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Archived Questions
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Violent Dreams
An elderly patient of mine complains of having violent dreams and that they are bothering him. He has no hallucinations. We discussed his alcohol intake; he admits to three drinks/day but will cut down to one. Lexepro has not helped.
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Thank you for your question.
I agree with you that alcohol may be the most likely etiology. Falling levels of ETOH during the night often produce rebound anxiety, restlessness, tachycardia, and a range of sleep disturbances. If your patient admits to consuming three drinks daily, he may actually be taking more, and even three would be substantial for an elderly individual and enough to produce nightmares. I am not surprised that Lexapro did not help, since SSRI antidepressants themselves are frequently reported to produce vivid frightening dreams. I suggest temporarily using low-dose Klonopin (i.e., o.25 or 0.5 mg.) at HS to avoid mild alcohol withdrawal phenomena and cover drops in ETOH level, provided you trust that your patient is actually cutting down to one drink per day. Klonopin has a five- or six-hour duration of effect and should last for most of the night. I would avoid Lexapro for now.
If none of the above helps, your patient may have a primary sleep disorder in some fashion related to cerebrovascular disease, in which case a neurological or sleep lab workup would be indicated. I assume that there has not been any obvious frightening or traumatic recent event that could contribute to the picture, but if so, a psychotherapeutic approach would be preferred.
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