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What Is The Treatment For Depression,anxiety,mood Swings And Suspicious Nature?

Posted on Tue, 14 Jan 2014

Question: My 54 year old has always had a history of being overly sensitive. She has some mood changes, and can become angry easily, and then calms down again. It seems to have worsened since she got into her 50s. She is easily offended and is somewhat overly suspicious (or what I call mildly paranoid) of the intentions of others, including myself, ans some low self-esteem based on her limitations related to osteoarthritis in her fingers (which she often hides to prevent others from seeing her hands). I have suggested that she consult her physician to discuss a mild anti-depressant, but she is reluctant to do so. She also has had a behavior of what I would call mild dermatilomania by obsessing about pimples on her face whenever she feels especially anxious, which of course enrages me. This practice has also worsened since she got into her 50s. Thank you.

Answered by Dr. Manisha Gopal (5 hours later)

Brief Answer: surely, she can be helped greatly with medicines Detailed Answer: Hello XXXXXXX welcome to HCM! I have read your question carefully and appreciate your concern about your family. From the details you have provided in the question-- patient has always been sensitive by nature, easily provoked to anger and irritability, and is somewhat suspicious.: all these reflect that she is depressed and anxious, with suspiciousness towards others , mainly family and close ones. The points that she has rheumatoid arthritis like symptoms which have disfigured her hands and she keeps them covered: lead to increase in depression and low self esteem, reduced public interaction--> increasing suspicious nature of the patients. intense concern about her pimples is also related to her anxious nature and (sometimes aggravated by suspiciousness- psychosis). It is very common that such people do not seek out help, even when under lot of stress. As you have said that complaints increased after she turned 50 years, also can be related to menopause hormonal problems, which aggravate already lying psychiatric disorder in patients. I think that she has a personality disorder- may be paranoid type with depression and some anxiety. It is seen that such people respond nicely to treatment, but the response to their basic nature-- sensitivetiy and suspiciousness is upto a certain limit only. The aggression responds easily and patients is more calmer within few days of treatment. Treatment is usually for long time in such people and may continue for life ( at the lowest possible effective dosage) --- but certainly helps. I have seen and treated personality disorders, and am very hopeful for this patient too. She will also feel the decrease in her irritation and get mental peace with medicines.( this is reported by patients themselves after about a month of treatment). Before giving drugs, it is good to get her vitals and basic tests done- routine blood test, thyroid profile. It is nowhere mentioned that patient is hypertensive or diabetic, so, I think she can be given any medicine for her problems, appropriate for her age. One has to meet the psychiatrist and get tests and at least once interview the patient in person. Psychiatric drugs are better started with proper prescription , especially when treatment is expected to be long standing. If she does not want to go, the doctor can be called home in one of her rages and the drugs can be stared.( initially may be given in food- hidden) and later with improvement, it is seen that patient usually accepts medicines willfully. I have found from my clinical experience that drugs like --resperidone or quetiapine or amisulperide show good results and are safe for her age. Hope the reply is useful and you can help your family with it feel free to ask more related questions Dr. Manisha Gopal

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Manisha Gopal (20 hours later)

Thank you kindly for your response. Please tell us your opinion of luvox and any side effects of it or the other medications you mentioned. Also what are the doses to start with for people in this situation? Especially if one wants to start based on a mild case?

Answered by Dr. Manisha Gopal (4 hours later)

Brief Answer: Amisulpride/ quetiapine are better for her Detailed Answer: Hello XXXXXXX welcome to HCM! I appreciate the efforts you are putting up for your family. You have asked of Luvox ( fluvoxamine) is a good option or not? I can say that the case history told by you suggest that fluvoxamine is not that suitable. you have not mentioned how you concluded to go for it? Did she meet any doctor? The patients is overly sensitive, with some suspiciousness in nature. Had i been treating her, I would go for something like quetiapine or amisulperide in her case. fluvoxamine will not help her suspiciousness or sensitivity. Quetiapine can lead to sedation, but this effect weans off with time, and moreover may help patients in becoming more calm. One may give it in early evening hours to handle the side effect. Amisulpride usually does not pose and sedation problem, slow but effective molecule. I start with like 25-50 mg twice a day. One needs basic test to start these tablets, like BP, Sugar, lipid, thyroid, liver and kidney test. The medicine will be required for a substantial amount of time, like atleast an year or so. The effect usually start showing within two weeks of starting medicines. Patient's sensitivity will reduce, and the flares up will also stop, the suspiciousness will take long time to go... Hope the reply is useful, get the tests beforehand. feel free to ask more queries regarding the same. Dr. Manisha Gopal

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

Follow up: Dr. Manisha Gopal (12 minutes later)

Thank you again. No, she has not spoken to any doctor yet about these issues, and as you may be aware, sometimes there is a stigma associated with consultation with a psychiatric physician which needs to be overcome.

Follow up: Dr. Manisha Gopal (2 minutes later)

Also, would either of these replace the need for Ambien at bedtime, which my wife takes??

Follow up: Dr. Manisha Gopal (5 minutes later)

She has a friend who has used Cymbalta and as a non-professional recommended it to my wife......

Answered by Dr. Manisha Gopal (54 minutes later)

Brief Answer: Symbalta will not help her much. Detailed Answer: hello XXXXXXX I have read your follow up questions. Your wife takes ambien at night for sleep, and also takes tramadol and NSAID for pain. 1. I think you should talk to your doctor regarding use if tramadol, as this may increase the problem in your wife if used regularly, (it is an opoid). Try using other medicines for pain if possible. 2. I know that here is stigma attached to psychiatric disorders, but just asking a frind or relative about the treatment can do more harm. Psychiatric illness increase only because people feel shame. I sometimes advice my patients to tell that they have sleeping issues or headache for which they visit psychiatrist, in this way they feel more comfortable handling public questions. you may also try it. moreover, what all talk happens between you and the doctor is strictly confidential, not revealed lead to anyone. 3. There are many symptoms of psychiatric illnesses which are similar in so many disorders, like sleep problem, sensitivity to criticism, lethargy , irritability. But only a qualified expert can diagnose the disorder of one patient correctly. People mistakenly think that same medicine will be effective on the basis of few symptoms only, which is wrong. 4. I find such cases doing well with Amisulpride or quetiapine, in my clinical practice. With quetiapine, the need for any sedative at bedtime is also reduced!, as this itself causes sedation in patients. So, it gives an added benefit over amisulpride. The dose is escalated after two- three weeks after seeing the response. I usually start with 25- 50 mg night , then increase as required, after monitoring the response. some patient may need higher dose in the begining itself , like 100-200 mg. Varies form patient to patient body responses. ## Symbalta- is used for other disorders, like sadness/ anxiety/stress, ect. Both of these are good drugs, any psychiatrist will be aware of them, they are safe for females and used frequently now a days. Hope the clears your doubts. Feel free to ask more question Dr. Manisha Gopal

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

Follow up: Dr. Manisha Gopal (4 hours later)

Thank you again. Is tramadol a problem if she takes it only once a week for osteoarthritis pain? She says is also improves her mood though it makes her a little groggy.

Answered by Dr. Manisha Gopal (33 minutes later)

Brief Answer: Let it be if it cannot be avoided.. Detailed Answer: Hello XXXXXXX Hope you are doing fine, You have told that tramadol is used by her only once in a week only. I donot know what effect once a week dosing will it have on a disease like osteoarthritis, as if there is pain, she is already on other NSAIDS for it. Why Tramadol once a week is required? It is also a pain killer, plus elevates the mood, which she also realises. Tramadol is a far of relative of opioid in lay- man terms, so, may harm her mental health. If not harm her, it may reduce the effect of any other medicine given to her for psychiatric problems. If your orthopedician doctor feels and the patient also wants it once a week, then the dosage strength of her behaviour problem may have to be increased. It is ok, if there is no better option available, as every patients is different and we have to make adjustments as per patients needs. There is no fixed rules in medical managment. Just discus this point with her orthopedician that if possible, she might be given something else apart from tramadol. If not, then just let it be, at least she can be persuaded in return to take psychiatric medicines regularly. Make a deal with her for this, she might agree happily as she likes the effect of tramadol! ## any doctor tries to achieve the best possible result within the safety limit for all the patients. So, I want to avoid any drug ( tramadol in her case) which may upset her mental health. However, in many cases one or the other thing is present, which cannot be helped, so, we have to accept it and move forward. The over all effect should be positive for the patient.### Let me know if there is any more issue you have in mind, I will be happy to answer. Good luck and best wishes Dr. Manisha Gopal

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