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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
Satisfied Customers: 10341
Experience:  14 years experience in the field of Family Practice
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I have depression and insomnia. My doctor prescribed zoloft

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I have depression and insomnia. My doctor prescribed zoloft and ativan for life (I am 65 years old). After 9 months I gave up the ativan and started Trazadone at night, continueing with zoloft in the morning. Because of side effects I had to stop the trazadone after 2 weeks, and today must increase the zoloft to 100mgs. and stop taking trazadone cold turkey. I am confused about the wisdom of these prescriptions and very concerned that this may be a recipe for disaster as I am prone to suicidal inclinations and understand Zoloft can in itself cause insomnia.
I would be deeply grateful for some advise and support.
Elly Rogac.
Anthony Bray MD : Hello!
Anthony Bray MD : The Zoloft is more likely to be helpful toward your depression and insomnia than adverse to either--- the results if this are monitored as an antidepressant does not have equivalent results for every patient. Psychiatric MEDS very much need to be individualized--- evaluating for effects vs side effects.
Anthony Bray MD : Depression itself commonly has insomnia as part of this... So that would be the first suspect in my opinion...
Anthony Bray MD : we would want to look at the time course of symptoms... How long have you been depressed? How long have you had the insomnia? How long have you been taking the Zoloft?
Anthony Bray MD : Does the insomnia bother you with more trouble getting to sleep I'm the first place? Do you wake up in the middle if the night and have trouble getting back to sleep?
Anthony Bray MD : If you have trouble getting to sleep then you may benefit from Ambien or Lunesta as a couple of examples of sleep aids....

I have been depressed probably since early childhood but did not have treatment until I was in my forties. I slept well until emmigrating to canada 30 years ago when the insomnia began. I have been taking zoloft for for 9 months.

Anthony Bray MD : If you wake up multiple times at night then you might benefit from a sleep study to check for sleep disorders such as obstructive sleep apnea or restless leg syndrome ...
Anthony Bray MD : Ok so the time course of your insomnia does not fit with your taking the Zoloft...
Anthony Bray MD : How are you doing now with your depression.... How close to 100% normal would you estimate that you are???
Anthony Bray MD : It may be that you need adjustment with your depression medication ---what dose of Zoloft do you take??

For a long time I was waking in the night and couldn't get back to sleep. Due to anxiety I ended up not sleeping atall for 3 days and nights, was admitted to hospital, did o.k. on amytrypteline for many years. Always groggy, weight gain, decided to try something else.

Anthony Bray MD : Ok I see.... I was thinking of Elavil as a possible option for you but you are exactly right with your concerns of side effects...weight gain for example is common with the Elavil....
Anthony Bray MD : the pattern of early awakening is common with depression...
Anthony Bray MD : Klonapin at bedtime might be an option for you and your doctor to consider but if this was tried the daytime drowsiness would need to be watched for...,
Anthony Bray MD : Lunesta may be helpful for you but might be better helping you get to sleep and less to stay asleep but it might be a very good choice for you.... I think this option would be very much worth a try ....

I have to say that I don't think I now what "normal" feels like! I'm either managing o.k. or struggling badly. Over the last 9 months with the adjusting of medications I have had some serious episodes of struggling and am generally not able to be sociable or get stuck into my work easily, but am managing reasonably too.

Anthony Bray MD : Rozerum works by different mechanism-- this works excellent in some but less effective in others... Melatonin 3mg/ night is an over the counter option that may be helpful for you...
Anthony Bray MD : Ok --- I see---/ well it sounds that perhaps an increased dose of the Zoloft might be helpful toward your depression... If not in counseling then adding this may be helpful... Adding Abilify to the Zoloft may be helpful... Considering switch to Cymbalta or Effexor may be helpful( these work on both serotonin like Zoloft but also norepinephrine ...transmitters that relate to depression...)

Thank you for these suggestions. I will certainly consider each one. My doctor has said my only choices are ativan or trazedone so this is very helpful. Tonight I have to go cold turkey quitting trazadone. Will this be o.k? Would melatonin help tonight?

Anthony Bray MD : It would be worth a try with the melatonin -- yes--- try this for next week to see if in general it helps--- you may still have some good nights and some poor with this... Judge effect over several nights...
Anthony Bray MD : The melatonin is something that you may try right away and it may help with the insomnia....
Anthony Bray MD : Try to make yourself exercise daily as this tends to benefit depression and sleep patterns ....brisk walk daily or other would tend to increase your sense of well being....
Anthony Bray MD : I hope this has been helpful for you!
Anthony Bray MD : Let me know if you have further questions and I will be happy to get back with you!!
Anthony Bray MD : If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. That would be very much appreciated! Thank you and best regards,
Anthony Bray MD : Anthony Bray MD

Thank you, ***** ***** It is a relief to know there are options.

Anthony Bray MD : You are very welcome! Good luck to you... I hope that you find good care and see improvement soon with these issues !
Anthony Bray MD : Let me know if you should have further questions and I will be happy to get back with you! Take care!!

Before checking out, how do I get back to you if necessary? Will I have to register again? Thank you so much. Elly.

Anthony Bray, MD and 3 other Medical Specialists are ready to help you
Customer: replied 4 years ago.

I think I checked out before you could answer the last question, but thank you anyway! Elly

Hello again!!
You may reach me by going to my profile page on this site or addressing you question to me >>>Dr.Bray...
I hope to talk with you in the future. Best regards ***** *****!
Anthony Bray MD