From the Research
The patient should discontinue Trazodone due to its hangover effects and consider switching to melatonin 3-5mg at bedtime, as it has been shown to improve sleep quality with minimal side effects, according to a recent study 1. For depression, consider starting an antidepressant such as sertraline (Zoloft) 50mg daily, increasing to 100mg after two weeks if tolerated. Regarding Clonazepam, establish a consistent schedule for nighttime use only at 1mg to avoid daytime sedation and preserve its effectiveness for sleep. Additionally, implement sleep hygiene practices including consistent bedtime routines, limiting screen time before bed, and creating a dark, quiet sleep environment. Consider adjusting work schedule if possible to establish more regular sleep patterns. Regular therapy sessions focusing on coping strategies for work stress and family concerns would be beneficial. The patient should follow up in 2-3 weeks to assess medication effectiveness and side effects. This approach addresses both the neurochemical imbalances contributing to depression and the practical aspects of improving sleep quality while managing life stressors, as supported by studies on sleep disturbances in depression 2 and the impact of methylphenidate on sleep problems in adults with ADHD 3. Melatonin has been shown to be a safer alternative to other sleep medications, with fewer side effects, as highlighted in a review of sleep disorders and melatonin 4. It is essential to prioritize the patient's sleep quality, as sleep disturbances can exacerbate depression and ADHD symptoms, and melatonin has been found to be effective in improving sleep quality with minimal adverse effects, as demonstrated in a study comparing the use of melatonin, trazodone, and doxepin for sleep disorders 1.