Nightmares

[Karri]

I've been researching the occurrence of nightmares with Citalopram and Vistaril use. Both of which seem to have some incidence of nightmares with usage.

My daughter has been receiving both since December of 2011. She is 19 yrs old with first onset of psychosis. She takes Citalopram 30mg daily in the am and Vistaril 25mg 1 cap at 2pm and 2 caps at 8pm. She also takes Risperdal 1mg at 8am, 1.5mg at 2pm and 2mg at 8pm. She is slowly improving and has within the past week begun to question more about her illness, is starting to recognize that the voices and delusions are not real and has much more insight into her illness and thinking.

She mentioned to her doc once about 4 weeks ago about having nightmares. Lately now that she is more aware and insightful she has been more forthcoming about her thoughts and has been talking alot about the nightmares. She states that they are frequent and nightly, they interrupt her sleep and make it difficult for her to stay asleep at night. She seems to sleep much better during the day without the nightmares. This has kind of lead me to believe it may be more related to the Vistaril than to the Citalopram.

Does anyone have any thoughts or experiences with nightmares using either of these medications? Any thoughts would be greatly appreciated. We have a follow up appt coming up soon and I wanted to leave a message with the doctor's nurse as well. I hate to think about changing any of her medications while she is doing so well but at the same time I hate the thought of her continuing to deal with these nightmares if we can reduce them.

 

[David Baxter PhD]

Citalopram (Celexa) is a Selective Serotonin Reuptake Inhibitor (SSRI). All medications in that family are known to produce more vivid dreams (one of my clients described it as dreaming in color instead of black and white) but there's no evidence that they alter the content of the dreams - basically the dreams seem more vivid and thus are more likely to be remembered on awakening. Thus it would not be responsible for increased frequency of nightmares but they may result in more recall of any nightmares your daughter may be experiencing, i.e., she may remember more of her nightmares than previously.

Vistaril is an antihistamine sometimes used as a sedating medication to help with sleep and anxiety. Again, I know of no evidence suggesting that this would increase frequency of nightmares.

Risperdal is one of the newer "atypical" antipsychotics which also involve changes in available serotonin and in turn, like SSRIs may result in more vivid dreams but again don't increase the frequency of any specific type of dream (see above).

It is quite possible that the nightmares are a result of the psychological trauma she has experienced following her psychotic break, with the vividness of the dreams and her recall of those dreams ehnaced somewhat by her medications.

 

[forgetmenot]

I think it would be a good thing for your daughter to be able to talk to her doctor about nightmares Maybe like said she is just recalling part of her illness now that she has more clarity of what is happening With medication and i think therapy your daughters nightmares will become less that is what happen with me anyways I don't know but i think it time her body will become use to the medication and the dreams will also decrease just my thoughts though

 

[Karri]

Thank you both for your input. Your thoughts make much sense. She does see a therapist as well and I will encourage her to discuss this with the therapist. It is still unclear at this time if she did or did not experience some sort of trauma prior to the start of the psychosis. Her therapist has suggested the same based on some of her delusions and paranoia. I had wondered if so then it could perhaps be a source of the nightmares as well. She does not elaborate much on what the dreams entail, just that they are frightening and that she has had them for some time. Hopefully now that she is able to be more open about them and is more cognizant of what is reality based and what is not they may begin to recede. Maybe I am worrying more than necessary at this point in time. Your input is much appreciated.

 

[David Baxter PhD]

I was actually suggesting that the psychotic break itself may have been traumatic for her. For example, the hallucinations occurring in schizophrenia or paranoid states are often quite frightening or terrifying.

 

[forgetmenot]

You are a mother and you will worry hun i understand that. I do know that the nightmares i had were very frightening at first and i do think it was because everything was coming out in therapy also minds way of releasing some of the tension perhaps. The nightmares they don't come now not as much so i do think your daughter will heal with time and the right meds and therapy she will be okay. With you there she will know she has a constant person one that will protect her until she is able to protect herself
She is lucky to have such a caring mother

 

[Karri]

I understand what you mean Dr. Baxter. I try not to overthink her symptoms and place other significance on them. But, in this case I did have worries because many of her delusions and much of her paranoia centered around rape issues. Because of this I worried there was more to it than just within her mind. Eventually her therapist also began to question the significance of this as well. She, the therapist, is trying to work on getting my daughter to open up more about this issue. I try particularly hard not to place too much emphasis on it or question too deeply into this issue for fear I will place thoughts or influence the direction of a delusion in her mind. I try to let her talk to me and not overly question.

Thank you so much Eclipse, I try very hard to be supportive and do the correct things. Now that she is becoming more "aware" for lack of a better word, she has questioned me as to why I went along with things so to speak. I've tried to explain to her that I was not going along or even reinforcing her beliefs just that I was trying to reassure her. I also explained to her that I did not want her to think that we were accusing her of lying or did not believe in her. It is such a difficult situation to deal with when someone is so sure of their thoughts and beliefs yet you know they are false. I certainly did not want to agitate or alienate her in any way. I did what I felt was best in each situation and I am sure at times it seemed as if I were agreeing with her. I continue to learn all the time as she does when dealing with this illness. I feel very fortunate to have found the support services that I have as well as all the many people who are compassionate and so willing to lend a helping hand.

 

[forgetmenot]

I too am glad you found support for YOU in all this because i know how overwhelming dealing with a family member who is ill and not having the skills to help them. You now have support for YOU and your daughter that is good use whatever supports that are out there okay