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Suggest Treatment For Disturbed Sleep And Lack Of Appetite
Question: My wife 58 year old,has been suffering from sleep deprivation for the past 45 days. She cannot eat well because of lack of appetite and she has lost 4kg within this short span of time.She does show interest in anything.As she has been suffering from Vertigo and migraine associated vestibular problem for past 20 years, she was on medication of vertin,sibelium etc on and off.One of my friends suggested to consult a psychiatrist for sleep disorder. The doctor identified the problem as depression and prescribed nexito forte 10mg 1tab,Etizolam 0.5mg 1tab daily night.She has been taking this medication for the past 5 days.Now she complains of tiredness,sleeping in the day-time,dullness etc. She cannot do anything with interst.Pl suggest me whether she can continue with this treatment or do u suggest any other medication so that she may become normal
Brief Answer:
take only one tablet of nexito forte.
Detailed Answer:
Hello
Welcome to HCM.
I can understand your concerns for your wife.
You have mentioned that your wife has disturbed sleep, lack of interest and low appetite.
She has been taking treatment for vertigo and migraine.
I think the diagnosis of depression is appropriate in her case (keeping in mind her symptoms and assuming that the doctor must have evaluated her thoroughly).
She has been prescribed nexito forte (combination of escitalopram and clonazepam) and etizolam.
In my opinion, she should avoid etizolam.
Etizolam and clonazepam are both sleep inducing drugs.
As she is taking both drugs, this must be causing daytime sleepiness and dullness.
Antidepressants take at least 1-2 weeks to show their effect. It has been just 5 days for her on nexito forte. I would suggest you to wait for atleast 10 more days to see noticeable effect.
To sum up,
My advice would be to continue with 1 tablet of nexito forte every night and stop etizolam.
Kindly discuss this with her doctor.
Hope this helps.
Feel free to ask further if you have more doubts.
Take care.
Thanks.
take only one tablet of nexito forte.
Detailed Answer:
Hello
Welcome to HCM.
I can understand your concerns for your wife.
You have mentioned that your wife has disturbed sleep, lack of interest and low appetite.
She has been taking treatment for vertigo and migraine.
I think the diagnosis of depression is appropriate in her case (keeping in mind her symptoms and assuming that the doctor must have evaluated her thoroughly).
She has been prescribed nexito forte (combination of escitalopram and clonazepam) and etizolam.
In my opinion, she should avoid etizolam.
Etizolam and clonazepam are both sleep inducing drugs.
As she is taking both drugs, this must be causing daytime sleepiness and dullness.
Antidepressants take at least 1-2 weeks to show their effect. It has been just 5 days for her on nexito forte. I would suggest you to wait for atleast 10 more days to see noticeable effect.
To sum up,
My advice would be to continue with 1 tablet of nexito forte every night and stop etizolam.
Kindly discuss this with her doctor.
Hope this helps.
Feel free to ask further if you have more doubts.
Take care.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much for ur advice.I stopped giving Etizolam 0.5mg as suggested by you.But she did not sleep on that night.Hence,I gave her half a tablet of Etizolam.Then she slept after 3 A.M.She complaints of all the troubles associated troubles.Pl. suggest any life-modificatons that she has to undergo.Previously, she was a robust woman and now she avoids meeting people.Pl advice me.
Brief Answer:
practice some sleep hygiene habits.
Detailed Answer:
You are most welcome.
I can really understand how worried you must be, for your wife.
When the person is in depression, the most important thing is to give him medicines as prescribed.
I know you must be taking good care of her.
She could not sleep without etizolam.
Well, I am of the opinion that no two benzodiazepines (sleep inducing drug) should be given to a patient, until absolutely necessary.
If I would have been her treating psychiatrist, I would have prescribed her plain Nexito (not nexito forte) to be taken in morning.
Along with this, I would give her clonazepam separately, one tablet (ranging between 0.5mg-2mg, whatever dose suits her for sleeping) in night.
This strategy helps us to easily withdraw from habit forming drugs like clonazepam.
(Kindly discuss this with your doctor).
Apart from this, some lifestyle modification can help her:
1. Avoiding daytime naps.
2. Avoiding tea, coffee, heavy meals at bedtime.
3. Practicing deep breathing and meditation.
4. Adequate light exposure in daytime.
5. Drinking plenty of water, green vegetables and fruits.
Hope you find my suggestions of some help.
Feel free to ask further if you have more queries.
Take good care of her.
Thanks.
practice some sleep hygiene habits.
Detailed Answer:
You are most welcome.
I can really understand how worried you must be, for your wife.
When the person is in depression, the most important thing is to give him medicines as prescribed.
I know you must be taking good care of her.
She could not sleep without etizolam.
Well, I am of the opinion that no two benzodiazepines (sleep inducing drug) should be given to a patient, until absolutely necessary.
If I would have been her treating psychiatrist, I would have prescribed her plain Nexito (not nexito forte) to be taken in morning.
Along with this, I would give her clonazepam separately, one tablet (ranging between 0.5mg-2mg, whatever dose suits her for sleeping) in night.
This strategy helps us to easily withdraw from habit forming drugs like clonazepam.
(Kindly discuss this with your doctor).
Apart from this, some lifestyle modification can help her:
1. Avoiding daytime naps.
2. Avoiding tea, coffee, heavy meals at bedtime.
3. Practicing deep breathing and meditation.
4. Adequate light exposure in daytime.
5. Drinking plenty of water, green vegetables and fruits.
Hope you find my suggestions of some help.
Feel free to ask further if you have more queries.
Take good care of her.
Thanks.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Sir,
Thank you very much for ur kind suggestions.I discussed with my doctor about ur medications.But he asked me to continue with Nexito forte and Etizolam 0.5mg for 15 days.She has been taking these medications for the past 10 days since 3-8-15.There is slight improvement only.Yesterday night she did not sleep till early morning. Hence i had no other alternative but to give Anxit 0.25mg.Then she slept well.Sometimes she had sound sleep after taking Nexito forte and etizolam but on some other occasions she does not sleep.Is it necessary that one more combination of drug should be added or this drug is enough to achieve the desired result? Pl.give ur valuable advice.
Thank you very much for ur kind suggestions.I discussed with my doctor about ur medications.But he asked me to continue with Nexito forte and Etizolam 0.5mg for 15 days.She has been taking these medications for the past 10 days since 3-8-15.There is slight improvement only.Yesterday night she did not sleep till early morning. Hence i had no other alternative but to give Anxit 0.25mg.Then she slept well.Sometimes she had sound sleep after taking Nexito forte and etizolam but on some other occasions she does not sleep.Is it necessary that one more combination of drug should be added or this drug is enough to achieve the desired result? Pl.give ur valuable advice.
Brief Answer:
dose increment of escitalopram needed.
Detailed Answer:
Hi Sir.
Good to hear from you again.
Its unfortunate that your wife has still not improved with treatment.
As I told you earlier, that she should be taking plain nexito.
In my clinical experience, I have observed escitalopram (nexito) and other SSRIs can cause sleep disruption when taken in night.
That is why I prefer to give these drugs in morning.
Another disadvantage of giving nexito forte combination is you can not adjust the dose of individual drug.
If she has responded only slightly to these drugs in first 10 days (I expect a subjective 30-40% improvement in my patients in first 10 days), I would suggest a dose increment of escitalopram from 10mg to 20mg.
There is no problem in giving anxit on SOS basis, for sleep.
As soon as the sleep is restored, you can withdraw anxit.
If she does not respond/poorly respond to 20mg nexito in next 2 weeks, I would prefer to add a sedative antidepressant like mirtazapine for her. This will help her sleep as well provide broader antidepressant spectrum of action.
Kindly discuss this with your doctor.
Hope this helps.
Thanks.
dose increment of escitalopram needed.
Detailed Answer:
Hi Sir.
Good to hear from you again.
Its unfortunate that your wife has still not improved with treatment.
As I told you earlier, that she should be taking plain nexito.
In my clinical experience, I have observed escitalopram (nexito) and other SSRIs can cause sleep disruption when taken in night.
That is why I prefer to give these drugs in morning.
Another disadvantage of giving nexito forte combination is you can not adjust the dose of individual drug.
If she has responded only slightly to these drugs in first 10 days (I expect a subjective 30-40% improvement in my patients in first 10 days), I would suggest a dose increment of escitalopram from 10mg to 20mg.
There is no problem in giving anxit on SOS basis, for sleep.
As soon as the sleep is restored, you can withdraw anxit.
If she does not respond/poorly respond to 20mg nexito in next 2 weeks, I would prefer to add a sedative antidepressant like mirtazapine for her. This will help her sleep as well provide broader antidepressant spectrum of action.
Kindly discuss this with your doctor.
Hope this helps.
Thanks.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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