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Taking Szetalo And Mirtaz For Mood Disorder, Depression And Morning Sickness. Feel Weak, Have Blank Looks.

Posted on Mon, 2 Sep 2013

Question: I m XXXXXXX XXXXXXX female 50 years .I M taking following medicines for my mood disorder,deppression,no feelings,cold attitude,no appetite,sometimes in morning feels like nauseating,dont want any physical activities,no XXXXXXX on any news,blank looks,etc.Taking SZETALO 10 mg 1.5 tab nd MIRTAZ 7.5 mg 1 tablet nd Lonazep .25 mg thrice a day for 30 days.plz suggest nd regards mail id is YYYY@YYYY

Answered by Dr. Susanta Padhy (32 minutes later)

Hi

Thanks for the query.

It seems the depression is still prevailing and is not controlled with the medications prescribed. Depression are of two types: unipolar and bipolar

You say that you have bipolar depression. In bipolar depression the main drug is mood stabiliser. Antidepressants (Eszitalo and mirtaz you are taking) are of added value during depressive phase.

Mirtaz at low dose act more as sedative less as antidepressant. Moreover, standard treatment (evidence based) is that, first, one need to try with one antidepressant at adequate dose for a reasonable period of 4-6 weeks, and see for response, before adding second antidepressant.

Ask your doctor why not to increase the dose of one to the maximum that suits your physical profile. If not he can add the next. You can discuss all these issues with your doctor. But, it is of utmost importance for you to remain in regular follow up with a psychiatrist, with whom you are comfortable with. Because one of the complication of bipolar depression is suicide.

I am available for further discussion.

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

Follow up: Dr. Susanta Padhy (1 hour later)

Sir..I understand that we should XXXXXXX local psychatrist but I am not satisfied with the treatment and medications given here.this is XXXXXXX XXXXXXX son of XXXXXXX XXXXXXX .she wants to be perfect asap..during day time she feels restless and during night she is unable to sleep peacefully..kindly suggest some medications for her which we can give to her to treat her at the earliest as it is been more than a year she is under depression

Answered by Dr. Susanta Padhy (1 hour later)

Feeling restlessness in day time may be symptom of akathisia. If so, akathisia should respond to drugs like propranolol. Once akathisia improves, she will have better night sleep

I would think, one possible reason of non-improvement of depression could be because she is no o any mood stabilizer

Other reasons for non-improvement of depression could be if she is not taking regular medication as advised by your psychiatrist. Regular medication means at least for 2 months. Alternatively, you should test "thyroid hormone level" and treat adequately any other medical condition, if she has.

Hope this helps

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

Follow up: Dr. Susanta Padhy (17 minutes later)

Kindly u suggest the medicine we should start from the initial level.plz tell us what all medicines should be taken at this point of time

Answered by Dr. Susanta Padhy (3 hours later)

If I go by your doctor's diagnosis of bipolar disorder with currently in depressive episode, then a mood stabiliser like lithium / valproate / carbamazepine along with a SSRI group of antidepressant like Escitalopram / sertraline / fluoxetine with or without propranolol / benzodiazepine would be helpful

Nonetheless, I must insist to not treat with medication on your own. Because Bipolar disorder, if treated properly, is quite controllable. If not adequately treated, it can recur frequently and will be complicated and difficult to treat

If you are not satisfied with your current psychiatrist, then you can take second opinion from another psychiatrist. Or else, NIMHANS, Bangalore; AIIMS, Delhi, IHBAS, Delhi, or PGIMER, Chandigarh, CIP, Ranchi may be the better and ideal hospital, where you can take a second opinion. Finalize the diagnosis and medication selection. I am not able to view your location.

Treating bipolar disorder is not like treating any infection or diabetes or hypertension, please, it has to be treated judiciously, for long term betterment of our patients.

Wish you good luck

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Susanta Padhy (20 hours later)

As per ur suggestion today we visited local psychatrist and he suggested following medicines -
1)cetalina s- one tab during noon
2)depilox 100- one tab at night
3)destyu er 50- one tab at night
4)dizox 10-one tab at might(SOS)
Is these medicines correct for her.kindly suggest what to do

Answered by Dr. Susanta Padhy (42 minutes later)

Brief Answer:
Seems partly correct

Detailed Answer:
Can you clarify where is your patient staying ?

Composition of Cetaline s, destyu er 50 and I do not know, could be some local company medicine. You can tell me the composition looking at the medicine strip so that I can give my opinion

Dizox contains chlorozoxazone, a muscle relaxant, may be she might have some spasm

Depilox contains Asenapine, a newer antipsychotic. It wold be useful, if your client had psychotic depression

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Susanta Padhy (2 hours later)

We are from Ranchi

we are giving her following medicines now after discussing with local doctor -
1)one tab zapiz .25 mg during day
2)one tab valproate cr 200mg during noon
3)one tab Zapiz .5 mg during night

What else to be done

Answered by Dr. Susanta Padhy (10 hours later)

Brief Answer:
Seems reasonable treatment

Detailed Answer:

I am happy with this type of treatment. If you are not satisfied with the current psychiatrist, you can take second opinin from CIP (Central Institute of Psychiatry), Kanke, Ranchi

It is important to have faith and confidence in your treating psychiatrist, for betterment of the client because this factor will give care givers at peace, motivate patient and family members to continue medication for a long time etc

I am available for further discussion, if any

Best of luck

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

Above answer was peer-reviewed by : Dr. Prasad