Brief Answer:
Provide more information and drug details

Detailed Answer:
Hello,

Thanks for writing to us. I can understand your concern.

I would like to help you in the best possible way. For that I need more information.

- which drugs have you taken until now?

- which drugs are going on at present?

- provide drug details with dose and duration.

- In bipolar disorder do you have depressive symptoms or manic symptoms at present?
Narrate brief details of symptoms.

I will be happy to help further after your response.

Regards,
Dr Chintan Solanki.

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Brief Answer:
plain quetiapine will help, other recommendations are below

Detailed Answer:
Hi,

Thanks for information.

Qutan 200 (pain not SR) will be helpful in sleep than qutan sr.

Other option is either increase clonazepam to maximum 4 mg gradually or adding zolpidem 10 mg.

I would also recommend following 'sleep hygiene'.

These are some measures called which would help in sleep. You can find the same in below link.

sleepfoundation.org/ask-the-expert/sleep-hygiene

Drinking a cup of warm milk before going to bed helps in 30-40% of patients and they do not need medicines as per my clinical experience.


- Can you describe other current bipolar symptoms?

- Is there difficulty in sleep onset, fragmentation of sleep or early morning awakening?

- What was the schedule (timing) and duration of sleep before the problem started? How much reduction in sleep from previous?

Waiting for your response.

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Brief Answer:
yes if you can tolerate the dose

Detailed Answer:
Hi,

Thanks for follow up.

As such gabapin has no role in your problem. It is occasionally used in insomnia when first line drug is not useful. It is used up to 1800 mg in that case. So increasing the dose of gabapentin may help.

However considering your depressive symptoms I recommend lamotrigine for sadness and fatigue with increasing the clonazepam for insomnia.

Other option is to add olanzapine at night and fluoxetine in morning with cover of mood stabilizer like valproate sodium.

Go for thyroid hormone checking if not done recently. If hypothyroidism is there , it must be treated.

You can discuss above recommendations to your doctor and change treatment accordingly.

If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service.

In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page with three follow up questions.

Wish you good health.

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