Brief Answer:
these are considered better

Detailed Answer:
Hello,
Thanks for using healthcaremagic.

I read your query and understand your concerns.
Before I move to answer your question, I like to make some general statements which are applicable more to seniors (>60 years) suffering with depression.

1. Older individuals are more prone to the side-effects of antidepressant drugs and experience greater difficulty in tolerating doses that are of therapeutic value.

2. They may take longer to respond to antidepressant medication than younger patients.

3. There is currently no single agent which can be considered as ‘first-line’ treatment for elderly patients with depression as all antidepressants have shown efficacy in them.

Coming to your question I prefer Trazodone as an antidepressant in elderly who has sleep problem which disturbs them most. Although the data is limited I find it less trouble maker for them and in most of individuals it causes good quality and quantity of sleep.

Generally my second choice is Mirtazepine which you are already taking.

My third choice is Nortryptiline. Regarding this drug I like to mention this belongs to tricyclic group of antidepressants which shown better efficacy in severe depression. Despite being of TCA group it has minimal anticholinergic side effects. Many of the experts would probably consider it the best antidepressant in your case, but the opinion varies because of risk of delirium.

What I mentioned above is my personnel preferences and do not reflect the literature available as it is inconclusive in regard to choice of antidepressant where insomnia is main problem.

I also like to inform you that recently studies have shown that insomnia should be treated as a disease rather than part of depression. It has shown that those who were treated for both insomnia and depression showed better response in compare to those who got treated only for depression with sedative antidepressants. The author claimed that it is separate disease and needs separate treatment.
I am mentioning this because, in case you do not find a single right drug suitable for your needs, you can consider taking a sedative along with antidepressant after consulting your psychiatrist.

'Hope I have answered your query. If you have any further questions I will be happy to help".
Thanks

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Brief Answer:
It is not bad to shift old comibination

Detailed Answer:
Hello,
Thanks for reverting back to me.

I understand the concern expressed by your GP but not everyone who takes Serepax becomes addicted. Persons who get addicted have some Novelty seeking kind of personality character and they do it very soon after getting prescription.

The risk of addiction is very low for a person who is taking a stable dose and never crossed the boundary to take one or another tablet to seek the effect o experiment. In my opinion if somebody used half tablet of serepax for years and did not encounter any problem of addiction, in future too the risk is very low.

I understand the Miratazepine is not doing well for you, and because of this reason it is not idea to shift back to old combination which was working for you. You need to talk to him and say what I said earlier about the new research and risk of addiction for you.

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.
Thanks and regards

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