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Suggest Medication To Get Over Depression
Question: 1) Dear Doctor, down below was the earlier reply given by you. I hope you exactly understood my problem. What my present request is kindly suggest exact combination of medicines so that I can overcome depression/sad mood/mood swings etc. Also you suggest me that with the combination of another medicines we can gradually taper the rivotrol. I know this is most addictive medicine and also gives temporary result. NOW MY QUESTION IS KINDLY SUGGEST EXACT MEDICINE FOR DEPRESSION/SAD MOOD/MOOD SWINGS ETC AND COMBINATION WITH RIVOTRIL. Also Doctor I went to talking session, CBT, Hypnosis and all therapies (what not and what more). You can understand very well my present requirement is only medicines because I am doing physical exercises, breathing exercises etc. but in vain. NOW I WANT TO CONTINUE IN TOUCH WITH YOU AND DON'T WANT TO GO TO PSYCHIATRIST WHO IS PRESENTLY TREATING ME. SHE IS TELLING THAT I DON'T ANY SOLUTION YOU HAVE TO FIND OUT ANSWER FOR YOUR PROBLEMS AND SHE DON'T PRESCRIBE MEDICINES.
2) My earlier question:
Dear Doctor, I am suffering from Depression and Anxiety (Panic Attacks) since I was 3 years old. I am male and age 42 yrs working in Government of XXXXXXX My job is sedentary. First thing recently I am taking 4mg rivotril since 2003. Doctor has prescribed apart from this serta 150 mg and petra beta. But in vein. Then Doctor suggested for RTMS (Rapid Transcranial Magnetic Stimulator) for 20 sessions. First she tried for 10 sessions in the left brain for depression but does not work out. Next 20 sessions she tried for right brain for anxiety that too also not worked. Again Doctor has changed medication and prescribed Amixide H and paxidep 25 mg but in vein. Now Doctor want to take the councilling and after that it does not work out Doctor would like to prefer to petscan. Kindly tell me the solution please.
First thing I am feeling unknown sadness through out day. Second thing I feel Anxiety ( 3 types: one is freezing of jaws/pain in the jaws and unable to express facial expressions freely, unable to argue), third thing addiction of rivotril. Kindly suggest me what to do I want to come out of these problems.
Asked by Me , Fri, 20 Feb 2015
Doctor's reply to your question above...
Brief Answer:
Medicines from other chemical group should be used
3) Your detailed Answer:
Hello,
Thanks for writing to us.
You have been given sertraline and paroxetine (it is pexidep I think, not proxidep) for depression and rivotril, petra beta and amixide h for anxiety. RTMS has also been used. You are still suffering from sad mood, nervousness and lack of confidence(unable to argue).
In my opinion, anti depressant from other medicine group should be used. Sertraline and paroxetine both are SSRI. Desvenlafaxine, Mirtazapine (both SNRI) or bupropion (NRI) should be used in optimum dose for optimum period. If still no improvement, lithium, lamotrigine, quetiapine or aripirazole can be added considering resistant depression.
Other option is ECT(electro convulsive therapy).
Rivotril addiction can be treated with gradually decreasing the dose of the same with supporting medicines like lorazepam, etizolam or oxcarbazapine.
Counseling and behavior therapy are useful approach. you must go for the same. But I don't think that they will be effective without help of medicines at this stage.
PET scan is not at all indicated in my opinion. It will not be useful in treatment. Simple MRI brain is sufficient to rule out any neurological problem.
If your job is continue with this problem also, I think your disorder is not too much severe that it can not be treated. You just need to be given right treatment from right doctor.
Discuss above aspect with your treating psychiatrist and move forward.
Hope I have answered your query,I will be happy to help further.
Regards,
Dr.Chhintan Solanki.
Replied by Dr. XXXXXXX Solanki , Fri, 20 Feb 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
2) My earlier question:
Dear Doctor, I am suffering from Depression and Anxiety (Panic Attacks) since I was 3 years old. I am male and age 42 yrs working in Government of XXXXXXX My job is sedentary. First thing recently I am taking 4mg rivotril since 2003. Doctor has prescribed apart from this serta 150 mg and petra beta. But in vein. Then Doctor suggested for RTMS (Rapid Transcranial Magnetic Stimulator) for 20 sessions. First she tried for 10 sessions in the left brain for depression but does not work out. Next 20 sessions she tried for right brain for anxiety that too also not worked. Again Doctor has changed medication and prescribed Amixide H and paxidep 25 mg but in vein. Now Doctor want to take the councilling and after that it does not work out Doctor would like to prefer to petscan. Kindly tell me the solution please.
First thing I am feeling unknown sadness through out day. Second thing I feel Anxiety ( 3 types: one is freezing of jaws/pain in the jaws and unable to express facial expressions freely, unable to argue), third thing addiction of rivotril. Kindly suggest me what to do I want to come out of these problems.
Asked by Me , Fri, 20 Feb 2015
Doctor's reply to your question above...
Brief Answer:
Medicines from other chemical group should be used
3) Your detailed Answer:
Hello,
Thanks for writing to us.
You have been given sertraline and paroxetine (it is pexidep I think, not proxidep) for depression and rivotril, petra beta and amixide h for anxiety. RTMS has also been used. You are still suffering from sad mood, nervousness and lack of confidence(unable to argue).
In my opinion, anti depressant from other medicine group should be used. Sertraline and paroxetine both are SSRI. Desvenlafaxine, Mirtazapine (both SNRI) or bupropion (NRI) should be used in optimum dose for optimum period. If still no improvement, lithium, lamotrigine, quetiapine or aripirazole can be added considering resistant depression.
Other option is ECT(electro convulsive therapy).
Rivotril addiction can be treated with gradually decreasing the dose of the same with supporting medicines like lorazepam, etizolam or oxcarbazapine.
Counseling and behavior therapy are useful approach. you must go for the same. But I don't think that they will be effective without help of medicines at this stage.
PET scan is not at all indicated in my opinion. It will not be useful in treatment. Simple MRI brain is sufficient to rule out any neurological problem.
If your job is continue with this problem also, I think your disorder is not too much severe that it can not be treated. You just need to be given right treatment from right doctor.
Discuss above aspect with your treating psychiatrist and move forward.
Hope I have answered your query,I will be happy to help further.
Regards,
Dr.Chhintan Solanki.
Replied by Dr. XXXXXXX Solanki , Fri, 20 Feb 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Brief Answer:
Self motivation is very important here
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have very carefully gone through the entire query. Let me assure you that Dr. Chhintan Solanki had addressed the issue beautifully and I have been thinking on the same lines. If I had a patient like you, I would perhaps have suggested him to take Prodep 20 mg (fluoxetine) twice daily for at least 6 weeks and then would have followed up to evaluate the situation. You have already tried Serta (sertaline) and the next thing to resort to might be Lithium. But the blood levels of such a medicine needs careful monitoring and hence remaining under the follow up of a psychiatrist is important. You may visit a different psychiatrist and take his suggestions.
Another important intervention is that you need to try and mingle with people even though you might find it hard to. Be amongst friends and family. Try to live your life. Remove the monotony.
Let me know if I could be of further help.
Regards
Self motivation is very important here
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have very carefully gone through the entire query. Let me assure you that Dr. Chhintan Solanki had addressed the issue beautifully and I have been thinking on the same lines. If I had a patient like you, I would perhaps have suggested him to take Prodep 20 mg (fluoxetine) twice daily for at least 6 weeks and then would have followed up to evaluate the situation. You have already tried Serta (sertaline) and the next thing to resort to might be Lithium. But the blood levels of such a medicine needs careful monitoring and hence remaining under the follow up of a psychiatrist is important. You may visit a different psychiatrist and take his suggestions.
Another important intervention is that you need to try and mingle with people even though you might find it hard to. Be amongst friends and family. Try to live your life. Remove the monotony.
Let me know if I could be of further help.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor, Thanks for giving prompt reply. Doctor one thing I was introvert prior to coming to XXXXXXX (in 1998). After came to XXXXXXX I became extrovert and moving in and around people. I have lot of friends and go to each and every occasion. Wantedly I go and mix the people, occasions. So there is no problem at all. WHAT I WANT EXACTLY IS:
1) Is there any medicine which can control sad mood/ depression/ mood swings as it is hampering my day-to-day life (because I am skipping important events like reading for promotion exams etc). Especially it is creating problem at the family front. As my mood swings when I am with my family ( quarrel occurs with my wife). I AM TRYING MY LEVEL BEST TO MINGLE PEOPLE AND WE HAVE ASSOCIATIONS ETC. BUT MY QUESTION IS KINDLY SUGGEST MEDICINE TO BALANCE MY MOOD LEVELS.
2) SECOND PROBLEM IS FREEZING OF FACE DURING SOCIAL AND NOM-SOCIAL ACTIVITIES. IT HAPPENS WITH KNOWN AND UNKNOWN PEOPLE. SYMPTOMMS ARE FREEZING OF FACE, FREEZING OF JAWS, PAIN IN THE JAWS, UNABLE TO EXPLAIN FACIAL EXPRESSIONS FREELY. KINDLY SUGGWEST ANY SUITABLE MEDICINES WHICH CAN CONTROL THESE SYMPTOMS.
3) AS FAR AS THIRD QUESTION IS CONCERNED KINDLY TELL ME SHALL I CONTINUE RIVOTROL 2 MG OR I TAPER GRADUALLY ALONG WITH OTHER MEDICINE.
WAITING FOR YOUR EARLY ANSWER PLEASE.
1) Is there any medicine which can control sad mood/ depression/ mood swings as it is hampering my day-to-day life (because I am skipping important events like reading for promotion exams etc). Especially it is creating problem at the family front. As my mood swings when I am with my family ( quarrel occurs with my wife). I AM TRYING MY LEVEL BEST TO MINGLE PEOPLE AND WE HAVE ASSOCIATIONS ETC. BUT MY QUESTION IS KINDLY SUGGEST MEDICINE TO BALANCE MY MOOD LEVELS.
2) SECOND PROBLEM IS FREEZING OF FACE DURING SOCIAL AND NOM-SOCIAL ACTIVITIES. IT HAPPENS WITH KNOWN AND UNKNOWN PEOPLE. SYMPTOMMS ARE FREEZING OF FACE, FREEZING OF JAWS, PAIN IN THE JAWS, UNABLE TO EXPLAIN FACIAL EXPRESSIONS FREELY. KINDLY SUGGWEST ANY SUITABLE MEDICINES WHICH CAN CONTROL THESE SYMPTOMS.
3) AS FAR AS THIRD QUESTION IS CONCERNED KINDLY TELL ME SHALL I CONTINUE RIVOTROL 2 MG OR I TAPER GRADUALLY ALONG WITH OTHER MEDICINE.
WAITING FOR YOUR EARLY ANSWER PLEASE.
Brief Answer:
Try to involve family and friends
Detailed Answer:
Thanks for writing back and thanks for the clarifications provided.
1) I have already mentioned that in a case like yours, Prodep might be right to be taken. That should help in balancing the mood levels. But self motivation simultaneously has a major role to play.
2) There are no suitable medicines that would help with the freezing of face issue. The best solution is to try and relax. Relaxation is the key. Meditation and yoga may help.
3) It would definitely be preferable to taper off rivotril.
Regards
Try to involve family and friends
Detailed Answer:
Thanks for writing back and thanks for the clarifications provided.
1) I have already mentioned that in a case like yours, Prodep might be right to be taken. That should help in balancing the mood levels. But self motivation simultaneously has a major role to play.
2) There are no suitable medicines that would help with the freezing of face issue. The best solution is to try and relax. Relaxation is the key. Meditation and yoga may help.
3) It would definitely be preferable to taper off rivotril.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor, my final question: Dr. XXXXXXX XXXXXXX suggested me to take
1) Rivotril 2 mg along with Pacitane 2 mg to overcome Anxeity (particularly for stiffness in the face etc.)
2) Also for moodswings Doctor suggested me to go for Divoloproex Sodium Extended Release Tablets i.e. Desvaler 500 mg for mood swings. My Psychiatrist advised me to take PAXIDEP CR -25 mg (But Dr. XXXXXXX XXXXXXX told me that freezing in the face is occuring due to this tablet because of extraperamidal effect).
3) Finally please tell me for mood swings along with Prodep shall I take Divoloproex Sodium Extended Release or Paxidep CR 25 and for Anxiety I will take Rivotrol 2mg along with Pacitane 2 mg with self development. Is it OK doctor. If so I will continue to take these tablets and develop myself by doing exercises, yoga, pranayam, walking, proper diet, sound sleep and self development. KINDLY SUGGEST FINAL ANSWER PLEASE AS EARLY AS POSSIBLE SO THAT I WANT TO CLOSE THE DISCUSSION WITHOUT GIVING YOU ANY TROUBLE.
4) ALSO DR. KINDLY SUGGEST ME ANY HOMEOPATHY AND AYURVEDIC MEDICINES HELP ME TO OVERCOME THESE PROBLEMS.
1) Rivotril 2 mg along with Pacitane 2 mg to overcome Anxeity (particularly for stiffness in the face etc.)
2) Also for moodswings Doctor suggested me to go for Divoloproex Sodium Extended Release Tablets i.e. Desvaler 500 mg for mood swings. My Psychiatrist advised me to take PAXIDEP CR -25 mg (But Dr. XXXXXXX XXXXXXX told me that freezing in the face is occuring due to this tablet because of extraperamidal effect).
3) Finally please tell me for mood swings along with Prodep shall I take Divoloproex Sodium Extended Release or Paxidep CR 25 and for Anxiety I will take Rivotrol 2mg along with Pacitane 2 mg with self development. Is it OK doctor. If so I will continue to take these tablets and develop myself by doing exercises, yoga, pranayam, walking, proper diet, sound sleep and self development. KINDLY SUGGEST FINAL ANSWER PLEASE AS EARLY AS POSSIBLE SO THAT I WANT TO CLOSE THE DISCUSSION WITHOUT GIVING YOU ANY TROUBLE.
4) ALSO DR. KINDLY SUGGEST ME ANY HOMEOPATHY AND AYURVEDIC MEDICINES HELP ME TO OVERCOME THESE PROBLEMS.
Brief Answer:
I would not suggest you to go for homeopathy or ayurved in this regard
Detailed Answer:
Thanks for writing back. Sorry for not being able to respond earlier.
1) Prodep should take care of your anxiety. Till then you can try Pacitane.
2) Continue to take Divalproate sodium extended release tablets. It is important. Prodep is an alternative to Paxidep (paroxetine) and so you need not take the latter if you decide to take Prodep.
3) Continue these medications along with self development measures like exercises, yoga, pranayam, walking and proper diet along with sound sleep.
4) I cannot suggest you any ayurvedic or homeopathy medicines. We are not trained in these fields. But my personal suggestion would be not to go for these branches of medicines with respect to the ailment mentioned.
Regards
I would not suggest you to go for homeopathy or ayurved in this regard
Detailed Answer:
Thanks for writing back. Sorry for not being able to respond earlier.
1) Prodep should take care of your anxiety. Till then you can try Pacitane.
2) Continue to take Divalproate sodium extended release tablets. It is important. Prodep is an alternative to Paxidep (paroxetine) and so you need not take the latter if you decide to take Prodep.
3) Continue these medications along with self development measures like exercises, yoga, pranayam, walking and proper diet along with sound sleep.
4) I cannot suggest you any ayurvedic or homeopathy medicines. We are not trained in these fields. But my personal suggestion would be not to go for these branches of medicines with respect to the ailment mentioned.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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