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Suggest treatment for depression and dementia

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Dr. Manisha Gopal

Psychiatrist

Practicing since :2005

Answered : 947 Questions

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Posted on Tue, 12 Aug 2014 in Anxiety and Stress
Question: I am a 42 year old woman who had a baby 2-1/2 months ago. About 2 years ago I was having problems with anxiety and depression and was taking Zoloft, with Ambien to help me sleep. A little over a year ago I began having serious memory and concentration problems. Eventually I also started passing out and had a couple of times when my blood sugar dropped. All of the tests (including a CT scan, but no MRI) I had done at the time were normal and I did not see a neurologist. At the time, I felt like all of the doctors thought I was hypochondriac once they found out that I was taking the Zoloft. I was no longer seeing my therapist at the time since he had released me because I was doing super and no longer showing signs of anxiety. After doing research on my own, I found out that Zoloft could in fact sometimes cause those types of symptoms and so I stopped taking it on my own (I gradually reduced my dosage first). About 2 days after I completely stopped the Zoloft I found out that I was pregnant. During the entire pregnancy I never had any problems with anxiety, depression, or memory issues. When my son was first born I did have extreme fatigue but I was also recovering from a c-section that had to be reopened twice to drain, slight infection, and anemia. I returned to work about 4 weeks ago and have been feeling much better…until a couple weeks ago. I suddenly started having problems again with my vision, memory, concentration, and even coordination. I’ve forgotten where I was a few times lately while I was driving (not really lost, just lost a few seconds of time and took me awhile to realize where I was), routine tasks such as shutting my car off and typing seem no longer automatic and I have to think through each step but it always feels weird, I have trouble getting the right words out, and sometimes I just wander around at home like I’m not sure what I’m doing or why I’m in a room, I even forgot I’d had another baby recently while talking about my older son. In the last couple of days I have also come close to passing out again. This time, I am not taking any medications at all other than a multi-vitamin so I know it isn’t from the Zoloft this time. I have not felt depressed or anxious. I have been under a lot of stress because of financial strain, but I haven’t felt “stressed” and we are dealing with that situation and I feel good about it. When I went to the ER last week, they did lab work and a CT scan (without contrast). I haven’t been able to get a neurologist appointment scheduled until March 2015. I haven’t had many headaches and the only thing I’ve noticed with my head is just an odd feeling in my forehead area, then the other day I began to have a slight tingling feeling in my head and face and pain in my lower jaw. Since my OB/Gyn is most familiar with my recent medical history, I do have an appointment with him later this week. My previous primary care physician left the practice she was in and so I am between doctors at the moment. I almost forgot to mention that dementia does run in both sides of my family, and particular early onset.

Here are my questions: Could this be anxiety or depression even though I don’t have other symptoms of anxiety or depression? Could this be postpartum depression even though I don’t feel depressed, have sleep issues, avoidance issues, etc? Could this be early onset dementia? Is there some neurological thing this could be that may have gone into remission during my pregnancy and be returning now that my hormones are getting back to normal? I don’t think it’s anything like a brain tumor or stroke. But, whatever it is does concern me since I have two young children.
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Answered by Dr. Manisha Gopal 44 minutes later
Brief Answer:
this is more in favour of neurological problem

Detailed Answer:
Hello,
I have read your query carefully and from that I could gather that you have a past history of anxiety/ depression for which you were on zoloft and kept well. You developed forgetfulness and concentration problmes and fall out ( and CT head was normal) ..so, suspecting zoloft to be the cause behind it - you stopped it. A week later you knew you were pregnant and pregnancy was almost asymptomatic.

You again developed memory issues along with difficulty in finding words, difficulty in typing (in which you were good earlier). Though there is financial stress but you deny having anxiety/ depression.

Now, the answers to your questions are-
1. From my clinical experience, I can say that it is not due to depression/ anxiety ( as both are mood disorders- so, mood complaint is the first and most important symptom to diagnose it. So, it is not psychological.

2. It dosent look like post partal depression either- as there is no sadness/ fear/ excessive negativity/ worry etc. No it is different from PPD.

3. I m not sure if this is early onset dementia, but I can tell that you need a through neurological examination and relevant tests to diagnose it. Your forgetting your new baby while remembering older one- suggest some fresh/ recent memory problem. MRI brain/ (may be with contras)t is needed. CT scan will not help in diagnosing this.

Another main point is that there is a family history of early onset dementia. So, this must be evaluated. Early diagnosis and treatment is very helpful in these conditions.

4. It is possible that hormonal changes in pregnancy didn't let this come out earlier. But it can also be due to recent sleep disturbance due to child birth and caretaking.

Though it is difficult to get an appointment of a neurologist, but try to get one.
Donot panic, let this be properly evaluated and then treatment can be started. With medicines it will get better.

Take proper rest, you may call someone near to help you out.

Carry a small diary and jot down all works which you need to finish- this wil help you to remember important tasks.

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

Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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