Brief Answer:
clarifications

Detailed Answer:
Hello,

Thanks for using health care magic for posting your query.

I have gone through your question in detail and I can understand what you are going through.

However I would require a couple of more details to help you in answering your query in a better justified way.

1. Do you have any symptoms of mania like big talks, elated mood, excess spending, irritability, overdressing or decoration, big plans or identity any time during your life?
2. What therapies have you tried until now?

Hope to hear from you at your earliest convenience.

Regards and wish you good health,



Dr. Srikanth Reddy MD

Neuro-Psychiatrist and Sexologist

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Brief Answer:
Sleep issues

Detailed Answer:
Hello
Thanks for all the information.
Now that there is no symptoms suggestive of mania during your lifetime, it's difficult to call your long standing depression as bipolar mood disorder as the clinical criteria requires an episode of mania to be there to be called as BMD.

However, even if it is a BMD, lamotrigine will help in improving your depression and there after sleep but not the sleep directly.

First of all you, need to follow good sleep hygiene:

1) Have some aerobic workouts during day preferably in the morning.
2) Have a light dinner.
3) Completely avoid coffee/tea/alcohol/energy drinks/coke/smoking.
4) Have a warm water bath before going to sleep.
5) Dont try very hard to go to sleep. If you are not sleepy then sit on a couch or sofa and do some reading and go to the bed only when you are sleepy.
6) Avoid watching tv or working on laptop/computer or bright screens at night.
7) Keep the lighting of your bedroom dim and make your bed every morning after you wake up so that you get a cozy bed to sleep at night.
8) Use your bedroom only for sleeping and resting and do not do any other work there.
9) Avoid afternoon nap for any reason.

If eszopiclone and xanax is not giving you sleep then you should try for other options like low dose quetiapine 25 mg or zolpidem. The former option is very helpful among my patients and i routinely use it to get them withdraw from the sleep medications.

Regarding your resistant depression, following options can be tried
1) Lithium augmentation
2) Thyroid augmentation
3) Divalproex augmentation
4) Combining medicines with cognitive behavioural therapy.
This therapy is taken by either a psychologist or a psychiatrist in which the therapist identifies impaired cognitions (Thoughts) and try to correct them. They are 15-20 min weekly session and there should be around 8-10 sessions to help you with your illness.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
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,
Kind regards
Dr. Srikanth Reddy M.D.

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