Question: My medication is as : amitryn 310, mirtaz 15 and quitipin 100 sr in the evening Stopped morning dose of duolextine 10 and betacap tr 20 about 10 days back For the last few days, I have become little irritated. Sleep still remains an issue. For the past few nights, have not had good night sleep barring last night. I still woke up twice last night but was feeling fresh and, therefore, was feeling energetic at work. I think if I sleep well, I feel better next day and if I don’t sleep well, I drag myself to work and by the evening I feel so tired, slow and fatigued. If sleep improves, I think it will help me to a great extent. Am bit confused, whether the irritation, tiredness is because of withdrawal of duloxetine or otherwise. Since last night I slept better, was wondering if it is because of improvement in the withdrawal symptoms. Confidence is almost there with a very slight hesitation, wondering if that will also improve with time. I am on leave till Sunday, pls help me with your advise on tweaking the present medication to help me with the above symptoms. Regards

Good evening doctor - Didn’t sleep well last night at all. Need your guidance to sort out my sleep problem. Should I reduce amitryn to 300 from 310 , if yes how should I go about it. First make 305 and then 300 or you think I should add quitipin normal 25 or 50?
I keep on lying on the bed in the night with sedation but it takes a long time to fall asleep. The pattern is before falling asleep I get some weird dreams ( don’t remember them at all) and then I scream out of fear. It happened twice last and it has been happening for sometime especially after stopping duloxetine completely. Pls help. Regards

Good afternoon Doctor - can’t thank you enough for the advise to make amitryn 300 from 310. Made that change day before yesterday and surely sleep has improved. The awakenings have reduced and I feel well rested when I wake up in the morning. As of now, my medication is as under:
Amitryn 300, mirtaz 15 and quitipin 150 sr in the night... I have stopped morning dose of duloxetine 10 and betacap tr 20 since two weeks
I look forward to your advise for any other change in the medication. Regards

Good evening doctor - Anxiety wise am much better. I have been getting tremors in the hands and body also feels a little shaky. I had to address a small gathering today and this shaky feeling was bothering me as the thought of losing control on words was crossing my mind frequently. I dont know its because of what! Is it because of stopping duloxetine or reducing amitryn from 310 to 300 or stopping betacap tr 20? If its because of stopping betacap tr 20 or duloxetine, that i did long back and this shaky feeling started recently and i dont know whether their withdrawal can trigger so late? Or you think its a part of anxiety? the recent change i have made is reducing amitryn, wondering if that's causing it? sleep is better, awakenings have reduced. I have to make big speeches tomorrow and day after as two of our XXXXXXX employees are retiring. The thought of feeling shaky or losing control on words because of shakiness is bothering me. What would your advise be to help me with shakiness and ensuring that my speeches go well and my mind becomes calmer with no thoughts of losing control on words or feeling shaky? Regards