Dr. Punya Mulky
Psychiatry
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Patient's Query
Hi doctor,
I am 79 years old. I have depression for over ten years. I usually take 10 ml alcohol every evening. I had been taking Prozac 20 mg for many years. I suffer from insomnia. I am taking Mirtazapine 15 mg, Valium 5 mg, and Phenergan 25 mg. These give me sleep for 12 hours. Before three days, I increased the dosage of Prozac to 30 mg as I was more depressed and extremely fatigued for many months. After taking it, it worsened my insomnia. I had no improvement in fatigue. A few months back, I took Mirtazapine 30 mg. It also worsened my insomnia. Then I reverted to 15 mg. Please help me.
Hi,
Welcome to icliniq.com.
Please use Prozac in the morning as it can worsen sleep when used at night. You can take Prozac 40 mg. Do not increase the dose of Mirtazapine as higher doses of Mirtazapine cause insomnia whereas low dose help in sleep. Mirtazapine 15 mg is sufficient. Do not take Phenergan and Valium at the same time. Please continue to choose only one drug, and the dose is adequate. I would also advise you get an MRI brain (magnetic resonance imaging) done. Along with the medicines, engage yourself in social activities and do exercise frequently. You can consider starting therapy for depression and alcohol dependence.
Patient's Query
Thank you doctor,
I always take Prozac in the morning. With an increased dose of Prozac, my insomnia got returned.
Hi,
Welcome back to icliniq.com.
Taking Prozac 30 mg in the morning has chances to worsen your sleep at night. If you are not comfortable, you can reduce the dose of Prozac to 20 mg. You can try Quetiapine 25 mg at night for sleep. But do not take Phenergan and Valium at the same time. You can take Valium up to 10 mg. Also, consider taking a Multivitamin supplement as it can help to get relief from fatigue.
Patient's Query
Thank you doctor,
Prozac 20 mg is not working. I am taking Multivitamins already. What is the reason for doing an MRI scan?
Hi,
Welcome back to icliniq.com.
You can gradually stop taking Prozac if it does not help you and start taking Escitalopram 10 mg. The reason for having an MRI (magnetic resonance imaging) scan is your age, and I want to know whether you have any neurological problem.
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Psychiatry
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