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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Need a psychiatrist

Answered by
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Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5059 Questions

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Posted on Sun, 13 Jan 2019 in Mental Health
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
doctor
Answered by Dr. Seikhoo Bishnoi 1 hour later
Brief Answer:
Please provide details.

Detailed Answer:
Hello thanks for using ask a doctor service

You can discuss your doubts with me.

Thanks
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
Please provide details.

Detailed Answer:
Hello thanks for using ask a doctor service

You can discuss your doubts with me.

Thanks
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Seikhoo Bishnoi 2 hours later
Hello
Iam a physician
My daughter 26 yrs is suffering from moderate to severe depression and anxiety for the past many years and ADD.
She has severe hypothyroidism on treatment and polycystic ovary disease but no gynaec symptoms

recently she has found help with stimulants with which she can Study and work a part time job
In the back ground she takes ecitalopram and aripiprazole

The point is the vyanese works
for only 2 hrs after which there is a crash and anxiety for which she has to resort to clonazepam

1.Is there a long acting stimulant ?

2.even if she takes 2 doses of stimulants( one morning and one evening )the in between time between doses is also difficult to manage. And why is this ?

3. What are the side effects of long use of stimulants

Thanks for your time

4 why is the crash difficult to manage ?
She is a responsible and hard working sensible girl with no tendencies of abuse



Sent from my iPhone
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Hello
Iam a physician
My daughter 26 yrs is suffering from moderate to severe depression and anxiety for the past many years and ADD.
She has severe hypothyroidism on treatment and polycystic ovary disease but no gynaec symptoms

recently she has found help with stimulants with which she can Study and work a part time job
In the back ground she takes ecitalopram and aripiprazole

The point is the vyanese works
for only 2 hrs after which there is a crash and anxiety for which she has to resort to clonazepam

1.Is there a long acting stimulant ?

2.even if she takes 2 doses of stimulants( one morning and one evening )the in between time between doses is also difficult to manage. And why is this ?

3. What are the side effects of long use of stimulants

Thanks for your time

4 why is the crash difficult to manage ?
She is a responsible and hard working sensible girl with no tendencies of abuse



Sent from my iPhone
doctor
Answered by Dr. Seikhoo Bishnoi 6 hours later
Brief Answer:
The doses can be adjusted.

Detailed Answer:
Hello thanks for providing details

I am sorry for replying late.

1) Vyvanse is a long acting drug and has long duration of action if we consider stimulants. Other option is Adderall XR, but the duration is more or less similar to Vyvanse.

2) Its better if she takes morning dose and one late afternoon dose. This will help in improving day time functioning. Taking stimulants in evening results in disturbance in sleep which could worsen functioning next day.

3) Stimulants are safe if used as per prescribed doses even for long period. One most common risk associated with stimulants is development of tolerance. With time tolerance develops and this results in increased need to increase the dose to get desired effects. In some individuals this could result in abuse.

4) This is difficult to manage because this results in reduced concentration of stimulant in brain. This causes reduced focus and thus fatigue, tiredness etc symptoms develop.

One option is to increase the dose of Vyvanse in morning and in afternoon dose should be same. This will improve her functioning. You can talk with her doctor for that.

Thanks.

Please don't hesitate to ask again for more clarifications.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
The doses can be adjusted.

Detailed Answer:
Hello thanks for providing details

I am sorry for replying late.

1) Vyvanse is a long acting drug and has long duration of action if we consider stimulants. Other option is Adderall XR, but the duration is more or less similar to Vyvanse.

2) Its better if she takes morning dose and one late afternoon dose. This will help in improving day time functioning. Taking stimulants in evening results in disturbance in sleep which could worsen functioning next day.

3) Stimulants are safe if used as per prescribed doses even for long period. One most common risk associated with stimulants is development of tolerance. With time tolerance develops and this results in increased need to increase the dose to get desired effects. In some individuals this could result in abuse.

4) This is difficult to manage because this results in reduced concentration of stimulant in brain. This causes reduced focus and thus fatigue, tiredness etc symptoms develop.

One option is to increase the dose of Vyvanse in morning and in afternoon dose should be same. This will improve her functioning. You can talk with her doctor for that.

Thanks.

Please don't hesitate to ask again for more clarifications.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Seikhoo Bishnoi 12 hours later
Thanks for your reply
1. Does she still need acetalopram and aripiprazole if she takes stimulants?
Those two seem not to be working and are just like sugar tablets!!

2. Sine these two are not working well
Can we club tricyclics with stimulants?

3. Or just stimulants are enough ?
She used bupyropion venlaflaxine and Prozac with almost no effect
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Thanks for your reply
1. Does she still need acetalopram and aripiprazole if she takes stimulants?
Those two seem not to be working and are just like sugar tablets!!

2. Sine these two are not working well
Can we club tricyclics with stimulants?

3. Or just stimulants are enough ?
She used bupyropion venlaflaxine and Prozac with almost no effect
doctor
Answered by Dr. Seikhoo Bishnoi 17 hours later
Brief Answer:
Stimulants are not the final treatment.

Detailed Answer:
Hello again

1) Escitalopram and Aripiprazole should not be stopped. Escitalopram should be helping her in depression and Aripiprazole helps in stabilising the mood. Stimulants can control but they are not the final treatment.

2) Escitalopram or any other SSRI drug is better choice than TCA. TCA are associated with many side effects.

3) Antidepressants should be given with stimulants to get best results.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
Stimulants are not the final treatment.

Detailed Answer:
Hello again

1) Escitalopram and Aripiprazole should not be stopped. Escitalopram should be helping her in depression and Aripiprazole helps in stabilising the mood. Stimulants can control but they are not the final treatment.

2) Escitalopram or any other SSRI drug is better choice than TCA. TCA are associated with many side effects.

3) Antidepressants should be given with stimulants to get best results.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 1 hour later
But doctor
ecitalopram venlaflaxine and Bupyropion prozac dint work
What else is there I wonder !!!
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
But doctor
ecitalopram venlaflaxine and Bupyropion prozac dint work
What else is there I wonder !!!
doctor
Answered by Dr. Seikhoo Bishnoi 20 hours later
Brief Answer:
The dose of Escitalopram can be increased

Detailed Answer:
Hello thanks again for asking

In that case one option is to increase the dose of Escitalopram. This will provide better results. Other option is to supplement Escitalopram with Lithium or Olanzapine. This will help to reduce the resistant depression symptoms.

You can talk with her doctor for this.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
The dose of Escitalopram can be increased

Detailed Answer:
Hello thanks again for asking

In that case one option is to increase the dose of Escitalopram. This will provide better results. Other option is to supplement Escitalopram with Lithium or Olanzapine. This will help to reduce the resistant depression symptoms.

You can talk with her doctor for this.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 1 hour later
Sorry
she tried olanzepine one tablet
Got into a fit of sleep couldn’t wake up for 2 days and we were worrying what happened
I don’t know about lithium
That seems to be an age old drug and has effects on thyroid
She already has severe hypothyroidism needing 300 micrograms of thyroid supplements

How high can we go on ecitalopram ?
Instead I am tilting towards TCAs
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Follow up: Dr. Seikhoo Bishnoi 0 minute later
Sorry
she tried olanzepine one tablet
Got into a fit of sleep couldn’t wake up for 2 days and we were worrying what happened
I don’t know about lithium
That seems to be an age old drug and has effects on thyroid
She already has severe hypothyroidism needing 300 micrograms of thyroid supplements

How high can we go on ecitalopram ?
Instead I am tilting towards TCAs
doctor
Answered by Dr. Seikhoo Bishnoi 15 hours later
Brief Answer:
The dose of Escitalopram can be increased

Detailed Answer:
Hello again

Yes Olanzapine is known to result in increased sleep. Low doses are used in depression and low doses don't result in much sedation and supplement the antidepressants. So this can be kept in options.

Considering her thyroid issue Lithium should be avoided.

The dose of Escitalopram can be upped to 15-20 mg for best results.

TCAs can help but they are associated with many unwanted side effects and weight gain. The drug selection should be done very cautiously.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Seikhoo Bishnoi 0 minute later
Brief Answer:
The dose of Escitalopram can be increased

Detailed Answer:
Hello again

Yes Olanzapine is known to result in increased sleep. Low doses are used in depression and low doses don't result in much sedation and supplement the antidepressants. So this can be kept in options.

Considering her thyroid issue Lithium should be avoided.

The dose of Escitalopram can be upped to 15-20 mg for best results.

TCAs can help but they are associated with many unwanted side effects and weight gain. The drug selection should be done very cautiously.

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