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Suggest treatment for anxiety disorder

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Posted on Wed, 11 Jun 2014
Question: My mom has all the symptoms of GEneralized anxiety disorder .she is 51 years old.not attained menopause,diabetic since 2 years and no hypertensive.what will you prescribe her doctor?????i want psychiatric consultation.can I start her with SSRI???
doctor
Answered by Dr. Manisha Gopal (28 minutes later)
Brief Answer:
please give answers to few questions

Detailed Answer:
Hello,
I appreciate your concerns about your mother's health. You think she has anxiety disorder, however, still I would like to know about her symptoms to confirm the diagnosis. Please answer the following questions ( there are several symptoms in psychiatry which overlap across various disorders, so just by reading one cannot decide about anyone's diagnosis). So, in order to confirm a proper and effective treament- I want these answers::

1. what is her predominant mood all day? sad or anxious and irritable?
2. is she able to enjoy life like previous?
3. how is her sleep & her appetite?
4. how does she feel in closed room and crowded places?
5. does she suspect people to be conspiring against her? or mutters to self?

Please try to give replies to these questions, ask her if you need to.

Wish you good health.
Dr. Manisha Gopal
MD Psychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (1 hour later)
Hello doctor,thanks for your prompt reply. 1)yes she is anxious whole day. 2)no ,she is not able to enjoy her life like before. 3)sleep-disturbed.apetite-normal
4)closed room-irritated,crowded places-normal
5)sometimes she feels relatives due to jealousy are conspiring against family's progress and kids development.
6)she do not mutter to herself.
My mother has severe sciatica with l4,l5,s1 annular bulge and nerve root compression which causes lot of pain.due to her health issues also she feels low.
Is that normal doctor?
doctor
Answered by Dr. Manisha Gopal (59 minutes later)
Brief Answer:
venalafaxine will be good

Detailed Answer:
Hello,
Yes, from the description she appears to have anxiety issues. Plus now we know he reason behind her anxiety and sadness- -health problems.

From her comorbid medical conditions we will be helped in deciding what anti anxiety will be best for her. I prefer trying venalafaxine in a non-hypertensie anxious patient who has pain symptoms also.
it is very good molecule and gives quick response in all spheres.
she will need something to sleep for initial few days that can be stopped compeltely later on.
Get her blood tests- dont repeat if she had them within previous six months and were normal. Get Hb%, TSH, Sr. b 12, Vit. d level and lipid profile.

You need not worry, drug will definitely make her better. You can discuss this with her treating team as well.

wish you good luck!
please feel free to ask more questions for clarification.

Dr. Manisha Gopal
MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (12 hours later)
Hello doctor,
All the investigations what u suggested is in normal limits.
My mom is on metformin 500mg-bd,pregabalin 75mg-bd for burning nerve pain ,calcimax ISO -1 od.
She is concerned about weight gain as her weight is 70kg.ht-5'1 feet.
Plz suggest the dose and time of taking the tablet .
Also suggest she should take it for how many days and how to start tapering the dose?
Dr why would you not suggest SSRI for her?plz let me know.

Regards,
XXXXXX.
doctor
Answered by Dr. Manisha Gopal (7 hours later)
Brief Answer:
venalafaxine is better here to ssri

Detailed Answer:
hello,
I prefer venalafaxine (snri) in this case to ssri as they are more effective in handling anxiety disorders and also as your mom has complaint of nerve pain - venelafaxine has a good action in that pain too.
so, by using venalafaxine we will be targeting two things together and help her nerve pain as well.
sSRI are good molecules but I have seen them showing limited response in cases with prominent anxiety.

You may start with 37.5mg venelafaxine and increase by same amount every week or ten days for two hikes. Then wait for a week or two and the effect will improve on same dose. Later increase the dosage by 37.5mg if needed. You can give it at anytime of day after food.

Initially add clonazepam (0.5-1mg) or zolpidem 10mg for sleep and later try to reduce it and stop completely. This may continue for 1-3 weeks.

Some people need etizolam 0.5mg in daytime to crub anxiety episode, so, she can have it on and off.

Please donot think unnecessarily over using ssri, I dont know why you are insisting on giving that. If someone has told you about it then you can give me why and what he said and I will try to explain things accordingly. However, from my clinical experience of seeing such patients- im sure that venalafaxine should be a better choice. Please donot worry. ok

Wish you good health.
Please ask more questions for more clarifications.

Dr. Manisha Gopal
MD Psychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Gopal (48 hours later)
Hello doctor
Yes I will definitely with your suggestion.
I want some points to be answered
1)whether my mom can take pregabalin along with venalaxafine.
2)initial dose is 37.5mg,then increase it next week by same amount,and keep it same for how many days and start tapering when.
Plz let me know...
doctor
Answered by Dr. Manisha Gopal (23 hours later)
Brief Answer:
dosage is increased till there is full response

Detailed Answer:
Hello,
the replies to your questions-
1. Yes, she can continue pregabalin with venalafaxine.

2. After the dosage is built upto 75mg, it is good to wait for 2-3 weeks to see if there is improvement in response. If the condition is almost controlled- then one need not increase the dose any further. However, many people require dose hike after 3 weeks and an additional 37.5mg is added. One continue to add venalafaxine upto maximium of 225mg in case of persisting symptoms.

3. The dosage is kept at the level on.which full symptom controlled is achieved till 6-9 months and then reduced by 37.5mg at a time. Reduction is carried out slowly to prevent any relapse. The reduction is done after every 3-4 weeks.

Hope this answers all your queries.
Wish you good health!

Dr. Manisha Gopal
MD Psychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Manisha Gopal

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Suggest treatment for anxiety disorder

Brief Answer: please give answers to few questions Detailed Answer: Hello, I appreciate your concerns about your mother's health. You think she has anxiety disorder, however, still I would like to know about her symptoms to confirm the diagnosis. Please answer the following questions ( there are several symptoms in psychiatry which overlap across various disorders, so just by reading one cannot decide about anyone's diagnosis). So, in order to confirm a proper and effective treament- I want these answers:: 1. what is her predominant mood all day? sad or anxious and irritable? 2. is she able to enjoy life like previous? 3. how is her sleep & her appetite? 4. how does she feel in closed room and crowded places? 5. does she suspect people to be conspiring against her? or mutters to self? Please try to give replies to these questions, ask her if you need to. Wish you good health. Dr. Manisha Gopal MD Psychiatry