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Does it make sense for my doctor to prescribe Topamax to me?


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This is a long story, so I'll try to keep it short. My whole life I've had trouble sleeping. At age 27 was diagnosed with ADD and anxiety issues. Have been seeing a doctor for insomnia for 13 years.

My current doctor seems frustrated that nothing is working for my insomnia. So far I have tried

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Is the idea here that topamax is going to help you SLEEP? Seriously? Um... no, that doesn't make any sense. Not a bit. I divide my dosage up, and don't take the last one later than about three or four, because I find it to be somewhat activating. It might be helpful with your depression or anxiety. I doubt it will help at all with ADD, espescially initially, as many people experience cognitive side effects durining initial titration. The weight loss thing is a side effect that some people get and others don't. I have somewhat, but not in any kind of drastic, dramatic way.

50mg is kind of a high starting dosage - 25mg is more common, as the cognitive side effects can be pretty harsh during titration, and apparently a slower titration helps to ameliorate them. Topamax has been great for me. It's almost eliminated some obsessive thinking and anger/rage stuff that no other med had ever even touched. And once I started hitting the right dosage, the cognitive side effects started dissipating. But the thing about topamax is that it's action is (if I'm remembering/understanding this correctly) pretty intensely focused on the temporal lobes. So if part of your crazy happens to be hanging out there, it'll do a great job of getting rid of it. But if your temporal lobes are relatively crazy free, then all you're going to get from Topamax are some not so pleasant side effects, and it'll very likely make your insomnia worse.

And yeah, you have to drink a LOT of water when you're taking topamax. It's to do with how it's metabolized, which once upon a time I knew about in more detail, but right this second all I can tell you is that you really do need to drink a lot of water with topamax. And I would talk to your pdoc about why he wants you to take it at bedtime, because that makes less than no sense to me.

Seroquel's been my wonderdrug for insomnia - the only thing ever that's worked consistently, and magically. And I see it on your list of failed meds, so I've got no suggestions for you there.

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Thanks SashaSue. Seroquel was TEH EVIL drug for me - I had some type of seratonin overload from it and wound up in the ER.

I think the anxiety half of my brain cooties resides up in the temporal lobe, so maybe that will mellow out.

Plus, what really keeps me awake at night is a constant inner chatter, a dialogue, thinking about random crap that doesn't stop. Maybe it will quiet that.

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Thanks SashaSue. Seroquel was TEH EVIL drug for me - I had some type of seratonin overload from it and wound up in the ER.

I think the anxiety half of my brain cooties resides up in the temporal lobe, so maybe that will mellow out.

Plus, what really keeps me awake at night is a constant inner chatter, a dialogue, thinking about random crap that doesn't stop. Maybe it will quiet that.

It might help with that, it's hard to say, but good luck! As soon as I got past the initial start up, Topamax started helping me a lot. I really don't know about taking it at bedtime, though, because it'll take awhile for the anxiety benefits to kick in, while the activating effects are more or less immediate, so even if it does help with the root causes of your insomnia in the longer term, in the short term, taking it at night is only going to keep you up.

I'm sorry to hear about your Seroquel problems... Yikes! Have you tried anything like Klonopin for sleep? I know benzos aren't really the best longterm sleep aid option, and I'm guessing you have, but pre-seroquel, klonapin was just about the only thing that worked when my sleep had just gotten completely out of control bad.

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He might have an interesting theory on why you can't sleep.

I wouldn't bet on it. I think I am going to sidestep him and find myself a sleep specialist. I don't *think* I need a refferal.

I'm surprised you haven't gone to a sleep specialist already after all you've been through. If I were you I'd be running to the sleep doctor.

i hope the topa does help in some way though. rumination is a bitch. abilify helped quite a bit with mine. but, alas, we are all so different.

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in the short term, taking it at night is only going to keep you up.

No dear. You, it may keep uyp. But we're all different. When I started it it helped me sleep. Of course, some of that may have come from my mania starting to be controlled, so no more 40-50 hour days.

I read that topa is used for PTSD issues, which may help with the anxiety thing, and hell--sleep apnea and snoring!

Have you tried any other APs? I know risperdal worked a treat for my fiancee, and of course zyprexa did it for me. But then there's more weight issues and of course the bloody cost...

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in the short term, taking it at night is only going to keep you up.

No dear. You, it may keep uyp. But we're all different. When I started it it helped me sleep.

Already duly noted and agreed with. But again, yes, absolutely, AC's effect everyone differently, and my mistake for speaking too quickly without taking that into account, or explicitly stating that I was only talking about my experience w/topamax.

Anyway, Halo Girl, once Penny put the word rumination to the kind of inner dialogue that's keeping you from sleeping, something clicked in my head and I realized that something that had helped me with that, as well as general anxiety, was Neurontin, which I don't see on your list? Though you may have tried it for anxiety, and not for sleep specifically. Just thought I'd put that out there, just in case.

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Have you tried an AD? I know you mentioned a bad serotonin rx. Is that just for Seroquel? The first time I got a good night's sleep in many years was my first mi med.: Cymbalta

Ask your pdoc? I agree also that a sleep place is in order. How do they study your sleeping if you can't sleep?? lol

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I agree also that a sleep place is in order. How do they study your sleeping if you can't sleep?? lol

That is something I've always wondered about! Pre-seroquel, when insomnia was a constant problem for me, I often thought about doing a sleep study, but wondered how on earth anyone would be able to study something that just wasn't happening.

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I agree also that a sleep place is in order. How do they study your sleeping if you can't sleep?? lol

That is something I've always wondered about! Pre-seroquel, when insomnia was a constant problem for me, I often thought about doing a sleep study, but wondered how on earth anyone would be able to study something that just wasn't happening.

which is why I haven't really pursued it much before now, but now I might as well

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