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Dr. Abby
Dr. Abby, Board Certified MD
Category: Health
Satisfied Customers: 10329
Experience:  Family Physician, practicing medicine for over 10 years, United States
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65 yr old white male in good health. History of clinical depression

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65 yr old white male in good health. History of clinical depression 11 yrs ago when I retired. Took Celexa for 6 months and recovered. Recently diagnosed with early stage prostate cancer which precipitated a stress reaction, insomnia and anxiety.

Taking 10 mg of generic ambien since 15 May 12 but unable to sleep for 7-8 hrs with it. Have resorted to cutting it in half with a pill-cutter to get at least 6 hrs which is not enough.

Is this safe for my health?

I am going to see a psychiatrist to check if the insomnia may be symptom of an underlying anxiety or depression again.

Just need an experienced medical professional to give me an outside opinion of my situation and options.
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Abby replied 2 years ago.
Good morning,

Just to clarify, are you taking 5 mg at bedtime and then a second 5 mg in the middle of the night?
Or are you taking a total of 15 mg of ambien?

Dr Abby
Customer: replied 2 years ago.
5 mg at bedtime and 5 mg in the middle of the night.
Expert:  Dr. Abby replied 2 years ago.
Yes, you can take it this way.
This formulation of ambien is not an extended release tablet so you can cut it in half.

The main issue with taking a second dose in the middle of the night is that it can increase your risk for morning sleepiness.

If you are not experiencing this and you are able to function during the day without difficulty (aside from the other issues that you are dealing with), in the short term splitting is ok.

Your psychiatrist may recommend the extended release formulation of Ambien (called Ambien CR) or a switch to Lunesta (which works better for some). However, these are not generic....

I am sorry you are going through a difficult time right now, Joe. I know that this new diagnosis is stressful. I wish you good health in the future.

Please feel free to ask any follow up questions you may have,

Dr Abby
Customer: replied 2 years ago.
Thank you DR Abby for your empathic and clear response. I can function ok with some fuzziness.

What meds could treat anxiety/depression znd allow me some restful sleep? Celexa had insomnia as a side-effect for me before.
Expert:  Dr. Abby replied 2 years ago.
One medication that was initially used as an antidepressant but is now prescribed (in lower doses) for insomnia is doxepin. This is one that I would consider trying...

Mirtazapine is another commonly used for depression with sedation as a side effect.

Trazodone and amitriptyline are two others that can be used for insomnia and depression. Amitriptyline can have many undesirable side effects, however, so I would avoid this unless nothing else seems to work.

Dr Abby
Customer: replied 2 years ago.
One final question Dr Abby and I will gladly "accept answers"

How long on average would I take the above meds and what would be the weaning schedule off them? Do I have to wean off Ambien first before I can use them?

Thanks for all your thoughtful and clear comments; they are greatly appreciated and I applaud your efforts in this forum.
Expert:  Dr. Abby replied 2 years ago.
I am sorry for the delay in responding to your final questions....

Because this is the second time you are experiencing depression/anxiety, we generally recommend that you take the medications for the long term due to the high risk of relapse.
However, if it is something that you do not want to do, treatment should be given for at least six months.

Weaning off of the medications can usually be done over a few weeks, depending on which one is used and the dosage.

If you are started on mirtazapine, it is generally not recommended that you take ambien with it;
Because these are all sedating, the hope is that you won't need ambien at all when taking them anyway...

Dr Abby
Dr. Abby, Board Certified MD
Category: Health
Satisfied Customers: 10329
Experience: Family Physician, practicing medicine for over 10 years, United States
Dr. Abby and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.
Dear Abby,

I have taken 10 mg of generic ambien for about 18 days and am already experiencing symptoms: warm fingers and stomach. Short term memory issues too.

What can I know or do to calm my fears of a nasty withdrawal from this drug? I start proton beam treatment for prostate cancer this week.

Your fan,

Joe
Expert:  Dr. Abby replied 2 years ago.
Joe,

I do understand your fears about withdrawal.
It will be important for your doctor to taper your dosage (for example, have you take 5 mg for a week and then possibly even 2.5 mg for a week) in order to help you stop taking the ambien.
I know that it is quite anxiety provoking to think about having nights that may be sleepless when trying to taper down off of the ambien.
Your doctor can start you on another medication, however, when tapering off of the ambien, especially when you are at the lower doses.
As long as you are not on the Intermezzo brand of ambien (which you are not, I believe because this is a sublingual form), you can take lower doses of ambien with mirtazapine.
You can also take ambien with trazodone.

I do believe that mirtazapine may be the better option for you if depression is a major issue, however, as this works better for that condition. Weight gain can be an issue with that medication, though, so if you are overweight, you may need to try trazodone instead or something else.

Make sure you express your anxieties about not sleeping to your psychiatrist. He should be able to help you through this.

As long as you are tapered and given something in place, you should be okay with minimal to mild difficulties sleeping just for a short time (if at all).

I wish you good luck this week. I am hoping that you have someone that is supporting you through this difficult time.

Dr Abby
Customer: replied 2 years ago.
Thanks Dr. Abby you are the best anti-depressant available! I am in South Korea and my Korean wife (of 26 yrs) and her family are supporting me. My psychiatrist is Dr Yu P. M. at Samsong Hospital in Seouwith training at UCLA so speaks English well.

Absent the insomnia problem, I am doing well after adjusting for jet-lag. My proton beam treatment is for 39 sessions for June and July.

Thanks again for your kind words, insightful suggestions and prompt responses.

Regards,

Joe
Expert:  Dr. Abby replied 2 years ago.
Joe,

Thank you also. You are also very kind to take the time to share your thoughts during this time.

I honestly was thinking about you just a few short hours ago and wondering how you were getting along preparing for the coming week.
I am glad to hear that you have a supportive wife and family. That makes all the difference.

Take good care these next few months, Joe,

Dr Abby

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