Long-term SSRI side-effects and insomnia

[ProzacCitizen]

Dear Doctor,

I'm a 19-yr old patient who has been on various SSRIs (Selective Serotonin Re-uptake Inhibitors) for 11 years, mostly prozac, on an initial diagnosis of Tourette's syndrome. In December 2007, I began to have sleep difficulties and my psychiatrist took me off prozac - which triggered a prolonged and persistent insomnia that can last for up to six days at a stretch.

It is caused by ruminations that persist regardless of study intensity during the day time or mental/physical fatigue. There has been no official diagnosis and my case has been treated symptomatically, a most unsatisfactory and erratic approach. Attempts at improving sleep hygiene have been futile. Would you have any idea why I'm unable to 'switch-off'?

My most recent drug combinations are (1) 30mg Remeron/Mirtazapine, (2) 150mg Quetiapine/Seroquel, (3) 500mg Epilim/ Sodium Valporate  everyday and (4) 10mg prozac every other day. This seems to work well, but I wonder what the long term consequences will be. Could you enlighten me?

[Steven Y Park, MD]

Have you tried a formal cognitive behavioral therapy program? If you can't find a sleep doctor that can do this in person, Dr. Gregg Jacobs on the Insomnia expert forum has an excellent online program called cbtforinsomnia.com. You may also want to post your question on his forum. Good luck.

p.s. Being on all your anti-seizure and antidepressants can also cause or aggravate insomnia. Sudden changes can also cause problems. It's also interesting to note that Tourette's and obstructive sleep apnea are linked. It's also been reported that obstructive sleep apnea lowers seizure thresholds. If all else fails, a sleep study is one option.

[ProzacCitizen]

Thank you very much Dr. Park. I'll look up Dr. Jacob's website and read up on the obstructive sleep apnea as you've recommended :)