Anxiety meds affect on REM sleep

[Hope_Anne_Faith]

I have POTS, PLMD, RLS, high norepinephrine and high anxiety. Sleep study also showed no REM sleep. I take paxil for anxiety, wellbutrin for mood and energy, and clonidine. Sleep doc wants me off paxil b/c of its effect on REM sleep. Could I take trazodone for anxiety with the wellbutrin? Or something else for anxiety that doesn't affect rem sleep?

[skribz]

hello.   i'm not familiar with everything you mentioned but i am familiar with the frustration of not being able to get good sleep.

i am by far NOT a medical expert of any kind nor am I pretending to be able to give psychiatric or medical advice.  i know "one person's experience with a medication doesn't dictate what another's will be," and all that jazz but i also know that when you're making decisions on these kinds of things sometimes it just feels better to hear something from somebody who has actually tried it.

i do have personal experience taking trazodone for sleep. for 6 months it worked very well for me.  it has also worked and continues to work very well for other people i know. this will probably be too long but i want to tell you whatever might help.

i was born when i was young...  

sorry. seriously now, i have had issues my whole life (I’m 37/female) but i ended up being hospitalized and diagnosed with bipolar disorder. after being stabilized i was partially hospitalized in a behavioral therapy program 6+ hours a day, five days a week. I still attend a less intensive program.  ergo, my medications have been under super strict psychiatric supervision.  and my experiences come from many, many, many hours amongst consumers and professionals.

after the hospital,  i was sleeping terribly,  a few hours a night, some nights no sleep and not good quality at all (waking up a lot, sweats, nightmares, seemingly always feeling exhausted).  i was put on trazodone for sleep and minipress for trauma nightmares. I was also on depakote750mg & wellbutrin150mg.  i started on trazodone50mg for a week or so.  it was helping, i was finally getting some sleep so they raised it to 100mg and that worked extremely well for me for and entire consecutive six months.  the only hiccup i had was when they raised it to 150mg because i was still having trouble falling asleep. at the higher dose i started having really weird dreams, sometimes scary, sometimes just bizarre but it was not good.  my doctor said trazodone gives some people vivid dreams.  at 150mg i also had a lot of trouble waking up the next day.  lowered it back to 100mg and everything went back to good.

i feel like i did get a good quality of sleep on the trazodone100mg.  once i fell asleep i usually stayed asleep (aside from a personal quirk of waking up one time every night around 4am).  i felt  rested the next day.  as long as i took it when i was supposed to it wasn’t hard to shake the sleepy in the morning. once i got up and got moving my head cleared pretty quickly, an hour or so to really feel awake.  i had to take it by 8 or 9 at night otherwise it was harder to get going.  i would  be able to get up when i had to but i’d feel really sleepy and not alert. i needed at least 12 hours after i took it to be able to depend on feeling sharp the next day.  other people i know don’t need that long.  i wouldn’t know exactly how to gauge REM sleep but if dreaming is any indication, i think dreamt more than i ever had in my life on the trazodone100mg.   the falling asleep part is so hard for me and it didn't always help me do that but it doesn't sound like the actual falling aseep is an issue for you?  

i only stopped taking trazodone because the vivid dreaming became a serious problem.  to say the dreams were vivid is a serious understatement.  and then all of the heavy stuff i was dealing with eventually took over my dreaming.  all of my worst anxieties, fears, worries, plans, problems, coming to life in Technicolor at night. along with some boring ordinary stuff like laundry and Walmart.  instead of feeling like i slept, i felt like i had spent all night doing whatever it was i was dreaming about.  i started feeling exhausted again.   and on top of that it all seemed so absolutely, positively, real.   i started to really have to really think about did something happen or did i dream it? to me, as a person with bipolar disorder, having trouble discerning reality felt like a really scary thing.  so i stopped the trazodone and tried a bunch of different stuff, still looking.
being this program i have gotten to know some other people pretty well since we spend so much time together and have a lot of group therapy and come to each other with all kinds of problems.  definitely we talk a lot about medications.  in my personal observation, trazodone seems to be the common sleep aid.  i know that my closest friend  has been18 months been on trazodone for sleep and it is still working well, not interacting badly with other medications. and my second closest about 12 months on trazodone for sleep and loves it.  i have heard personally with my own two ears people say it did not help them sleep.  more often, i have heard personally with my own two ears people complain it was too sedating.  i have not heard of anyone with dreams as vivid as i have on trazodone, and i have asked everyone i could ask.  i have not personally heard a trazodone horror story.  and that’s what i know about that.

in case anyone reading this is interested, the program consists of a lot of cognitive and dialectical behavioral therapy, help with personal particular issues, illness education, stress and symptom management, relapse prevention, working through PTSD/trauma. all kinds of help figuring out how to live a life more like the one you want to live. i am incredibly grateful for the opportunity and experience.  i have worked hard and it has worked absolute WONDERS for me.  i now have a life that i never could have imagined before.  the world is not so scary anymore and things feel possible.  

and i hope something in here can help you.
be well

[Hope_Anne_Faith]

Thanks, but my question was about how trazodone works for anxiety - it is one of few or possibly the only antidepressent that doesn't suppress REM sleep. I have been on Wellbutrin for years and it works fine for the purpose I am taking it. Also I have no problem going off Paxil. Obviously sleep is a problem for me as I have no REM sleep (due to paxil according to the sleep specialist). Clonidine helps me get to sleep but not the quality of sleep. In any case my question is for anyone who has experience taking trazodone for anxiety. Thanks!

[Paxiled]

This is a bit off.  Wellbutrin and Paxil are both antidepressants, not anti-anxiety meds.  Most antidepressants, however, have also been found to help people with anxiety.  Because wellbutrin is very stimulating it can make people more anxious, so it's not usually used if anxiety is the primary problem.  The snris are also like this, but still, some people do find taking them helps with anxiety because anxiety very often comes from depression.  Wellbutrin, in other words, is not a better antidepressant than Paxil, just different; Paxil was in fact approved for depression treatment and was then used later for anxiety, as have most antidepressants.  Sometimes they work for a person, sometimes they don't.  Secondly, all drugs that affect sleep affect REM sleep.  Wellbutrin, because it's very stimulating, is often combined with an ssri such as Paxil when the ssri is too sedating or to combat sexual side effects and weight gain.  So any drug you take for mental problems can affect REM sleep, including Wellbutrin.  Trazadone will also affect REM sleep most likely, as it's a very sedating medication.  So the first thing I would ask is, how are you sleeping now?  The second issue is, Paxil is a very difficult medication to stop taking, and as it's one of the strongest antidepressants out there it's not always easy to find another medication to work once you've been on it.  That's probably one reason why it's so hard to stop taking.  So if you do decide to stop taking it, you need to do it very slowly and carefully, and switching to another medication before you finish tapering off won't help stop any withdrawal problems.  You'll want to completely finish the Paxil before starting something else.  So given all this, and you should do your own homework and research it yourself, if this combination is working, I'd be reluctant to change, and if your doctor has told you Paxil isn't an antidepressant but is only for anxiety, I'd find a good psychiatrist who knows these drugs better.   Good luck.