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Suggest Medication For Depressive Disorder

Posted on Tue, 25 Apr 2017

Question: Need an advise from a psychiatrist

Answered by Dr. Seikhoo Bishnoi (32 minutes later)

Brief Answer:
Antipsychotics can be added to her prescription

Detailed Answer:
Hello thanks for asking from HCM.

I can understand your concern. A lot of individuals with depressive disorder who fail to respond to one SSRI show response to other SSRI drug. Fluoxetine failed to act and Citalopram caused sedation.

Coming straight to the doubts.

- TCA drugs can be tried. Amitriptyline or CLomipramin can help in her case. But both drugs cause sedation and weight gain.

- Yes atypical antipsychotics like Olanzapine or Risperidone or Aripiprazole or Lurasidone etc can be used. Aripiprazole can be used and will augment the actions of antidepressants. Addition of antipsychotics help to reduce symptoms in resistant depression.

- Anxiolytics like Vilazodone or Vortioxetine etc can be tried. These are newer drugs and should help her. Addition of antipsychotics will augment her actions.

Thanks and Take care.

If you have more doubts for her management you are welcome to ask in follow up.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Seikhoo Bishnoi (41 minutes later)

Thanks
For reply

Pl let me know the
1. Usual Starting doses of the newer anxiolytics
2. The basic dose of commonly used antipsychotics in these cases
3. And starting dose of tricyclics

This is only just to have an idea from you
We are going to visit a psychiatrist and take a prescription proper

Answered by Dr. Seikhoo Bishnoi (7 hours later)

Brief Answer:
Vilazodone can be started in dose of 20 mg

Detailed Answer:
Hello again

- Vilazodone can be used. Starting dose is 20 mg in morning after breakfast. In 2 weeks dose can be increased to 40 mg.

- Lurasidone can be used in dose of 40 mg.

- Clomipramine can be started in dose of 25 mg in night after dinner. Dose can be increased to 50 mg after a week then to 75-100 mg depending upon response. The drug will help in sound sleep and will control the symptoms.

Either Vilazodone is started or Clomipramine. In my opinion, please avoid using both these drugs.

Take proper prescription of the drugs.

Thanks. Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (3 hours later)

A. Vilazadone is an anxiolytic but should not be combined with tricyclics you say ?

And other questions
I .She is already on bupyropion 75 mg per day
Can she take tricyclics now?

2. She feels that the anxiousness is due to bupyropion
And also doesn't want to stop it abruptly
What is your advise regarding this ?

3. We came to know that some patients can develop drastic withdrawal after bupyropion
Which she did initially
Then she developed a massive weight gain and thereby triggering another massive anxiety attack

4. Now she has 75 mg of bupyropion in her blood
Can this dose trigger anxiety attacks as side effects ?
Please aler the above doubts

5. We live in Canada
Can we do a skype or ga e time consultation with you ?
And we will pay you

6. I wonder if we take a prescription from you will they give us the drugs 'here'

7. Where do u practice ?

Thank you

Answered by Dr. Seikhoo Bishnoi (9 hours later)

Brief Answer:
Bupropion is relative safe and easy to stop

Detailed Answer:
Hello thanks for asking again

1) Yes if she is taking Bupropion she can take Tricyclic drugs without worries.

2) Bupropion 75 mg dose is not a high dose. The drug cause minimal or no withdrawal symptoms. So this can be stopped without any tapering. No need to worry.

3) In my opinion Bupropion withdrawal doesn't cause much symptoms. Stopping 75 mg dose which is a low dose would cause very less symptoms. Slight nausea or vomiting might occur.

4) No Bupropion will not trigger anxiety. The drug infact helps to augment the actions of other drugs.

5) Yes real time consultation is possible but you have to contact healthcaremagic.com customer care for that.

6) 7) I am a Assistant Professor in Psychiatry in a medical college in XXXXXXX Due to legal control its not possible to prescribe drugs online. I don't think they will give you drugs. But you can visit a GP and ask for prescription if he/she agrees.

Thanks. You are welcome to ask follow up doubts.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar