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Susan Ivy
Susan Ivy, Nurse (RN)
Category: Health
Satisfied Customers: 4057
Experience:  BSN, MSN, CNS
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I have recently (about 1 month ago (October 12th will be 1

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I have recently (about 1 month ago (October 12th will be 1 month) upped dosage from 10 mg to 20 mg of paxil. Told to take it at night by my primary care physician..then it caused insomnia. Told then to take it in a.m. by phychiatrist. Did that. Feel much better as far as anxiety. Insomnia still 4-5 hours of sleep nightly. So was told to take Xanax at night to help until I transition to the higher dose of paxil. Great! I am following all directions, now dr. tapering me off Xanax (from .125 to half of this. Been in Xanax whole month. Small amount. Still insomnia. Is it still from paxil or the Xanax? Will I have side effects after 7 day of tapering? Does Xanax cause insomnia in some? I can fall asleep fairly easily. Just can't sleep for more than 5 hours most of the time.
Submitted: 9 months ago.
Category: Health
Expert:  Dr. Brims replied 9 months ago.

Dr. Brims :

Hello, welcome to the site! My name isXXXXX will try to assist you with your medical question and any medical information you seek.

Dr. Brims :

I'm sorry to hear about this

Dr. Brims :

Do you have depression or anxiety?

Customer:

I have anxiety as stated in email.

Expert:  Susan Ivy replied 9 months ago.
Hello and thank you for requesting me.

First of all, do you feel rested after you wake up from 4 to 5 hours of sleep? (this would be rare, but it is important to consider this).

Secondly, only rarely is Xanax cause activating symptoms such as insomnia, mania, or hyperactivity, and this is typically in the elderly, and there will also be confusion when this occurs.

The insomnia is more likely to be from the Paxil. In some people, the SSRI antidepressants can actually be activating (energizing - and in an even smaller percent of people it can induce hypomania or mania such as what may occur in some forms of Bipolar Disease). In fact, sometimes it will be discovered whether or not a person has a tendency towards Bipolar illness (of which there are many types and degrees of severity) after they are started on an antidepressant which throws them into mania. Now, we don't know at this time if this is what is occurring in your case. And even if it were, it would be considered possibly hypomania, unless there are other symptoms that you have not mentioned that are present that might indicate Bipolar illness. But this is something that can only be diagnosed through an evaluation period. You will need to continue to monitor and report to your psychiatrist the symptoms you are having. It is very good that you are keeping an account of the hours you are sleeping each night. I would encourage you to continue to do this. Of course if the hours of sleep continue to decrease, your doctor may have to consider another antidepressant or even a mild mood stabilizer in addition to the Paxil or in place of it. But of course, again, I do need to stress that this is just one possibility and one has to consider other symptoms you have and your history. Also, if you are having problems from the insomnia, such that you are not able to function during the day, then you will need to contact your psychiatrist for an urgent visit so that changes can be made more quickly.

I hope this information is helpful. Please do reply if you have any other questions or details you would like to provide. If for some reason I am not available right away when you reply to me, I will get back to you withing a few hours at least (except during the night). Thank you.
Customer: replied 9 months ago.

 


 


I function after 4-5 hours a sleep but do not feel rested.
I forgot to mention that I have been on paxil for 20 years and originally diagnosed with GAD (all was more or less ok until I had severe anxiety problems right before the dosage increase). So if Xanax has only a shelf life of about 6 hours isn't that why I am waking up? I take my paxil in the morning and by 9:00 at night (12+ hours ) after taking Paxil, I am tired and sleepy. No doctor ever mentioned that it was anything other than anxiety. Does this help you to further discuss with me.


Thanks...

Customer: replied 9 months ago.


P.S. I never had problems before they increased my paxil dosage. It does not make sense to me why you would bring up Bi-polar and mania. Please explain when I have told you it is form anxiety which I have suffered most of my adult life. Thanks.

Expert:  Susan Ivy replied 9 months ago.
I am so sorry, I assumed that you had recently started the Paxil. And only if you had just started the Paxil within the last few months, would the information I provided apply.

I want to give you this message so that you don't worry, I will continue with more info. about Xanax shortly.
Expert:  Susan Ivy replied 9 months ago.
Insomnia is not a common effect , but a paradoxical effect of Xanax. Insomnia can occur as a side effect of Paxil.

It sounded to me that you had stated that your insomnia started after the increased dose of Paxil, and then Xanax was started in order to treat the insomnia (perhaps the MD felt the insomnia was actually due to anxiety). This is why I did not correlate the Xanax as being a cause of insomnia in your case (along with it not being a typical side effect of Xanax -- although it could be a side effect of Xanax withdrawal. )

If the Xanax is being withdrawn too quickly for you, then insomnia could possibly be the result, yet I am a bit perplexed, since didn't you stated the insomnia started before the Xanax was started?

Xanax is FDA approved for treatment of panic disorder and anxiety disorder not for treatment of insomnia.

A sleeping medication such as Lunesta is a good choice when treating sleep pattern disruption (and FDA approved for that purpose)

Xanax is known to cause withdrawal and rebound symptoms when stopped abruptly, even after just a few weeks of therapy.

It seems that this may be what you are suspecting is occurring to you, that you are experiencing insomnia due to a too rapid a taper of the Xanax? It could indeed be that you do require a slower taper.

You should discuss this with your doctor, to determine if a re-start and slower taper of the Xanax would be appropriate in your case.

As far as the insomnia, have you tried any other measures? Did you ever have insomnia before this recent episode? Do you think the insomnia started related to the acute episode of anxiety, and if so, is it possible that this is still the reason for the insomnia?
Customer: replied 9 months ago.

Thank you for your detailed answer. The insomnia started when I took the paxil increase. Never had any problems sleeping before on 10 mg of Paxil, Took it at night religiously. When the dosage increase happened I started the insomnia and that is when my dr. switched taking it to a.m. telling me to take Xanax at night to sleep because he believed the paxil was "activating". Unfortunately, I won't know if I still have insomnia until I get off the Xanax (since it helps me sleep although only for 5-6 hours. I don't believe that I am experiencing insomnia due to rapid taper of Xanax. I only take .125 mg (half of .25) It was given to me to help me sleep because the paxil was activating. What would be the rebound symptoms and common withdrawal symptoms of Xanax and how long could they last? I know everyone is different. Is it possible that when I get off the Xanax my sleep might improve somewhat. I wake up al little restless (thinking I have not had enough sleep) but after I am up I seem to be better. (Tired but ok) Any thoughts would be really appreciated.


I never really experienced insomnia in my life that I can remember. The two things that stick out here are: 1) Paxil to treat anxiety (got insomnia from that first night I took it and 2) dr. switched taking it at night and to take Xanax to treat sleepless nights. If the dr. wants me off the Xanax and is tapering me off to half of .125 for 7 days should the paxil start kicking in? It already has in many ways reducing anxiety that I had so bad right before the increase given. I can fall asleep even without the Xanax but then I wake up and take it because I am suppose to. All a process but compared to where I was 1 month ago I am so much better.


 


Thank you for your support and thoughts.

Expert:  Susan Ivy replied 9 months ago.
Good morning.

Just for background information, somnolence, rather than insomnia is more commonly the adverse effect experienced from Paroxetine (Paxil). The literature shows that 23% experience somnolence vs 13% that experience insomnia.

Adverse effects occurring from Paroxetine are found to be more intense in the 1 to 4 week period after starting (or increasing) it.

Since you are at the 4 week point now (having the increased the dose 1 month ago) you should start to see a decrease in the insomnia now. At least this would be expected, since most side-effects will disappear or lessen with continued treatment, and adverse effects have been found to lessen within 1 to 4 weeks after a dose increase. These are averages that we are speaking of though. For some people, even after a period of time when some tolerance should have occurred, the adverse effect continues. In those cases it may be dose dependent and may not resolve unless the dose is again adjusted down.

As far as 'kicking in', the benefits may take up to 4 to 6 weeks to fully appear, although as you have experienced, improvement can often be noticed even within a few days of starting the medication. (Additionally, although a bit off topic, it is interesting to note that brain imaging studies are showing that SSRI's effect the structure of the brain positively, over a much longer period, by for example boosting neurogenesis in the hippocampus, a process that is disrupted in those with depression and stress related illnesses.)

Since your doctor is tapering you off the Xanax you should not have withdrawal side effects. Unless you are extremely sensitive to it, which again, would not be typical and only rarely reported. Withdrawal side effects of an antianxiety medication like Xanax (which again should only occur with a too rapid taper) could be that of anxiety itself, muscle twitches, headache, loss of appetite. For those that have been on a substantial dose over a long period, abruptly stopping the drug could result in seizure (but that does not apply in your case! Likely none of these withdrawal side effects will occur, and as you continue on the Paxil, you may continue to notice less anxiety, and hopefully, less insomnia. So continue to work closely and follow the direction of your doctor, and communicate frequently.

I don't know what the situation is with your doctors (as far as if you are seeing a general physician for most of your medication management or a psychiatrist) but usually a psychiatrist would have the most expertise in monitoring an individual on these medications and these symptoms (insomnia, anxiety). This is the area for which they are specifically trained and what a great deal of their daily practice consist.

As far as your insomnia, I would be sure to try and get in some vigorous exercise each day (which can be as simple as a long walk, a few short walks, or a bike ride) as this is one of the best treatments for insomnia (and also a very effective treatment for anxiety.) Exercise helps to discharge the very stress hormones and neurotransmitters that create insomnia and anxiety.

I hope some of this is helpful, although I can't tell you specifically what will happen, it is very positive that your anxiety has lessened.

Unfortunately especially medications for anxiety are not predictable in a scientifically proved manner.. There is a range of effects to be expected, yet individual chemistry is such that there can be variations from individual to individual. This type of medicine is an art, and more often than not a psychiatrist would be more proficient at the art of working with these medications, but that is not true in every single case.

I am available throughout the weekend and next week if you have any questions that I can assist with, and I would appreciate hearing how this resolves for you.
Customer: replied 9 months ago.

Thank you so much for the insight and explanation. I understand what you are saying and it makes sense. You have provided more explanation and insight than my own doctors. I have used just answer before for health questions about my pet. This service has been valuable and I have walked away with more of an understanding of the processes involved. For that I thank you. It can be frustrating on this end but with qualified and caring professionals like yourself I am feeling better at the moment. I will update you after I am weaned off the Xanax (next week)). Last dose will be Wednesday night and then I'll see if I can sleep. I will contact the psychiatrist if I still have the insomnia and will be sure to update you and finish our discussion.


 


Thank you,


 


 

Expert:  Susan Ivy replied 9 months ago.
Thank you for your feedback. It is appreciated. I will be interested in hearing how this works out for you, and please do feel free to update or check in at any time with your progress. Susan
Susan Ivy, Nurse (RN)
Category: Health
Satisfied Customers: 4057
Experience: BSN, MSN, CNS
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