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Ask Dr. Kaushik Your Own Question
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4505
Experience:  MD Psychiatry
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Any psychiatrist available besides Dr Z?

Customer Question

Any psychiatrist available besides Dr Z?
Submitted: 9 months ago.
Category: Mental Health
Customer: replied 9 months ago.
Dr Z hi I was hoping to get a different perspective on my ongoing battle with insomnia. My problem is the Seroquel works great for a while then just stops. I've increased my normal 100 mg dose to 150 and added in .5 mg klonopin. Last two days it's just not working anymore. Can you please him. Thank u.
Expert:  Dr. Kaushik replied 9 months ago.

Greetings.

Welcome to the site.

I am a psychiatrist and I believe I can help you with your query.

Well, there are two approaches which one can take to manage your insomnia , one approach will be to potentate the action of seroquel by adding another drug which has its own sedative action and which will enhance the effect of seroquel. Such a drug that you can use concomitantly at night time with seroquel could be Phenergan ( promethazine hcl) at dose of 25 mg or ativan ( lorazepam) at dose of 0.5 mg- 1 mg or nitrazepam at dose of 5 - 10 mg. Clonazepam(klonopin) 0.5 mg that you have decided to usesis not that stronger a sedative in comparison to the options enlisted here, so you may replace klonopin with any one of these.

The second approach will be to altogether replace seroquel with any one of these below mentioned medications such as Remeron ( mirtazapine) at dose of 15 mg at bedtime or Desyrel ( trazodone) at dose of 25 - 50 mg at bedtime. However at the moment first approach will prove to be less time consuming and may yield quicker results, so you may apply that as of now.

I hope this helps.

Wish you all the best.

Please kindly leave a POSITIVE RATING if you are satisfied with the answer. Regards

Customer: replied 9 months ago.
Ativan is stronger than klonopin? Thought they were in the same class.
Expert:  Dr. Kaushik replied 9 months ago.

Well, both ativan and nitrazepam belong to the same class of benzodiazepine to which klonopin belongs to but still they vary in their sedative actions, while ativan is a stronger sedative than klonopin and so is nitrazepam but the efficacy of nitrazepam and ativan is almost similar when it comes to sedation however they differ from each other in terms of the onset of their action as sedatives, while ativan is faster in onset while nitrazepam is slower in its onset as a sedative.

So in my opinion ativan would be a more effective replacement of klonopin since it is not only stronger sedative than klonopin but also is faster in its onset of action.

I hope this brings more clarity to you so as to help you to make a decision on which drug to replace klonopin.

Wish you all the best.

Please kindly leave a POSITIVE RATING if you are satisfied with the answer.

Regards

Customer: replied 9 months ago.
What about Xanax?
Expert:  Dr. Kaushik replied 9 months ago.

Xanax is not as powerful a sedative as either ativan or nitrazepam plus it is high potential for abuse and addiction so it needs to be ignored.

Regards

Customer: replied 9 months ago.
Should I just keep increasing the Seroquel until it makes me drowsy again? This is a very strange medication to use for insomnia. Also would using melatonin be an option?
Expert:  Dr. Kaushik replied 9 months ago.

No, i would not support the use of seroquel at higher dose for the purpose of managing insomnia because it is an antipsychotic medication and it should be judiciously used for indications other than insomnia. Only because of you have been taking it for a while so that is why i suggested above options to add to it so as to help you with your insomnia, but i will not recommend further increment in its dose, instead it will be better if you can just switch over to either desyrel or remeron which are more suited for managing insomnia.

Melatonin alone would not be able to help your insomnia but yes you may add it to seroquel and see how much it helps. It does have good sedative action so adding it to seroquel may prove to be helpful.

I hope this helps.

Wish you all the best.

Please kindly leave a POSITIVE RATING if you are satisfied with the answer.

Regards

Customer: replied 9 months ago.
Would it be ok to take a Seroquel holiday and use ambien for a few days just to make the Seroquel work again?
Customer: replied 9 months ago.
Remeron does not work for me and trazodone worked for a year then stopped
Expert:  Dr. Kaushik replied 9 months ago.

Well, instead of taking ambien you may use trazodone 50 mg at bedtime for some time and this shall give seroquel much needed break so that later it can be used again once trazodone is not being helpful for your sleep.

In other words you may alternate between trazodone and seroquel, ambien is not likely to be helpful after use of such stronger medications so much so that it will fall short in terms of

demand of your body to get sleep from its use. Regards

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