next to groggyness, is there an additional reason to take SSRI's in the evening?
next to groggyness, is there an additional reason to take SSRI's in the evening?
I’ve noticed that I actually sleep better taking them in the morning and don’t feel that groggy at all. Is there a valueable effect that I’m missing from taking them in the mornings instead of in the evenings?
This is really a question for your doctor.
I'll echo that this is really something to talk in depth with, with your provider.
That being said, I can relay what I've been told by providers along with the anecdotal.
Any antidepressant is going to need to "build up" in your system to keep you feeling better. But any pill is going to have a cycle through the day. You take it, and it needs time to get that pill taken up from your digestive tract. Towards the end of your dosage, the levels will dip slightly.
If you take it when you wake up, you're having that uptake process happen while you're trying to get going in the morning. If you take it before bed, by the time you wake up, the dosage is going to be stable. That stability will last through most people's normal day, when they need the effects the most. Your two times when the support of the medication are the weakest will be when you (theoretically) have the least external stressors, which is while sleeping.
Secondarily, bedtime rituals are easier to remember because there's no need to rush around getting ready for the day, leading to better compliance with stable dosage. You fall into the habit of bedtime, and there's less to interrupt that patterm.
Now, my personal experience is that taking the pills before bed is better because the affect on dreams is better. SSRIs are notorious for causing dream changes. I'm already hyperphanstastic (extra vivid dreams and mental imagery). If I take my dose in the morning, then I'm at the low point of the dose when sleeping, which tends to cause less pleasant dreams. Since the kind of dreams I have when I'm not on an antidepressant tend to be the sort you don't want, there's no way in hell I'm doing a morning dose as the norm. You really, really don't want the kind of nightmares I have with the hyper vividness I dream in.
Obviously, that's not going to be the case for everyone, but it is true that most people will have less dream disturbances if the take their dose before bed rather than in the morning. It's that gradual uptake minimizing the effects of the meds on dreams, and avoiding the disturbances that can be caused when a dose is falling off.
There's other little things as well, though they tend to be individual. An example of that is pain relief. If that's one of the effects you take them for, the pain reduction of a fresh dose is typically more useful while sleeping, and during the early part of your day.
I was always told to specifically take them in the morning because they give you energy. I've been on quite a few different ones and none of them have made me drowsy. If anything I might get a very slight bit of the opposite effect in that they keep me awake but even then it's barely noticable.
Should you really be asking this here?
I started taking mine in the morning because the boost they give your brain can make your dreams unusually intense, resulting in less sleep or worse quality.
I've only ever really taken them in the morning, I typically risk forgetting to take them in the evenings causing a headache for myself the next day. Beyond that I assumed most people took them in the morning.
Certain meds can make you drowsy and others can make you groggy but restless, the former are better before bed, the latter are better had in the morning.
What changes if you do not take the SSRI at all for a week or so?
So you normally can be ok for a day or so, might be a little bit more sensitive, some people get panic attacks/heightened anxiety, some get a feeling of emptyness or depression. It really varies on the individual, where they are and what's going on in their life.
There were days were I'd have a meltdown if I missed a day. By comparison; one day about a month or two after having stopped smoking tobacco due to having COVID, I felt like I didn't need it and just stopped with basically no negatives, though I was also in a good place in terms of my life which likely helped.
Personally if people are curious about SSRIs, I'd suggest they look into Vortioxetine, it's technically not an SSRI, which means it has much fewer side effects, but still does the same job as them, just with less foggy cognition/groggyness
If you quit SSRIs cold turkey then you're going to wind up with discontinuation syndrome (aka withdrawls). This is going to vary depending on the person so I am just speaking from personal experience. Typically this will mean your depression or anxiety comming back with a vengance. In my cas it hit way harder than it normally does when I'm just at my baseline unmedicated. I also got extremely agitated over the most minor things. Plus you've got all of the physical symptoms such as tremors, nausea, and bouts of cold sweats. Then you have the one withdrawl symptom that is unique to meds like SSRIs which is brain zaps (aka brain shivers, brain flips brain shocks). Brain zaps are really hard to describe. The best equivalent that I can think of is when you get your reflexes checked and you feel that reflexive muscle twitch; it's basically that feeling except it feels like its comming from right in the middle of your brain and it happens about once per minute for the entire duration of the withdrawls (1-2 weeks). It's not something that is painful but it is annoying, constant, and highly distracting. Basically every time one hit I would lose my entire train of thought which made it impossible to focus on even the most basic things. From what I understand noone knows what actually causes the brain zap sensation but one of the leading theories right now is that they're basically just micro seizures.
This can literally kill people.
SSRI Discontinuation Syndrome is a massive problem that can lead to severe lasting neurological and psychiatric effects. Starting from Tics, motion deficits, sexual dysfunctions to severe and life threatening mental health episodes (extreme episodes of depression and suicidal thoughts, mania, etc.)
Furthermore sudden intake of the old dose can elevate the risk for the acute life-threatening SSRI syndrome.
Guys and Gals, seriously:
Don't fuck around with SSRIs.
They are absolutely dangerous stuff and messing around with them without experience and training can absolutely ruin the rest of your life.
Specifically, I do take my meds in the evening for this reason. No need for melatonin when the strattera brings the sleepy vibes.
My other reason is, since I'm doing IF, I don't want to take them on an empty stomach.
Those are just my reasons. Not sure if they help, just thought I'd contribute
My psych actually suggested I take my atomoxetine (for adhd) in the morning. I take the rest of them (to keep darkness at bay) at night.
Meds affect people differently. I tend to have paradoxical reactions to meds. Have learned to trust my instincts. I mention cuz it's good you're asking questions, educating yourself. Just keep in mind, figuring out what works for you may not match up with other people's experiences.
Paradoxical reactions to SSRIs are quite common and simply mean that the required levels are not yet reached - either by too low of a dose or by (much more common) not taking them long enough. SSRIs take 14-21d of taking the right dosage to properly work.
And please: Do not fiddle around with SSRI dosages and administration: This can absolutely kill or fuck someone up permanently.
Lot of what you said is true. Good advice many people should follow.
Just, paradoxical reactions are a bit more complex, took me decades to figure out. Nyquil has me curled in a ball, twitching, spasming uncontrollably. Nodoze sent me into a violent rage, up all night. Lot of meds, make most sleepy, but me, rush of energy, awake all night. Antipsychotics meant to calm me, instead out of control anger. Benadryl means eyes wide, pulse racing.
It had nothing to do with dosage, plasma levels, titration. There are just some people bizarrely hypersensitive to meds, who have the bizarre 1% side effects the other 99% doesn't get.
But for that 99%, everything you said is true, again good advice and info.
Depression I guess ...