Q. I have depression and severe insomnia. Please help me.
Hi doctor, I am 79 years old. I have depression for over ten years. I usually take 10 ml alcohol every evening. I had been taking Prozac 20 mg for many years. I suffer from insomnia. I am taking Mirtazapine 15 mg, Valium 5 mg, and Phenergan 25 mg. These give me sleep for 12 hours. Before three days, I increased the dosage of Prozac to 30 mg as I was more depressed and extremely fatigued for many months. After taking it, it worsened my insomnia. I had no improvement in fatigue. A few months back, I took Mirtazapine 30 mg. It also worsened my insomnia. Then I reverted to 15 mg. Please help me.
Hi. Please use Prozac in the morning as it can worsen sleep when used at night. You can take Prozac 40 mg. Do not increase the dose of Mirtazapine as higher doses of Mirtazapine cause insomnia whereas low dose help in sleep. Mirtazapine 15 mg is sufficient. Do not take Phenergan and Valium at the same time. Please continue to choose only one drug, and the dose is adequate. I would also advise you get an MRI brain (magnetic resonance imaging) done. Along with the medicines, engage yourself in social activities and do exercise frequently. You can consider starting therapy for depression and alcohol dependence.