Hello, My mom used to have these horrible runs of anxiety in the middle of the night straight out of sleep. She got on Zoloft, and they not only went away, but she sleeps so well now. The doctor now wants to move her to Lexapro and has started taking away the Zoloft by 25 mg. Already her sleep is getting worse. I am so hesitant to decrease this med any more. Her issues are more cognitive than motor -oriented, although she had gait and posture issues and some falling that have been much improved by PD meds. Her sleep is so essential to her health. Also, what if she gets off of it and has to get back on and it doesn't work as well anymore?
Does Zoloft really interfere with PD meds much? Any advice is much appreciated.
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Zoloft and Lexapro are both in SSRI antidepressant category. That being the case I'm not sure why your doctor decided Lexapro would be better especially if the Zoloft is working for your mother. I don't believe there is a conflict with sinemet but perhaps your mother is on a different PD Med. Have you asked the doctor why the change? You may need to really stick up for your mother and insist on things being left as they are as long as they are working if there isn't a good reason for a change.
Excellent point!!! I'm going to see the doc this morning. That was also my intention, to say, unless you (dear Dr.) can give me evidence that it is bad, we don't want this changed. I know that it helps my mom, and she knows it too. Going back to poor nights of sleep and perhaps more anxiety is not a good plan for her health. I also suspect that the Zoloft might be sort of keeping down a so-far mild sleep disorder. I don't want her suddenly getting more active in her sleep and falling out of bed. I was out of town for the last doctors appointment when they started changing things. It is concerning how easy it is for doctors to just make changes. There really is a need to self advocate and advocate for loved ones. I like our doctor, but let's face it, there is so much the medical industry doesn't know and so much that is individual response. I really appreciate your input, Enidah. Thank you.
Is there much difference between the two? My dr mentioned Lexapro. I know it can take most anxiety drugs some time to work could that be the reason for not sleeping as well yet? Anyone take lexapro and find it helpful?
I would definitely call the doctor & find out why they are switching. Doesn't make sense if the Zoloft was helping her. Maybe your mother told the doctor something you aren't aware of?
She loves the Zoloft, but feels if the doctor says, then she is supposed to listen. The doctor indicated that there is thinking that the Zoloft might interfere..this is my understanding of what she said so grain of salt...with the uptake of dopamine..like that somehow those two processes, the uptake of dopamine and serotonin might step on each others' toes a bit. But, frankly, my mom is not in danger of freezing in her motor movements and..at the moment..doesn't have much tremor. It's the cognitive that gives her the hardest challenge. I want her to have as much emotional/mental balance as possible. She is the dearest person, and I don't want her to suffer.
This is what my psychologist sister is wondering too. She says a lot of her patients seem to be switching to Lexapro, and she's trying to figure out why.
Could you explain more - the "horrible runs of anxiety in the middle of the night straight of sleep" ? Almost sounds like I might describe my husband's REM sleep disorder symptoms. Curious & encouraging that the Zoloft helps her sleep well. Would like to hear if others are taking it along with their carb./levadopa - ?
Hi, yes. She was waking up in what sounded like panic attacks. Her heart was racing, and she didn't know why. She has shown evidence of a sleep disorder when she would doze in the day, which interestingly, she does not seem to do anymore. She would move her hands like she was knitting. Her doctor says once PD people start showing signs of a sleep disorder that she immediately treats it because it usually gets worse, and she is worried people will fall out of bed, etc. in activity. So she put her on 10mg melatonin. But when we put her on Zoloft, climbing slowly to 100mg, at 25mg steps, boom, no longer having anxiety, no longer having sleep problems. It took a good month and a half or two months for it to really kick in. During this time, she kept wondering if it was the source of any problem that would come up, but then she decided that she loved this medicine. Her husband is very hearing impaired and takes out his hearing aids at night, so he doesn't know if she's talking in her sleep or anything, but no falling out of bed, no talking about being awake in the night. Now that the doc has backed her off by 25mg, it seems like she is talking more about looking at the clock, etc. in the night. I am so resistant to moving off this med because of how it has benefited her, but the doctor indicated that maybe it might interfere some with the dopamine uptake from levadopa. So, was trying to see if anyone feels this is much of a problem. It was presented as sort of this might be a little bit of a thing so preference would be to move her to something where it might not be the possibility. But anyone who has any experience with antidepressants knows, one size does NOT fit all, and something that works should not be taken for granted.
My mom had the same problem. She didn't slept for 6 months. All night she was calling for me or my dad. So i asked her doctor to give something to her. He gave ger seroxat for the day and mirzaten for the night. And first night she slept fo 15 hours...until then everything is fine! Talk with her dr obout this they say that these meds go well with PD meds! Good luck
Lexapro (and any pure ssri, such as paxil...also known as xeroxat...is bad news, it is a stimulant and it agitates all the hidden things that come out as disturbing dreams and other over-kill stimulant activity. Don't mess with it. Any professional that goes for the SSRIs are professionally ignorant and behind the curve (in my opinion, for what it is worth).
From scientific inquiry and personal experience, including as a practitioner and patient both, I can tell you: better to do with a SNRI (such as duloxetine) and not SSRI...especially the most recent SSRIs like the naked stimulant ones such as paxil...which often leads one into psychotic agitation so troublesome that it leads to frankly psychotic behavior...better to use a SNRI supplemented as needed with a nice late generation benzo such as clonazepam, though the older benzodiazepenes are appropriate, just not fashionable, to help with sleep and any severe agitation, then take it easy in the morning until you feel functional. The SNRI Duloxetine would do better for you, and even then, I would take the tabs and divide them between morning and afternoon (if you take it too late, then you will suffer disruptive dystonic dreaming...if you don't get sufficient depressive relief from that handling of SNRI, then go ahead and take the full 30 or 60 tab in the mornings). SSRIs are just too rough when it comes to people with co-occurring depression and PD. Ultimately something with some safe mao-b inhibition would also help, done carefully, but in the meantime SNRIs plus low dose benzodiazepenes (which unleash your system's natural emotional brake fluid, otherwise known as gamma-aminobutyric acid type-A (or what we generally understand as GABA) should take care of both ends (insufficient stimulation, insufficient relaxation). The anxiolytic properties of benzos are actually rather helpful, just keep the doses in close moderation and don't worry (really, don't WORRY). If you feel drowsy or slow-starting in the morning, that is typical of both medication types, just go slow until the feeling goes away, maybe have some coffee, be patient. And you DO very much need the non-REM sleep, so talk to your doctor if you aren't getting sufficient of that.
Ultimately, for co-occurring depressions overlapping with PD, a key is going to be either better control of MAO-B mechanisms, or better HTP controls, which precede on a more subtle and early onset level...meanwhile, you can educate your practitioners as to the naked crudity of using simple SSRI therapy, and suggest they at least do some reading if nothing else. O, if they would only have the humility to accept peer supervision, but the profession does not require it of licensed practitioners...too bad.
In moderation, no it is not...without moderation, like virtually anything, yes. So much of the reward pathways involve what amounts to an addictive process, called opponent process, that nearly all of "non-associative learning" (which is a very large percentage of all learning) follows the exact same model...i.e., learning itself is so important in survival, an addictive component is built in to promote it. In other words, addiction process is actually a widespread mechanism for evolutionary learning. Established long ago. So "addiction" is merely an evolutionary survival mechanism gone too far. But if you manage it by being conservative, you can very possibly avoid those addictive potentials. I.e., instead of increasing doses too far and habituating and tolerating, you just are judicious about using it and hold some discipline, you can actually easily avoid any natural dependency from becoming addictive. Like food and obesity...or alcohol...or sugars...television...or just about anything. Your brain is set up to accommodate addictive mechanisms because they are very supportive (on an evolutionary scale) of survival. But if you just use conscious effort and some discipline, you can bypass your brain's natural predilection to become addicted to things. Benzos are just a specific example of a natural brain mechanism...and if you introduce conscious effort and awareness to substitute unconscious survival mechanisms, i.e., all things in moderation, you can do well without having to trigger your natural unconscious automatic needs to become addictive to something. As your grandmother might have said, just don't make it a bad or excessive habit. If you go to the casino, only spend so much. Then go home.
Ok, that’s very helpful to know. I’ve been a bit scared of them as the psychologist said they’re addictive but I would like to get him off the Zoloft and mirtazapine gradually and eventually and we have these clonazepam left over from last time he was very anxious and we know only 1/4 of one is enough to calm him if he gets over anxious again.
My husband takes Zoloft 50mg and mirtazapine for sleep which is now down to 3.75mg.
Mirtazapine makes him so dozy he won’t get up and caused the blank stare face at 30mg which he used to be on but at this low level he can eventually get up in the morning. He is on 1 C/L at the moment. Something is making him feel under the weather and fluey in the morning so we are trying to work out what.
He had clonazepam when he had extreme anxiety and only 1/4 of a tablet helped a lot ( the prescribed 2x 3 per day) but I thought they were very addictive and required increasing doses to keep working? Perhaps it depends what age you are and how advanced. If you are well into your 80s and not very active it may not matter if you are addicted perhaps? He is just 59 so it’s a long time to be hooked on something. They certainly worked well in the short term.
Why using the mirtazapine in the first place, what was the purpose? One must take that into account, very much so. Chronic use, or occasional? For depression, or for sleeping aid? How many mg per dose, and how many doses during the day and evening? And importantly, you also did not mention all the medications he is on, how much and when, that is very critical to know as well. It's a matter for your prescriber.
You did not say what mg strength the clonazepam is, nor how many times a day, so I can't know what one quarter tab of a clonazepam is and that would be important to help. It is somewhat addictive, but not if you don't over do it, and if you want to get off it, you just do so very very gradually, such as stepping down the dose by a tiny bit for a week or two, then a tiny bit more, and so on. Yes you can become "tolerant," meaning the same dose doesn't seem to work anymore, but only again if you become overly dependent on it. But then, the human brain is like that, it develops tolerance to many psychotropics, drugs that are psychiatric or pain-relieving, the brain just works like that, it is built to do so, which is a problem for something that you want to keep a chronic effect for. So there is going to be some toleration (the same amount eventually losing its effect experience), dependence (remove it and you have withdrawal) and potentially addiction (big time toleration and dependence and serious illness both from taking it and from withdrawing from it). Yet, the same mechanisms can develop from lots of other medication, it's all part of a more general construction of the brain, called the reward pathway, and dopamine is a large part of it (along with the things we talk about it concerning PD, it is also the brain's "joy juice," a little spuurt of it from a stimulant or a good run or some sex or whatever, and your brain says "that feels good, what can I do to make that happen again, and maybe then get it into a habit, whatever it is, I like it, let's have some more please!"). That's dopamine! The same things occur. Sugar is addictive. Too many carbs, or the wrong kinds, are addictive.
Listen, it is also technically correct to say that we are all addicted to food. (Well, just try living without food. Feels good to eat, to taste, to have gustatory pleasure sensation, feel satisfied when you were empty. Without it, you eventially sicken and die. Technically that is addiction.)
Clonopin is supposed to be episodic in any event, not a chronic thing all day, unless he suffers from severe anxiety, and under the prescriber's supervision. With some illnesses, phases of illness, or conditions, yes you may have to risk some dependence. That's why you work with a prescriber, if they are properly trained using psychotropics, they know that and are supposed to be able to help it be managed, in balance with what else you take and how they interact or don't interact to affect each other and the reasons for taking them, all a package together. But please, the dose and number of times used a day matters and you neglected to say what that is. For example, if he is taking 1 whole mg per dose, and 3-4 times a day, that is a fair amount and you should see it acting effectively, sedating. But a quarter of a mg or a half of a mg should be enough to take the edge off or aid sleep and it is a nominal amount for agitation or for inducing a bit of drowsiness. If you find he is becoming too dependent on it, ease of a little, with his help, engage his help to try to think through lifestyle choices that might act as if they also help ease things so it is not just a matter of relying only or totally on the drug.
Also, mirtazapine is prone to cause physical dependence, meaning that once on it for a long time, withdrawal produces agitation symptoms, insomnia, and other discomforts...but gradual withdrawal works fine and that should be worked out with your prescriber. Mirtazapine in my view is a much nastier chemical than clonazepam. But you don't want to be taking too much clonazepam for too long either. Like I say, unless he has a job to go to in the morning, he doesn't need to have a fast start to his day or wake up abruptly. When you are taking more than one psychiatric medication, sometimes they act in combination, and sometimes they work at cross purposes, so that must be managed.
Mirtaz withdrawal too abruptly can lead to agitation and insomnia. So can Clonopin if you have been on it at a high dose for a long time, and the idea is to be on as little as you can do, but without suffering so it is also important to not be too tight fisted about it either. Since mirtaz can have a sleepiness side effect, I might try a more gentle over the counter continuous release melatonin for a bit. It is a naturally produced hormone in your brain that helps you get off to sleep and in two to four hours it is gone from your system, so it is used as a sleep aid, and if you are prone to unnecessarily waking up, a little higher dose pill that is absorbed over time is sold that keeps its effect present a bit longer into the night. If he didn't need to wake up to urinate anyway, that might be of some use, quite safe.
And of course, if he is gaining the desired sleep effect from smaller and smaller doses of mirtaz, that's a good thing. I never did like any of the "tetracyclics," meaning they have four benzene or aromatic rings, that's a lot and those four benzene rings, something about when you have four of them, or maybe it is all those extra nitrogens, but tetracyclics are close cousins of some very toxic and powerful things, trazodone is another of them, they are somehow just rough on people, yes they produce sleep, but it is a rough sleep, often disturbed, very hard to climb out of, very hard to relax out of, and they don't do that much for depression. I think you can do better with other psychotropics.
Thanks Marion. He was on Prozac first for depression for a few years starting about 4 years ago. It made him suicidal. So the psychiatrist put him on mirtazapine as well , 30 mg, and he became impulsive with food, gambling etc so Prozac was taken away. Then the mirtazapine made him so dopey he wouldn’t get up or do anything, just sit it a chair if he did get up. Then last May his Pd was diagnosed. So he slowly over about 4 months weaned off it as a lot of the Pd symptoms seemed to be caused by the mirtazapine until last September he was off it. His energy increased and apathy went away, and his face started to work again. He was great for a few months then suddenly he became so anxious he was suicidal and had to go to the mental health unit for help. They put him on 25 mg Zoloft which made him worse so they doubled it, added 15 mg mirtazapine back and clonazepam, 0.5mg up to 6 per day and a sleeping tablet which he only took a couple of times. He only took a couple of the 0.5 mg tablets and found 1/4 of one a couple of times a day was working then the mirtazapine knocked him out again so he didn’t need it again. Since then he has got back down to 3.75 mg mirtazapine and has just started trying to decrease the Zoloft by 1/4 of the 50mg tablet over the last few days just in case it is that making him feel nauseous but he’s feeling pretty bad still. Not anxious though. Just fluey and hungover.
My sister and I both have REM sleep disorder. I’d get up about 90 minutes from falling asleep and think the weirdest stuff was happening! A low dose of clonazepam completely stopped all the crazy sleep acting out. I’m on Zoloft now, though, in addition, and though it helps about 50% of the time with sleep (I can go for weeks sleeping great), I still really struggle with sleep, sometimes not sleeping for days at a stretch. It’s horrible. It the crazy dreams and acting out has ended completely since introduction of clonazepam. Good luck! Your mom is blessed to have you!
I have been on Zoloft for over 20 years and I wouldn't want to take anything else. My doctor recently increased it from 75mg to 100mg & it's a lot better because anxiety & depression are major symptoms of PD. I am also taking Sinemet quick release 1/2 tab. 2 x a day & extended release 4 x a day, plus at night to sleep I take 75mg of Trazodone to help me sleep, because I also have a hard time sleeping. I'm kind of leary when doctors want to change medications when the one that is working works well. Maybe ask about adding Trazodone, that might be better for your mom.
My wife has used Lexapro for a number of years, well before her PD diagnosis. It's never had a negative effect on her though. What did give here problems was her Lorazepam. She was taking 8 x 1mg tabs per day [that is maximum]. It was stopping her Sinemet from working to it's potential. We cut her Loraz dosage in half and it made ALL the difference. But Lexapro, no negatives at all (2 x10mg per day).
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