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Suggest Treatment For Depression With Anxiety
Question: I was on antidepressant Flunil ... flunil 20 1month flunil 40 for 2 months and flunil 60, ciplar10 and attentrol18 for 2 months. I stopped taking medicine since XXXXXXX end and now again am having depression and panic attacks. Shall I start with flunil 60, ciplar10 and attemtrol all over again?
Brief Answer:
Please see details below
Detailed Answer:
Dear XXXXXXX
I read your query and can understand the fact that you want to start the same medications all over again as it gave you good results earlier.
You seem to be suffering from recurrent depression with anxiety. In such cases, we generally recommend that the same drug which gave good response in earlier episodes must be tried first.
In your case, you were on three medications: Flunil (Fluoxetine) which is an anti-depressant, Ciplar (Propranolol) which is used for anxiety and Attetnrol (Atomoxetine) which is used for attention deficit and is a stimulant.
In your case, I would recommend you start with fluoxetine and propranalol initially. I don't think that you need atomoxetine for depression.
However, the dose of fluoxetine should not be 60 mg/day from the first day. You can start with 20 mg/day and increase to 40 mg/day in 2-3 days and then increase to 60 mg/day in another 2-3 days. It will help reduce the initial side effects of fluoxetine like nausea and vomiting. High dose straight away will have more chances to cause them. Going to 60 mg/day is recommended because it is this dose that brought response in you earlier.
Propranolol can be started at 10 mg/day and can be increased to 30-40 mg /day if required for anxiety.
Another important thing to note is that you had stopped treatment too early. In case of single episode of depression, it is recommended that the treatment is continued for 6-9 months after complete recovery. In case of more than one, the treatment continues even longer. In your case, since it is second episode, it should be continued for at least 2 years.
Hope that answers your query. Please feel free to ask any further query that you might have.
Wishing you speedy recovery,
Regards,
Dr. Sunil Gupta
Please see details below
Detailed Answer:
Dear XXXXXXX
I read your query and can understand the fact that you want to start the same medications all over again as it gave you good results earlier.
You seem to be suffering from recurrent depression with anxiety. In such cases, we generally recommend that the same drug which gave good response in earlier episodes must be tried first.
In your case, you were on three medications: Flunil (Fluoxetine) which is an anti-depressant, Ciplar (Propranolol) which is used for anxiety and Attetnrol (Atomoxetine) which is used for attention deficit and is a stimulant.
In your case, I would recommend you start with fluoxetine and propranalol initially. I don't think that you need atomoxetine for depression.
However, the dose of fluoxetine should not be 60 mg/day from the first day. You can start with 20 mg/day and increase to 40 mg/day in 2-3 days and then increase to 60 mg/day in another 2-3 days. It will help reduce the initial side effects of fluoxetine like nausea and vomiting. High dose straight away will have more chances to cause them. Going to 60 mg/day is recommended because it is this dose that brought response in you earlier.
Propranolol can be started at 10 mg/day and can be increased to 30-40 mg /day if required for anxiety.
Another important thing to note is that you had stopped treatment too early. In case of single episode of depression, it is recommended that the treatment is continued for 6-9 months after complete recovery. In case of more than one, the treatment continues even longer. In your case, since it is second episode, it should be continued for at least 2 years.
Hope that answers your query. Please feel free to ask any further query that you might have.
Wishing you speedy recovery,
Regards,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
will it be a problem if I directly started with flunil 60, ciplar10? as I already did from today.
I stopped medicines because I imagined that they were no more working and my Dr was unavailable for consultation as he relocated elsewhere
I was quite normal without medicines since last 4 months and am always scared of being addicted and of its severe side effects as I have heard from many.
Please may I know till when do I have to continue same dosage? and how shall I reduce the dose? will it be ok if I see a psychiatrist after a month?
I stopped medicines because I imagined that they were no more working and my Dr was unavailable for consultation as he relocated elsewhere
I was quite normal without medicines since last 4 months and am always scared of being addicted and of its severe side effects as I have heard from many.
Please may I know till when do I have to continue same dosage? and how shall I reduce the dose? will it be ok if I see a psychiatrist after a month?
Brief Answer:
Please see details below.
Detailed Answer:
Dear XXXXXXX
Thanks for following up. I do understand that people get scared of psychotropics and there are many myths regarding them which is why many people don't want to take them. However, the fact is that they are medicines which are actually helpful and have very good response in psychiatric disorders.
You won't get addicted to most of the psychotropics. Addiction generally happens with sedatives and only if you take them unsupervised, In you case, you are not taking any sedative, so you don't need to worry anyway.
You should see your psychiatrist the earliest possible date. It is recommended that you seek treatment under guidance of a psychiatrist.
Since you have already started taking 60 mg, you can continue if you didn't face any problem. In case, you feel any nausea, just reduce the dose. If you respond well to it, you can continue taking the same dose. In case there is incomplete response, dose can be increased to 80 mg.day.
You will have to continue fluoxetine 60 mg/day at least 2 years if you respond well to the medicine. This period is recommended because you are having a second episode of depression. This will help reduce the chances of any further recurrence. You can taper and stop ciplar if your anxiety subsides after a month or so. You can taper it by reducing to half for 1-2 weeks and then stop.
Regarding fluoxetine, it should be tapered at 10 mg dose at a time and response seen for 2-3 weeks. If you maintain well, another 10 mg dose can be reduced and so on. It should be done under supervision of a doctor.
I do hope that answers your query. Please don't hesitate to ask any more doubts that you might have. In case you don't have any more queries, please close the discussion and rate the answer.
Regards,
Dr. Sunil Gupta
Please see details below.
Detailed Answer:
Dear XXXXXXX
Thanks for following up. I do understand that people get scared of psychotropics and there are many myths regarding them which is why many people don't want to take them. However, the fact is that they are medicines which are actually helpful and have very good response in psychiatric disorders.
You won't get addicted to most of the psychotropics. Addiction generally happens with sedatives and only if you take them unsupervised, In you case, you are not taking any sedative, so you don't need to worry anyway.
You should see your psychiatrist the earliest possible date. It is recommended that you seek treatment under guidance of a psychiatrist.
Since you have already started taking 60 mg, you can continue if you didn't face any problem. In case, you feel any nausea, just reduce the dose. If you respond well to it, you can continue taking the same dose. In case there is incomplete response, dose can be increased to 80 mg.day.
You will have to continue fluoxetine 60 mg/day at least 2 years if you respond well to the medicine. This period is recommended because you are having a second episode of depression. This will help reduce the chances of any further recurrence. You can taper and stop ciplar if your anxiety subsides after a month or so. You can taper it by reducing to half for 1-2 weeks and then stop.
Regarding fluoxetine, it should be tapered at 10 mg dose at a time and response seen for 2-3 weeks. If you maintain well, another 10 mg dose can be reduced and so on. It should be done under supervision of a doctor.
I do hope that answers your query. Please don't hesitate to ask any more doubts that you might have. In case you don't have any more queries, please close the discussion and rate the answer.
Regards,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks a lot Dr for your respond
I have noticed after continuing these medicines for few months I start having certain side effects like acidity, nausea, and have tendency to get into depression even while on medicines
I'll definitely see a psychiatrist as soon as possible and taper the doses accordingly
But to be honest this is the 3rd episode to depression it started in Oct 2012 with severe panic attacks, I didn't had any clue y I was being so unreasonably afraid of traveling, of crowds, and even staying inside the house after sunset till midnight was difficult for me, I surfed internet to find the term panic attack, and went to a psychiatrist for the 1st time
I was prescribled Xet12.5, and S-citadep5 I became normal within a week and continued medicine for 4months till I felt excessively drowsy whole day, by then the dose was reduced to xet10, but I couldn't sustain taking it because of its sedative effect.
2nd episode started from September 2013 and has a physical cause of depression, my dad was serious, I was prescribed ciplar10, 1 month prodep40 - 2months and prodep60 2months by this time my dad expired... felt medicines are not working but continued taking them for one more month meanwhile trying to get in touch with my Dr who didn't respond
thereafter I came to know he has relocated elsewhere, hence I had to stop my treatment.
that's the entire episode... thanks for your replies, and I hope this time I don't land up with depression and panic attacks during treatment.
....
I have noticed after continuing these medicines for few months I start having certain side effects like acidity, nausea, and have tendency to get into depression even while on medicines
I'll definitely see a psychiatrist as soon as possible and taper the doses accordingly
But to be honest this is the 3rd episode to depression it started in Oct 2012 with severe panic attacks, I didn't had any clue y I was being so unreasonably afraid of traveling, of crowds, and even staying inside the house after sunset till midnight was difficult for me, I surfed internet to find the term panic attack, and went to a psychiatrist for the 1st time
I was prescribled Xet12.5, and S-citadep5 I became normal within a week and continued medicine for 4months till I felt excessively drowsy whole day, by then the dose was reduced to xet10, but I couldn't sustain taking it because of its sedative effect.
2nd episode started from September 2013 and has a physical cause of depression, my dad was serious, I was prescribed ciplar10, 1 month prodep40 - 2months and prodep60 2months by this time my dad expired... felt medicines are not working but continued taking them for one more month meanwhile trying to get in touch with my Dr who didn't respond
thereafter I came to know he has relocated elsewhere, hence I had to stop my treatment.
that's the entire episode... thanks for your replies, and I hope this time I don't land up with depression and panic attacks during treatment.
....
Brief Answer:
Adequate continuous treatment will help.
Detailed Answer:
Dear XXXXXXX
Thanks for following up. From what you have mentioned, it seems that you are suffering from agoraphobia with panic disorder in addition to depression. Agoraphobia with panic disorder is a condition where you fear crowded and closed places and being alone and have frequent panic attacks.
Regarding the side effects of acidity and nausea, I think you should worry not worry much. most of these side effects are self limiting. You can also take a proton pump inhibitor like rabeprazole 20 mg before meals for a few days, if it is causing much distress.
You need not worry much about having symptoms again if you take treatment adequately. Do not interrupt the treatment this time around and you will be fine. Since you have had 3 episodes, continuing treatment even a bit longer will do no harm. It will only help you remain fine in future. In addition, also start exercising daily as that will help you feel relaxed.
I am sure with proper treatment, you will do really fine. In case of any issues you can contact me directly at:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657
I will be glad if I could be helpful to you in overcoming your condition.
Best wishes for a speedy recovery,
Dr. Sunil Gupta
Adequate continuous treatment will help.
Detailed Answer:
Dear XXXXXXX
Thanks for following up. From what you have mentioned, it seems that you are suffering from agoraphobia with panic disorder in addition to depression. Agoraphobia with panic disorder is a condition where you fear crowded and closed places and being alone and have frequent panic attacks.
Regarding the side effects of acidity and nausea, I think you should worry not worry much. most of these side effects are self limiting. You can also take a proton pump inhibitor like rabeprazole 20 mg before meals for a few days, if it is causing much distress.
You need not worry much about having symptoms again if you take treatment adequately. Do not interrupt the treatment this time around and you will be fine. Since you have had 3 episodes, continuing treatment even a bit longer will do no harm. It will only help you remain fine in future. In addition, also start exercising daily as that will help you feel relaxed.
I am sure with proper treatment, you will do really fine. In case of any issues you can contact me directly at:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657
I will be glad if I could be helpful to you in overcoming your condition.
Best wishes for a speedy recovery,
Dr. Sunil Gupta
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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