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Suggest An Alternative To Lexapro And Inderal For Treatment Of Anxiety
Question: I am currently on lexapro 30 mgs, inderal 40 to 120 mgs for anxiety and trazodone 75 mgs for insomnia. My anxiety is still off the charts and I still am only sleeping 4 hours a night. Have you suggest any other drug combination that will lessen my anxiety and let me sleep more than 4 hours a night. My depression is managed well on 30 mgs of lexapro perhaps too well as I have no motivation what so ever.
Brief Answer:
Mirtazapine, Paroxetine and Quetiapine are options
Detailed Answer:
Hi, thanks for your query. Welcome to HCM.
I have read your concerns and shall answer accordingly.
So, you have problems with your sleep and your GP is not prescribing your sleeping pills because of your past suicidal behaviour.
Here, I also in favor not to give you sleeping pills instead you should try psychotropic drugs that produce sedation as a side effect.
Antidepressants that causes sedation are Mirtazapine and Paroxetine. Both of them should be taken at night only. Mirtazapine can be started at low dose but 15 mg would be sufficient. Paroxetine is similar drug to lexapro but it causes significant sedation so it would rather fit you best. Discuss all these suggestions with you doctor for improving your sleep.
Antipsychotic drug with minimal side effects at low dose is quetiapine. I am using it frequently in my patient because I don't want them to become dependent on sleeping pills. 50 mg of quetiapine at night produces enough sedation and patient has good sleep at night for at least 6 hours.
Here, Combining Paroxetine, Mirtazapine and quetiapine will resolve your problems. These drugs together will take care of your depression as well as sleep problems. In addition all the drugs are to be taken at night so it will be convenient for you to take them.
Apart from this, you need to learn and read about sleep hygiene. Sleep hygiene is very important in any type of insomnia. You can search and read it from the internet.
Hope I have answered your query. If you have further question then feel free to ask. Wish you good health.
Mirtazapine, Paroxetine and Quetiapine are options
Detailed Answer:
Hi, thanks for your query. Welcome to HCM.
I have read your concerns and shall answer accordingly.
So, you have problems with your sleep and your GP is not prescribing your sleeping pills because of your past suicidal behaviour.
Here, I also in favor not to give you sleeping pills instead you should try psychotropic drugs that produce sedation as a side effect.
Antidepressants that causes sedation are Mirtazapine and Paroxetine. Both of them should be taken at night only. Mirtazapine can be started at low dose but 15 mg would be sufficient. Paroxetine is similar drug to lexapro but it causes significant sedation so it would rather fit you best. Discuss all these suggestions with you doctor for improving your sleep.
Antipsychotic drug with minimal side effects at low dose is quetiapine. I am using it frequently in my patient because I don't want them to become dependent on sleeping pills. 50 mg of quetiapine at night produces enough sedation and patient has good sleep at night for at least 6 hours.
Here, Combining Paroxetine, Mirtazapine and quetiapine will resolve your problems. These drugs together will take care of your depression as well as sleep problems. In addition all the drugs are to be taken at night so it will be convenient for you to take them.
Apart from this, you need to learn and read about sleep hygiene. Sleep hygiene is very important in any type of insomnia. You can search and read it from the internet.
Hope I have answered your query. If you have further question then feel free to ask. Wish you good health.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you for replying Dr XXXXXXX
I hope I'm not annoying you asking the same question again !!
What is your opinion on trazodone ? Should I continue another week or accept that it isn't the drug for me ? Also why is inderal not recommended for taking at night, I thought it would aid sleep as it lowers pulse rate and BP ? And also I was once prescribed propanolol 40 mgs at night while on holiday due to my usual insomnia.
Thank you in advance XXXXXXX
I hope I'm not annoying you asking the same question again !!
What is your opinion on trazodone ? Should I continue another week or accept that it isn't the drug for me ? Also why is inderal not recommended for taking at night, I thought it would aid sleep as it lowers pulse rate and BP ? And also I was once prescribed propanolol 40 mgs at night while on holiday due to my usual insomnia.
Thank you in advance XXXXXXX
Brief Answer:
Drug response differs from patient to patient
Detailed Answer:
hi, Thanks for writing again.
The reason behind giving you trazodone is to make you sleep. It has worked for first two day and then it doesn't, so for sleep it will not benefit you but for depression and anxiety it will help lexapro. So for depression you can continue that with advice from your doctor. You can give it a try for a week or so.
Usually we do not give propranolol in the night. It usually in the morning and in the evening. Some patient start developing insomnia with it. It is the side effect of the drug but when a person has significant anxiety that is interfering with sleep then one can take it at night and ultimately it can help with sleep. Prescribing the drug is a skill and it depends upon the patient's symptoms profile. Same drug can not be used in all patients. Patient who are having some different symptoms may benefit from other drugs.
Hope I have answered your query. if you do not have further question then close the discussion and rate the answer. Wish you good health.
Drug response differs from patient to patient
Detailed Answer:
hi, Thanks for writing again.
The reason behind giving you trazodone is to make you sleep. It has worked for first two day and then it doesn't, so for sleep it will not benefit you but for depression and anxiety it will help lexapro. So for depression you can continue that with advice from your doctor. You can give it a try for a week or so.
Usually we do not give propranolol in the night. It usually in the morning and in the evening. Some patient start developing insomnia with it. It is the side effect of the drug but when a person has significant anxiety that is interfering with sleep then one can take it at night and ultimately it can help with sleep. Prescribing the drug is a skill and it depends upon the patient's symptoms profile. Same drug can not be used in all patients. Patient who are having some different symptoms may benefit from other drugs.
Hope I have answered your query. if you do not have further question then close the discussion and rate the answer. Wish you good health.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you Doctor XXXXXXX
Just to recap, as I am going to visit my GP tomorrow,
I will ask him to prescribe paroxetine ( at what dose please ) mirtazepine 15 mgs and quetiapine 50 mgs, and I can stop taking lexapro and trazodone ?
My GP is very unfamiliar with psych treatments !!
Thanking you XXXXXXX
Just to recap, as I am going to visit my GP tomorrow,
I will ask him to prescribe paroxetine ( at what dose please ) mirtazepine 15 mgs and quetiapine 50 mgs, and I can stop taking lexapro and trazodone ?
My GP is very unfamiliar with psych treatments !!
Thanking you XXXXXXX
Brief Answer:
That is the best you can do
Detailed Answer:
Hi, thanks for appreciation and considering my advice.
Yeah, keep ot in mind that the drugs can't be stopped suddenly, they need to taper gradually over period of time. Your GP will guide you if he will consider this as beneficial to you.
Take care. Wish you good health.
That is the best you can do
Detailed Answer:
Hi, thanks for appreciation and considering my advice.
Yeah, keep ot in mind that the drugs can't be stopped suddenly, they need to taper gradually over period of time. Your GP will guide you if he will consider this as beneficial to you.
Take care. Wish you good health.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hello again,
I went to my GP and I have now got Quetiapine XL 50 mgs, paroxetine 20 mgs,
and trazodone 150 mgs,
My question is should I have got quetiapine immediate release or slow release for my insomnia,
I didn't realise he gave me slow release, this could have been just a mistake or maybe he meant me to have slow release but I am wondering would immediate release have been more appropriate as I am taking it for severe insomnia. My GP was quite happy to prescribe this combination of drugs for me, so thank you.
Awaiting your reply
I went to my GP and I have now got Quetiapine XL 50 mgs, paroxetine 20 mgs,
and trazodone 150 mgs,
My question is should I have got quetiapine immediate release or slow release for my insomnia,
I didn't realise he gave me slow release, this could have been just a mistake or maybe he meant me to have slow release but I am wondering would immediate release have been more appropriate as I am taking it for severe insomnia. My GP was quite happy to prescribe this combination of drugs for me, so thank you.
Awaiting your reply
Brief Answer:
Yeah, immediate release would be better
Detailed Answer:
Hi, thanks for writing again.
It is good that you got what I suggested.
Quetiapine immediate release , we usually prescribe for insomnia. It is better to take immediate release, but if you alreadt bought it then give sustained release a try. If it causes some sedation even during the day then you should go for immediate release.
Half life of quetiapine is 15 to 14 hours. So sustained release, after 5 days will reach a steady plasma level. So if it s only for insomnia better to take immediate release. At 50 mg dose you wont face any of thw side effects.
Hope you don't arrythmia of heart rhythm. It causes problem with heartbeat sometimes bit not at this dose.
Hope i have answered your query. If you do not have further question then close the discussion and rate the answer.
Wish you good health.
Yeah, immediate release would be better
Detailed Answer:
Hi, thanks for writing again.
It is good that you got what I suggested.
Quetiapine immediate release , we usually prescribe for insomnia. It is better to take immediate release, but if you alreadt bought it then give sustained release a try. If it causes some sedation even during the day then you should go for immediate release.
Half life of quetiapine is 15 to 14 hours. So sustained release, after 5 days will reach a steady plasma level. So if it s only for insomnia better to take immediate release. At 50 mg dose you wont face any of thw side effects.
Hope you don't arrythmia of heart rhythm. It causes problem with heartbeat sometimes bit not at this dose.
Hope i have answered your query. If you do not have further question then close the discussion and rate the answer.
Wish you good health.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hello again,
Went back to my GP who gave me a script for quetiapine IR 50 mgs ,
Filled script out at the chemist and only opened the bag when I got home to find the chemist has given me olanzapine 2.5 mgs x 2 instead, is this the same drug or will I go back to chemist and ask for quetiapine. I looked it up on the net and as far as I can determine it is a completely different drug and not the exact same drug just with a different name. Please advise me what to do.Any thoughts on the olanzapine 5 mgs vs quetiapine 50 mgs for insomnia
Which is more effective for insomnia
Thank you XXXXXXX
Went back to my GP who gave me a script for quetiapine IR 50 mgs ,
Filled script out at the chemist and only opened the bag when I got home to find the chemist has given me olanzapine 2.5 mgs x 2 instead, is this the same drug or will I go back to chemist and ask for quetiapine. I looked it up on the net and as far as I can determine it is a completely different drug and not the exact same drug just with a different name. Please advise me what to do.Any thoughts on the olanzapine 5 mgs vs quetiapine 50 mgs for insomnia
Which is more effective for insomnia
Thank you XXXXXXX
Brief Answer:
Hi, Go for quetiapine 50 mg IR
Detailed Answer:
Hi, thanks for writing again.
Quetiapine is more effective at this dose. I will advise you to go for 50 mg IR preparation of Quetiapine.
Though, Olanzapine is equally effective but it has more side effects at this dose of 5 mg. It causes weight gain and increases the risk for cardiovascular and cerebrovascular accidents. You are approaching the elderly age and if you continue olanzapine for long you might have so many problems. At least obesity is itself a risk factor for chronic medical illness in old age.
I insist you to go for quetiapine only. Else you can discuss with your GP.
Hope I have answered your query. If you do not have further query then close the discussion and rate the answer.
Wish you good health.
Hi, Go for quetiapine 50 mg IR
Detailed Answer:
Hi, thanks for writing again.
Quetiapine is more effective at this dose. I will advise you to go for 50 mg IR preparation of Quetiapine.
Though, Olanzapine is equally effective but it has more side effects at this dose of 5 mg. It causes weight gain and increases the risk for cardiovascular and cerebrovascular accidents. You are approaching the elderly age and if you continue olanzapine for long you might have so many problems. At least obesity is itself a risk factor for chronic medical illness in old age.
I insist you to go for quetiapine only. Else you can discuss with your GP.
Hope I have answered your query. If you do not have further query then close the discussion and rate the answer.
Wish you good health.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
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