After a debilitating head injury 30 years ago, and as a result of serious depression from that event; 20mg Fluoxetine (originally Prozac) in the morning, and 25mg doxepin at night, which was essentially to promote sleep, were prescribed. Both meds have consistently been used & worked well. Since doxepin was recently removed from the market, nortriptyline replaced doxepin. After 3+ months on nortriptyline, this med has continuously caused serious sleep deprivation at night. The effects of poor sleep have been significant, including loss of balance. Checking at the pharmacy which supplied these meds, the pharmacist asked: for what main reason was doxepin prescribed? Was it for depression or to promote good night-time sleep, as the Fluoxetine should work successfully for 24 hours for depression. This is the reason for inquiring, and to confirm; how long should the effects of a 20mg Fluoxetine daily med last. Also, is there a better alternative for replacing doxepin without the side effect of disrupted night-time sleep?
Yes, the effects of fluoxetine last much longer than 24 hours so you do have an overlap in coverage.
As far as sleep aids you might want to ask your doctor about an atypical antidepressant like low dose Remeron (mirtazepine), an anti-psychotic such as Seroquel (quetiapine) used as a low dose to promote sleep, or the common anti-insomnia medications such as Lunesta or Ambien. There may also be some OTC remedies you could use.
There are actually many options so it's a question best addressed to your health care provider for professional advice.
Best regards and I hope you're sleeping well soon.
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