I just recently started taking Paxil, switching from imipramine, to
combat anxiety, panic attacks, with mild depression. My sleeping pattern
was fine on the imipramine but I was fatigued after a long day and would
need 12- 14 hours of sleep to feel rested. My primary care Dr. suggested
the switch to Paxil. I have been having trouble timing the dosage. If I
take it at night, it seems to keep me awake. If I take it in the morning
I feel drowsy mid day.

Is it safe to take melatonin to help me sleep, or any other sleep med?

What suggestions does anyone have regarding the timing of dosage/

Is this something that I should be seeing a Psychiatrist for and not my
internist? (HMO)

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I usually suggest that Paxil be taken as early as possible in the day. If
you have been taking this med. for a short time, the side effect of
daytime drowsiness may disappear after a few weeks. My wife had a very
difficult time with Paxil in the beginning (nausea/drowsiness), but these
effects were transient and subsided over a 2-3 week period. As always,
consult your doctor if you are not feeling well with this medication.

I was wondering why Paxil didn't seem to help my depression but it was
only when I got up to 50mg (the max dosage) that I realized it wasn't
depression but the side-effects of Paxil that was making me want to stay
in bed all day.

I assume you are on a lower dosage.... you might want to try spliting
the dose and taking one in the am and one around lunch or mid-afternoon.

Look up the structures of paroxetine (paxil) and melatonin.  (Do this
first.)  You will see that paroxetine is a molecule that contains a
structure very similar to melatonin; this should be because paroxetine
is aimed at serotonin functions.  (Serotonin and melatonin are very
similar.)  If you will read my theory of sleep at
http://www.naples.net/~nfn03605 on the web, you will have a theory of
why melatonin is so important to the function of our lives.  

Paroxetine is evidently attaching to the same receptors that melaonin
uses to produce sleep.  This is why paxil can inhibit sleep.  You need
extra sleep time so that melatonin can eventually reach its receptors
and procede with its function.  My work suggests melatonin and DHEA
function in a cycle.  Taking paxil during the day disrupts this cycle;
if one has insufficient DHEA, one will be tired during the day.

James Howard

Paxil is fairly sedating, but a dosage variation may help overcome
this problem. At 20 and then 30 mg it was controlling my depressed
mood pretty well, but with SAD on top of the depression I was
suffering from a major sleep disorder - or rather a day-length
disorder. 40 mg brought me back onto 24 hour days but I still stay up
at night and sleep in the morning: at least it's a regular disorder
now!

I've played with different times of day and split doses etc. and it
doesn't seem to make much difference TO ME; I've settled for 20 mg am
and 20 pm, but try this for yourself, as you can see it affects some
people different from others.

I'd advise avoiding melatonin, it's one of the chemicals involved in
the serotonin cycle, some find it increases depression and you may
find yourself taking two chemicals whose effects cancel out.

A psychiatrist or psychopharmacologist should be sufficiently
experienced to have some worthwhile suggestions.

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"The opinions expressed herein are my own and not those of my employer
even though I am self employed."