Week 3 on Prozac...And now I can't sleep!?! What to do?

[stephconn]

I have to say that I feel much improved on Prozac, however I am not sleeping! I go to bed around 10, wake up around 12, try to go back to sleep until about 3:30, and them doze off until I get up at 5 to go to work. That does not make for a very restful night! I have been taking my meds around noon everyday. Should I change the time of day that I take them? Any advise out there? Does this eventually go away?

[insights]

I have to say that I feel much improved on Prozac, however I am not sleeping!

Prozac has such a long half-life, nearly 10 days, that it takes quite a while for plasma levels to reach a steady-state. Up to 5 weeks. During that time fluctuating plasma levels can have odd effects, including insomnia if you take it just before going to sleep. But given you're taking it at noon this probably isn't what is causing your insomnia.

A more likely explanation is that insomnia is just a frequent side effect of SSRIs. So much so that many doctors routinely prescribe a small dose of the highly sedating antidepressant trazodone (Desyrel) together with SSRIs. Trazodone is actually a pretty good antidepressant in its own right which, apart from sedation, usually has few side-effects. However, these days it is almost exclusively prescribed as a sleeping aid. It may also counter SSRI induced sexual dysfunction. At the low doses typically prescribed for insomnia trazodone has almost no effect on serotonin reuptake, so it won't affect the actions of Prozac.

Ian