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Suggest Alternative Medication For Poor Sleep, Anxiety And Depression

Posted on Mon, 14 Sep 2015

Question: I am having trouble working with my doctor to find a combination of drugs that will help all my mental health issues. It seems like we need to treat 3 out of 4 and deal with any one of them untreated. I am 25, 165lbs, 5'11" and have a long history (since 14 or so) of depression and anxiety. The anxiety is most troublesome in social situations and currently it feels untreated. I am currently on 70mg of Vyvanse, once to twice daily for ADHD but also receive some amount of benefit towards depression, and 2mg of risperidone tablets once daily for axiety and sleep. The risperidone is a recent change from 50mg Seroquel which also helped me with chronic insomnia that is not exacerbated by the vyvanse. I have tried not taking the vyvanse for a while to see if that helps with the social anxiety but found no benefit to perhaps more difficulty. The only medication I have been on that helped with anxiety was lorazepam, but that was about 5 years ago when I was not taking any stimulant medication for my ADHD. The vyvanse seems to treat my ADHD well without negative effects. The Seroquel seemed to treat my insomnia well without any negative side effects. The vyvanse seems to coincidentally improve my depression. But nothing is currently helping my anxiety. What are some common medications that might be used in a situation like this were there is co-occurring ADHD, depression, anxiety, insomnia with anxiety and depression being the hardest to treat?

Answered by Dr. Seikhoo Bishnoi (23 minutes later)

Brief Answer:
Mirtazapine or Paroxetine can help

Detailed Answer:
Hello, Welcome to Health Care Magic

I can understand your concern. After reading the history you have mentioned it is clear that you have ADHD and depression. Poor sleep, anxiety and depression are bothering you. You have tried many medicines but not much relief was there. If we consider the drugs you are taking then Vyvanse is helping you in ADD symptoms. The drug has been found to be very useful in depression also because it improves focus, concentration and helps to reduce the tiredness. So if you are stable on that then no need to change it. But at the same time it helps to reduce the symptoms of depression but it is not an antidepressant drug. For treatment of depression antidepressants will be needed. Drugs like Mirtazapine or Paroxetin etc can be tried. Both drugs helps to reduce depression and help in good sleep also. These drugs are advised to be taken in evening after dinner and thus result in good sleep. As they are antidepressants so no risk of development of dependence or tolerance.

Lorazepam is also a good drug for insomnia but the drug can result in dependence if taken on regular basis. The drug can be reserved for treatment of insomnia and anxiety symptoms on SOS basis.

Consult your doctor and discuss about the drugs I have mentioned and these medicines will surely help you.

Thanks, Hope this helps you, if you have more doubts you can ask again

Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (41 minutes later)

Thanks for the quick response. What medications could be helpful for the anxiety in particular (my biggest missing piece of the puzzle)? I get asked the normal questions and this is what I have to say . . . I do demonstrate the physical symptoms of anxiety like sweating and increased heat rate etc, but those are only because I have the racing thoughts, worry, self-esteem, fear of judgement in my head going on full force. So after trying many things medications for my other issues, I have found relief for depression, ADHD and insomnia with the Seroquel and Vyvanse, what would work alongside these medicines to deal with this type of anxiety. Also, I do try to practice as much lifestyle related problem solving as I can. Thank you.

Answered by Dr. Seikhoo Bishnoi (4 hours later)

Brief Answer:
Beta blockers can help in acute states

Detailed Answer:
Hello again and thanks for asking a follow up

For acute anxiety symptoms or in panic like situations medicines like beta blockers as Propranolol or Atenolol can help. Propranolol in low dose helps to reduce symptoms like palpitations, breathless like state which are seen commonly in social situations. Apart from your conventional medicines either of this medicine can be used. These are quick acting and can be used on SOS basis also.

Thanks, still have more doubts please ask again.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar