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Best and Worst Combination: Zolpidem and Mirtazapine


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hello all,

i have a particular dilemma that seems bizarre and it really is as i can't really wrap my head around it. i take 15mg of mirtazapine at night along with 15mg of zolpidem. this combination works very well as an antidepressant combination and also as an anxiolytic combo. they're taken along with duloxetine, pregabalin, and clonazepam all for mdd as well as refractory and very severe panic disorder and generalized anxiety disorder.

okay, so the problem? well, nocturnal binge eating during which i'm fully awake/lucid and aware of what i'm doing. i have a hard time controlling my appetite and eating habits on this combination during the daytime, but at night i'll eat anything and everything in the house. so after about a year and a half of being on these two (i was put on them both at the same time - the others i've been on for years and years), i had gained about 50 pounds and it was taking a toll physically and mentally/emotionally, so i told my dr that i wanted to substitute one of these medications, but didn't want to remove either for fear of relapse as they can be very severe. his suggestion was to reduce mirtazapine to 7.5mg/night which i did, however, the binging did not stop and i fell unstable with regard to panic disorder. his next suggestion was to increase  mirtazapine back to 15mg/night and to substitute zolpidem for its z-drug cousin eszopiclone which to my astonishment stopped the nighttime binge eating. it actually did more than that -- it normalized my appetite almost entirely. so two months later and i have lost more than 30 lbs, which is great, however, eszopiclone combined with mirtazapine causes for sexual side effects that are very severe, think chemical castration, and while it keeps my anxiety/panic very well controlled, it has led to depression of a pretty intense magnitude. suffice it to say that my quality of life is terrible now but it was also terrible when i was a whale for obvious reasons even if i was happier (relatively speaking) than i am now.

i tried to return briefly to zolpidem somewhere in the past two months but had the same nocturnal binge eating episodes reappear and i didn't want to gain back weight that i had worked hard to lose, so i switched over again to eszopiclone.  i have tried everything to stop the nocturnal binges, from limiting what i have in the house (i'll drive to the grocery store in the middle of the night) to locking my door with a timed lock (i just broke the lock and that wasn't the smartest idea anyhow in the event of an emergency) to trying to only binge on veggies and fruits which is a total failure when all i want are sweet and salty carbs. 

my doctor is now suggesting that the cause of the sexual dysfunction is duloxetine when that isn't the case at all and is making the proposition that i drop mirtazapine and add vortioxetine. i just don't see this as working - i actually see this as potentially inducing sexual dysfunction in its own right as layering a novel ssri with some funky anti-sertonergic activity on top of duloxetine doesn't sound very sex friendly. also, vortioxetine has been reported to be quite activating and i have not responded well at all to other activating antidepressants due to suffering from severe panic disorder, e.g., bupriopion, sertraline, fluoxetine, reboxetine, agomelatine.

i have no ideas on how to make mirtazapine + zolpidem work as i felt fantastic on these two plus the rest of my cocktail, but i can't continue to just gain and gain and gain weight despite an acceptable level of sexual functioning and otherwise okay side effect profile. does anyone have any ideas to take to him? i live in the US but i am also an EU citizen and thus the trials of some of the european market antidepressants that have been activating and not worked out well for me, however, the US is my primary country of residence so trying to see a psychiatrist in spain while also being treated in the US is a nightmare and have stuck with US treatment. insurance is not an issue and i have any drug at my disposal, generic or not, as long as its available in the US market. i'm looking to replace mirtazapine at this point and return to zolpidem in lieu of eszopiclone, i just have no idea what would take mirtazapine's place. any suggestions would be very much appreciated. 

 

thanks for taking the time to read this and i hope you all are doing a bit better than i am at present. 

Edited by basuraeuropea
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Would you be willing to try other sleep meds instead of the zolpidem? I’m thinking sonata or belsomra. Remeron is a bit unique in the us, there aren’t many 1-to-1 replacement options with the same act

yeah, know that ambien can be really love/hate in that it is the only option for some and be a total mess for others. have you ever tried any of the tricyclics? they can sometimes be sleep promoting,

Have you ever tried Trazodone?......It's technically an anti-depressant, but is prescribed very often for insomnia due to it's sedating properties.....It has a pretty wide dosage range....For instance

Would you be willing to try other sleep meds instead of the zolpidem? I’m thinking sonata or belsomra. Remeron is a bit unique in the us, there aren’t many 1-to-1 replacement options with the same action. For what it’s worth the trintellix is supposedly much better than traditional SSRIs in the sexual side effects department, but I agree that it may not make sense if u can’t tolerate activating meds.

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hi there - so because ambien is working as both a sleep med and is also working to keep me stable as an anxiolytic, sonata was ruled out by my doctor because the half-life is so short (i thought it was worth a shot because ambien kept me so stable all day). belsomra i have sitting in my closet and he mentioned it but after taking ambien every single night for over a year and a half, i've become physically dependent on the z-drugs (either ambien or lunesta) and go through withdrawal and fall unstable if they're removed which was why ambien was added in the first place.

it's all super bizarre in that ambien somehow potentiates the hunger caused by remeron but lunesta normalizes it. it's like super weird to think about, but that's how my body reacts when either of those two combinations is taken by me.

trintellix, yes, and like i could try it but what i can't do is just drop remeron like my doctor wants me to because even at the low dose of 15mg/night it has a large impact on my overall steadiness w regard to panic disorder in particular, so i've decided that i'm gonna tell him that i need to be cross-tapered, but it does seem odd to me that he's suggesting such an activating med when i can't tolerate activating medications.

i know there's not a lot out there left, which suuuucks. so it may be figuring out a way to manage the depression which probably isn't via trintellix. remeron and ambien together are pretty damn special and it's a shame that there is such an impactful side effect standing in the way, but i just can't continue to binge eat. :(

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yeah, know that ambien can be really love/hate in that it is the only option for some and be a total mess for others. have you ever tried any of the tricyclics? they can sometimes be sleep promoting, but they are side-effect heavy(ier) and im not sure if they would play nice with higher doses of ambien. sorry, im trying to not just start listing stuff and repeating things youve already tried 

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Posted (edited)

no, it's very much appreciated! thank you!

the only tricyclic i've been on has been doxepin and it was pretty terrible compared to remeron and remeron is by far a walk in the park.

what my doctor proposed in order to perhaps stop the binge eating is to lower my dosage of ambien just a tad to increase anxiety slightly which will offset the hunger to hopefully a significant degree without destabilizing myself. it's actually something that i'm going to try, so i'm going to switch back to a slightly lower dosage of ambien tonight and stop lunesta.

i think a better question for my psychiatrist (who doesn't have an answer) is how to make the ambien/remeron combo work without the nocturnal binge eating. he proposed topamax and i was down for trying it and did indeed try it but it made me super sleepy at the lowest of doses. like, suppppppper sleepy. also, my hair began to fall out. so i wasn't able to work (and i have a full-time, white-collar job that's intensive as it is), so topamax was out. all of the stimulants used to control appetite are out because i suffer from such severe anxiety disorders and also because the binge eating happens in the middle of the night. lowering remeron left me unstable as it's doing a hell of a lot at such a low dose. lowering ambien just a tad might work? maybe? it might also put me into panic attack hell or just general discomfort, but i'm willing to try it.

if that fails, my doctor mentioned prescribing a very low dose of dexedrine to alleviate sexual dysfunction should i have to remain on lunesta. that's not ideal as dexedrine is easier to take than, say, wellbutrin or even adderall (for me) but it's still not an easy nor a pleasant drug (for me) to take. refractory panic disorder is a bitch.

Edited by basuraeuropea
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22 hours ago, basuraeuropea said:

thanks for taking the time to read this and i hope you all are doing a bit better than i am at present. 

Have you ever tried Trazodone?......It's technically an anti-depressant, but is prescribed very often for insomnia due to it's sedating properties.....It has a pretty wide dosage range....For instance, a typical starting dose might be 25-50mg, but I take 200mg, because I've found that to be what works best for me.

 I've even lost a few pounds on it......I take it at bedtime with clonazepam.

 

Edited by CrazyRedhead
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1 hour ago, CrazyRedhead said:

Have you ever tried Trazodone?......It's technically an anti-depressant, but is prescribed very often for insomnia due to it's sedating properties.....It has a pretty wide dosage range....For instance, a typical starting dose might be 25-50mg, but I take 200mg, because I've found that to be what works best for me.

 I've even lost a few pounds on it......I take it at bedtime with clonazepam.

 

i actually have and i've also tried nefazodone as well. my doctor isn't too keen on prescribing trazodone to panic disorder sufferers, though, because of its main metabolite mcpp, but that's another good suggestion for me to take to him.

i don't think, as a side note, that slightly reducing ambien will help with the hunger, rather it's just going to make me feel horrible.

i see that you have also been prescribed trintellix - do you find it activating or sedating or rather neutral? from what i've read online it seems most people find it activating/energizing, however my doctor claims his patients don't find it particularly so. i'm a bit skeptical because there are  a ton of people who don't find zoloft activating or wellbutrin activating but those people aren't usually those who suffer from extreme anxiety disorders that are very treatment resistant.

 

edit: also, your diagnoses are very similar to mine, severity included!

Edited by basuraeuropea
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I know you’re skeptical, but I I think that a slight reduction is a reasonable strategy, 15 of ambien is pretty high ... I’m not saying it’ll work, but it would at least establish that the 15 of ambien is a must have 

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13 minutes ago, Iceberg said:

I know you’re skeptical, but I I think that a slight reduction is a reasonable strategy, 15 of ambien is pretty high ... I’m not saying it’ll work, but it would at least establish that the 15 of ambien is a must have 

i'm gonna try that tonight - i'll see over the next few days if it does work or if my anxiety levels spike pretty quickly. 10mg is the highest dose here in the US and yeah, 15mg is a bit high, but i tend to just not respond to medications very well or am an ultra rapid metabolizer as one might infer from my medications and dosages taken.

 

edit: i chickened out and took lunesta only because i am absolutely positive that i'm gonna eat the entire kitchen on both remeron and ambien. it's just not going to work the way i want it to. i have to really think about whether trying trintellix is a smart move because it could really destabilize me and the half-life of the medication is ultra long, too. i just have some serious reservations about that medication.

it sucks that mianserin is not available in the US and that i can't easily obtain it when visiting the EU. Ugh. I know there is no potential gain if there are no risks taken, but i've fallen unstable so many times experimenting with medications and it's really difficult to restabilize me due to the refractory nature of the disorders that i suffer from. damnit.

Edited by basuraeuropea
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so, just as an update, i think there is something unique to the pharmacology of ambien that makes it slightly more pleasant to take and thus aids in working alongside remeron as an antidepressant. there is apparently nothing dopaminergic about the drug, but i swear it does make me feel just so utterly content in a good way with life overall when combined with remeron.

 

it's a really difficult decision to remain off of the drug but i know that even with the strongest of willpower i will not every night be able to resist binge eating. i'm thinking, however, that even though i feel absolutely terrible when i do binge eat, that perhaps it's permissible to do a few nights a week only because the ambien/remeron combination is so good in nearly every other way. i dunno, it's just very difficult to go from no sexual functioning and depression but a very normal appetite on lunesta/remeron back to struggling every single day with appetite and nocturnal binge eating episodes and subsequent weight gain but just overall being happy with life on ambien/remeron. i'm just trying to think back on whether or not i've been able to limit the binge eating to a few times a week and i can think of instances in which i could and others in which i couldn't. it's always a battle on that combination with regard to appetite, though. always. and i feel that that's going to be a battle that i'm ultimately going to lose.

 

my major concern with the lunesta/ambien combo is surrounding dating. like how the f am i supposed to date with just dexedrine to be taken as needed when i have no sexual response cycle at all - from libido to orgasm, the entire thing is absent on this combo. it's so terrible, but i'm thin.

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12 hours ago, basuraeuropea said:

i actually have and i've also tried nefazodone as well. my doctor isn't too keen on prescribing trazodone to panic disorder sufferers, though, because of its main metabolite mcpp, but that's another good suggestion for me to take to him.

i don't think, as a side note, that slightly reducing ambien will help with the hunger, rather it's just going to make me feel horrible.

i see that you have also been prescribed trintellix - do you find it activating or sedating or rather neutral? from what i've read online it seems most people find it activating/energizing, however my doctor claims his patients don't find it particularly so. i'm a bit skeptical because there are  a ton of people who don't find zoloft activating or wellbutrin activating but those people aren't usually those who suffer from extreme anxiety disorders that are very treatment resistant.

 

edit: also, your diagnoses are very similar to mine, severity included!

I can understand your doc's reasoning, but my already high anxiety has not gotten worse on the trazodone, in other words it's pretty neutral as far as my anxiety goes, but it does at least help me get a decent night's sleep, and I don't gain any weight on it.

I have tried ambien before, but unfortunately, it did nothing for my insomnia, so I stopped it...Can't remember exactly what dose, but it was pretty high as I remember.

Trintellix is pretty neutral for me, definitely not activating at all at 20mg.....But when I tried Wellbutrin I can say it was VERY activating, so that was stopped.

Yes, I have seen that our diagnoses are very similar.......I'm sorry you are going through this, but you are definitely not alone.

Edited by CrazyRedhead
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Off the cuff thought- cymbalta is maybe more likely than remeron to cause sexual side effects. I know you don’t think it’s the cause alone, but what about trying more remeron and a little less cymbalta. I’d imagine that at 120mgs tapering off the cymbalta to something else just isnt going to happen 

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2 hours ago, CrazyRedhead said:

I can understand your doc's reasoning, but my already high anxiety has not gotten worse on the trazodone, in other words it's pretty neutral as far as my anxiety goes, but it does at least help me get a decent night's sleep, and I don't gain any weight on it.

I have tried ambien before, but unfortunately, it did nothing for my insomnia, so I stopped it...Can't remember exactly what dose, but it was pretty high as I remember.

Trintellix is pretty neutral for me, definitely not activating at all at 20mg.....But when I tried Wellbutrin I can say it was VERY activating, so that was stopped.

Yes, I have seen that our diagnoses are very similar.......I'm sorry you are going through this, but you are definitely not alone.

super insightful - thanks for telling me! my doctor wants me, per a conversation we had today, to switch from remeron to trintellix as soon as possible and resume taking ambien in lieu of lunesta. i told him that i don't think both of those changes should be made at the same time and that i would consider switching to trintellix after switching back to ambien from lunesta as it's not terrible to switch between the two, but it's not without its bumps in the road either.

 

thanks so much for the words of encouragement and support and yes, it's comforting in some weird way to know that someone else out there knows how i'm feeling. i also have a diagnosis of ocd, although mine is moderate compared to the very, very severe panic disorder w/ agoraphobia, generalized anxiety disorder and major depressive disorder that i suffer from.

1 hour ago, Iceberg said:

Off the cuff thought- cymbalta is maybe more likely than remeron to cause sexual side effects. I know you don’t think it’s the cause alone, but what about trying more remeron and a little less cymbalta. I’d imagine that at 120mgs tapering off the cymbalta to something else just isnt going to happen 

hey there - actually cymbalta doesn't cause me much of any sexual dysfunction at all which is counterintuitive and very atypical to what most people experience especially at the dose that i'm taking, but it doesn't. also atypical is that remeron above 15mg does cause sexual dysfunction and it's pretty severe which is really not anticipated in most. remeron above 15mg also acts as a psychological depressant, making existing depression worse or inducing depression that wasn't there, so my doctor has made a notation on my chart to never have remeron prescribed above 15mg for any future physician as he's been my doctor for about ten years now and is going to retire at the end of the year sadly.

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so, oh my god, i had a glimpse of a normal sexual response cycle today and so i told my doctor about this before all of the changes that my doctor wanted me to make and he said it's my choice to switch or not, but that he would stick with lunesta for a bit longer to see if an acceptable amount of sexual functioning returns. he also said that he believes sexual functioning and my depression levels are highly intertwined (and they are), so that again, he would wait it out because the ambien/remeron combo was so good save for the overeating, the lunesta/remeron combo may be just as good if i give it time.

 

i don't know how much time to give it as i just restarted lunesta maybe a week or so ago after a failed attempt to return to ambien, resulting in eating galore - hungry, hungry hippo status, so maybe like three weeks? if not, then switch back to ambien and also try trintellix (which honestly i don't think will solve anything as it's being layered on top of cymbalta) or just use dexedrine prn? i dunno, but for now i'm going to stick with lunesta for a bit longer to evaluate what's what.

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so i guess that glimpse was just a glimpse and nothing more. the big question is whether to switch over to trintellix from remeron and back to ambien from lunesta. nearly all of the reviews on askapatient mention nausea/vomiting which sounds like a nightmare. furthermore, there are many reviews online that mention hair loss and that also sounds like a nightmare. i know neither of these are guaranteed to happen to me, but the sheer number of people complaining about these issues is startling. also, the half-life of trintellix is extremely long so once i take even one pill, it's going to be present within the body for quite a long time.

i'm not sure via which mechanism it causes either of these side effects, however, i do believe the nausea and vomiting are caused by initial stimulation of 5ht3 which it antagonizes, but the initial stimulation is likely what causes those effects. i already take remeron which antagonizes the same receptor, so i think i might be fine on that front, however many mention to get a prescription for zofran (ondasetron) which i already have, but that's also a 5ht3 antagonist so i'm a bit confused as to how this medication is causing nausea.

and then there is hair loss which seems to occur more frequently than other antidepressants via who knows which mechanism. itching, which frequently is also reported doesn't really scare me and i know that i can  briefly take an antihistamine if this should occur.

lastly, there is constipation and bloating, which, again, i know won't necessarily happen to me, however, some of these serotonin receptor sites that are antagonized are many of the same that are antagonized by the atypical antipsychotics and a doctor once thought it was a brliliant idea to try me on a low-dose round of atypicals to which i responded horribly (major bloating, edema, overeating and subsequent weight gain, slowed thinking, slurred speech, movement problems, extreme and unremitting constipation) and granted some of those side effects were antidopaminergic in nature, but many of them were due to serotonin antagonism.

 

so, that's why i'm a bit wary to take this trintellix drug. also, i kinda think layering on an ssri + serotonin modulator on top of cymbalta is going to cause sexual problems. my doctor clearly doesn't think so, but i do. so, the question really is, do i risk destabilization (solidly stable with regard to anxiety disorders/ocd but only moderately stable with regard to depression which is likely tied to sexual dysfunction) or do i remain on the cocktail i'm currently on and use dexedrine prn? i guess i want input, but i know only i can figure that out. others can help me figure that out, however. taking dexedrine even sparingly leads to hair loss and while taking the drug does alleviate sexual dysfunction, it's also highly stimulatory (even in tiny doses) for obvious reasons and this isn't appealing for someone suffering from anxiety disorders of an extreme nature, so i wind  up rarely if ever taking the drug and just living the life of a priest, which sucks because i'm young and  i want to actively date to marry.

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11 hours ago, basuraeuropea said:

so i guess that glimpse was just a glimpse and nothing more. the big question is whether to switch over to trintellix from remeron and back to ambien from lunesta. nearly all of the reviews on askapatient mention nausea/vomiting which sounds like a nightmare. furthermore, there are many reviews online that mention hair loss and that also sounds like a nightmare. i know neither of these are guaranteed to happen to me, but the sheer number of people complaining about these issues is startling. also, the half-life of trintellix is extremely long so once i take even one pill, it's going to be present within the body for quite a long time.

i'm not sure via which mechanism it causes either of these side effects, however, i do believe the nausea and vomiting are caused by initial stimulation of 5ht3 which it antagonizes, but the initial stimulation is likely what causes those effects. i already take remeron which antagonizes the same receptor, so i think i might be fine on that front, however many mention to get a prescription for zofran (ondasetron) which i already have, but that's also a 5ht3 antagonist so i'm a bit confused as to how this medication is causing nausea.

and then there is hair loss which seems to occur more frequently than other antidepressants via who knows which mechanism. itching, which frequently is also reported doesn't really scare me and i know that i can  briefly take an antihistamine if this should occur.

lastly, there is constipation and bloating, which, again, i know won't necessarily happen to me, however, some of these serotonin receptor sites that are antagonized are many of the same that are antagonized by the atypical antipsychotics and a doctor once thought it was a brliliant idea to try me on a low-dose round of atypicals to which i responded horribly (major bloating, edema, overeating and subsequent weight gain, slowed thinking, slurred speech, movement problems, extreme and unremitting constipation) and granted some of those side effects were antidopaminergic in nature, but many of them were due to serotonin antagonism.

 

so, that's why i'm a bit wary to take this trintellix drug. also, i kinda think layering on an ssri + serotonin modulator on top of cymbalta is going to cause sexual problems. my doctor clearly doesn't think so, but i do. so, the question really is, do i risk destabilization (solidly stable with regard to anxiety disorders/ocd but only moderately stable with regard to depression which is likely tied to sexual dysfunction) or do i remain on the cocktail i'm currently on and use dexedrine prn? i guess i want input, but i know only i can figure that out. others can help me figure that out, however. taking dexedrine even sparingly leads to hair loss and while taking the drug does alleviate sexual dysfunction, it's also highly stimulatory (even in tiny doses) for obvious reasons and this isn't appealing for someone suffering from anxiety disorders of an extreme nature, so i wind  up rarely if ever taking the drug and just living the life of a priest, which sucks because i'm young and  i want to actively date to marry.

Not trying to be lecture-y here, but just a reminder that those sites are biased towards people reporting side effects as healthy people are often less likely to report. For what it’s worth, hair loss is not listed as common on the adverse effects and I have not heard of anyone (of any gender) experiencing that. Also, even though the half life is long, I’d think that if you start low the potential damage could be mitigated before anything really manifests long term. 
 

also I *think that the difference of effect between zofran and trintellix is that zofran have more effect on the the 5ht3 receptors in the GI tract, but there are smarter people on here that I would defer to 

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@basuraeuropea, just for what it's worth, the only notable side effect I've had from Trintellix, was some mild nausea when I first started it....The nausea went away after a few weeks.......I've been on it a little over a year.

I haven't had any vomiting or other GI problems from it, and absolutely no hair loss, either.

Just my 2 cents.

Edited by CrazyRedhead
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thank you to the both  of you for responding. @Iceberg i definitely recognize that more people have an inclination to report a negative adverse effect than a positive one, although there are certainly trends amongst the highest adverse effects  experienced and documented by  any given drug, increased appetite and subsequent weight gain on mirtazapine for example.

 

i've been struggling with depression and haven't made any  drastic changes, although have seriously contemplated returning to ambien from lunesta to escape the oppressive depression but am holding out hope that i will stabilize on the combination that i'm on. the anxiety disorders are very well sorted, which makes it even more difficult because they are a bear to deal with.

@CrazyRedheadi'm just really  unsure because if my physician had told me that he was going to lower cymbalta by x amount and  at the same time start trintellix, then it would make sense, but adding additional ssri activity on top of a maxed out dosage of an snri makes no sense to me whatsoever. i mean, it might cover the anxiety disorders fine in tandem with ambien, but it sounds like a nightmare to take otherwise in the manner in which he wants me to take it with regard to the side effects typically experienced with the ssris (sexual dysfunction, emotional flattening/blunting, inability to cry, etc.) and while my current dosage of cymbalta isn't causing any of these save for the inability to cry which is in itself distressing, i think that layering more ssri activity would only have more undesirable side effects pop up. i just can't wrap my head around it. he had stated the the goal was to get me off of cymbalta completely and replace it with trintellix but i don't quite understand why when cymbalta is doing an admirable job.

 

i'm just really frustrated with psychiatry as it seems that i have tried a whole lot and i tend to have atypical responses to medications, or at least responses that lead to disorders that are difficult to treat to say the least. i'm not quite sure what to do. it's not as though i can just hop on trintellix, either, for a few weeks and with its super long half-life expect it to clear my system in a matter of days. the pharmacist at the pharmacy i frequent told me that once steady state is reached that it'd be about 16-17 days for the drug to clear my system which is a bit concerning.

 

on one last note, i do find myself sleeping more and not in a good way, but in a sort of let me see how much i can sleep off my suffering sort of way because being asleep is better than being awake. i tried to garden this weekend and i surprisingly did get a lot done, but i slept much more than i would have wished i would have if i were well and i haven't been feeling well since dropping ambien, but along with dropping ambien, i've also dropped several dozen pounds. sometimes, i'll awake and feel less depressed than when i went to sleep, although this is rare and i honestly have feelings that aren't quite to be classified as suicidal ideation, but more along the lines of i'd definitely be better off dead. i'm still able to function at a basic level, though, completing my career tasks with admiration given how shitty i often feel.

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so i fell suicidal and i was able to tell my doctor without telling my doctor directly such that i'd avoid a hospital trip, so he had me switch back to ambien from lunesta last night and also added a tiny dose of zonisamide (25mg) to stop the night binge eating. so the first night really doesn't count because it's a day in flux, however, i wasn't hungry at all.

if this medication causes hair loss, i swear i'll cry, though. topamax caused hair loss as well as a host of cognitive side effects and sleepiness at even 12.5mg, so i'm hoping zonegran (zonisamide) will be  a whole lot better as well as being quite effective.

everyone wish me luck!

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