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So I am in quite a nasty situation. Over 3 months ago I was able to kick my addiction to heroin with therapy and Suboxone. Also, I successfully got my bipolar II under control with Lithium ER 900mg and Seroquel XR 300mg. For the last 6 weeks I am having fragmented sleep. I am able to fall asleep relatively easily only to wakeup after 2hrs. I then go back to sleep and from then on I wake up roughly 5 times a night. I've eliminated all caffeine from diet, I don't smoke cigarettes within 2hrs of bed and I don't watch TV or use any other screen before retiring. My addiction specialist has tried me on trazadone 150mg--did nothing Doxepin 75-150mg--only makes me sleeoy Ambien CR (w/ doxepin)--barely any change. I think it slightly improves the quality of sleep in between waking up. Does anyone have any recommendations for a sleep maintenance medication? I prone to rapid weight gain from AP's and dont want to double up as I am taking quetiapine already. For what it's worth....my sleep hygiene is very good. I've started exercising in the morning before work. I work as a credit analyst and sit in front of a computer from 9 to 5. HOWEVER...my insomnia is causing me to nod off at my desk which is unacceptable. Any tips/ideas/recommendatins are welcome. Mikl_pls I'm looking your way as you are the resident amateur psychopharmacologist. ;-)

Though I came up surrounded by close family members who struggled with various mental illnesses, I wouldn't say I had an especially traumatic or even a really remarkable childhood, apart from the sporadic, sometimes episodic fireworks Crazy can bring. On the whole I had a pretty typical middle class upbringing, for which I am grateful. My older sister served as my introduction to the mysteries and miseries of mental illness. She suffered from Bipolar Disorder, and it was clear my parents despaired at her condition. There was much acting out, at least one suicide attempt that I am aware of, multiple stays at inpatient facilities, and an ever-changing cocktail of medications throughout her teens. She tapered off meds when she planned to start a family, and has done amazingly well without them. My younger sister struggles with panic disorder and more physical ailments than anyone her young age ought to be saddled with. My mother was a survivor of child abuse, and subsequent to the passing of her father when I was about 12, she suffered a series of psychotic breaks that led to the first of several inpatient hospitalizations, and a lifetime of profound treatment resistant MDD that continues to this day. Not only did she not perpetuate the cycle of abuse she suffered but I never even knew what she'd been through until I was much older. My father never (to my knowledge) sought treatment for any mental illness, and tended towards stoicism and emotional opaqueness. I suspect however that he suffered (or even suffers still) from depression -- at the very least. HIs siblings suffered from myriad mental maladies. His upbringing was somewhat of a mystery to me, as what remained of his immediate family were separated by geography. I believe he too was a survivor of child abuse, based on what I've gleaned from anecdotes. My older brother was a bit of a black sheep, and when youthful indiscretions of the self-medicating type became too much for my well-meaning folks to handle he was given an ultimatum and joined the armed services. He was stationed in South Korea, and I gather his self-medicating ways came along for the ride. Upon returning stateside he had a hard time reintegrating, finding stable work, and had to rely on the support of his family more than I think he would have liked. He was a very emotional person, and felt things very deeply. I imagine if I would have asked him for one word to describe himself he might have chosen "failure". That's certainly not how I would have described him, but he was the type of person for whom every setback might have seemed like the universe pointing a spindly celestial finger at the tip of his nose and proclaiming FUCK. YOU. By the time my brother killed himself with the sputtering exhaust of the sparkly brown hatchback my mother had given him, I was living my own kind of Crazy. Today, I find myself at a strange cross roads. I am happily married. Successful, especially considering I never finished college. I have more than my fair share of material possessions. I have family and friends whom I love, and who love me. As much as I curse those who use the phrase, I'm Blessed. And yet, I can't recall a time I felt more lost. You see, growing up as an insatiably curious child in a household surrounded by Crazy, and where both parents worked in the medical field. So I didn't just *live* with Crazy, I, in a sense, *studied* it. Psychology. Anatomy. Psychiatry. Biology. Pharmacology. And most especially *Psychopharmacology*. I was never under the illusion that reading medical texts would make me a doctor any more than reading cookbooks would make me a chef. But I found, and still find the subject phenomenally interesting. In the late 80's and early 90's before webforums, TV drug adverts, wikipedia, etc., it seemed physicians expected laypeople to know almost nothing about medicine, so much so, that if you knew even a little, and went in with talking points memorized, you were going to leave with whatever it was you came for (within reason). Maybe it's always been that way. But I certainly felt clever, and in retrospect maybe a part of the burgeoning vanguard that changed how pharmaceuticals are consumed. Modern medicine is so unabashedly, brazenly consumer driven, I doubt any clinician bats an eye when patients come in and know exactly what their diagnosis is, the name brand and dosage of the drug they want, and oh by the way I've already printed off my own coupon that makes my copay 3 dollars until the drug goes off patent in 2030. But back to my personal tale of medico-consumerism. 22 years ago, at about 14 years of age, I self-diagnosed myself with depression. PART II To Follow Later