I've been getting a lot of these patients that no matter what, they cannot sleep. For a number of them, they have a diagnosis of PTSD and I have been just trying to give them Benadryl/Trazodone/Vistaril. Of course, this is of limited benefit. I have noticed that even Clonidine is not as sedating and I worry because it is not FDA approved for nightmares. Also, a lot of these patients want something PRN instead of scheduled so I worry about rebound Side effects with antihypertensives.
Of course I have them on their morning does of SSRI's which help with anxiety somewhat. However, I was wondering if anyone has had any luck with giving Doxepin or Mirtazapine at a low dose on PRN basis? It is my obligation to inform them about side effects and whenever I talk about possibility of serotonin syndrome, they are reluctant. Is it really that unsafe to give these two with an SSRI, though? Incidence of SS is quite low if i recall.
The other alternative is Seroquel, but I just don't like prescribing Neuroleptics to people (especially kiddos) without trying everything else.
Of course I have them on their morning does of SSRI's which help with anxiety somewhat. However, I was wondering if anyone has had any luck with giving Doxepin or Mirtazapine at a low dose on PRN basis? It is my obligation to inform them about side effects and whenever I talk about possibility of serotonin syndrome, they are reluctant. Is it really that unsafe to give these two with an SSRI, though? Incidence of SS is quite low if i recall.
The other alternative is Seroquel, but I just don't like prescribing Neuroleptics to people (especially kiddos) without trying everything else.