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Suggest Treatment For Generalized Anxiety Disorder And Mild Depression
Question: Dear Doctor,
I am using Nebicard-5 and Telma 40 mg on alternate nights(if one night telma-40, then next night Nebicard) for my BP for the last 2 years. My BP before treatment was 160/98(avg), but now after start treatment, it is about 135/85 (avg). I also using Escitalopram(Nexito-10mg) for my GAD/mild depression for the last 4 years. I developed GAD almost 20 years ago after a job loss and under various medication since then and now on Nexito-10mg only. I am 52 years old now.
My questions are (1) Is it ok if I continue both BP drugs alternatively ? Eventhough my doctor suggested me both together on every day, I changed alternatively by myself one year ago with the fear of side effects and drowsiness but still BP controlled.
I am always sleepy in the day and cannot revise my study materials ( I am a Math tutor) and so cannot memorize easily. A kind of lack of memmory and sleepy mood. I want to get rid of that mood urgently as it affects my tutoring job badly. Is the drowsiness due to any of these drugs? I tested these 3 drugs in the night as well as morning to see any improvement, but no improvement in sleepy mood. How can I modify the medicines so that I feel less lethargic in the day? Is it advisable to use one of the BP medicine regularLy and if so which among these two is best to continue without much drowsy feeling. Hope to get a detalied reply. Thanks
I am using Nebicard-5 and Telma 40 mg on alternate nights(if one night telma-40, then next night Nebicard) for my BP for the last 2 years. My BP before treatment was 160/98(avg), but now after start treatment, it is about 135/85 (avg). I also using Escitalopram(Nexito-10mg) for my GAD/mild depression for the last 4 years. I developed GAD almost 20 years ago after a job loss and under various medication since then and now on Nexito-10mg only. I am 52 years old now.
My questions are (1) Is it ok if I continue both BP drugs alternatively ? Eventhough my doctor suggested me both together on every day, I changed alternatively by myself one year ago with the fear of side effects and drowsiness but still BP controlled.
I am always sleepy in the day and cannot revise my study materials ( I am a Math tutor) and so cannot memorize easily. A kind of lack of memmory and sleepy mood. I want to get rid of that mood urgently as it affects my tutoring job badly. Is the drowsiness due to any of these drugs? I tested these 3 drugs in the night as well as morning to see any improvement, but no improvement in sleepy mood. How can I modify the medicines so that I feel less lethargic in the day? Is it advisable to use one of the BP medicine regularLy and if so which among these two is best to continue without much drowsy feeling. Hope to get a detalied reply. Thanks
Brief Answer:
The drugs may rarely cause it
Detailed Answer:
Hello,
both of these (antihypertensive) drugs are usually well tolerated, but if you've excluded other reasons for your difficulties then the drugs can be blamed.
Other potential reasons would include:
- anemia (low hematocrit) and electrolyte disorders
- sufficient rest (regular sleep)
- escitalopram (6% somnolence)
- depression itself!
So the best plan would be to consult your psychiatrist regarding depression. If the psychiatrist believes that you're perfectly fine with escitalopram or you could change regimen.
You could try alternative medications for hypertension and even stopping them for a few days just to check whether you'll notice improvements or not. A high blood pressure won't hurt most individuals for a while. Aneurysms, heart failure and severe coronary artery disease are conditions that would call for a more strict approach.
Using them in alternative days is also OK if you achieve the target of 130 (systolic) mmHg. There is likely no benefit from lowering blood pressure beyond 130 (systolic). Nebivolol would be better used every day but if it works, there is no problem!
Also remember that drugs is not the only way to fight hypertension. Salt restriction, a healthy diet and body weight and physical activity are important measures against hypertension.
I hope I've answered your query!
If you'd like more information, please specify which part of my answer needs clarifications or additions.
Kind Regards!
The drugs may rarely cause it
Detailed Answer:
Hello,
both of these (antihypertensive) drugs are usually well tolerated, but if you've excluded other reasons for your difficulties then the drugs can be blamed.
Other potential reasons would include:
- anemia (low hematocrit) and electrolyte disorders
- sufficient rest (regular sleep)
- escitalopram (6% somnolence)
- depression itself!
So the best plan would be to consult your psychiatrist regarding depression. If the psychiatrist believes that you're perfectly fine with escitalopram or you could change regimen.
You could try alternative medications for hypertension and even stopping them for a few days just to check whether you'll notice improvements or not. A high blood pressure won't hurt most individuals for a while. Aneurysms, heart failure and severe coronary artery disease are conditions that would call for a more strict approach.
Using them in alternative days is also OK if you achieve the target of 130 (systolic) mmHg. There is likely no benefit from lowering blood pressure beyond 130 (systolic). Nebivolol would be better used every day but if it works, there is no problem!
Also remember that drugs is not the only way to fight hypertension. Salt restriction, a healthy diet and body weight and physical activity are important measures against hypertension.
I hope I've answered your query!
If you'd like more information, please specify which part of my answer needs clarifications or additions.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hi Doctor,
Thanks for the advise. But unfortunately I gave wrong medicine name in my question. I was not in Telma-40 but it is Olmesartan Medoxomil-20 mg. Sorry for the wrong info. I have used Telma-40 two years ago and changed to Olmesartan-20 by Dr due to not very effective in my case. So Olmesartan -20 and Nebicard-5. Is there any concern with this drug for my extreme drowsiness? As my BP is not too high and I am trying to control it by diet change and excercise, can I stop any one of them and continue other regularly? If it is possible, which of these 2 drugs is more better in terms of less side effects and drowsiness?
In fact, I really hate using drugs for life long. In my case , I am not very hypertensive (I believe so)and my hypertension partially related to my anxiety and stress(It is true) , is it possible to stop both drugs in future if I can improve my BP through regular excercise, diet change, stress reduction etc ? or do I need to use those life long?
As per my psychiatrist, I have tried to stop my Escitalopram one year ago as I don't feel any severe anxiety since my situation improved very much. But when I stopped it gradually, all my anxiety and depressed feeling came back. So my Psychiatrist told me to continue it ,probably life long, as he said I need it for regular functioning. He also told me it is more better than any other drug of same category in terms of less drowsiness and is well tolerated. So as a second advise from you, is it ok if I continue this drug life long as per my Psych or do I try to taper again and stop it (or) do I need to consult another Psych to check for alternate drug ? Do you think any implications/serious side effects if any if I continue to use Escitalopram life long?
Thanks in advance for your further advise.
Thanks for the advise. But unfortunately I gave wrong medicine name in my question. I was not in Telma-40 but it is Olmesartan Medoxomil-20 mg. Sorry for the wrong info. I have used Telma-40 two years ago and changed to Olmesartan-20 by Dr due to not very effective in my case. So Olmesartan -20 and Nebicard-5. Is there any concern with this drug for my extreme drowsiness? As my BP is not too high and I am trying to control it by diet change and excercise, can I stop any one of them and continue other regularly? If it is possible, which of these 2 drugs is more better in terms of less side effects and drowsiness?
In fact, I really hate using drugs for life long. In my case , I am not very hypertensive (I believe so)and my hypertension partially related to my anxiety and stress(It is true) , is it possible to stop both drugs in future if I can improve my BP through regular excercise, diet change, stress reduction etc ? or do I need to use those life long?
As per my psychiatrist, I have tried to stop my Escitalopram one year ago as I don't feel any severe anxiety since my situation improved very much. But when I stopped it gradually, all my anxiety and depressed feeling came back. So my Psychiatrist told me to continue it ,probably life long, as he said I need it for regular functioning. He also told me it is more better than any other drug of same category in terms of less drowsiness and is well tolerated. So as a second advise from you, is it ok if I continue this drug life long as per my Psych or do I try to taper again and stop it (or) do I need to consult another Psych to check for alternate drug ? Do you think any implications/serious side effects if any if I continue to use Escitalopram life long?
Thanks in advance for your further advise.
Brief Answer:
Many questions, please read the detailed answer
Detailed Answer:
Hello,
what I wrote about telmisartan applies for olmesartan. This cannot be considered the reason of your drowsiness unless other potential cause have been excluded.
I still believe that either depression itself or its treatment (escitalopram) is the cause.
Regarding your antihypertensive treatment I would suggest stopping them one at a time (starting with olmesartan, since cutting down on a beta-blocker may cause tachycardia and other autonomic symptoms). If you see no difference in drowsiness then I would suggest taking them for life. This is not a real problem for any of the drugs you mentioned. Many people use them for very long without serious problems.
If you won't succeed in correcting the problem with the antihypertensives intervention then I suggest (again) to discuss your problem with the treating psychiatrist. If you decide to stop escitalopram, you should do it very very slowly because a fast withdrawal causes symptoms of depression all over again. Your psychiatrist knows how to do it, so it would be better for you to follow his instructions.
I hope you find my answer helpful!
Of course you can ask for further clarifications.
Kind Regards!
Many questions, please read the detailed answer
Detailed Answer:
Hello,
what I wrote about telmisartan applies for olmesartan. This cannot be considered the reason of your drowsiness unless other potential cause have been excluded.
I still believe that either depression itself or its treatment (escitalopram) is the cause.
Regarding your antihypertensive treatment I would suggest stopping them one at a time (starting with olmesartan, since cutting down on a beta-blocker may cause tachycardia and other autonomic symptoms). If you see no difference in drowsiness then I would suggest taking them for life. This is not a real problem for any of the drugs you mentioned. Many people use them for very long without serious problems.
If you won't succeed in correcting the problem with the antihypertensives intervention then I suggest (again) to discuss your problem with the treating psychiatrist. If you decide to stop escitalopram, you should do it very very slowly because a fast withdrawal causes symptoms of depression all over again. Your psychiatrist knows how to do it, so it would be better for you to follow his instructions.
I hope you find my answer helpful!
Of course you can ask for further clarifications.
Kind Regards!
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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