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Suggest Treatment For Anxiety And Depression
Question: Hi Dr. In May of this year i suffered a severe episode of anxiety for which i was prescribed diazepam which i haven't taken for a few months. I had suffered from anxiety in the past and had been prescribed citalopram, which had worked. However this time i was still on the Citallopram when the anxiety struck. At the time of the episode i was already taking 40mg of Citalopram daily. In July i was moved to Venlafxine MR and a mirtazapine 15mg (at night). My dosage of Venlafaxine has been upped over the last few months to 225mg which i have been on for 3 months. I am attending cbt sessions fortnightly and have monthly checkins with psychiatrist. At some point in the last 4 months the anxiety has morphed in depression and have noticeably become withdrawn and feel even worse than i ever thought possible. I dont drink or smoke. My psychiatrist has suggested upping the dosage to 300mg (which is the highest they go to in the uk), can this uplift make any difference? given that i am feeling this bad? Do you haver any suggestions that i can talk to my psychiatrist about?
Brief Answer:
can add lamotrigine/Thyroid/lithium or quiteapine
Detailed Answer:
Hello,
Your case needs some special attention. I have read the query carefully and can see that citalopram and venalafaxine both are almost not effective anymore. As per my opinion the hike in venalafaxine wont bring any better results; but for now you may do that till we start somehing else and get some basic tests done.
Treatment resisitant or acute relapse of anxiety can be managed with -
1. Addition of lamotrigine or even thyroid hormone. The only precaution is taking care of rash due to lamotrigine. Most cases respond to this regimn.
We also go for adding lithium. This is cheaper alernative and widely studied and quite an old method.
2. Many times I have successfully used quiteapine in managing anxiety. This even takes care of night time sleep as it has some sedative action as well.
3. Do get your thyroid levels checked and correct if they are disturbed. Thyroid disorders are commonly associated with depression and anxiety. Correcting it helps a lot.
4. Another important test is of serum Vit. B12. Get it tested and if found low : take supplements. This alone can bring 10-30% relief in anxiety.
5. Check your diet and go for more green salads and vegeteranian diet if possible. Include nuts (walnuts) in daily diet and one bowl of sprouts. These are natural sources of -happy hormones.
6. It is quite common to have or develop depression in long standing anxiety disorder; so dont worry a lot. Both of them will show response to same drug.
7. Please learn JPMR- a relaxation exercise. This is very helpful even in managing most severe anxiety cases.
I have tried to provide several possible options to handle your case. Do let me know if you have anything more to discuss.
P.S. please tell me if there is a famiy history of any psychiatric illness or there is a current or chronic stressor?
Wish you a speedy recovery.
Dr. Manisha Gopal.
MD Neuropsychiatry
can add lamotrigine/Thyroid/lithium or quiteapine
Detailed Answer:
Hello,
Your case needs some special attention. I have read the query carefully and can see that citalopram and venalafaxine both are almost not effective anymore. As per my opinion the hike in venalafaxine wont bring any better results; but for now you may do that till we start somehing else and get some basic tests done.
Treatment resisitant or acute relapse of anxiety can be managed with -
1. Addition of lamotrigine or even thyroid hormone. The only precaution is taking care of rash due to lamotrigine. Most cases respond to this regimn.
We also go for adding lithium. This is cheaper alernative and widely studied and quite an old method.
2. Many times I have successfully used quiteapine in managing anxiety. This even takes care of night time sleep as it has some sedative action as well.
3. Do get your thyroid levels checked and correct if they are disturbed. Thyroid disorders are commonly associated with depression and anxiety. Correcting it helps a lot.
4. Another important test is of serum Vit. B12. Get it tested and if found low : take supplements. This alone can bring 10-30% relief in anxiety.
5. Check your diet and go for more green salads and vegeteranian diet if possible. Include nuts (walnuts) in daily diet and one bowl of sprouts. These are natural sources of -happy hormones.
6. It is quite common to have or develop depression in long standing anxiety disorder; so dont worry a lot. Both of them will show response to same drug.
7. Please learn JPMR- a relaxation exercise. This is very helpful even in managing most severe anxiety cases.
I have tried to provide several possible options to handle your case. Do let me know if you have anything more to discuss.
P.S. please tell me if there is a famiy history of any psychiatric illness or there is a current or chronic stressor?
Wish you a speedy recovery.
Dr. Manisha Gopal.
MD Neuropsychiatry
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Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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