Suggest Treatment For Sleeplessness In An Anxiety Patient

Posted on Mon, 16 Mar 2015

Question: A year and a half ago I had a major depressive episode. I was on 50mg of Zoloft and it took me a year to get off of it. In the past few months my stepdad of 26 years was battling cancer and finally succumbed to it 3 weeks ago. The enormous pressure and stress of those first few days scrambling to make funeral plans really screwed with my sleep. Afterwards I started having what seemed like massive anxiety attacks at work where I was completely scared, revved up and fearful with massive intrusive racing thoughts of doom and gloom. After a few hours they would subside and I would feel wiped out but myself again. I have been suffering from Pure-O for almost two years now hence the year of Zoloft. My doctor put me back on 25mg of Zoloft a week and a half ago. I am still majorly depressed when I am at home or off but have almost normal days when I'm at work. Yesterday I was fine now today depressed and panicked. So my question is am I on the right medication and what disorder do you think I might have because my doctor really doesn't know. I am also on testosterone replacement therapy 125ml per day. I've always had a little anxiety and the OCD thing but these panic attacks and massive depressive episodes never really occurred before even though I have had major devastations to accompany them but when I was younger I could cope much better. Could the two be linked if not what is going on with me? P.S. I've lost about 8 pounds in three weeks no matter what I eat and on my bad days have no desire to do anything but lie in bed until I force myself to get up and function.

Answered by Dr. Shubham Mehta (34 minutes later)

Brief Answer:
continue with zoloft.

Detailed Answer:
Hello
Welcome to HCM.
You have history of major depressive episode in past. Now, the death of your setp-dad and stress of funeral has disturbed your sleep. You have attacks of anxiety, thoughts of gloom and doom, lost weight and no desire to eat and do anything.

Dear, I can understand your concerns.

Your details suggest that you are suffering from major depression with panic disorder. The stressors which you have faced because of your setpdad's demise and funeral has led you to it. Ability to handle stress varies with age and so does coping skills.

Regarding the medication, the thumb rule of prescribing is if a person has responded well to some medicine in past, the same medicine is restarted in future episodes as well.

Since you have responded to zoloft in earlier episode, I think it is the right choice for you now.
However, the dose increments may be required depending upon the response.
I would suggest you to continue with zoloft.

Donot worry about testosterone replacement therapy.

Discuss this with your doctor.

Hope this helps.

Feel free to ask further.

Kindly close the discussion if you are satisfied with the response and give your valuable feedback.

Thanks.
Dr. Shubham Mehta, MD (Psychiatry).

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

Follow up: Dr. Shubham Mehta (15 hours later)

Thank you. Since you are a psychiatrist maybe you can tell me what to do or discuss with my doctor. One day I feel like my normal self with a little mild anxiety but then when I'm off of work I have anxiety all day long, don't know what to do with myself anymore so I lie in bed and try to relax. Some days all I want to do is lie in bed and when I get energy its in little spurts then I feel drained again. My thoughts tend to be in the past and future and all negative. I try to stay in the present but it doesn't always work. Since I suffer from OCD I get an intrusive thought and if I can't brush it off the anxiety starts. I'm trying my hardest to beat depression but I'm exhausted and loosing weight because I have no appetite. Should I discuss raising my dosage or alternative medication with the primary? This bout of depression is not as bad as the previous one I had but it is still pretty debilitating. Any suggestions either natural, physical, mental or otherwise I should be trying to help alleviate the symptoms? I have started listening to meditation audios to relax but I need to get my strength back some how. Thank you.

Answered by Dr. Shubham Mehta (7 hours later)

Brief Answer:
consider dose increment; XXXXXXX dose-250mg.

Detailed Answer:
Thanks for the follow-up query.
Sorry for the delay in response.

Considering the details which you have provided, I would suggest a dose increment of sertraline. It is a good antidepressant can be given upto 250mg (maximum dose) depending on the response.
Most of the clients respond well with doses of around 150mg.
Please discuss this with your doctor.

Along with the drug, other alternative ways which will help you are:
1. Take omega-3 fatty acid supplements. These help to lift mood.
2. Increase green vegetables in your diet. These are natural serotonin boosters of body.
3. Go for aerobic exercises. Simple brisk morning walk of 30 minutes daily is an excellent stress-buster.
4. Soothing music can help in relaxation.

Hope this helps.

Feel free to ask further.

I wish you good health.

Thanks.

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

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