4 ms·

I have heard that people in post-acute care (think nursing homes) frequently end up taking Seroquel because it appears on their hospital discharge paperwork, de

by ef4 12y ago

I have heard that people in post-acute care (think nursing homes) frequently end up taking Seroquel because it appears on their hospital discharge paperwork, despite never having any diagnosis of psychosis. It turns out that certain hospital physicians find it a convenient sleep aide for use in the hospital, and the prescription unintentionally follows the patient, sometimes for months or years. (Source: I sell software to long-term care facilities and their pharmacists.)

logn 12y ago
I've had periods of insomnia. Personally, I liked https://en.wikipedia.org/wiki/Trazodone https://en.wikipedia.org/wiki/Trazodone and it comes in generic. I've only ever needed to use it on a short-term basis. Also, I think banning drug ads and the profession of pharmaceutical sales rep would go a long way toward fixing over-prescribing and medical costs. When the new Congress wants to reform Obamacare, someone should add this ban.
- oldspiceman 12y ago
  This is a great read for anybody with issues sleeping. The vast majority of sleep problems are in your head and after reading this I never had another issue. He debunks the utility of sleeping pills and give you lots of strategies for improving your sleep. http://www.amazon.com/Say-Good-Night-Insomnia-Drug-Free/dp/0805089586 http://www.amazon.com/Say-Good-Night-Insomnia-Drug-Free/dp/0...
- thret 12y ago
  I think you've got the wrong approach. Sleep is a waste of time! If you can't sleep count your blessings and do something productive.
  - lotsofmangos 12y ago
    I sometimes get severe insomnia. After the third day, the most productive thing I could do is menace in a deranged and hallucinatory fashion anybody who dares hand out this kind of advice.
    - thret 12y ago
      I've always had what you might call severe insomnia. I rarely sleep for more than four hours, and I've found I do pretty well on two. As far as I know I've never slept eight without either being up 2-3 nights beforehand or being very, horribly drunk. In my experience if you are not sleeping, staying in bed will just make you more tired. It is better to embrace it, get up and do something. So that's where I'm coming from, I'm sorry if it caused offence. Three days/two nights without sleeping, as in without going to bed at all, should not cause you to hallucinate. That's just a weekend. That's as uncommon as you might think. If you are hallucinating there might be something else going on.
hga 12y ago
I have really bad insomnia, due to genetic anxiety and depression (apparently "of a bipolar nature", but only a drug can make me manic), and without a low dose of Seroquel before bed I'd only be getting ~4 hours of sleep a night (and my anxiety would be much worse). It's been pretty much a life saver. Seroquel is ... interesting in that it hits a histamine receptor harder than anything else; for someone like me, who also suffers from bad allergies, this duel side effect is particularly advantageous. As far as I know, all atypical anti-psychotics have been black boxed (major league warning) for treating the elderly with dementia, the side effects in them are worse than the benefit.
- derefr 12y ago
  > apparently "of a bipolar nature", but only a drug can make me manic Insomnia is, in my experience, symptom of low dopamine. You need to exert executive function to intentionally drop trains of thought that are keeping you awake—without enough dopamine to do so, you end up increasingly exhausted but unable to sleep. Vyvanse is the best thing that ever happened to my sleep schedule.
  - hga 12y ago
    There are several kinds of insomnia. In my case, getting to sleep is seldom a problem (and when it is, it's indeed often if not most often that kind of "thinking too much"), waking up too early is the big one. So, besides this being a generic disorder (my uncle the engineer followed the same path as I at the same times in our lives, but he's frankly bipolar with anxiety being of less significance), the effects of Seroquel on dopamine are not much if anything of an issue for me. Then again I'm taking a low dose of it (50-100 mg in one dose before bed, therapeutic dose of it for its formal indications don't go below 300 mg/day). One thing to emphasize from our disparate experiences is that in this arena there aren't "one size fits all" solutions. There are common symptoms which respond to common solutions, sometimes after a search for a particular drug that works with acceptable side effects, then there are people like me where doctors and myself struggle for years to find a set of drugs that provide the best solution (for now) that control but by no means cure my symptoms (like my uncle, this eventually disabled me). Getting back to the original basis of this discussion, I'm absolutely sure that Amblify when used as an adjunct for current generation antidepressants works from some people with refractory depression, which I can attest is no fun at all, since mine is only partially alleviated, and I have friends who spent years before they found at minimum partial solutions for their more standard unipolar depression. Is it seriously over-prescribed? Who knows? In my experience, there are enough people out there with refractory depression that it might well not be. And I'd certainly try it before e.g. electroshock therapy, which is one of the alternatives if you're desperate enough. As a side note, I learned cognitive psychology in the '80s (now cognitive behavioral psychology, http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336/ http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808... is the classic and highly recommended layman's introduction), and it's tremendously useful, and in retrospect ended any benefits from talking therapy, but it's pretty clear that like the 3 particular antidepressants I've tried from two generations of them, only a partial solution for me.

by ef4 12y ago

logn 12y ago

I've had periods of insomnia. Personally, I liked https://en.wikipedia.org/wiki/Trazodone https://en.wikipedia.org/wiki/Trazodone and it comes in generic. I've only ever needed to use it on a short-term basis. Also, I think banning drug ads and the profession of pharmaceutical sales rep would go a long way toward fixing over-prescribing and medical costs. When the new Congress wants to reform Obamacare, someone should add this ban.

oldspiceman 12y ago
This is a great read for anybody with issues sleeping. The vast majority of sleep problems are in your head and after reading this I never had another issue. He debunks the utility of sleeping pills and give you lots of strategies for improving your sleep. http://www.amazon.com/Say-Good-Night-Insomnia-Drug-Free/dp/0805089586 http://www.amazon.com/Say-Good-Night-Insomnia-Drug-Free/dp/0...
thret 12y ago
I think you've got the wrong approach. Sleep is a waste of time! If you can't sleep count your blessings and do something productive.
- lotsofmangos 12y ago
  I sometimes get severe insomnia. After the third day, the most productive thing I could do is menace in a deranged and hallucinatory fashion anybody who dares hand out this kind of advice.
  - thret 12y ago
    I've always had what you might call severe insomnia. I rarely sleep for more than four hours, and I've found I do pretty well on two. As far as I know I've never slept eight without either being up 2-3 nights beforehand or being very, horribly drunk. In my experience if you are not sleeping, staying in bed will just make you more tired. It is better to embrace it, get up and do something. So that's where I'm coming from, I'm sorry if it caused offence. Three days/two nights without sleeping, as in without going to bed at all, should not cause you to hallucinate. That's just a weekend. That's as uncommon as you might think. If you are hallucinating there might be something else going on.

hga 12y ago

I have really bad insomnia, due to genetic anxiety and depression (apparently "of a bipolar nature", but only a drug can make me manic), and without a low dose of Seroquel before bed I'd only be getting ~4 hours of sleep a night (and my anxiety would be much worse). It's been pretty much a life saver. Seroquel is ... interesting in that it hits a histamine receptor harder than anything else; for someone like me, who also suffers from bad allergies, this duel side effect is particularly advantageous. As far as I know, all atypical anti-psychotics have been black boxed (major league warning) for treating the elderly with dementia, the side effects in them are worse than the benefit.

derefr 12y ago
> apparently "of a bipolar nature", but only a drug can make me manic Insomnia is, in my experience, symptom of low dopamine. You need to exert executive function to intentionally drop trains of thought that are keeping you awake—without enough dopamine to do so, you end up increasingly exhausted but unable to sleep. Vyvanse is the best thing that ever happened to my sleep schedule.
- hga 12y ago
  There are several kinds of insomnia. In my case, getting to sleep is seldom a problem (and when it is, it's indeed often if not most often that kind of "thinking too much"), waking up too early is the big one. So, besides this being a generic disorder (my uncle the engineer followed the same path as I at the same times in our lives, but he's frankly bipolar with anxiety being of less significance), the effects of Seroquel on dopamine are not much if anything of an issue for me. Then again I'm taking a low dose of it (50-100 mg in one dose before bed, therapeutic dose of it for its formal indications don't go below 300 mg/day). One thing to emphasize from our disparate experiences is that in this arena there aren't "one size fits all" solutions. There are common symptoms which respond to common solutions, sometimes after a search for a particular drug that works with acceptable side effects, then there are people like me where doctors and myself struggle for years to find a set of drugs that provide the best solution (for now) that control but by no means cure my symptoms (like my uncle, this eventually disabled me). Getting back to the original basis of this discussion, I'm absolutely sure that Amblify when used as an adjunct for current generation antidepressants works from some people with refractory depression, which I can attest is no fun at all, since mine is only partially alleviated, and I have friends who spent years before they found at minimum partial solutions for their more standard unipolar depression. Is it seriously over-prescribed? Who knows? In my experience, there are enough people out there with refractory depression that it might well not be. And I'd certainly try it before e.g. electroshock therapy, which is one of the alternatives if you're desperate enough. As a side note, I learned cognitive psychology in the '80s (now cognitive behavioral psychology, http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336/ http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808... is the classic and highly recommended layman's introduction), and it's tremendously useful, and in retrospect ended any benefits from talking therapy, but it's pretty clear that like the 3 particular antidepressants I've tried from two generations of them, only a partial solution for me.