Insomnia due to medications?

  Dear Doctor:
  I am a 30 year old male.My physician has been treating my depression and anxiety with
  150mg of Wellbutrin twice a day. I have been on this medication for
  7 months now. He has also prescribed 50mg of serzone at bedtime to
  help me sleep. This is no longer working. I turn in for bed at
  midnight and I awake at 3 or 4am every day. I am exhausted but
  can not fall back to sleep. My mind is constantly on the go and it
  is really starting to take a toll on my body. I need to sleep
  not only for health reasons, but I have to get up early to take care
  of my 2 year old son. (I work nights). The only thing that helps me
  sleep through the night is drinking a 2-3 beers before I turn in.
  I do not want to depend on alcohol to sleep, so I stopped drinking.
  (Not to mention I am not supposed to drink on these meds.)
  Is it possible that the meds I am taking are causing this? I am going
  to tell me doctor on my next visit that I would like to try to lower
  my dosage of medicaton so I can eventually stop taking it.
  My depression is gone, and my moods have been great. Thanks to
  wellbutrin and psychotherapy.
  Do you have any suggestion of what may help me get my sleep
  pattern back to normal? Should I try any other maedication?
  Thank You.
  Chris

[HFHS MD-JM]

_
Chris,
You report having what is known as terminal insomnia or early morning
awakening resulting in three to four hours of sleep which is clearly
inadequate.  It appears that your physician added Serzone to help with
insomnia in addition to wellbutrin for your anxiety and depression.  It
sounds like the Wellbutrin has been successful for some time in terms of
your depression and anxiety but not for your insomnia.  
There are several things that can cause problems with sleep including
depression and anxiety itself, Wellbutrin or other medications, alcohol
or poor sleep hygiene.  Wellbutrin tends to be a more stimulating anti-
depressant and could interfere with sleep especially if you take it later
than 5 PM.  However, in general it would be unusual for Wellbutrin to
cause insomnia after taking it for seven months if you weren't taking it
too late in the PM.  Interestingly alcohol can also cause or exacerbate this
problem-it can be helpful to fall asleep initially but disrupts the sleep
cycle resulting in early morning awakening.
The last thing to mention is sleep hygiene.  Going to bed at the same time every
night and getting up the same time every morning helps keep your sleep
cycle constant.  Shift work (nights) can pose a real problem for some people.
Other things that might interupt sleep are heavy physical exertion and
ingesting stimulants like caffeine or a heavy meal a few hours prior to
bedtime.  I hope this has been helpful.  Please discuss this further with
your physician.
Sincerely,
HFHS MD-JM
Keywords:  Early morning awakening, terminal insomnia, depression