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Suggest Treatment For Anxiety Related Dermatitis
Question: I need a medication review. I'm on a bunch of meds--hx. of migraine & depression/anxiety PTSD (topamax 150 mg HS, prozac 20 mg q AM, wellbutrin 150mg bid, amitriptyline 50 mg hs, clonazepam 1 mg hs), omiprazole 150 mg q am for GERD s/p gastric bypass 2004, (new) gabapentin 300 mg bid for skin itchiness/burning,
(new) Ashwagandha herbal (i) capsule bid per Ayruvedic trained dermatologist. Derm. Dx.: Anxiety related dermatitis. I pick at skin outbreaks are itchy, sometimes stinging and then I create lesions.
The severity of the skin issue comes and goes but never completely clears. I have gained 15 lbs on the gabapentin and started taking it just one capsule at night, but since this current bothersome flair-up, I've gone back to bid. I've tried to re-regulate my sleep cycle, going to bed with my partner at least by midnight--but I still sleep a lot during the day, wasting time and not tending to my chores, home based work and gardening. I feel a lack of motivation. My "naps" can be hours during the day.
(new) Ashwagandha herbal (i) capsule bid per Ayruvedic trained dermatologist. Derm. Dx.: Anxiety related dermatitis. I pick at skin outbreaks are itchy, sometimes stinging and then I create lesions.
The severity of the skin issue comes and goes but never completely clears. I have gained 15 lbs on the gabapentin and started taking it just one capsule at night, but since this current bothersome flair-up, I've gone back to bid. I've tried to re-regulate my sleep cycle, going to bed with my partner at least by midnight--but I still sleep a lot during the day, wasting time and not tending to my chores, home based work and gardening. I feel a lack of motivation. My "naps" can be hours during the day.
Brief Answer:
drug/dose changes indicated.
Detailed Answer:
Hello
Welcome to HealthcareMagic.
I have read your details and understand your concerns.
You are taking a number of meds and many of them are underdosed. This has resulted in a drug cocktail. Iam not sure whether your depression/anxiety and migraine has responded to this in past. You still feel lack of motivation and desire to do work.
Please allow me to discuss about the medicines you are taking:
1. Topamax (Topiramate): must have been given for prophylaxis of migraine. It can cause stinging sensations in body as a side effect. You already have such symptoms.
I do not consider this drug to be suitable for you.
2. Prozac (Fluoxetine): is a good antidepressant. 20mg is inadequate dose if there is no response. Dose can be increased to 80mg depending on tolerability.
3. Wellbutrin (Bupropion): another antidepressant but weak action. 300 mg is and adequate dose. I would suggest to choose between prozac and wellbutrin, to be tried in XXXXXXX dose.
4. Amitriptyline: another antidepressant. given for prophylaxis of migraine. 75 mg is adequate dose for migraine. Antidepressant dose is upto 150mg. To be continued in same dose if migraine controlled. Can cause sedation.
5. Clonazepam: relieves anxiety. Can cause sedation. Dose can be decreased as you have excessive sleepiness.
6. Gabapentin: given to you for stinging sensations, can be used as anti-anxiety drug. Very much sedating. Can be replaced by lyrica (pregabalin) as it has less sedation and same efficacy.
7. Omeprazole: to be continued.
8. Ashwagandha: can not comment on this as this not my field. Sorry for that.
Hope my suggestions are helpful to you.
Kindly discuss these issues with your doctor before making any drug/dose changes.
Feel free to discuss further.
drug/dose changes indicated.
Detailed Answer:
Hello
Welcome to HealthcareMagic.
I have read your details and understand your concerns.
You are taking a number of meds and many of them are underdosed. This has resulted in a drug cocktail. Iam not sure whether your depression/anxiety and migraine has responded to this in past. You still feel lack of motivation and desire to do work.
Please allow me to discuss about the medicines you are taking:
1. Topamax (Topiramate): must have been given for prophylaxis of migraine. It can cause stinging sensations in body as a side effect. You already have such symptoms.
I do not consider this drug to be suitable for you.
2. Prozac (Fluoxetine): is a good antidepressant. 20mg is inadequate dose if there is no response. Dose can be increased to 80mg depending on tolerability.
3. Wellbutrin (Bupropion): another antidepressant but weak action. 300 mg is and adequate dose. I would suggest to choose between prozac and wellbutrin, to be tried in XXXXXXX dose.
4. Amitriptyline: another antidepressant. given for prophylaxis of migraine. 75 mg is adequate dose for migraine. Antidepressant dose is upto 150mg. To be continued in same dose if migraine controlled. Can cause sedation.
5. Clonazepam: relieves anxiety. Can cause sedation. Dose can be decreased as you have excessive sleepiness.
6. Gabapentin: given to you for stinging sensations, can be used as anti-anxiety drug. Very much sedating. Can be replaced by lyrica (pregabalin) as it has less sedation and same efficacy.
7. Omeprazole: to be continued.
8. Ashwagandha: can not comment on this as this not my field. Sorry for that.
Hope my suggestions are helpful to you.
Kindly discuss these issues with your doctor before making any drug/dose changes.
Feel free to discuss further.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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