Struggling with Insomnia: Anxiety and Depression Treatments

I haven't been able to sleep for three months; I haven't slept at all?

Psychiatry before bed: Leeyo (Escitalopram) 10 mg * 2 tablets, Mirtazapine 50 mg * 2 tablets, Zolpidem 10 mg * 2 tablets, Flunitrazepam 2 mg * 2 tablets.

Metabolism department: Metformin HCL 850 mg.

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

Cardiology department: Verapamil (cartil) 40 mg three times a day.

I have been suffering from depression and anxiety, and I haven't been able to sleep for three months—completely unable to sleep for a single minute for three months.
I also experience palpitations 24 hours a day, but tests from the cardiology department, including thyroid and heart evaluations, show no issues.
The problem may lie in anxiety.

1.
Will my weight decrease? I have noticed weight loss.

2.
Does Mirtazapine 50 mg * 2 tablets have antidepressant and anxiolytic effects?
3.
Can the combination of Escitalopram and Mirtazapine yield better results? I don't feel any effect.
If the effects are poor, what other medications can help me? Would switching to another SSRI be effective? Are there stronger medications available?
4.
Does Clonazepam affect urination? The urology department diagnosed me with bladder contraction weakness and residual urine.

Thank you, doctor.
Please help me.

Niming, 30~39 year old female. Ask Date: 2020/09/02

Dr. Huang Xiaoxian reply Psychiatry

Hello Coollo, it is generally unlikely for a person to go without any sleep for more than two weeks.
Sleep is typically divided into deep sleep, light sleep, and rapid eye movement (REM) sleep.
You may be experiencing predominantly light sleep, which could lead to the subjective feeling of not having slept at all.
The key issue is how to address your predominantly light sleep state (waking up at any sound).
The combination of Zolpidem and Flunitrazepam, if taken in amounts exceeding two pills, can compress sleep into lighter stages, resulting in the subjective experience of almost not sleeping throughout the night.
However, adjusting medication requires careful evaluation and discussion, so I recommend that you have a detailed conversation with your prescribing physician to find a suitable adjustment method for you.

Regarding other issues:
1.
The relationship between sleep and weight is not direct.

2.
The anti-anxiety effects may not be effective.

3.
You may need to discuss further with your physician.

4.
The relationship between Sertraline and urination is not significant.

Wishing you all the best.

Reply Date: 2020/09/02

More Info

Struggling with insomnia, anxiety, and depression can be incredibly challenging, and it's important to understand the interplay between these conditions and the medications used to treat them. Based on your situation, you are currently taking a combination of medications, including Escitalopram (Leeyo), Mirtazapine (美舒鬱), Zolpidem, and Flunitrazepam, among others. Let's address your concerns systematically.

1. Insomnia and Weight Loss: Chronic insomnia can indeed lead to weight loss. When individuals experience prolonged periods of sleep deprivation, their metabolism can be affected, and they may also have reduced appetite or increased anxiety, which can further contribute to weight loss. It's crucial to monitor your weight and discuss any significant changes with your healthcare provider.

2. Mirtazapine and Its Effects: Mirtazapine is an antidepressant that is often used to treat both depression and anxiety. It can also have sedative effects, which may help with sleep. However, the effectiveness of any medication can vary from person to person. If you feel that Mirtazapine alone is not providing the relief you need, it may be worth discussing with your doctor whether adjustments to your dosage or a change in medication might be beneficial.

3. Combination of Medications: Combining medications like Escitalopram and Mirtazapine can be effective for some patients, especially when treating co-occurring anxiety and depression. However, if you are not experiencing the desired effects, it’s essential to communicate this with your doctor. They may consider alternative SSRIs or other classes of antidepressants, such as SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) or atypical antidepressants, depending on your specific symptoms and history.

4. Concerns About Urination: Regarding your question about the medication "思樂康" (likely referring to a medication like Escitalopram), it is generally not known to significantly affect urination. However, individual responses can vary, and if you have been diagnosed with bladder issues, it’s crucial to discuss these concerns with your urologist. They can provide insights into whether your current medications might be contributing to your urinary symptoms.

5. Exploring Other Options: If you find that your current regimen is not effective, it’s important to have an open dialogue with your healthcare provider about alternative treatments. There are various classes of medications available, and sometimes a trial-and-error approach is necessary to find the right fit for your symptoms. Additionally, non-pharmacological treatments such as cognitive-behavioral therapy (CBT) for insomnia or anxiety can be very effective and may complement your medication regimen.

6. Lifestyle Modifications: Beyond medication, consider incorporating lifestyle changes that can improve sleep and reduce anxiety. Regular physical activity, a balanced diet, mindfulness practices, and establishing a consistent sleep schedule can all contribute positively to your mental health and sleep quality.

In conclusion, managing insomnia, anxiety, and depression often requires a multifaceted approach that includes medication, therapy, and lifestyle changes. It's essential to maintain regular communication with your healthcare provider to adjust your treatment plan as needed. Remember, you are not alone in this struggle, and with the right support and treatment, improvement is possible.

Similar Q&A

Understanding Anxiety and Depression: Sleep Issues and Emotional Struggles

Hello, doctor. I have been struggling with insomnia for a long time, often having difficulty falling asleep and staying asleep. Even when I finally manage to fall asleep, I wake up easily and spend a long time tossing and turning in bed. I was previously prescribed oral medicatio...

Dr. Wang Yaoting reply Psychiatry
Hello: Based on your description, it seems more like an adjustment disorder due to stress, but there may be depressive tendencies. The tranquilizer you mentioned belongs to the category of sedatives and sleep aids. I would recommend making the following adjustments: 1. Maintain a...

Overcoming Insomnia and Anxiety: Seeking Help for Mental Health Challenges

Hello, doctor. I have been visiting the psychosomatic clinic since 2014 for several years. Initially, I was prescribed Lexapro, but the side effects were too strong; I felt fatigued and sleepy all day after taking it. After a while, I couldn't tolerate it anymore, so I stopp...

Dr. Li Zhengfeng reply Psychiatry
Hello: According to the letter, you may be suffering from depression. Whether you need to take a leave of absence should be determined by your attending physician's professional assessment. If necessary, rest can indeed improve your condition. In addition to medication, trea...

Overcoming Insomnia: Coping with Anxiety and Fear of Sleep

I have been experiencing insomnia for about three months now. Initially, it may have been due to my boyfriend going into the military, which left me feeling unbalanced in life. For the first couple of nights, I found it difficult to fall asleep, and then I began to develop a sign...

Dr. Liang Sunyuan reply Psychiatry
Hello: It is recommended to focus on living in the present moment. During the day, concentrating on work, studying, or activities can help reduce worries about other matters. The more time you spend focused on the present, the less time you will spend feeling anxious. Even if anx...

Coping with Insomnia and Anxiety: When to Seek Professional Help

Hello Dr. Wang, I have been feeling very anxious lately as I prepare to graduate and enter the workforce. I am unable to concentrate, feel restless, and have been experiencing insomnia for a week. I am now very afraid of sleeping, getting less than three hours of sleep each day. ...

Dr. Wang Zhenbang reply Psychiatry
Hello: It seems that your issue has caused significant distress. I recommend seeking assistance from a professional physician. There are many ways to improve mood and sleep, and even sleep aids come in various types. You can discuss with your doctor to determine the most suitable...