The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Thanks for this overview.
In Latvia melatonin is over the counter and people sometimes buy it but generally they find it ineffective. Benzos are commonly prescribed although recently the health authorities have started to push back. Still, when someone is hospitalized, the patient is almost always given alprazolam at night. My elderly mother doesn't like benzos and she has to instruct the hospital staff every time to not give any benzos to her. She tells that she has a paradoxical reaction to them that she becomes even more agitated. You would think that by now it would mentioned in her medical records but no, she still has to actively refuse them every time. I think doctors are completely irresponsible in this regard. There was a case of one famous elderly person dying from a fall while normally walking through the city. I am 100% that was due to benzos she was prescribed.
Quetiapine gets prescribed a lot for sleep but in cases when doctors suspect that anxiety or depression is the cause. In the UK it is much more restricted. Quetiapine on prescription indicates rather serious psychiatric problems or strong anxiety that is not resolved by usual antidepressants. Tricyclic antidepresants especially mirtazapine or amitriptyline get often prescribed as sleeping pills too especially when if pain keeps a person awake at night but can also prescribed just for sleep.
Interestingly that melatonin is prescription only in the UK. Most commonly it is prescribed to autistic children. I cannot believe that it works so well for them but carers seem desperate to get the prescription filled. I wonder if a placebo effect by proxy is involved. The UK guidelines are very strict that no medication is effective for autism, so all benzos, antipsychotics, even antidepressants are out of question unless one can prove respective co-morbidity indication.
The way you write suggests to me that what I'm about to say may already be known to you, so mostly throwing out additional context for others-
Patient reported sleep issues are more about subjective experience in most cases (as opposed to objective). This is a big piece of why benzos can be popular while melatonin often isn't, since benzos effectively make you pass out more than they make you sleep but to patients that seems like a good deal.
Paradoxical agitation due to benzo administration in a hospital setting is a known quantity and dare I say it, the norm. However what to do about this becomes a complicated and long running fight. Yes, in some settings getting any sleep at all is the way to go (most classically: helping to abort a manic episode or substance induced insomnia) but more commonly we see nursing staff demanding benzo administration until the medical team or a consulting team gives up and recommends it to make nursing shut up.
Nursing isn't entirely wrong since an agitated patient takes away from others and can be dangerous in a variety of ways, but the literature suggests this is typically a bad idea.
For Quetiapine, Mirtazapine, and TCAs- for these managing the side effects is the primary problem. In the US we don't really use Quetiapine anymore because of concerns of weight gain, even in the setting of psychiatric comorbidity. Mirtazapine still has weight gain concerns but ultimately is better on that front so you see it more often. TCAs are a bit more complicated but probably the most commonly used option in settings where cost is a big factor.
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