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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for insomnia and depression

Hello Dr. Grief,
I am a 23 year old male 6' tall weighing 175lbs. I currently suffer from Depression, PTSD, Anxiety, and severe Insomnia. Most of my conditions are controlled well by medications. I take 3 x 25mg doxepin for depression and an adjunct for anxiety. I take 15mg Inderal for the physical symptoms of anxiety (sweating, hyperventilation, hand and body tremors). I take 2mg alprazolam as need for panic attacks. I take 30mg temazapam for insomnia. My question is this: My sleep aid has begun to work less effectively, I follow a strict diet, no caffeine don't get in bed except to sleep, exercise vigorously during the day for my job, and have tried many other sleep aids such as zolpidem, zapelon, lunesta, trazadone, intermezzo, and melatonin supplements. I am wondering whether it would be appropriate to raise my temazapam dosage or to switch to another similar class medication (Triazolam comes to mind due to it's short half life, though some studies have suggested there could be some unpleasant side effects. Which, in your medical opinion would be the better route to talk with my doctor about
Wed, 12 Feb 2014
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Sexologist 's  Response
Hello
I think you are developing tolerance to temazepam. I can suggest Ramelteon 8 mg .It has no dependance issue and very specific site of action (supra optic nucleus) Second is Trazadon , these two are my favorite and have no dependance . You may consider increase in dose of doxepine to 150 mg or more to better control the anxiety. Vigorous exercise also is counterproductive to sleep. Please observe other principles of sleep hygiene , available on internet . Relaxation exercise before sleep (progressive muscular relaxation? may some times help.
DR SAATIISH JHUNTRRAA
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