Q. Kindly suggest a medicine for my sleep issue.



Hi doctor,

I have been suffering from depression and anxiety since 10 years. I went to a psychiatrist and he prescribed too many medicines, which made matters worse. My family doctor has put me on Mirtaz 7.5 and due to severe problems of falling asleep I am on Zolfresh 10. My depression is a little better as it has been 15 days, but still I am not being able to fall asleep. We have tried having the medicine earlier in the night so I sleep on time, but it does not help. I face erections problems too. Kindly suggest a medicine that works well with Mirtaz for falling asleep.





Welcome to dr.sitehome.info.

A number of issues need to be addressed here.

  • Before we talk about medicines, it is important to give much attention to sleep hygiene as your medications.
  • Regarding the medicines, Zolfresh (Zolpidem) is a medicine that has a short duration of action and starts working immediately.
  • A key condition for Zolfresh to work well is that you lie down soon after you take it. In other words, you should take it no earlier than 5 to 10 minutes before your sleeping time.
  • On the contrary, Mirtaz (Mirtazapine) acts after a time lag and has a relatively long duration of action. So, you need to take it a good two to three hours before your sleeping time.
  • So, if all the above aspects have been taken care of, the next step would be to increase the dose of Mirtazapine.
  • You are currently on the least available dose of Mirtazapine. You can try increasing it to 15 or 30. Remember that the maximum dose of Mirtaz is 60 mg per day. Consult your specialist doctor, discuss with him or her and get the dose altered.
  • Your daytime sleepiness may be related to two things.
  1. Inadequate sleep at night.
  2. Continuing effects of Mirtazapine into the day.
  • Since you are having problems with sleeping at night, I would assume that predominantly it is the scenario one. I would suggest you stop Armod (Armodafinil) 150 for the time being and get your sleep back on track with these measures.
  • Pay special attention to the sleep hygiene points. You will also need to get a serum TSH and hemogram done.
  • As far as erectile difficulties are concerned, with the above measures some improvement is expected because psychological well being is closely related to erectile function. Once the sleep and depression issues are sorted out and the erectile problem still persists, then we can look into it.

  • Investigations to be done:

    Serum TSH (thyroid-stimulating hormone) and hemogram.

  • Probable diagnosis:

    Depression with insomnia.

  • Treatment plan:

    Mirtazapine and Zolpidem 10 mg with careful instructions.

  • Preventive measures:

    Sleep hygiene.

  • Regarding follow up:

    Revert back after a week to a psychiatrist online.—> https://www.dr.sitehome.info/ask-a-doctor-online/psychiatrist

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