Dear Dr. Roach: I need your advice on a new prescription my primary doctor has given me; it鈥檚 called trazodone, 50 milligrams. I听have mild anxiety and trouble staying asleep at night.
I鈥檝e had these pills for almost two weeks and I鈥檓 leery of taking them; I听really am concerned about the side-effects. Plus, I really am more concerned about the anxiety than not sleeping. There are over-the-counter pills for that. My pharmacist told me these pills are more for sleeping; I really want something that is more for my mood.
K.V.
There are many medications for anxiety and for sleeping and the particular choice depends on many factors.
The Food and Drug Administration鈥檚 indication for trazodone is for treatment of depression; however, many doctors use it 鈥渙ff label鈥� (meaning, without an FDA-approved indication) for sleep disturbance. It is particularly used for sleep disturbance because it is one of the few medications that increase the time spent in higher-quality sleep (REM sleep and deep, restorative sleep). Most other sleep medications, especially the over-the-counter ones, reduce sleep quality. This leads some people to feel exhausted when they wake up from a sleep induced by diphenhydramine (the usual ingredient in OTC sleep aids).
I have often warned against the frequent use of听sleep aids because of the听fall risk and sedation and driving risk associated with habitual use. It may be that your doctor feels that improving your sleep may help treat your anxiety. I more often have prescribed the other way: Treating anxiety often improves sleep. Anxiety can be treated with therapy, or with medications like sertraline (Zoloft) or citalopram (Celexa). Your preferences are critical to success: Go back to听your primary doctor and听discuss treating the anxiety.
听
Dear Dr. Roach: I am a 54-year-old man, married for 33 years. My health is excellent and I take no medications. My recent annual exam checked out fine 鈥� I have never smoked, don鈥檛 drink alcohol and exercise regularly.
My problem is that I am having trouble maintaining an erection firm enough for听sex. I still am able to, but it takes a lot of effort and it is easier to avoid sex than to deal with the听frustration and embarrassment. Any advice you could give me would be appreciated.
R.P.
Male sexual troubles are very common, and can occur with or without other medical illness. However, a new diagnosis of erectile dysfunction should be considered a warning that there might be a problem in any of the systems needed for normal sexual function: cardiovascular, endocrine and neurologic.
Given your young age and good health, none of these is likely, but it certainly is worth a discussion with your doctor. A careful doctor will do a thorough history and exam, and might check some blood levels, like testosterone and听prolactin, and even consider looking for blocked blood vessels if you听have risks.
It is easy to prescribe a medicine like sildenafil (Viagra), but it鈥檚 harder (and necessary, in my opinion) to consider that this might be the presentation of a serious condition.
Finally, you have been married a long time. Sexual troubles sometimes indicate underlying relationship problems. As you note, they also can cause stress. I hope you are confident enough in your relationship with your wife that you can discuss this issue openly. It can be tough to talk about, but I think you will feel better if you do.
Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may听email questions to [email protected]
