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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2209
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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Anxiety-insomnia or insomnia-anxiety

Customer Question

Hello,is Prozac the right medication for insomnia? I am taking 10 mg  for the past 3 weeks,every morning for anxiety insomnia. My doctor sad my insomnia is anxiety driven,so just keep taking it. It has not helped my sleeping at all yet. Before Prozac I used to take 0.25mg  Xanax XR for night time and 0.125mg Clonopin for day time.Hoping my doctor can restart my brain.That did't help. After 1 month she added Prozac 10 mg every morning.It's been 3 weeks and my sleeping has not improved yet at all. I volunterly gave up on Xanax and Clonopin slowly because they did not seem to help anymore. It was total 7 weeks on benzodiazepine, I think my body got used to it,doesn't help with sleeping anymore. So Prozac is not helping me yet, xanax is not helping me anymore,and I don't even know if Prozac is the right medication for insomnia.Because my insomnia and anxiety I am dizzy,lightheaded,exausthed all the time.Can't function. Am I on the right path??  I need help. Thank You.
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Vikas replied 3 years ago.

Hello,

Prozac is an activating antidepressant and can itself cause insomnia if taken at night.

Insomnia can be anxiety driven or could be a comorbid condition along with Anxiety.
If your is insomnia anxiety driven, Prozac can be useful for it but you are currently on a very low dose and the dose of Prozac should be increased further by your doctor up to 20 mg initially and further more if needed.

What we usually do in our patients who also complain of insomnia is to add a sedating antidepressant such as Remeron on (Mirtazapine) in low dose ( 7.5 mg) along with Prozac. Remeron not only augment the antianxiety and antidepressant effect of Prozac but being very sedative is useful in insomnia also. It may also reverse the sexual and gastrointestinal side effect of Prozac.

So you can discuss with your doctor about increasing the dose of Prozac and addition of Remeron in your case and hopefully this should be sufficient enough to control your symptoms.

Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Customer: replied 3 years ago.

Thank You for your answer. I have never heard of Remeron.Would You tell me more about it? Is it another SSRI? If yes, would it be good enough by itself? My doctor wanted me to start taking non-benzodiazepine as a sleeping aid along with 20 mg prozac. Ambien or Zaleplon. Zaleplon 10 mg.Is it a good idea? Or should I go back to Xanax Xr until Prozac 20mg "kicks in"? And slowly come off after?

Expert:  Dr. Vikas replied 3 years ago.

You are most welcome.

Remeron is not a SSRI antidepressant and has totally different mechanism of action. Alone also it may be useful in anxiety disorder but we prefer to use it as an augmenting agent with SSRIs antidepressant.

Yes, you may try Ambien or Zaleplon. This medicines are specially useful in patients who are having difficulty in sleep initiation. In case, you see no benefit with ambien or zaleplon also, you can discuss with your doctor about trying Remeron as I mentioned earlier.

Best wishes,

Vikas


Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2209
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Dr. Vikas and 2 other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.
Dr Vikas, I don't even know if my insomnia is anxiety driven. It is started 8-10 months ago, when I happened to go to bed very late and somehow my body got used to it. I managed my days with 5-6 hours of sleep and catched up on the weekend with 10-12 hours sleep . And one day I just never was able to sleep. That has been going on for 3 months. Being soooo exausthed i started to feel dizzy,lightheaded,my stomach hurted all the time,I lost weight and then panic came. These are all from not sleeping. Did I develop anxiety? Don't know if the chicken or the egg was first..
Customer: replied 3 years ago.

Dr Vikas, I don't even know if my insomnia is anxiety driven. It is started 8-10 months ago, when I happened to go to bed very late and somehow my body got used to it. I managed my days with 5-6 hours of sleep and catched up on the weekend with 10-12 hours sleep . And one day I just never was able to sleep. That has been going on for 3 months. Being soooo exausthed i started to feel dizzy,lightheaded,my stomach hurted all the time,I lost weight and then panic came. These are all from not sleeping. Did I develop anxiety? Don't know if the chicken or the egg was first..

How long should I take Remeron along with Prozac? Until the increased amount Prozac start to work?

Expert:  Dr. Vikas replied 3 years ago.
Many thanks for ACCEPTING the answer.

It appears to me that Insomnia developed first and later on anxiety symptoms appeared. In that case Insomnia is comorbid with anxiety disorder.

Remeron should be taken with Prozac for at least 5 to 6 months and after that your doctor may decide whether to continue it or not.

Remeron with Prozac is a very good combination and I personally have seen excellent results in most of my patients so you can give it a try in my view.
Customer: replied 3 years ago.
Would it be ok to take over the counter melatonin along with Prozac before I try Remeron? If yes how many mg? Is Remeron a benzodiazepine? How do You come off of it after 5-6 months taking it? Am I going to build tolerance to it? Addiction?
Customer: replied 3 years ago.
Is Prozac a good medicine for this comorbid anxiety? It is more likely for depression..I read.
Expert:  Dr. Vikas replied 3 years ago.

I have not seen very good result with melatonin so can't recommend you melatonin.

No, Remeron is also an antidepressant with different mechanism of action. It acts on different neurotransmitter. It is always better to taper down all antidepressant instead of stopping them cold turkey. Remeron is not an addicting medicine so no tolerance or dependence.

Please click the link below to find out more about Remeron.

Remeron (Mirtazapine)

Yes, Prozac is among the first line medicine for treating both anxiety and depression symptoms and is very effective in treating both of them.
Customer: replied 3 years ago.
So am I having severe insomnia right now because of Prozac side effect ( taking 10 mg for 3 weeks ) or because Prozac did not work yet... And when should I see improvement in my sleep from 20mg Prozac? Weeks ,months? Or Prozac is not really to help my insomnia?
Expert:  Dr. Vikas replied 3 years ago.

No, I guess you are suffering from Insomnia as well as anxiety disorder.

Usually sleep is the among the first symptom to improve and it may take 1 to 4 week as a wild guess.
Prozac may or may net help in Insomnia and that is why I am suggesting you to discuss with your doctor about trying Remeron.
Customer: replied 3 years ago.

So I should not take Xanax Xr 0.25 mg anymore for sleep..or take more until I get Remeron? I dont want to introduce the sleeping med Zaleplon.Another new medicine..;(

 

Expert:  Dr. Vikas replied 3 years ago.

If you don't want to go for a new medicine in that case, taking Xanax for the mean while, till your doctor prescribe you Remeron could be a good idea.

In case, you are not noticing any benefit from .25 mg of Xanax, you can ask him to increase the dose up to .5 mg to be taken at night and this should solve the problem.
Customer: replied 3 years ago.
How about Xanax XR? Same dose ?
Expert:  Dr. Vikas replied 3 years ago.
Xanax XR is comparatively less sedating than Xanax so better to try Xanax for sedation.
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2209
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Dr. Vikas and 2 other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.

The best of the best answers from You Dr.Vicas! Thank You so much! Sylvia

Expert:  Dr. Vikas replied 3 years ago.

You are most welcome Sylvia. Thanks for coming to JA.

Kind regards

Vikas
Customer: replied 3 years ago.
One more question Dr.Vikas .:) Does insomnia develop because of lack of serotonin or high adrenalin and cortisol level? What is really going on in human brain in case of insomnia? Just trying to understand.. Thank You,Sylvia
Expert:  Dr. Vikas replied 3 years ago.

Sylvia, believe me, it is indeed a very complex topic and nothing is conclusive yet. Nearly all sort of neurotransmitter may have some role in sleep regulation.
The neurotransmitters of sleep.You will find this presentation below very interesting and hopefully it will answer your question.

The role of neurotransmitter in sleep
Customer: replied 3 years ago.

Dr.Vikas,it's Sylvia again. Would it be ok to take a natural sleeping aid called Somnapure for my insomnia? I am taking 10 mg Prozac also for comorbid anxiety.(22 days today)

Somnapure supplement facts:500mg Valerian extract

300mg Lemon Balm extract

200mg L-Theanine

120mg Hops extract

50mg Chamomile flower extract

50mg Passion flower extract

3mg Melatonin

Should I try it first? Before I start taking Remeron 7.5 mg along with Prozac? Any interaction these herbs with Prozac? If Prozac doesn't help with insomnia would You recommend another medication which would take care of insomnia and anxiety at the same time? I don't want to take 2 different medicine.

Expert:  Dr. Vikas replied 3 years ago.
Hi Sylvia,

You have mentioned that "I don't want to take 2 different medicine." but you are asking about taking Somnapure for Insomnia along with Prozac, isn't it the same thing.

There are no or scanty information available regarding the drug interaction between herbal / natural medicine and antidepressant so no one comment on the safety of any such combination.

I will again recommend you to try Remeron with Prozac if your doctor agree. This is very useful combination. Remeron not only augment the antianxiety and antidepressant effect of Prozac but being very sedative is useful in insomnia also. It may also reverse the sexual and gastrointestinal side effect of Prozac.

You won't be needing any other medicine one you start this combination.
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2209
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Dr. Vikas and 2 other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.

Thank You for the answer. What do You think about Celexa or Paxil instead of Prozac?

I feel Prozac makes my insomnia worst. I am up until 2 am every night,Prozac gives me almost to much energie. And of course can't sleep. Without sedation I am not able to sleep at all. And it wasn't this bad.I had sleeping problems but not this bad...

After stop taking SSRI medication(any) and Remeron,will my sleeping be fine?Like it used to be? Concerned. Is it ever going to be fine?

Expert:  Dr. Vikas replied 3 years ago.
Well, Paxil can indeed be a good option in your case if you want to take a single antidepressant only which is also sedating in nature.

Paxil is very sedating in nature and your doctor can switch you over to Paxil easily from Prozac.

So, now you have a choice, either you can go for Paxil or you can go for a combination of Prozac and Remeron. In both the cases, as soon as your symptoms are under control, your sleeping will also improve and will become normal once again although it may take some time, may be few weeks to months (may be few days also!).

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