Dr. Mehmet Akif Camkurt
Psychiatry
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Patient's Query
Hello doctor,
I am 23 years old. Two years ago, one night I heard that my fiance is cheating me. I could not sleep that night, and I got a severe panic attack. My sleep has become worse in the past two years. Every night, I try to go to bed, but I cannot sleep. Sometimes, I get some sleep, but my brain remains active. My heart rate increases the next morning. Every day, I am getting headache and pain in my legs and back. Sometimes, I have nightmares in my sleep. When I try to watch TV or use my laptop, my head and body shake. I met a few doctors, and they gave me some medicines. When I take the medications, they put me in tiredness. Even I cannot walk or stand up, and it brings sadness and depression to me. Because of that, I stopped taking the medicines. The medications which I took are Remeron 15 mg, Apo-amitriptyline 25 mg, Lorazepam 2 mg and two more, which I forgot their names. Now, I am in a terrible condition. I cannot sleep peacefully. I am a student, and I could not concentrate my studies. Please help me. Thank you.
Hello,
Welcome to icliniq.com.
As far as I see, you have an anxiety disorder not otherwise specified. Your main complaint looks like sleep problems. However, that problem is associated with extensive thoughts and anxiety. So that, your main problem is anxiety, although you define it due to sleep. You need treatment, and I consider you as a patient who is sensitive to adverse drug reactions like dizziness, somnolence, increased sleepiness, nausea, etc., and because of that slow start of medication is necessary. While your sleep problem is serious, I suggest you get a sleep medicine prescribed by your doctor, which has lesser side effects like increased daytime sleepiness. Regarding medication, I think you should take two medications as you have a long history of psychiatric complaints. For patients like you, I suggest with two drugs to the treatment and later tapering off the medication for sleep. The drug for the first two weeks is Venlafaxine 37.5 mg at 9 AM and two weeks later continue with Venlafaxine 75 mg at 9 AM. The second drug is Trazodone 25 mg at 10 PM (if 25 mg is not enough for your sleep, then take 50 mg at 10 PM). Please keep in mind that the effect of treatment will start in four to six weeks, So, do not stop your medicine. Consult your doctor, discuss with him or her and take treatment with consent. I hope this helps. Thank you.
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Psychiatry
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