Can Fluoxetine be tried instead of Venlor XR?

Question

Hello doctor,

I tried Venlor XR 75 mg during the night and got very poor result for put me to sleep. I tried to take it only in the morning and that too resulted in me being very sleepy. Can I try Fluoxetine? Or any other alternative medicines like ayurveda? Can I take St.John's wort or 5-HTP? I would also like to know can Tofisopam be tried? If so, in what dosage do I need to take them? Can any combination among these provide good sleep only during nights and keep one fresh and active in the morning? Please guide.

Answer 1

Hello,

Welcome to icliniq.com.

I would like you to continue Venlor XR (Venlafaxine) 75 mg at night, as there is response to this medication in terms of improved depressive symptoms.

It was advised to increase the dose by taking 37.5 mg in morning and 75 mg at night. However, you continue taking Venlor XR 75 mg at night.

For excessive daytime sleepiness we can start with a stimulant in daytime.

We can add Armod (Armodafinil) 50 mg in daytime. It is a stimulant drug, which helps in improving the reticular activation system of our body, which in turn increases arousal and reduces excessive daytime sleepiness.

Before switching to Fluoxetine, this measure can be tried. If you want to start Fluoxetine, it can be started at dose of 20 mg a day in the morning after meals.

Rather opting for ayurveda measures or opting for St John's wart or 5HTP; you can add the following supportive measures.

Bright light therapy - Exposure to bright light for at least 20-30 minutes during daytime will help in improving arousal. Bright light therapy helps in boosting circadian rhythm, which is regulated by a hormone melatonin.
Follow sleep hygiene measures.
Weight reduction and regular workout will further help in improving the condition. Workout releases natural endorphins in our body, which have a mood elevating action.
Tofisopam is a non-sedating Benzodiazepine, which have an anxiolytic action but does not cause sedation.

Yes, it can be tried if anxiety symptoms are not controlled. To begin with dose of 50 mg in morning after meals. Gradually increasing to 100 mg if required.

Currently, you can take Venlor XR 75 mg at night along with Armod 50 mg in morning, this combination will improve anxiety and depressive symptoms, improve sleep at night and will increase attentiveness and arousal during daytime.

If required low dose Thyroxine 12.5 mg (thyroid hormone congener) can also be added to this. If this combination does not show any improvement, then Fluoxetine can be tried.

For further information consult a sleep medicine physician online.