could be remembering wrong. i do that a lot lately.

I wouldn't know about the genetic thing, but yes the side effects can be rough long term...PRN for sleep at low dose would have a lower potential for issues tho. They can help to shut your brain off from all the rumination. People on here have different ones they stand by but Thorazine, loxapine and stelazine are commonly mentioned. Haldol too but I think that can be harsher. Some have the added benefit of being good against anxiety if you dose them right 

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Posted (edited)

thanks for all the suggestions, it definitely gives me something to go on. i honestly cannot remember if i ever tried buspar. it sounds familiar, but i could have just heard about it in passing. i have no discernible memory of taking it or what the outcome was, so maybe not. however, i did have a pdoc who tried me on a bunch of stuff, so much so that i can't begin to remember all the things we tried.

unfortunately i think these may be more complicated meds than i would feel comfortable trying with only my PCP for guidance, but if i can get a pdoc, this gives me some things to open a discussion with.

Edited by WytchyWoman
Typo

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Yep, you have taken a PCP pretty far and need the expertise of  pdoc. You need to get at the root cause ad not just cover it up with sleeping meds.

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4 hours ago, WytchyWoman said:

thanks for all the suggestions, it definitely gives me something to go on. i honestly cannot remember if i ever tried buspar. it sounds familiar, but i could have just heard about it in passing. i have no discernible memory of taking it or what the outcome was, so maybe not. however, i did have a pdoc who tried me on a bunch of stuff, so much so that i can't begin to remember all the things we tried.

unfortunately i think these may be more complicated meds than i would feel comfortable trying with only my PCP for guidance, but if i can get a pdoc, this gives me some things to open a discussion with.

That makes sense.

Of those in the list, I would think hydroxyzine (brand name atarax or vistaril) , would be one that a PCP could comfortably prescribe, as it's mostly a sleep med and anti anxiety med, vs something like Lyrica which is primarily for nerve pain (so a neurologist?), and buspar which would be part of a pdoc's toolkit.

Beyond hydroxyzine being an inverse agonist (I misspoke earlier when I said antagonist), to H1, there are some 5HA-2A, alpha andrenergic and D2 antagonism actions going on. The affinity isn't as strong as say a proper AD or antipsychotic, but it's there and can possibly explain why it's a better anti-anxiety medication than just a plain antihistamine.

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1 hour ago, notloki said:

Yep, you have taken a PCP pretty far and need the expertise of  pdoc. You need to get at the root cause ad not just cover it up with sleeping meds.

The sleep cocktail was previously rx'd by a pdoc, so the pcp and I were both ok with a maintenance rx through PCP in the absence of a pdoc, but for any kind of modification I definitely want a psych professional, and I'm sure the pcp would agree.

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5 minutes ago, grendelsmom said:

have a question about the unwanted effects of trazodone. Does the dizziness subside? Has anyone had heightened anxiety as it "wears off" in the morning? I wonder if it is an interaction with caffeine, as when I was taking 900 mg quetiapine I had to stop drinking coffee well before noon or when I took my meds at night I would have a panic attack. Another weird thing is that it makes my nose so stuffy that I have to use nasal spray to sleep, strange for something with antihistamine properties. Benadryl doesn't do that, of course it also doesn't put me to sleep either. Am I just really weird or does that happen to anyone else?

i can' say i ever had any dizziness or anxiety from trazodone, but the congestion is interesting as i developed allergies around the same time i went on a 15 year long sleep med cocktail.  it would be notable if there was a connection. but it was a long time ago, so i can't say for sure in my case.

good luck with the 150mg and let us know how it goes? i hope it does the trick for you!

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