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Suggest treatment for insomnia along with bi-polar disorder

DOCTOR OF THE MONTH - Dec 2014
Dec 2014
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Answered by

Psychiatrist
Practicing since : 2007
Answered : 4836 Questions
Question
SIR I HAVE BEEN SUFFERING RADHER MORE BY INSOMNIA THAN BIPOLAR DISORDER SINCE1998.I HAVE BEEN TREATED BY PSYCHITRIST.
MY DOSE WAS 1 -2MG CLONAZEPAM+75MG PROTHEDIN UPTO2005 2.2MG CLONAZEPAM+ 15 MG MIRTAZE THAN 30MG MIRTAGE UPTO2010. 3. 2MG CLONAZEPAM EITHER WITH NITROZEPAM OR REMITEX OR VALLIUM WITH LITHIUM. LITHIUM BADLY AFFECTED MY S.CEATINE AND THYROID PROFILE SO I HAD TO STOP IT. 4.2MG CLONAZEPAM WITH REMITEX OR DIAZEPAM OR NITROZEPAM WITH 200MG QUETIAPIN SR WITH 600MG GABAPIN SR. UPTO 2014. 5.2MG CLONAZEPAM WITH REMITEX OR VALLIUM WITH 400 MG QUTIAPIN PLAIN WHICH CONTINUED. BECAUSE OF B12 DEFFICIENCY GABANEURON 600MG WAS GIVEN WITH 400MG QUTIAPIN+ 2MG CLONAZEPAM+REMITEX. HOWEVER I PREFFERRED B12 INJECTION(10) AND STOPPED GABANEURON 600MG.AS A RESUILT I HAVE TO TAKE CLONAZEPAM 3.5MG FOR MY SLEEP DIS ORDER WITH 400MG QUTIAPIN PLAI + REMITEX. SIR I M ALSO PLANNING TO TAKE 30 MG DIAZEPAM+400MG QUTIAPIN PLAIN .SIR PLEASE GUIDE ME TO REDUCE CLONAZEPAM OR SWTCH OVER TO 30MG DIAZEPAM +400mg qutiapin plain. PLEASE HELP ME
Tue, 17 Apr 2018 in Mental Health
 
 
Answered by Dr. Seikhoo Bishnoi 3 hours later
Brief Answer:
Dose equivalence of 0.5 mg of Clonazepam is 10 mg Diazepam

Detailed Answer:
Hello thanks for asking from HCM

I can understand your problem. If we consider the medicines you have taken so far then you took a number of benzodiazepines or sleep medicines, antidepressants, mood stabilisers and also antipsychotics for sleep and mood stabilisation.

Your current medicines are 3.5 mg of Clonazepam, 400 mg Quetiapine and Ramelteon. You want to shift to Diazepam which is also a benzodiazepine drug like Clonazepam.

If we consider equivalent dose of Diazepam to Clonazepam then 5 mg of Diazepam is roughly equal to 0.25 mg of Clonazepam. You are on 3.5 mg so this is equal to 70 mg of Valium roughly. This is a high dose for Diazepam and you should talk with your doctor before starting this dose.

Cross tapering over 4-6 weeks can help you to shift you to Valium from Clonazepam. Reduce the dose of Clonazepam by 0.5 mg every week and increase the dose of Valium by 10 mg per week. This will help in smooth transition. Talk with your doctor for that. If you get good sleep with 30 mg Diazepam then that is a good progression.

Thanks
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for insomnia along with bi-polar disorder 41 minutes later
Sir then what should I do?should I cont.3.5mg clonanazepam with remote and 400mg quetiapin plain? What are the side effects? Should I take 2mg clonazepam with 15 mg diazepam and 400mg quetiapin plain? Please guide me.
 
 
Answered by Dr. Seikhoo Bishnoi 1 hour later
Brief Answer:
Better to take one benzodiazepine at one time

Detailed Answer:
Hello again

Taking two benzodiazepines at one time regularly would only add to side effects and more risk of dependence. So this should be avoided. If you are doing good with 3.5 MG Clonazepam then better to continue with this dose only.

Clonazepam is a habit forming drug so if possible try to reduce its doses gradually otherwise this could harm your brain. You can continue to take 400 MG Quetiapine as advised.

Thanks
Above answer was peer-reviewed by
 
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