Struggling to Sleep Despite Medication: Urinary Issues and Treatment

I took sleeping pills but still can't sleep?

The doctor mentioned that my uroflowmetry and urodynamics tests showed abdominal voiding, poor bladder elasticity, reduced bladder capacity, and long-term retention has caused damage.
I have a post-void residual of 50cc.

Psychiatric medications at bedtime: Leeyo (Escitalopram) 10mg * 2 tablets, Mirtazapine 50mg, Zolpidem 10mg * 2 tablets, Flunitrazepam 2mg * 1 tablet.

Dermatology: At bedtime, Lyrica (Pregabalin) 75mg * 2 tablets, Doxepin 25mg * 2 tablets.

Otolaryngology: Loratadine 10mg or Xyzal (Levocetirizine) 5mg (choose one of these to take).

Metabolism: Metformin HCL 850mg.

Urology: Tamsulosin 0.2mg * 2 tablets, Baclofen 5mg once in the morning and once at night, Bethanechol chloride 25mg three times a day.

Cardiology: Diltiazem HCL (Cartia) 60mg.

1.
The urologist diagnosed me with bladder weakness and insufficient bladder contraction with a post-void residual of 50cc.
Which medications might be best to discontinue that could be affecting my urination difficulties? Are any of the psychiatric medications I am taking contributing to my urination issues, and which ones should I ask my doctor to change? Thank you, doctor.

2.
What is the purpose of Mirtazapine?
3.
What is the purpose of Doxepin? Thank you, doctor.

Niming, 30~39 year old female. Ask Date: 2020/08/22

Dr. Huang Xiaoxian reply Psychiatry

1.
Doxepin and Seroquel may have some anticholinergic effects, which can be associated with urinary retention; it is advisable to discuss this with the prescribing physician.
2.
Mirtazapine generally has some antihistaminic effects that can aid sleep, as well as antidepressant effects.
3.
Seroquel has mood stabilizing and antipsychotic effects, and it also has some sleep aid properties.
Wishing you well.

Reply Date: 2020/08/22

More Info

It sounds like you're dealing with a complex situation involving multiple medications and urinary issues, which can indeed be quite challenging. Let's break down your concerns and provide some clarity on the medications you're taking, their potential interactions, and how they relate to your urinary symptoms.

1. Understanding Your Medications
You mentioned several medications prescribed by different specialists, including:
- Escitalopram (Leeyo): An SSRI (selective serotonin reuptake inhibitor) commonly used to treat depression and anxiety. While it can help improve mood and anxiety symptoms, SSRIs can sometimes lead to urinary retention or difficulty in urination in some individuals.

- Zolpidem and Flunitrazepam: Both are sedative-hypnotics used to treat insomnia. They can cause sedation and may contribute to cognitive impairment, especially in older adults. While they are effective for sleep, they can also lead to next-day drowsiness, which might affect your overall alertness.

- Pregabalin (Lyrica): This medication is primarily used for neuropathic pain and anxiety disorders. It can cause sedation and dizziness, which may indirectly affect your ability to manage urinary symptoms.

- Doxepin: This is a tricyclic antidepressant that can also be used for insomnia. It has anticholinergic properties, which can lead to urinary retention.

- Tamsulosin: This medication is specifically used to treat urinary symptoms associated with benign prostatic hyperplasia (BPH) by relaxing the muscles in the prostate and bladder neck, making it easier to urinate.

- Bethanechol: This medication is used to stimulate bladder contractions and is often prescribed for urinary retention.

- Diltiazem: A calcium channel blocker used for hypertension and angina, which can sometimes lead to peripheral edema and may have an indirect effect on urinary function.

2. Urinary Issues and Medication Interactions
Given your diagnosis of bladder dysfunction and the medications you are taking, it is essential to consider how these drugs might interact and contribute to your urinary symptoms.
- Antidepressants: As mentioned, both SSRIs and tricyclic antidepressants can lead to urinary retention. If you are experiencing difficulty urinating, it may be worth discussing with your doctor the possibility of adjusting or discontinuing these medications.

- Sedatives: Zolpidem and Flunitrazepam can impair cognitive function and coordination, which might make it harder for you to respond to your body's signals to urinate.

- Pregabalin and Doxepin: Both can cause sedation and may contribute to urinary retention as well.

3. Recommendations
1. Consult Your Doctor: It is crucial to have an open discussion with your healthcare provider about your urinary symptoms and the medications you are taking. They can help assess which medications may be contributing to your urinary issues and whether any adjustments are necessary.

2. Medication Review: Consider asking your doctor about the possibility of tapering off or switching medications that may be causing urinary retention, particularly the SSRIs and tricyclic antidepressants.

3. Lifestyle Modifications: In addition to medication adjustments, consider lifestyle changes that may help manage your urinary symptoms. This could include bladder training techniques, pelvic floor exercises, and ensuring adequate hydration throughout the day while limiting fluid intake before bedtime.

4. Monitoring Symptoms: Keeping a diary of your urinary patterns, fluid intake, and any side effects from medications can provide valuable information to your healthcare provider.

4. Specific Questions
- What is the use of 美舒鬱 (Doxepin)?: Doxepin is used for its antidepressant properties and is also effective in treating insomnia due to its sedative effects. It can help improve sleep quality but may cause urinary retention in some patients.

- What is the use of 思樂康 (Pregabalin)?: Pregabalin is primarily used for neuropathic pain and anxiety disorders. It can help alleviate pain and anxiety but may cause sedation and dizziness.

In conclusion, managing your urinary issues while on multiple medications requires careful consideration and collaboration with your healthcare providers. By discussing your symptoms and medication side effects openly, you can work together to find a treatment plan that improves both your urinary function and overall quality of life.

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