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MAOIs and sleep meds?


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i'm looking for ideas for a sleep med that doesn't interact badly with parnate.  i can't take seroquel anymore (screaming in my sleep), and melatonin or benzos don't work.  i've tried some other AAPs before with bad prolactin effects so those are out, except abilify, which is activating for me (but maybe there are some i haven't tried and didn't think of).

 

pdoc was kinda stumped about what else to try (she isn't my regular pdoc, mine is away for several months).  so i thought i'd do a little research myself to see what kind of options i have.  she turned up her nose at trazadone, i'm not sure if that's a bad interaction or what.

 

thanks if anyone has ideas!

 

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Try again on the trazodone. In general, if you type in "parnate" and "trazodone", an alarm goes off and a red flashing light starts spinning on top of the computer. But . . . that is for high doses of trazodone with an MAOI - the general concern being Serotonin Syndrome (not hypertension).  Ironically, ask your doctor if she prescribes trazodone as a hypnotic for patients who are taking an SSRI - I bet you'll find she does it all the time. Now - who do you think would be more likely to have a serotonin reaction? 

 

For hypnotic use, you take a low dose of trazodone and there is research to back up its safety and effectiveness. Bring in copies of the research and give it to her. Ask her to consult with other psychiatrists and pharmacists - she'll find that the parnate + trazodone combination is used.  Here are some links to get your started:

Low-dose trazodone as a hypnotic in patients treated with MAOIs and other psychotropics: a pilot study.

Management of monoamine oxidase inhibitor-associated insomnia with trazodone

Pharmacological Management of Treatment-resistant Depression

Antidepressants and Insomnia

 

Finally, one case report of using Quetiapine with an MAOI:

 

 

You can also try chronotherapy yourself. Two parts to this, which can be done alone or combined:

1) Take 0.5 mg of melatonin 4-5 hours before your desired bedtime. This works better in changing your circadian rhythm than taking it at bedtime, and high doses are not needed.

2) bright light therapy - get a light box (~15,000 lux) and use it for 1 hour in the morning. 

Then there are generic recommendations and cautions. Such as - don't use a computer for an hour prior to your bedtime: you're basically staring straight into a light source (and the blue light component is thought to be particularly effective in resetting your circadian clock). Of course, by typing this message to you, it's obvious I'm violating this guideline.  ;) 

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sorry to get back to this thread so late.  thanks notfred and Kodos!  especially for the links with additional information, that really helps. 

 

the lightbox i ordered online just came in on monday, and this is my second morning using it.  between that and new sleep meds (whatever they end up being, as i don't see pdoc for another two weeks), i'm hoping i can get a regular schedule that's at least close to normal!

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