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Suggest Treatment For Anxiety, Depression And Mood Disorders

Posted on Tue, 17 Feb 2015

Question: This question is for a XXXXXXX psychiatrist.i am 41 and was taking depakote250 mg,paliris 1.5 mg and buspin 5 mg for almost a year now. Before that also I was taking the same but in slightly high doses.These I was taking taking for depression,anxiety and mood disorders and in consultation with my doc in XXXXXXX Now I have moved to XXXXXXX and had consulted a psychiatrist here and he asked me to stop these three medications and just take one medicine for depression I.e. Zyven.i tried to stop depakote 250 mg today and woke up with dry mouth,dehydration and lil heavy head.when I stop taking paliris also I feel withdrawal symptoms and don't feel completely alright.do u still suggest to stop these and start with zyven.i hope it won't have any adverse effects on me.Need a second opinion.Please advise on this on a urgent basis.

Answered by Dr. Vipul Prajapati (17 minutes later)

Brief Answer:
I would had suggested you to gradually taper off the medicines.

Detailed Answer:
Hi dear,

Thank you for your query.

First of all, if you are stable with above medications and if you do not any side effects of then you need not change the medicines.

Zyven (desvenlaflexine) is antidepressant and you are on combination of mood stabilizer and anti anxiety medication, so if you change medicines it is possible that you have reappearance of symptoms.

Please let me the following details:
1. Whether you have any bipolarity symptoms like high talk, talkativeness, increased expenditure, sleep disturbance, hyper religiosity, racing thoughts, etc..
2. Is there any history of psychiatric disorder in your family and if yes what kind of illness?

According to me you need to gradually taper the medicines like palliris or buspin first instead of changing all the three medicines.

Please let me the know the details to discuss with you further.

Awaiting your response.

Thank you

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Vipul Prajapati (59 minutes later)

Hello,

Thanks for your prompt reply.To answer your question...no I don't have any of the above mentioned bipolarity symptoms.Everything is in moderation.i do get normal sleep although get it late.There is no history of psychiatric illness in family whatsoever.
So you suggest not to take zyven and to taper down these medicines which I am currently taking gradually.i have a few questions regarding this:
I just stopped taking depakote 250 mg ...feel a lil bad as I guess these are withdrawal symptoms and hope it doesn't continue for long.but I don't want to continue it unless if really required.So how should I taper down these medications.please advise on this.And how much time will take to stop these.
And also once these medicines are stopped should I take zyven as suggested by my doc here or stop everything completely.kindly advise.

Answered by Dr. Vipul Prajapati (5 hours later)

Brief Answer:
No need to take zyven, if you are not having any problem.

Detailed Answer:
Hi dear,

You need not stop Depakote 250 directly.
First of all, you need to gradually taper down palliris and buspin.
Start with any of the two medicines and gradually reduce down to half dose medicine.
It may take 3 to 4 months to stop medicines. Please do not change the doses on your own. Discuss regarding this with your treating doctor and under his supervision only taper down the doses.

If you do not have any symptoms after stopping of medicines no need to start zyven.
If you have experienced some symptoms, wait for some period as it may be due to withdrawal.

Yes, withdrawal features last for sometimes only.

Thank you

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Vipul Prajapati (2 hours later)

Hello,

I have already discussed regarding this with my treating doc over here and he only suggested that i should stop depakote 250,paliris 1.5 and buspin 5 mg and start taking zyven.
In the past also another doc had suggested to stop paliris first but i was unable to stop paliris as after stopping that my condition became worse as it could be the withdrawal symtoms but continued for 3 days so i started again.Yesterday i stopped depakote and feel fine as of now.And don't want to continue that again.Right now can i take paliris and buspin and then try to stop that gradually?please advise.

Answered by Dr. Vipul Prajapati (13 hours later)

Brief Answer:
No need to start it again and taper down other gradually

Detailed Answer:
Hi dear,
if you already stop depakote and you don't have any withdrawal features or any other complain, no need to start it again.

And after 15 days to 1 month try to reduce the dose of buspin or palliris. Discuss about this with your doctor

No need to start other medicine like zyven if you have not any complain.

Thank you

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Vipul Prajapati (44 hours later)

HI This question is for Psychiatrist Dr XXXXXXX Prajapati.I was consulting with him previously and tried to recharge for same question but it was unable to process it.I would appreciate if Dr.Prajapati would answer this question.As i discussed with you doctor earlier i was on Depakote 250,paliris 1.5,and buspin 5 mg and was feeling fine with that dose.But when consulted with my local doctor here he asked me to stop these and taken zyen 50 mg.Last night i stopped the above medication and tried zyven 50mg and whole night felt terrible.I guess it had an adverse reaction on me.First of all could not sleep whole night and early morning felt nausea,guidiness and felt terrible in the head with a heavy feeling which i still do.
Please advise doctor what should i do now.Can i immidiately stop taking zyven since i just took for one day and continue with my original medicine.Or stop everything.Please help on urgent basis.

Answered by Dr. Vipul Prajapati (11 hours later)

Brief Answer:
Start previous medicines after discussing with your doctor.

Detailed Answer:
Hi dear,
Sorry for delay.
Thank you again for your query.

What ever complains you have is not due to zyven but it is due to withdrawal of previous medicines.
So you need to start again with previous medicines and if you want to start zyven than you have to continue previous medicines and start zyven with those medicine then after 15 to 20 days you need to withdraw one after another.

With this method you can start zyven and discontinue other medicines.

So be relaxed and start previous medicines after discussing with your doctor.

Thank you

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Vipul Prajapati (10 minutes later)

Now actually i don't want to take zyven at all.It definitely had some effect as i couldn't sleep whole night.It didn't suit me so i want to discontinue it.Can i stop that since i just took it for one day and start on my previous medicines from tonite.
Please advise!

Answered by Dr. Vipul Prajapati (22 minutes later)

Brief Answer:
You can stop zyven and start previous medicine

Detailed Answer:
Hi dear,

yes you can start previous medicines without any problem and stop zyven as one dose of zyven does not lead cause any problem to you.

If you want to continue zyven there is one medicine named zyven od plus which is combination of desvenlaflexine and clonazepam and it has very good sleep property also.

So if you want to continue previous medicines you can continue without any fear.

Thank you

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

Follow up: Dr. Vipul Prajapati (1 hour later)

Hello,

Zyven caused me more depression and no sleep last night when i took it.I was feeling really depressed whole day and now i have taken my previous medicines without zyven and feel much better.
I have been maintaining a stable health with my original medicines for a long time and as u had suggested earlier also i think i should continue them only.
My last question to you is :Do Depakote 250 mg,paliris 1.5 mg or buspin 5 mg have any side effects if taken for the long run?I am more concerned about paliris as it increases prolactin level.
Please advise!
Thank you

Answered by Dr. Vipul Prajapati (13 hours later)

Brief Answer:
Not much side effects

Detailed Answer:
Hi dear,

As every medicine has some side effects but in your case you are on lowest dose of medicines, so even if you take it in a long term it has no significant side effect on you.

Depakote 250 mg causes weight gain and sedation property ,otherwise not much side effect. Palliris may increase your prolactin level but at 1.5mg dose it does not increase significantly and Buspin also has not much side effect which is dangerous.

so without any worry regarding side effects you continue the medicines.

Thank you

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

Above answer was peer-reviewed by : Dr. Shanthi.E