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Dr. Andrew Rynne

Family Physician

Exp 50 years

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On arip mt 10 mg. Getting sleep problem, speech problem and low mood. Any suggestion?

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Dr. Jonas Sundarakumar

Psychiatrist

Practicing since :2003

Answered : 2190 Questions

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Posted on Thu, 27 Dec 2012 in Mental Health
Question: Hi Doctor

Hope you remember me , I consulted you October Last week. You Prescribed me Arip MT 10 mg & 2.5 Mg Oleanz. I stopped taking olanzapine 2.5 mg and was on Arip MT 15 mg for 15 days. Few days i felt better and was going to bed early and waking up early. After few days again my sleep problem has started, not able to fall asleep soon ,mind remains overactive

Apart from that feel very low mood , feel sad not happy, a strange feeling when going outside , feel like staying back at home instead to go outside, not able to mingle with friends, speech problem. Also I am not able quickly understand what I am reading , earlier while taking oleanz my reading skills was better, I dont know what are symptoms of ADHD , but i doubt I have it .

Please suggest
doctor
Answered by Dr. Jonas Sundarakumar 9 hours later
Hi XXXXXXX

Of course, I remember you... I'm sorry to hear that you have been experiencing these recent symptoms. Now, these symptoms which you have described seem to be indicative of a depression. Low mood, feeling sad, lack of interest, social withdrawal, poor concentration, etc. are all depressive symptoms. You don't seem to be having any definitive features of ADHD.

I would like to have a few more clarifications, in order to understand your problems better:

How long have you been having these recent symptoms?

What is your current sleep pattern? Do you have difficulty falling asleep or do you wake up too early?

Do you feel anxious, get negaive thoughts or any guilty feelings?

Do you have any fears or suspicions or a strange feeling that something wrong is going on around you?

Have you been under any stressful situation or unexpected environmental changes lately?

Please get back to me with these clarifications, so that I can advise you in a better way.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 2 hours later
Hi Doctor

Please find my answer

How long have you been having these recent symptoms?
Past One Week.

What is your current sleep pattern? Do you have difficulty falling asleep or do you wake up too early?
Was not getting sleep till 2:00 - 3:00 am for last one week , feeling restless, body didn't feel comfortable that made me awake in between sleep , I was not getting XXXXXXX sleep like when i was on Oleanz , i never used to wake up inbetween night ,expect if needed to go for Urine , otherwise I used sleep like i dont know what is happening in the surrounding.

Do you feel anxious, get negaive thoughts or any guilty feelings?
Yes, Correct, When I go to sleep , I feel anxious wether i will get sleep today or not

Do you have any fears or suspicions or a strange feeling that something wrong is going on around you?
Yes, Correct , past one week this feeling has started , When going out I feel something wrong is going on around , something bad is going to happen and feel fear and suspicious. When I am at home feel comfortable.


Have you been under any stressful situation or unexpected environmental changes lately?
Yes, had to much work recently

Also I would like to add on , Speech is slurred , i dont know why , sometime i had with olazapine also , but never took it that serious, but is this side effect of the anti psychotic medicine

Thanks
XXXXXXX
doctor
Answered by Dr. Jonas Sundarakumar 3 hours later
Hi again XXXXXXX and thanks for the clarifications.

Form the description of your symptoms, it appears that you may be going through a depressive episode. Anxiety symptoms like vague fear, worrying thoughts, apprehension, etc. can also be commonly seen in depression. It is likely that your recent work stress could have triggered this depressive episode.

Now, since these symptoms have been quite distressing to you and since you also have difficulty with your sleep, it may be worthwhile to start an anti-depressant on a temporary basis. Mirtazapine is a safe and effective antidepressant which has anti-anxiety properties and can also help you get better sleep. It's better not to use sleeping pills for sleep since they can have an addictive potential.

So, I would recommend that, in addition to taking Arip MT 15mg, you can also add Mirtaz (Mirtazapine) 7.5mg at night (the usual starting dose of Mirtazapine is 15mg, but I think we can try just 7.5mg initially). Importantly, try to reduce your stress levels and practice relaxation exercises like XXXXXXX breathing, yoga, etc.

Though your current symptoms are not likely to be psychotic symptoms, yet you should also be watchful for recurrence of any past psychotic symptoms. Follow strict sleep hygiene, eat healthy, exercise regularly and completely avoid stress. Hopefully, your problems should subside soon with the anti-depressant medication.

Wish you good health.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 10 minutes later
Thanks Doctor , Can you please send me soft copy of the prescription or Upload a scanned copy of prescription so that it would be helpful for me when buying medicine from chemist. Some time the chemist tends to ask for prescription and Doctor name or hospital.

In between if i have problems with health i will get back to you immediately and also When can I again follow up with you ?


doctor
Answered by Dr. Jonas Sundarakumar 8 hours later
Hi XXXXXXX

Unfortunately, the website's policy does not permit online prescriptions and so, I wouldn't be in a position to give you that. But most pharmacies will be able to give you anti-depressant medication even without a prescription, if you have been advised by a doctor. They are usually insistent on prescriptions only for sleeping pills like benzodiazepines.

Please feel free to contact me in the future if you have any problems or for a review. You can follow-up with me after a week's time. You can get in touch with me through this link directly:
WWW.WWWW.WW
Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 35 hours later
Hi Doctor

I Have started on your prescription and feel better now.

I have a doubt .Everyday at night, a sharp pulse tends to strike on the body regions , that tends to make me alert while i am asleep , really looks like someone is playing pranks on me. More over we are tamilians settled in bangalore , is these kannada speaking people doing this, i am really upset with this.

You may wonder what type of pulse it is , it looks like a Electronic Muscle stimulator with high frequency wave , it strikes at such force and stimulate for 5 -15 secs , that i am made awake while falling asleep , it makes my mind active.

Please let me know if this is some kind of pranks by some neigbour or is it body generating these type of pulse ? I have heard of brain shiver (Electric Shock - I am not sure about sympotms) , but this looks more like external rather than XXXXXXX


Thanks
XXXXXXX
doctor
Answered by Dr. Jonas Sundarakumar 12 hours later
Hi XXXXXXX

I'm glad that you are feeling better now. Now, regarding the 'pulse' or shock-like sensations, it is unlikely that it could be externally induced by anyone. It is most likely due to some sensations from your body only.

I am a little worried whether you are developing unecessary suspicions, which could be an early sign of a relapse of your previous psychotic symptoms. Moreover, you seem to be in a stressful period in the last few days - not sleeping properly, and feeling depressed and anxious - which again is a risk for relapse. So, to be on the safer side, I would advise you to increase the dosage of Arip MT to 20mg at night and continue to take the Mirtaz 7.5mg. Let me know how you are feeling after 5 days.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 7 days later
Hello Doctor

Yes Iam Feeling better now , The only symptoms i am noticing are

Speech is slurred ( As if spoken with thick tongue)
I notice there is urgency with all the work I am doing and not relaxed way of doing it.
Some days getting sleep till late and not fall asleep soon

Will this side effects come down ?

Thanks
XXXXXXX
doctor
Answered by Dr. Jonas Sundarakumar 9 hours later
Hello XXXXXXX

Well, the slurring of speech could be a side effect of the Arip MT. Usually these side effects will gradually come down with time. You can try splitting the dosage of Arip MT into 5mg in the morning and 10mg at night and observe if this problem goes away. But if this problem is troublesome and distressing despite this, then let me know and we can do some medication adjustments.

The problem of difficulty in falling asleep and getting up late can be tackled by taking the medication a little earlier, say at 8 pm itself.

Overall, don't worry too much about these because any new medication will take some time to get 'set' to your body. Hopefully, with some more time your problems should gradually subside.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 9 hours later
Thanks Doctor.
doctor
Answered by Dr. Jonas Sundarakumar 1 hour later
You're welcome. Take care.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 11 hours later
Sure Doctor, Thank You...

If the Speech is slurred and continues to be , is there any medicine which I need to take ? If you can prescribe the medicine.

I will close the discussion after it and follow up with you later.

Thank You
XXXXXXX
doctor
Answered by Dr. Jonas Sundarakumar 8 hours later
Hi XXXXXXX

If the slurring of speech continues to be there, then you can take T. Pacitane 2 mg along with the other medication.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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