Brief Answer: Could be a depressive episode Detailed Answer: Hello, Thanks for choosing health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. You have mentioned that you have: 1) Depressed Mood 2) Stressed feeling 3) Sleep disturbance 4) Day time somnolence Although with this information its difficult to pin point but its is likely that you could be having depression. Depression mostly starts with a sad mood, with reduced energy, reduced pleasure, reduced interest, hopelessness, worthlessness, reduced appetite, reduced sexual drive and reduced sleep with pessimistic thoughts. But many times the full blown symptoms may not appear and only some of them may be there. Coming to the treatment its advisable to first initiate the non-medical therapies first before starting the medical management. Interpersonal therapies and cognitive behavioural therapy are both useful. If they dont respond then escitalopram and mirtazapine are good option and safe as well. 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. Psychiatrist and sexologist

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Brief Answer: Its a two way problem Detailed Answer: Hello Its a reciprocal two way problem. If you are depressed you cannot sleep and if you XXXXXXX not sleep you feel further stressed and depression. In case if you feel that sleep alone can help you in delaling with the problem then you can follow the below mentioned steps: 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. Still if the sleep doesnt improve then your local doctor can help you with some sleeping pills like zolpidem 5mg or alprazolam 0.5 mg at noght as required. Hope that helps 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. Psychiatrist and sexologist

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Brief Answer: You require a change in medications Detailed Answer: Hello Thanks for the followup. I understand that you are already on two good drugs. But if you are not responding then it would be wise to change the medications. The other good options are escitalopram or paroxetine or olanzapine or risperidone etc. Also along with theee medicines you will require some supportive psychotherapy and ventilation by a good psychologist. Also there is a possibility that you might have developed traumatic stress disorder and in that case you can ask your psychiatrist for a therapy called EMDR which is very useful. Hope that helps Regards Dr. Srikanth Reddy

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