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Insomnia and depression

Feb 8, 2005

Dear Doc,

I'm on Remeron to treat my Sustiva depression (Nevirapine is not an option anymore, because it raised my liver enzime up to the roof!). But I'm experiencing insomnia. Do you know any treatment for depression induced by sustiva that does not cause insomnia? I'm willing to try anything, from the start. Thanks

Response from Dr. Horwath

Remeron is an excellent choice of antidepressant if you are suffering from insomnia. Other good antidepressant that help with insomnia are amitriptyline (Elavil) and doxepin (Sinequan).

Trazodone is often used at doses of 50 mg to 200 mg for insomnia. Although it is an antidepressant, this dose range is usually sub-therapeutic for depression, but helps with insomnia. If used in this way, it needs to be combined with another antidepressant to be effective. Trazodone is often used in combination with SSRI's (like Zoloft, Lexapro, etc.) because SSRI's are usually not helpful with insomnia (in fact, they may cause it in some cases).

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