Brief Answer:
Please go through the details provided below

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns about lack of sleep and anxiety over the years.

Before I proceed to answer you I feel there is inadequate dose of almost all medications in your case. For example effective dose of nexito is 5-20 mg but for the recurrent cases the dose is 10-20 mg per day. Since you have the disorder over the last 6-7 or more years I feel the dose of nexito needs some correction.

Similarly the dose of mirtaz is 15-60 mg per day and I do not see any value for 7.5 mg specially when there is problem with sleep and ongoing anxiety. At the same time I feel the dose of Mirtaz should not be changed as a single change in medication often causes sufficient improvement. In other words the dose of either nexito or Mirtaz can be changed at a time but should be avoided at the same time.

Now in regard to your questions.
1. Nexito starts working in a period of two weeks and optimum effect develops by 6 weeks. If the response is inadequate with starting dose than it should be increased to higher dose after certain period (say six weeks).
The medication need to be continued on regular basis as long as there is complete symptom relief. Once that is achieved the dose can be tapered to down after course completions (ranges between months and years depending upon the number of episodes and symptom severity).
There is nothing called effect of nexito remains after.

2. As I said above you probably need optimum dosage of medication. I do not see any problem with your current medication other than the suboptimal dosage which needs revision by your treating psychiatrist.

3. Zapiz can be used for sleep for short period or for few weeks but should not continued for longer or indefinite period as far as possible. At the current stage I feel taking the mirtaz slightly earlier from the current timing can help you to some extent.

4. Sleep medicine can be combined with gabapentin although make sure that you avoid driving or working at places where the risk is high (operating machinery).

Lastly Zapiz is psychotropic medication which can not be procured without physical prescription issued after in-person consultation.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards

---

Brief Answer:
Please go through the details provided below

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns about lack of sleep and anxiety over the years.

Before I proceed to answer you I feel there is inadequate dose of almost all medications in your case. For example effective dose of nexito is 5-20 mg but for the recurrent cases the dose is 10-20 mg per day. Since you have the disorder over the last 6-7 or more years I feel the dose of nexito needs some correction.

Similarly the dose of mirtaz is 15-60 mg per day and I do not see any value for 7.5 mg specially when there is problem with sleep and ongoing anxiety. At the same time I feel the dose of Mirtaz should not be changed as a single change in medication often causes sufficient improvement. In other words the dose of either nexito or Mirtaz can be changed at a time but should be avoided at the same time.

Now in regard to your questions.
1. Nexito starts working in a period of two weeks and optimum effect develops by 6 weeks. If the response is inadequate with starting dose than it should be increased to higher dose after certain period (say six weeks).
The medication need to be continued on regular basis as long as there is complete symptom relief. Once that is achieved the dose can be tapered to down after course completions (ranges between months and years depending upon the number of episodes and symptom severity).
There is nothing called effect of nexito remains after.

2. As I said above you probably need optimum dosage of medication. I do not see any problem with your current medication other than the suboptimal dosage which needs revision by your treating psychiatrist.

3. Zapiz can be used for sleep for short period or for few weeks but should not continued for longer or indefinite period as far as possible. At the current stage I feel taking the mirtaz slightly earlier from the current timing can help you to some extent.

4. Sleep medicine can be combined with gabapentin although make sure that you avoid driving or working at places where the risk is high (operating machinery).

Lastly Zapiz is psychotropic medication which can not be procured without physical prescription issued after in-person consultation.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards

---

Brief Answer:
Follow up

Detailed Answer:
Dear XXXXXXX
Thanks for follow up.

First of all before making any change please make sure your treating doctor approves the change in treatment. I understand that I am similarly qualified but I never examined you personally and it is never possible to examine through this mode of communication.

As stated above only one change is required. Either increase the mirtaz or Nexito. In my opinion dose of Nexito need to be increased to 10 mg as 5 mg is too low for a adult person to show effects.

I do not think you need to increase mirtaz at this time. We need to have some time to know how the increased dose of nexito works for you. Depending on the response we can decide further course of action.


Since neuropathy is different issue it need to be tackled in the similar way. In other words continue gabapentin as prescribed by your doctor.

The effect of Nexito remain around 20-35 hours. So taking once a day is enough for most individuals.

I hope this clarifies.
Thanks and regards.

---

Brief Answer:
Follow up

Detailed Answer:
Dear XXXXXXX
Thanks for follow up.

First of all before making any change please make sure your treating doctor approves the change in treatment. I understand that I am similarly qualified but I never examined you personally and it is never possible to examine through this mode of communication.

As stated above only one change is required. Either increase the mirtaz or Nexito. In my opinion dose of Nexito need to be increased to 10 mg as 5 mg is too low for a adult person to show effects.

I do not think you need to increase mirtaz at this time. We need to have some time to know how the increased dose of nexito works for you. Depending on the response we can decide further course of action.


Since neuropathy is different issue it need to be tackled in the similar way. In other words continue gabapentin as prescribed by your doctor.

The effect of Nexito remain around 20-35 hours. So taking once a day is enough for most individuals.

I hope this clarifies.
Thanks and regards.

---