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paradoxical reactions to different drugs?


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trying to puzzle through something.  I've had sleep-related paradoxical reactions to at least two drugs and now possibly a third.  I'm curious if there's anything to be learned from this as a result, since I don't understand the pharmokinetics/biochem.  Maybe there's a common thread?

  • Zyprexa didn't put me to sleep at any dose.  I started at 2.5 mg and maxed out at 15mg
  • I'm currently taking Fanapt, which is also supposed to make you sleepy.  I have to take it in the morning because if I take it at night I don't sleep (insomnia, not mania)
  • The new drug is luvox.  I'm taking at night because it's supposed to make you drowsy...but I've been up a lot later than normal the past few nights and, on the days that I'm getting enough sleep, it's because i'm sleeping in until 11am.  I know that's not good, so I didn't do it this morning, and yet I'm still awake.

So, anything that would make all three make sense?  There are probably more that I'm not coming up with.  I've got to think about calling my pdoc to see about trying the luvox in the morning.  As with the fanapt, I'm fairly sure that it's pure insomnia (though not as bad) as opposed to hypomania.

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Unless we are thinking, ultra subtle subsyndromal hypo which only caused sleep issues, there isn’t much of a link imo. Atypicals do tend to hit serotonin receptors however that is completely different than sert via the ssri.

You just might have hit the semi rare side effect lotto.

dr Wikipedia does have insomnia as a side of zyprexa and Luvox.

fanapt had insomnia as a common side in one study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810169/

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interesting!  good to know, thanks.  Although it took me until 12am last night, I didn't manage to get 7.5 hours.  so maybe something's just going on weird with my sleep cycle.  I'll try staying up late enough again tonight to see if it persists. No calling the pdoc yet.

Edited by dancesintherain
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9 hours ago, dancesintherain said:

  I've got to think about calling my pdoc to see about trying the luvox in the morning.  

I think that's a good idea......Taking the Luvox in the morning might be worth a try....

When I tried Luvox, it was very activating for me....

However, I have no personal experience with fanapt, so can't really comment on what's going on there...No personal experience with Zyprexa either.

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FWIW, zyprexa and fanapt never knocked me out cold either. But if I had to pick one zyprexa was more calming.

And I, like you, need a med that does makes me sleep!

Enter a decent dose of Seroquel. And also saphris knocked me out after I ate half the fridge. Oops.

Now Clozapine and Seroquel together really knock me out bad. 

Have you ever thought of trying to take lunesta or trazodone or remeron or Ambien or switching to Clozapine or a typical AP? Let me know if you have any questions about my experience with any of those meds. There's also rexulti or vraylar, but I have no experience with those. That is, if you are wanting to switch any of your meds. I just know that you have been having bad sleep issues for quite a while now. 

8 hours ago, dancesintherain said:

thanks--I'll give her a ring when her office is open.  I know the fanapt was causing insomnia (it started right when I started taking it and went away as soon as I started taking it in the morning), so that one's a little more straightforward. 

Good idea to call your pdoc. 

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thanks Cheese--I want to give it a handful more days to see if it straightens itself out.  Worst case scenario is I see my pdoc 1/21.  I probably won't wait that long.  But I need a better sense about whether the luvox is causing the problem or not.  I feel less anxious in general so I think it's doing some good.  I'm also questioning whether we got the OCD diagnosis correct, but that's a bigger issue.

I really don't want to add another medication and I really don't want to do a medication switch.  So I think I'm stuck trying to make this work.  (Seroquel caused massive weight gain, ambien made me have a tea-party with my dog in my sleep, trazadone caused an allergic reaction)

thanks for the ideas though--if it doesn't straighten itself out, I'll come back to them.

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screw the wait and see idea...I'll call and see what she thinks.  I'll let her know that I'm willing to stick it out at night if she wants me to (it's not like the fanapt where I was getting 3-4 hours per night).  But that I'm not sure if it makes sense to switch to morning.

 

 

though...now I'm wondering and may be off base.  What if the issue is that the luvox simply isn't doing enough yet?  If obsessive thinking and ruminations and other forms of anxiety are what is keeping me awake, would the increase from 25 to 50mg (scheduled for Wednesday) make things better? 

Edited by dancesintherain
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Luvox gave me the worst insomnia I've ever had in my life. It felt like my brain was crawling up the walls. It never got any better either. When I went off it I slept the entire next month away except going to work.

 

My sister literally was crawling up the walls when she was given Thorazine in the ER. They had to give her a hefty dose of Ativan to calm her down.

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10 hours ago, dancesintherain said:

screw the wait and see idea...I'll call and see what she thinks.  I'll let her know that I'm willing to stick it out at night if she wants me to (it's not like the fanapt where I was getting 3-4 hours per night).  But that I'm not sure if it makes sense to switch to morning.

 

 

though...now I'm wondering and may be off base.  What if the issue is that the luvox simply isn't doing enough yet?  If obsessive thinking and ruminations and other forms of anxiety are what is keeping me awake, would the increase from 25 to 50mg (scheduled for Wednesday) make things better? 

Good idea to call. You shouldn’t have to wait and see and suffer in the meantime. I’d run that possible increasing the Luvox by your pdoc , see what she says.

How is your sleep going the past week or past few days? Still crappy, right? Darn. I was hoping the Luvox would do the trick. Well, maybe it still can if you just need a higher dose. 

Good luck dances,

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Thanks PIL...I hadn't heard of it happening, so it helps to know that it could in fact be what's going on.

Cheese, I have a hard time figuring out if the sleep issue has actually gotten worse or if it's just that it hasn't gotten better and I was hoping for better.  I need to check my sleep charts from my fitBit.  I think her office is closed today, but I'll try and see...I figure there are a bunch of different ways she could go with this (stop luvox, switch to morning, keep in evening and increase dose, wait it out a few more days), all of which make sense for different reasons.  I guess this is why she's a pdoc and I'm not.

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closed due to snow, reopening tomorrow at 8:30.  I'll give her a call tomorrow morning. 

 

Side note--I reviewed my fitbit chart.  It looks like what's happening is I'm fairly steadily falling asleep between 11 and 1, which is late for me...and therefore feels like I'm not falling asleep, that it's taking forever, etc.  Once I do get to sleep, I get about 7 hours (if I wake up to my alarm) or as many as 11 (if I ignore the alarm/reset it accidentally).

So there's some consistency there.  It makes me cautiously optimistic that playing with the time that I take it might be a fix. 

Edited by dancesintherain
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I have severe OCD and have found the most effective medication for that is Paxil. I am on a high dose of Paxil and it didn't cause mania, I take it in the morning. 

I often have paradoxical reactions as well:

Zyprexa just calms me but doesn't put me to sleep

Seroquel keeps me up/gives me hallucinations/increases heart rate 

Invega/Risperdal keeps me up/ makes me somewhat manic/makes OCD worse

Vraylar keeps me up/ makes me manic

All AP's keep me up/ gives me akathisia

Saphris keeps me up/ increases heart rate

Ability keeps me up/makes me paranoid/hyper

Geodon keeps me up

****The ONLY AAP that works as its supposed to is Clozapine. I sleep like a baby, it calms me, it squashes Mania and Psychosis, it is a VERY effective medication

 

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thanks!  that's a lot of awful reactions.  My tendency is toward EPS (SeroquelXR, Risperdal, Abilify).  I think that my OCD is mild enough that I can probably try to go without the med if changing it around doesn't help much.  I don't have a ton of experience with SSRIs, so I'm kind of just rolling the dice for how I'll respond. 

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3 hours ago, dancesintherain said:

thanks!  that's a lot of awful reactions.  My tendency is toward EPS (SeroquelXR, Risperdal, Abilify).  I think that my OCD is mild enough that I can probably try to go without the med if changing it around doesn't help much.  I don't have a ton of experience with SSRIs, so I'm kind of just rolling the dice for how I'll respond. 

Is the sleep its own symptom or could it be resolved by first addressing other conditions? Also most AAPs didn't consistently knock me out either 

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1 minute ago, dancesintherain said:

sleep has been a constant problem but this particular pattern (falling asleep consistently 11:30-1:30ish) is new.  Other symptoms, minus some anxiety and OCD, are pretty stable.

I kno many people where the SSRI induced a pattern that your discribing so I'd just be weary of that 

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