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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Are Flurazepam And Nortriptyline Right Medication For Depression, Anxiety And Insomnia?

My doctor had prescribed flurazepam 30 mg and nortriptyline 25 mg have been on both for depession, anxiety and insomnia. These stop working for my insomnia and my nerves are all over the place. I have only been on these medications for a little over 3 months. I met with him yesterday and he wants me to just stop the flurazepam 30 mg with no reduction and start cymbalta 30mg. As far as the nortriptyline 25 mg take one every other day for 6 days and then stop. He also added the generic lunesta 3 mg for sleep. I have only been sleeping about 3 hrs. a night and stoping these medication so abruptly have me concerned, since I had such severe withdrawals symptoms coming off remeron after only taking that for a little over 2 months, had to stop taking remeron because it caused mouth sores. Do you have any advice?
Wed, 29 Jul 2015
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Psychiatrist 's  Response
Hi, welcome to HCM. Thanks for asking your query at this forum.
We understand your concern. I have read your question carefully and understood it. I will try my best to answer it.

As you told that you are suffering from depression, anxiety and insomnia and recently you have been taking Tab Flurazepam and Nortriptyline for last 03 months. Flurazepam is a good anxiolytic and sedative, hence produce relaxation and sound sleep. I must educate you that Flurazepam is an addictive drug with abuse potential. It is prescribed for initial few days and should be discontinued over a period of next few days. If a person continues to use this drug for weeks, over a period of time tolerance develops and more dose is required to produce the same desired effect. Apparently this has happened with you. Apparently you did not went for review by your doctor in time and continued to take the earlier prescribed medicines. Due to continuous use of more than 3 months, you might have developed tolerance to this earlier dose and now not getting enough sleep.

Your doctor has taken a right decision to discontinue this drug but it is always better to taper it gradually. Cymbalta (Duloxetine) is a good antidepressant with nice anxiolytic property, tolerance does not develop, and it is not addictive, hence suited for long term use. So I consider it is a good switch. Lunesta (Eszopiclone) is good for sleep induction and maintenance. So it may take care of insomnia due to Flurazepam withdrawal. Nortriptyline 25 mg is a suboptimal dose for anxiety/ depression and it can be stopped without much difficulty.

You may discuss these issues with your doctor. I hope he may be agreed to taper the dose of Flurazepam before stopping it completely.

I hope it answers your query. i wish you all the best.
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Are Flurazepam And Nortriptyline Right Medication For Depression, Anxiety And Insomnia?

Hi, welcome to HCM. Thanks for asking your query at this forum. We understand your concern. I have read your question carefully and understood it. I will try my best to answer it. As you told that you are suffering from depression, anxiety and insomnia and recently you have been taking Tab Flurazepam and Nortriptyline for last 03 months. Flurazepam is a good anxiolytic and sedative, hence produce relaxation and sound sleep. I must educate you that Flurazepam is an addictive drug with abuse potential. It is prescribed for initial few days and should be discontinued over a period of next few days. If a person continues to use this drug for weeks, over a period of time tolerance develops and more dose is required to produce the same desired effect. Apparently this has happened with you. Apparently you did not went for review by your doctor in time and continued to take the earlier prescribed medicines. Due to continuous use of more than 3 months, you might have developed tolerance to this earlier dose and now not getting enough sleep. Your doctor has taken a right decision to discontinue this drug but it is always better to taper it gradually. Cymbalta (Duloxetine) is a good antidepressant with nice anxiolytic property, tolerance does not develop, and it is not addictive, hence suited for long term use. So I consider it is a good switch. Lunesta (Eszopiclone) is good for sleep induction and maintenance. So it may take care of insomnia due to Flurazepam withdrawal. Nortriptyline 25 mg is a suboptimal dose for anxiety/ depression and it can be stopped without much difficulty. You may discuss these issues with your doctor. I hope he may be agreed to taper the dose of Flurazepam before stopping it completely. I hope it answers your query. i wish you all the best.