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SSRI and Insomnia, my off label adventure into selective serotonin reuptake inhibitors

By Edited Nov 13, 2013 0 0

Selective Serotonin Reuptake Inhibitors are a new class of drugs that are great for their intended purpose as antidepressants and treating generalized anxiety disorder (GAD) but like any drug it's legal for a physician to prescribe them for "off-label" use. If you're prescribed an SSRI for something like insomnia, as I was, get ready for better living through chemistry.

SSRI for depression and GAD.

This article is a first person experience article for the general reader. If you are already on an SSRI please skip to the end where I give two links to great resources. In researching this article on infobarrel I found a number of good articles on SSRI medications and generalized anxiety disorder and several of the articles mention that sometimes patients learn more from each other than from doctors or therapists.

Three days without sleep, I need a drug!

Like many writers I'm a fantasy prone personality. Great for article writing but bad for anxiety. Throw in a family history of manic depressive illness and the biggest recession in a generation and it was a perfect combination for insomnia. Constant worry about being laid off and not being able to pay two mortgages came to a head right after the Thanksgiving holiday and after three days of virtually no sleep I was a mess. Three days of sleep deprivation produces actual physical pain so I stumble into my neurologist and plead for an insomnia prescription. He gives me three boxes of 10 milligram tablets of Lexapro, a brand name for escitalopram, and assures me this will raise my serotonin levels which are needed to trigger sleep. And what's even better, it isn't one of those old barbiturate drugs with all those bad addictive properties; this is the latest and greatest pharmacological wonder. These are doctor sample boxes with no patient info sheets in them (I looked). I was so happy! I took one 10 mg table right there and took one every morning. I'm saved! The doctor did look pretty serious when he told me that I had to come back in a week for a status check. (If the general reader is hearing strange noises in the background right now, it's because you're hearing the howls of laughter of every SSRI patient who didn't skip to the bottom of this article and is reading along with you. Just ignore them.)

The escitalopram worked but that's not all it did.

So there I am, popping one 10 mg tablet a day in the morning and I'm absolutely clueless about what I'm taking. The small bit of self preservation still left in my brain tells me I need to start googling this drug. Not that I didn't trust the good Dr. Benway (not his actual name, an obscure reference to the novel Naked Lunch) but still, a new drug with no patient info sheet listing all the side effects like kidney failure and, you know, death, that usually accompany drugs starts to bother me. So I google. Let me tell you something folks, it is hard to type with one hand while you are using the other hand to press your hair down on your head because every hair is standing straight up. Fortunately I found some great sites and I've put two links at the bottom of this article to them.

Selective Serotonin Reuptake Inhibitors are amazing drugs. Your brain produces serotonin to do all sorts of things, like fall asleep, then it reabsorbs it. If you delay reabsorption then your brain pickles itself in its own serotonin. It's a great solution to a serotonin level problem so I understand why Dr. Benway decided to directly fix the problem in my head instead of prescribing some habit forming barbiturate to just knock me out. As the wonderfully named website crazymeds points out, there are three main neurotransmitters in our brains: serotonin, norepinephrine and dopamine so the majority of mental problems are probably caused by some screwup in maintaining proper levels of one or more of those. The trick is finding the right drug in the right dosage that works in your particular head and which has side effects that aren't worse than the original problem. Oh, did I say side effects?

There is no such thing as side effects.

When you pop an SSRI into your system (or any drug) there are NO such things as side effects. This is a totally artificial label that doctors, patients and researchers use so we can talk intelligently about drug effects. But a pill doesn't give a damn about what you do or don't think is a side effect. There are just effects. Whether they are good or bad is a judgment call by you and all the people around you that you are annoying.

Now let's speak about those annoying "side effects". As I found out through research, you have to be careful with this new class of drugs. Escitalopram is so new that it hasn't been around long enough to reliably study but similar SSRIs have a problem of generating suicidal thoughts. Oh lovely. That is why Dr. Benway looked so serious when he told me to come back in a week. Another little problem with escitalopram, among manic depressives (people who alternate between hyper mental states and depressed mental states) escitalopram can trigger a hyper state. I have a family history of manic depressive disorder which Dr. Benway did NOT check before dropping the boxes in my lap.

Escitalopram works a little faster, on average, than most SSRIs. I did start to sleep. I would only wake up five times a night then four then three times a night. That's the good news. Now let's talk about what else was happening. Shortly after taking a pill I would get the same damn anxiety attack that was causing the insomnia. My brain would race at a thousand miles an hour while imagining getting laid off and losing my house and on and on. I would break out in a flop sweat. Then, after about an hour, I would get hyper. Now I'm superman. I'm mad as hell and I'm not going to take it any more. Seriously. I've had it with this $&!# and I'm going to call my boss on the phone right now and give him a piece of my !@#$%^& mind! Anxiety? Forget about it! I EAT anxiety for lunch! I spit in the face of anxiety! I got your !@#$%^& anxiety right here! Then I fall asleep.


The first time I starting using the F-word as a universal adjective was at the breakfast table. My wife just stared at me wide eyed. When I went off again at a restaurant (fortunately under my breath but at a million words a minute) she said "Uh dear, I think you're getting hyper". So I called my sister, the retired special education teacher who has seen absolutely everything. She not only confirmed the hyper diagnosis but said that I had been talking to her about the fear of getting laid off since Thanksgiving of last year. That shocked me, then I figured out why. My company reports half year results at end of calendar year so the layoffs usually come just before Christmas when the bad numbers are getting obvious. It was no accident that my insomnia started over Thanksgiving holiday. Thanksgiving is a "trigger" (more on that word later).

Okay, time to start taking the pill in the evening just before bed. I developed a nice ritual, take the pill, go through the anxiety attack and restless leg syndrome (a good 10 to 20 minutes of shaking your foot while in the middle of a flop sweat) then bang, you fall asleep and wake up again in four hours. But I was getting deep sleep now and I was actually dreaming. After one week I go back to Dr. Benway and remind him that I have a family history of manic depressive illness. The look on his face when I said this told me all I needed to know. He immediately cut me down to 5 mg a day.

Your brain does get used to the "side effects".

The crazymeds web site became a real friend to me. As the webmaster explained, and other GAD suffers wrote on the forums, the brain adjusts. Eventually the brain adapts to the "side effects". The night sweats get smaller and you get more in control of your hyper stages. Then the effect you are looking for, sleeping, finally kicks in. Now my case is easy, with insomnia you pretty much know it's serotonin that's the problem. If you just walk into a doctor's office with depression or GAD then the doctor is going to experiment with different SSRIs and dosage levels. 5 mg a day is my sweet spot. And I confess to stacking, that's taking another drug to mitigate the effects of the first. In Kentucky I was taking a shot of bourbon just before bed. Eventually I switched to Benadryl just for the drowsiness. SSRIs, like all drugs, interact with others. Many patients do it, some tell their doctors about it.

Another dirty little secret about hyper mental states, they aren't all bad. Sure, you're socially unacceptable but you also have a ton of energy too. If you can stay in the house and get something done, then go for it. Labeling an effect as good or bad is entirely up to you. The pills don't care. And the fear of having an anxiety attack can actually trigger an anxiety attack. The way I handled things was by reciting Psalms 23, other rituals may work for you. After reading from GAD sufferers I found one way to handle a "bad" side effect was just to acknowledge it. You say to yourself, okay, I'm hyper and in a flop sweat that means I have to try new things to see what works. There are no limits to what may work. Change the house temperature; get out of bed and go lay down on the couch in a slightly inclined position (I really liked that one). Some people go out to their car and try sleeping there. Don't beat yourself up about what you are doing. Anything that works is fair game. Just knowing that you are prepared to explore options when the problem hits actually goes a long way to reducing anxiety about the problem. One unexpected discovery was a friend of mine who mentors in a 12 step Alcoholics Anonymous program. He was wealth of good techniques. I'm sorry he had to go through all he did to acquire his current wisdom it but it sure benefited me. Just remember to find a way to pay it all back (another good mental technique).

SSRI Withdrawal Syndrome

Eventually you may want to get off this stuff. For some people, SSRIs have an effect called SSRI withdrawal syndrome. If you go cold turkey some patients get "brain shocks" like an electric current just zapped your head. Not everyone suffers this but enough people do to worry about it. Forewarned by the crazymeds entry for Lexapro I started cutting the 5 mg pills into quarters and took the 2.5 mg portions for two weeks. Total time on the drug was five weeks. Relatively short. Some people go for years and they need months to wean themselves off it. Not everyone gets withdrawal symptoms but enough that it's a worry. Again this is something you'll read about on the websites written by people actually taking the drugs as opposed to the doctors prescribing them. This is mentioned often by patients. Doctors usually have never had the mental problem they are prescribing for, whereas a medical doctor or surgeon has experienced pain, fevers, blisters, and so on so there is some common understanding there. The first time mother can ask a male doctor a question and get a nice reassuring answer about how their first childbirth will be "just fine" but the mother-to-be might want to ask that same question of a mother with five kids and see what she thinks about it. The internet has been a great help for patient to patient communication and thank goodness I'm an expert at searching and did search when I first took the drug. Sharing my experiences in this article is a nice way to pay forward to future SSRI users.

My two cents on my SSRI experience:

1) It did work for me but the doctor knew which neurotransmitter to target. GAD and depression patients will have to try various drugs and dosages until you hit the sweet spot.

2) SSRIs have fewer harmful effects than the older class of SRI drugs because they are "selective" (duh) so I hope I haven't painted too negative a picture here.

3) Tell people you are on SSRIs. You need feedback. There are going to be anxiety "triggers" which they see and you need to see. If you are worried about getting laid off then reading about the latest round of layoffs in the paper is going to trigger a reaction. You need to learn about triggers and try a non drug therapy like cognitive behavior therapy (CBT) which may actually work better than drugs for you. This goes double if you have generalized anxiety disorder (GAD). "Mentors" like alcohol anonymous mentors are excellent to talk to as they can give you real world tips on stopping "future tripping" i.e. obsessing over every possible negative future outcome and ignoring any possible positive outcomes.

4) I don't recommend you tell your boss or co-workers. In this recession it is too easy to get laid off. Keep your job. If you have GAD then getting laid off is probably NOT going to free that suppressed creative artist that lives inside you and is waiting to escape the confines of a 9 to 5 job.

5) The internet really is your friend, especially patient web sites.

Excellent further resources.

People who take the same drug you are taking can often be better sources of information than doctors or therapists. One authority site I found for mind altering prescriptions is the crazymeds site. The administrator works hard to find the patient info sheets on all the drugs and explain them in everyday, understandable language.

Consider a nondrug therapy if you are a GAD sufferer. Cognative Behaviour Therapy can be as effective as drugs for some people so try a self directed CBT course written by therapists who really know what they are doing.

If any of this info helps you then it's been a good day!

Author's note: no affiliate links, no self referring links and no animals were used in the writing of this article.



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