<s>[INST] Hi doctor, My mother is 51 years old. Over 9 years she is unable to sleep properly either in the day as well as night. She started to feel irritated and we consulted one of our family doctor and he suggested to start Stalopam plus. But now a days even after taking the same medicine she is not getting proper and sound sleep. Currently, she is on Stalopam plus one capsule a day. I have attached the prescription. Please suggest us what to do? [/INST] Hello. I have gone through the prescription attached (attachment removed to protect patient identity). Diagnosis was anxiety with insomnia for which Stalopam plus (Escitalopram) was prescribed. It seems she has developed tolerance to this drug. So, either dose should be increased or new drug should be substituted. To manage her insomnia and anxiety you need drug therapy such as starting on a sleep aid drug which also lessens anxiety like Clonazepam at dose of 0.5 mg to be taken half an hour before bedtime and continue to take the same. This will ensure quick relief of your mother's anxiety and insomnia but it has to be taken after consultation with a psychiatrist. Proper sleep hygiene needs to be practiced daily, so as to help her maintain good sleep in the long run. Sleep hygiene entails following important points. Anxiety. Check blood pressure. Insomnia Selective serotonin reuptake inhibitor (SSRI) and Benzodiazepines along with sleep hygiene. </s>