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Hi Dr. Ashori here.
What dose of alprazolam have you tried in the past?
Both mirtaz and lamotrigine are quite effective medications.
I'm sorry for your loss. How long has it been since the incident?
Thank you for sharing that.
Alprazolam can help, especially at night, you might need somewhere in the 0.5-1mg range for it to be effective.
Mirtazepine for nighttime is a very good medication, it can prevent those sudden bouts of night terrors.
I think a good psychiatrist should be well-versed enough in those medications. I realize it isn't easy to find a good local doctor that you feel comfortable with but perhaps asking around might be a good idea.
You may have to add on another medication such as wellbutrin or sertraline.
I think increasing the dosages even further for the lamotrigine and the mirtazepine would be a good idea.
I don't recommend alprazolam at those high doses, they build up in your system too much but don't last long enough.
You would be better served with lorazepam starting at 1mg and increasing slowly to 2mg. The dosages with the different benzodiazepines aren't equivalent. So 8pm mg of alprazolam would be the same as 4mg of lorazepam.
You seem to have post traumatic stress disorder. The treatment is a trauma-focused cognitive-behavioral therapy (CBT), medication (a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI)), or a combination of both modalities. The first-line treatment of PTSD is a trauma-focused CBT over medication . An SSRI or SNRI can be used for first-line treatment in patients who prefer medication to psychotherapy, or when CBT is not available. As an example, paroxetine can be started at 20 mg/day orally and increased up to 60 mg/day. For patients with PTSD who show minimal response to two trials of SSRIs or SNRIs, we suggest second-line treatment with quetiapine as monotherapy. Start quetiapine 25 mg orally, increase one week later if the response is inadequate up to 50 mg/day, and then in weekly 50 mg increments up to 400 mg/day. For patients with PTSD who show a partial response to an SSRI or SNRI, we suggest adjunctive treatment withquetiapine or risperidone. As an example, start risperidone at 0.5mg orally, increase after five to seven days if the response is inadequate up to 4 mg/day. If no clinical benefit is seen after two to three weeks of treatment at the maximal tolerated dose, gradually discontinue the medication. For patients with PTSD who achieve a partial clinical response to pharmacotherapy, we suggest trauma-focused CBT as an adjunctive treatment. We suggest treatment with prazosin for patients with PTSD who experience sleep disruption or nightmares or other PTSD symptoms. This medication can be used alone or as an adjunct to an SSRI or SNRI. You should not take alprazolam for a long time because it is tolerant and addictive. You should stop alrazolam slowly under the supervision of your psychiatrist so that you have minimal withdrawal symptoms.
Any questions about my answer?