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Suggest Treatment For Depression And Suicidal Thoughts

Posted on Fri, 10 Jun 2016

Question: sir, my wife is 55 yrs old and she is taking dep.medicines for the past 15 yrs. still she is not cured. Her symptom is concentrating silly unwanted things and we say anything her reply is I will get suicide and she is crying very often with out any reason and very possessiveness and weight is also increased to105 kgs because of these medicines and sleeping always we loss our entertainment in our family totoally. Pl. give some good solutions always we are co operatingher views

Answered by Dr. Chintan Solanki (3 hours later)

Brief Answer:
rule out bipolar depression and personality problems

Detailed Answer:
Hello,

Thanks for writing to us. I can understand your concern.

She is taking anti depressant and anti psychotic medicines. Her medicines for depression in low dose i.e. nexito should be used in dose up to 20 mg and paroxetine up to 25 mg. These both are SSRI drugs so in my opinion there is no need to combine both these drugs together. Rather drug from other group like SNRI should be added.

There is also no need to combine lorazepam and nitrazepam if patient is feeling ore sleepy.

Suicidal threats, frequent crying spells and this much weight gain suggest possibility of bipolar depression or personality problem like borderline or histrionic.

Please let me know her symptom history in more details :

- How did problem start? Any stress was there?

- What were the symptoms initially and what are the current symptoms?

- Is there any suicidal attempt? If yes, provide details.

- Is there history of treatment with ECT?

- Which medicines have been tried until now?

- Is there any family history of psychiatric illness in her family?

I will be happy to help further after your response.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (3 days later)

Loneliness after getting our daughter married 15 years ago.
Sleeplessness and frequent anger outbursts. Obsessive behaviour to get everything done immediately. Excessive worry about things, even though she had nothing to worry about.
Intent to take tablets often/Threatening to commit suicide often.
Medicines have been mentioned in the original post
Yes, there is a history of illness in the family - Her sister.

Answered by Dr. Chintan Solanki (10 hours later)

Brief Answer:
needs change in medications

Detailed Answer:
Hi,

Thanks for information and sorry for delayed response.

She seems to have agitated depression and there may be possibility of bipolar depression.
If I were her treating doctor I would like to increase the dose of paroxetine cr to 25 mg or nexito to 20 mg. I recommend either of these SSRI medicines, both should not be given together. I would also like to give lonazep in daytime in low dose to curtail anxiety. I would like to stop risperidone, tancodep and nitrest. I would like to add lithium or valproate considering her anger outbursts. She needs also supportive psychotherapy to modify her psychodynamic.

You can discuss these recommendations to her treating doctor and modify the treatment.

Feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (14 hours later)

Thank you for the response Doctor.
Her treating physician is no longer in XXXXXXX and so I have been following the past prescription for the past 5 years.
Morning - Eltroxin 100mcg 1, paroxetine 10 mg 1, Nexito 5 mg 1, Stablon 12.5 mg 1, lonazep MD 0.5 1.
Afternoon - lonazep MD 0.5 1. paroxetine 10 mg 1, Nexito 5 mg 1, Neugaba M75 1
Night - Nightrest 5mg 1, tancodep 2 mg 1, respidon 2 mg 1, lonazep MD 0.5 1, glyciphage SR 500 mg.
Request your review of the above prescription. Please suggest altenatives wherever you consider best, as mentioned above. Highly appreciate your valuable inputs.
Regards,
XXXXX

Answered by Dr. Chintan Solanki (8 hours later)

Brief Answer:
please consult another psychiatrist, do not give medicines on your own

Detailed Answer:
Hi XXXXX,

Thanks for clarification.

5 years is pretty long duration and you should not go with these much multiple medicines without consulting doctor.
I have already mentioned my recommendation for changing prescription. All these drugs are prescription drugs and you must have valid written prescription of local doctor as online prescription is not valid. It is better to consult another local psychiatrist to review her situation and change the treatment according to needs.

As you are in XXXXXXX I of course can help you to find another psychiatrist. Please let me know your exact location for the same.

Take care.

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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar