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On treatment for anxiety and chronic insomnia, Medicines do not seem to be effective. Help?

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Psychiatrist
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I have been treated for anxiety and corresponding chronic insomnia for the past ten years. I've tried every medicine out there and they are not working....like tonight. I need to change so I can sleep!!!For example: 90 minutes ago I took 40 mg of Restoril, 1mg of Halcion, and 4 mg of Xanax. I'm still wide awake. My main issue is my brain never stops.
Posted Sat, 25 May 2013 in Mental Health
 
 
Answered by Dr. Srikanth Reddy 34 minutes later
Hello,
Thanks for choosing health care magic for posting your query.
I understand that you have been treated extensively with medications for your panic disorder and sleep disturbances.
However from the list of medications that you have given, all the three of them are benzodiazepines (BZD). Although BZD are good drugs for anxiety disorders, but there effect is more or less superficial. You need to treat the core symptoms of anxiety disorder. The two treatments which will be useful for you are:
1) Medications: Escitalopram/ paroxetine/venlafaxine/sertraline/mirtazapine
2) Talk therapy: Cognitive behavioural therapy. You should undergo atleast 5-6 weekly sessions of the CBT.
Further you should be investigated for your thyroid profile.
Good diet and exercise will go a long way in helping you with the mentioned conditions.
Regarding sleep, try maintaining a good sleep hygiene:
1) Stop all caffeine until the problem gets solved.
2) Start regular morning exercise.
3) Take a warm water bath before going to sleep.
4) Keep the sleeping and waking hours regular.
5) You the sleep area exclusively for sleeping and not for any other prupose.
6) Keep the lighting dim and cozy.
7) Don't try very hard to sleep. IN case if you are not getting sleep, you should sit up and do some reading and go to bed only if you are sleepy again.

Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you can close the discussion and rate the answer accordingly.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy

Wish you good health,
Dr. Srikanth Reddy M.D.
Above answer was peer-reviewed by
 
Follow-up: On treatment for anxiety and chronic insomnia, Medicines do not seem to be effective. Help? 59 minutes later
I have been through two years of CBT w/ no improvement. I have also participated in an overnight sleep study which showed unusually high brain activity, even while sedated. My problem is I can't find a medication that can shut my brain off at night so I can sleep, resulting in an average of 3-5 hours a night at best, which brings on the anxiety and depression because I can't function at my job. I'm a high level exec at a major bank with a 60-70 hr work week. What can put me to sleep? That is the root cause.
I have also practiced good sleep hygiene for the past 10 years with no luck unfortunately. Help!!
 
 
Answered by Dr. Srikanth Reddy 4 minutes later
Hello again,
its unfortunate that you couldn't get improvement with even 2 years of CBT. One thing you may try is change the therapist and re-try the CBT. I understand that your sleep disturbance is the major problem, but its your anxiety/depression which is not letting you sleep. That needs to be corrected first.
Please discuss the medications that I have suggested in my previous mail as only the use of BZD will not do much good.
Secondly get a thyroid profile done and follow all the steps mentioned in sleep hygiene.
Do some exercise, that will help a lot.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you can close the discussion and rate the answer accordingly.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy

Wish you good health,
Dr. Srikanth Reddy M.D.
Above answer was peer-reviewed by
 
Follow-up: On treatment for anxiety and chronic insomnia, Medicines do not seem to be effective. Help? 3 minutes later
Which medication would you prescribe? I've tried all but the mirtazipine over the years.
 
 
Answered by Dr. Srikanth Reddy 21 minutes later
Hello,
Mirtazapine is a good antidepressant and antianxiety drug which also causes sedation and is hypnotic. for certain patients even a low dose of 7.5mg is highly sedative, while for some it has to be given at 15-30 mg. I gess your treating psychiatrist would like to start you low.
Agomelatonin, a new antianxiety and antidepressant is also an effective drug acting on melatonin receptors and getting sleep.
Do discuss these issues with your psychiatrist who can start you on these drugs.
Thanks and regards,
Dr. Srikanth Reddy
Above answer was peer-reviewed by
 
Follow-up: On treatment for anxiety and chronic insomnia, Medicines do not seem to be effective. Help? 3 minutes later
I thought the point of this website was to get a diagnoses and have medications prescribed. I travel daily and recently moved and losty primary Dr.
 
 
Answered by Dr. Srikanth Reddy 9 minutes later
Hello,
Sorry for the inconvenience,
As far as the terms are concerned for the ask a doctor query, the website rules permit us to guide and give advice to the patient and strictly prohibit us from providing a prescription cause of legal issues.
You are residing in the US and you will need a prescription of a US board certified doctor for getting the medications.
My prescription will not help you in getting the medications from US.
I would request you to contact the customer care of health care magic for the same.
Do let me know if I can be of any further help to you.
Thanks and regards,
Dr. Srikanth Reddy MD
Psychiatrist
Above answer was peer-reviewed by
 
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