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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for anxiety, depression and OCD

Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Posted on Wed, 28 Oct 2015 in Mental Health
Question: Hi Sir
I am 34 yr old male sufeering from anxiety and associated depression with obsessions also. Started in 2001. That cme once or twice in a year. So i avoid it. After 2008 it was completely dissappeared till 2012. In 2012 I got maried. Just two days before my marriage the problem stared again.It also last for one week then gone. Then again come after 10 days abd then gone. This cycle continued for almost two to three months. After that my life almost normal. Then again it came in 2015. Till that time I never went to see a doctor. i am living away from my native state for my job with my family and kid. I am govt. employee. In feb 2015 when it started. i was totally disturbed. I read many pages in internet regarding these problems. I undergone several online symptom checks. Finallly I went to my native place visited first a psychologist and apsychitrist. both of them said that I have some mood problems associated with obsessions. No need o worry. No need to take medicine. Try to change my life style and try some relaxation technique. Afetr 1 month I consulted one more psychiatrist abd he prescribed me nexito plus medicine for one month and diagnosed the problem as OCD. I came back to my workplace did not consume the medicine. almost three months gone without any problem. But in aug problems stared again. Actually I am in a dilema, I dont know what to do. my wife is also worried about my problems. I have anxiety some times obseesions and depression, Pls give me aguidance sir. I want to live a normal happy life with my family.
doctor
Answered by Dr. Chintan Solanki 17 minutes later
Brief Answer:
cognitive behavior therapy and stress management will help

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us.

From your history it is clear that whatever the psychological problem OCD, depression or anxiety it is not severe enough which requires medicines. Problem is frequency of the problem. Episode subsides with your efforts or on your own with some efforts. It means you can come out of the problem permanently with professional help.

In any of the mentioned problems Cognitive behavior therapy (CBT) is specifically used to correct automatic thoughts and distorted cognition.

In CBT psychiatrist/psychologist helps person to identify his/her automatic thoughts and faulty behavior which would ultimately be modified by person with active efforts and help of therapist. It also includes time management, daily sleep, meals and exercise timing.

Relapse of your problem should be associated with some stress likely. You need stress management also. It is also part of CBT.

I have successfully used CBT without medicines in few patients of depression, anxiety and OCD with mild severity. You can also be cured with the same in my opinion.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Chintan Solanki 2 hours later
Sir Thank you so much for your reply. I think that you really identified my problem. I also know that my problems are not lasting for weeks or months. Since 2001 only in this year problems are increased. But in this year also durations are not big but frequency increased significantly. In between 2008 December to February 2012 I was completely OK. Even one single episode was not happened. In between 2012 and 2015 only one episode happened. But Feb 2015 onwards I was disturbed. Problems are coming and going. That's why I went to a doctor and consulted you also. Anxiety depression and obsession are there. But none them last for weeks moreover these are coming together. That's why I also hesitant to take medicine. For which problems I have to take medicine. I don't know. So I think your opinion is right. May I know something more about CBT. How much duration or spell it required. Is any significant side effect for CBT. Is it available in XXXXXXX because I am residing near to XXXXXXX Sir I really want to come out of this problem permanently. Hope you will help further.
doctor
Answered by Dr. Chintan Solanki 42 minutes later
Brief Answer:
find details about CBT in following links

Detailed Answer:
Hi XXXXXXX

Thanks for follow up.

CBT has no side effects. You need to give time for sessions. Role of therapist and patient matters for effective CBT. For detail information you can read following links.

http://www.nhs.uk/Conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspx

https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
XXXXXXX has lots of psychiatrists. You can find the names with following link.

http://doctor.healthcaremagic.com/doctors/Psychiatrists-in-Pune/L18934S35/20

I recommend Dr. Dhavle and Dr. Deshmukh.

However you can choose any psychiatrist near to you. But the point is that very few psychiatrists will be ready for exclusive CBT. Never the less you can ask to any of the psychiatrists about the clinical psychologist who is good at CBT.

Feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki 13 hours later
Sir Sorry for disturbing you again. Can you identify my problem. From my experience can you tell that it is depression anxiety or OCD or any other problem. Secondly if CBT is unsuccesfull then I have to undergo for medication. If yes then what are the side effects of medication.I am deeply concerned about my problems.
Sir One more query is that one doctor prescribed me nexito plus. in your opinion how is this medicine. Is it useful for these problems. What are the side effects of this medicine.
doctor
Answered by Dr. Chintan Solanki 5 hours later
Brief Answer:
I need detail history and mental status examination for diagnosis

Detailed Answer:
Hi,

Thanks for new queries.

From your available history possibility of anxiety disorder is likely. For specific diagnosis I need detail history and mental status examination.

Yes if CBT is unsuccessful (that is unlikely I guess) you may need medicines.

No significant side effects of medicines are there and exact side effects depend on type and dose of drug.

Whatever the diagnosis from above three medicines will remain same with minor variation in dose and duration of treatment.

Nexito plus contain escitalopram and clonazepam. Escitalopram is an SSRI group of medicines and good drug with the least side effects profile and used in anxiety and depressive disorders. Clonazepam is a benzodiazepine and helps in anxiety and sleep. No significant side effects of nexito plus are there. If you feel sleepy or drowsy you should use plane nexito (escitalopram).

Hope this answer will help.

All the best.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki 19 hours later
Sir
May I know that the things I posted is exclusively visible to you only or is it available to public those visiting the site. I wish to post my medical history. that is why I am asking
doctor
Answered by Dr. Chintan Solanki 20 minutes later
Brief Answer:
it is between you and doctor only

Detailed Answer:
Hi,

Things you posted will be visible to you and me only and also to the person handling the site and moderating communication. It is not visible to public at all.

Whatever the samples of question and answers you can see on site do not disclose identity of the persons. And on request of your after completing the consultation you can ask to customer care to remove all communication also.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki 22 hours later
Sir
Thank you so much for valuable support. I will try to explain the mental history in detail.
Let me introduce myself. I am 34 yr old male working in central govt. as a class II gazetted officer. I got married in April 2012 and have a boy kid of 2yrs. I am staying away from my state (south india) in XXXXXXX
My problems started in XXXXXXX 2001. Immediately after my study at that time I was preparing for an interview for a private job. During that day I feel tensed (not because of interview, I think so), lost concentration to study, loss appetite, early morning sleep disturbance, shivering of legs and hands, these are the symptoms. Two three days gone like that and one day some obsession thoughts came into my mind. I had a feeling that I will physically attack my brother. That time I spoken to my mother and brother. They told that it will go don’t worry. Next day I went for interview with my mother. The problems lasted two more days and then completely gone. I cleared the interview and worked there for three years. I was away from home (weely visited home). In that three years these problems are came like episodes but not severe as my 1st experience. These episodes lasted for weeks or some days. During episodes sometimes I was comfortable sometimes I was disturbed a little. After three years I got a govt job near to my home and joined there in 2004. In 2005 feb one episode came like my 1st experience and lasted for two weeks. But in between I had an affair with my cousine sister. Actually I was in love with her. But she just liked me as friend rather than brother. This affair started in 2001 also. Why I am telling is that after 2002 to 2008 60% of my problems are started because of her relationships with her lovers. She loved me as a friend and at the same time had affairs. So most of the time trigger of my episode was her affairs. My family was aware of my problems with her, So whenever I got tensed they thought it is because of her. They were not aware about my mental problems. After my 1st episode I didn’t disclosed a single episode to my family. So from 2002 to 2008 episodes are started some time because of her and some time without any reason. But episodes lasted for weeks or some days only. When that happens I thought better to consult a doctor but I scared to consult a doctor. After the episodes I was completely Ok. Yearly two, three times these episodes happened. Not exactly every year. Approximate guess. In 2009 she went to gulf and I got central govt job in XXXXXXX Sir I can really say that after 2008 dec to april 2012 one single episode was not happened. Two happened but that is of genuine reasons one is that I met when she came from gulf for the first time in 2009 aug and the second at the time of her marriage. I can specifically say that that was only because of that incidents. Apart from that almost 3 and half years I was completely Ok. So I thought my problems are over. From 2009 onwards I was staying away from my state also. I thought about my marriage in 2011. As I was completely Ok I never had a feeling that I am doing injustice by engaging in a marriage. Such kind of thought never came in my mind. And I got married in 2012. From 2008 dec to 2012 april I was 95% Ok. Only two episodes with genuine reasons happened.
But unfortunately three days before my marriage the problems started again without any trigger. I was totally broken because I never thought that it will come back. I thought to cancel the marriage but that didn’t happen. I got married and the episode started three days before marriage lasted for almost 10 days and gone. Then I was completely Ok. After two weeks I came back to my workplace for two week stay. But after two days of my arrival to work place the problems started again I went back to my home after one week. At that time my wife and my family came to know that I have some problems. After reaching home two to three days staying there again I was completely Ok. Two weeks I stayed there then went back to workplace with my wife. After came here the problems started again but this time it was due to some obsession thoughts. I had a feeling that my wife is not so glamour. My choice was wrong. I was trying to convince me. But I got severely tensed and episode started again, after two weeks I disclosed about my feeling to my wife. Means she was not beautiful. She was really crying. But once I expressed my thought to her my problems started decreasing slowly and I was ok till 2015 feb. In between these three years only once the problem came and lasted for only one week. By hearing about my obsession thought of my wife glamour the psychiatrist diagnosed me as OCD. But after 2012 XXXXXXX that thought completely disappeared from my mind. I was 90% ok from XXXXXXX 2012 to 2015 february.
I can say that all the times I suffered almost similar symptoms that I mentioned earlier. And I was completely ok in between the episodes.
But in this year February the problems started again without any specific reason. Anxiety was there with obsession thought and depression was also there. But the symptoms like early sleep disturbance shivering of hands and legs were almost absent. Loss of appetite was present at some time only. But this time I really shattered search in the internet about these problems and tried several online symptom checks finally I went to my home. My wife parents were also came to know about these problems. Accordingly I consulted two doctors in my home town one psychologist and one psychiatrist. Both of them diagnosed not serious problem, at present no need of medication. So I came back with my family but problems are came in between. Then in april 2015 I went to home again consulted a psychiatrist and by hearing about my obsession thought of my wife glamour the psychiatrist diagnosed my problem as OCD and given nexito plus. But I didn’t consume the medicine. Then I came back to workplace alone left my family in their house. I was almost Ok on may XXXXXXX and July. In july I brought my family back. In august the problems started again lasting for one week gone then came after one week and are going on. My wife is totally disturbed with my problems. I also don’t know what to do exactly. Because I can clearly say that I was completely Ok in the last week but in this week I am disturbed a lot.
In this year symptoms like early morning sleep disturbance, loss of appetite were almost absent. But some physical symptoms like headache, numbness in face were present. In feb 2015 during episodes some obsession thoughts like I will thrown my kid from top floor present. Not all the time. Some time only. But now that is completely absent.
One more thing I really need to mention is that from teenage I had some obsessions and anxiety problems. Obsession means repeatedly doing something, some kind of numbering systems etc. But that was not severe at all. Not disturbing at all also. Not associated with my problem episodes also. And anxiety means associated with diseases. For example during dengue fever season if I got fever then I rush to the doctor and confirmed that I had not dengue fever. But as I got matured and read books search internet I came to know that these kind of obsessions and anxiety problems are small kind of mental disorders. As I came to know that fact I tried to control that and I can clearly said that I completely controlled that both problems. Both are completely absent from many years.

I really want to come out of these problems permanently. My wife is ready for treatment but after hearing about medication she also worried. Sir please help me to come out of this problem permanently.

Hope you help me further.

Thanks
doctor
Answered by Dr. Chintan Solanki 16 hours later
Brief Answer:
It is likely panic disorder, not severe, without medicine it may be treated

Detailed Answer:
Hi Mr. XXXXXXX

Thanks for excellent details. I am sorry for delayed response. Actually your narration was long and I had busy day. I read your problem twice.

Your illness is not continuous means very less possibility of OCD.

Depression symptoms can appear secondary to any type of anxiety problem but to diagnose depression problem should be sufficiently disabling and needs attention for treatment. Primary diagnosis of depression is also less likely.

You had anxiety symptoms like panic attacks most of the times. Symptoms started with some stressful situations/incidences most of the times. Sometime you had apprehension about such symptoms/problem when you are normal in between panic attacks. These all suggest possibility of panic disorder though severity is not so much. You feel depressed and worried after such episodes only for few days and recovered on your own. As time progressed your episodes duration is increasing likely and you are worried more about the same.

If you have progressed well in your career according to your caliber with these disturbances, there is no severe disorder that is confirmed.

Even after 4 years of marriage your wife is cooperative to you and no major relationship problem also suggest that your disorder is not severe.

As you have controlled your apprehensions regarding dengue on your own I think you are good candidate for CBT.

To alleviate panic attack I would like to suggest some approach.
General approach to manage panic attack is relaxation therapy and deep breathing. Take deep slow breathing. Inhale for 3 seconds, keep breath in for 3 seconds and exhale for 3 seconds. Do it for 10-15 minutes. You will feel relax.

Apart from medicines you need to maintain healthy lifestyle. This includes regular daily exercise (walking or running), hygienic food habits ( no junk food, no fatty food, preferably only home-made food with law salt and fat with more fruits and vegetables) and timely scheduled sleep. Yoga- meditation can also help.

In medications anti anxiety medicines like clonazepam or etizolam can help as on when required basis.
Simultaneously CBT- cognitive behaviour therapy can stop panic attacks and can cure the same if applied genuinely.

At any stage if you need medicines no need to worry about the same. Latest medicines are enough good without significant side effects and they can be stopped under doctor's guidance. Inform this to your wife and ask her to relax and not to worry.

I suggest reading criteria for OCD and Panic disorder according to DSM-IV TR or DSM- 5 to get some idea about your problem.

Hope this answer will provide some help.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki 39 hours later
Sir Thank you so much for your support. Inspite of your busy schedule you read my long story and give me a positive response. Once again thank you so much sir. I am completely agreed with your opinion about depression and ocd because my depressive episodes are coming with anxiety or obsession and lasting for only two to four days. My obsessions are also not continuous but the obsession thoughts are really disturbing me when they come. Some more queries are, the breathing technique you mentioned is to be done regularly or at the time of anxiety problems only. Based on your suggestions I made a plan, please advise me my plan is that firstly I will change my life style in terms of food, sleep, exercise etc try to practt yoga or meditation. If it not give good result then I will go for CBT with the help of a good psychologist or physiatrist. And both of them fails only then I will go for medication. Is it fair sir. Or I have to do the first two steps simultaneously with medication. Pls guide me. Regarding your opinion about my career I can clearly say that I got a job that is the topmost in terms of salary and status with my qualifications. My wife also cooperative. Yes she is definitely worried about my problem. But she is adjusting and assured me that she will with me till the end. Right now I have some physical problems like headache, feeling that my ear is blocked etc. But after my discussion with you I have improved a lot. Sir can you said that if I need medication then what will be the minimum duration six month, one year etc.The stigma associated with medication is still disturbing me sir. Expecting good reply from you sir I assure that will not disturb you further. Thanks and regards. XXXXX
doctor
Answered by Dr. Chintan Solanki 17 hours later
Brief Answer:
no medication in first step

Detailed Answer:
Hello Mr . XXXXXXX

Again sorry for delayed response. You are not disturbing me at all. This is just coincidence that I am busy with some work for few days.


Deep breathing you can do regularly as a part of meditation or yoga but you need to do so specifically when you feel more anxiety or panic attack.

You have decided almost right plan. I recommend going for lifestyle changes with psychotherapy simultaneously as lifestyle is part of behavior therapy.

If after 3-4 months of psychotherapy no sufficient improvement we can go for medicines.

If at all medicines are required medicines should be continued at least for 6 months after complete improvement so duration varies according to drug response and your symptoms. Probably in your case not more than a year that is for sure. No need to worry about medicines as they are like same as you take for other physical problems.


You have support of your wife. Go ahead.

Do not hesitate to ask further if still any doubt.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki 25 hours later
Sir thank you so much for your support. Now I have a right way in mind to go ahead. I will follow the plan as advised by you. I will let you know the progress and results. Only one doubt left in my mind is that the side effects of medicines means what means the effects are purely physical or it is mental. Once again thank you so much sir XXXXX
doctor
Answered by Dr. Chintan Solanki 2 hours later
Brief Answer:
more physical side effects but not in all persons

Detailed Answer:
Hi,

Let me clarify you about side effects of medicines. When you take paracetamol for fever it also can cause side effects in some persons but it is in less than 2% of the people. Likewise all medications used for psychiatric problems can cause some side effects but not in all persons. Common side effects like nausea, vomiting and headache occur in 3-6% of the people. Most of the side effects are reversible. And no serious side effects of most of the medicines use for depression, OCD or anxiety.
Some psychological side effects like irritability, anxiety and nervousness can occur with these medicines but not in all patients.

By chance if you need any medicine ask the doctor about side effects of that medicine and doctor will clarify you. Internet can give you list of side effects but clinical experience provide right info from doctor.

If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page

All the best and wish you early recovery.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki 19 hours later
Sir

I will close the discussion after this question and answer.

Regarding side effects I heard (via internet) that some people are saying that after consuming medicine their identity really changed. Means their problems are almost solved but they felt that they are not like what they are before medication. Means it changed the entire mental status of the person. I dont exactly what it means.

Secondly can I live my normal life with this medicine. Can I do my all routines. Right now I am having medicine for cholestrol. Can I take this medicine with psyichiatric medicine. Can I have a normal sexual life with this medicine.

Hope you will clarify.

Thanks and regards

XXXXX
doctor
Answered by Dr. Chintan Solanki 6 hours later
Brief Answer:
No it is not true for medicines for depression and anxiety

Detailed Answer:
Hello,

There are almost more than 350 diagnoses of psychiatry disorders. Some rare occurring disorder like schizophrenia or uncommon disorders like bipolar disorder may need anti-psychotic medicines. These may have some side effects on person's behavior. However disorder process itself changes the person's identity and behavior drugs alone are not responsible. And believe me it is very rare possibility.
For disorders like depression, anxiety or OCD such medicines are not used and no such side effects I have observed in my patients with such problems.

Yes you can take the medicines with cholesterol medicines. Of course you can live normal life with medicines. Some sexual side effects are there with SSRI medicines but not always and not with low dose and ultimately they are reversible or treated if by chance it happens.

I wish you good health and probably you do not require medicines.

Take care.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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