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Suggest treatment for insomnia, anxiety and mood swings

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Posted on Fri, 15 May 2015
Question: I am 55 year old male. I had 3 instances of depression 15-25 years ago, and was finally put on 60mg Celexa and Welbutrin XL.
I have had libido and ED issues. My urologist put me on 100 mg of TRT shots a week. I was ok for a few months, and then had a bad week of insonmia, anxiety and mood swings. My primary care doctor checked my T level, and it was "over 1,500". She said this was the dause of the issues, and cut me back to 80 mg every two weeks. I felt better, but about a month later, had another "crash". Thinking i was going down to fast, she cut me to 50 mg every week. I was ok for awile, but the started getting mood swings, anxiety, insomnia, and we decided to cut the TRT altogether. I went to 60 mg every other week for two weeks for two rounds, then to 30 mg for two rounds. All through this i am getting mood swings and anxiety. She then decided to change my shots to every 10 days. This week has been awful. Low mood to the point of depression. I am of course concerned my old depression is coming back. Is all of this due to TRT withdrawal, where i will start to feel better soon?
doctor
Answered by Dr. Pankaj Borade (5 hours later)
Brief Answer:
relapse of previous condition

Detailed Answer:
dear,
Welcome to HCM
It appears a relapse of your previous condition of anxiety and depression.
The precipitating factors being the hormonal and endocrine imbalance, and related stress.
My suggestion:
1) your endocrinological condition is directly related to the condition of mood and anxiety symptoms. It has to be dealt promptly as it can worsen the mood symptoms further and create resistance to psychiatric drug treatment. It is advisable to consult an expert endocrinologist for it.
2) Regarding your problems and complaints of mood and anxiety, it is very evident that your previous condition has relapsed. Here restarting the course is indicated. However instead of citalopram that you were prescribed before, i suggest you to discuss drugs like sertraline with your treating psychiatrist as they have a better efficacy and side effect profile. Wellbrutin can be continued like before.
A short course of benzodiazepines can be indicated. I would suggest you to consult a local psychiatrist soon and discuss these suggestions with him.

Hope to have given you a useful advice.
Kindly revert back for further queries.

Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Pankaj Borade

Psychiatrist

Practicing since :2011

Answered : 571 Questions

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Suggest treatment for insomnia, anxiety and mood swings

Brief Answer: relapse of previous condition Detailed Answer: dear, Welcome to HCM It appears a relapse of your previous condition of anxiety and depression. The precipitating factors being the hormonal and endocrine imbalance, and related stress. My suggestion: 1) your endocrinological condition is directly related to the condition of mood and anxiety symptoms. It has to be dealt promptly as it can worsen the mood symptoms further and create resistance to psychiatric drug treatment. It is advisable to consult an expert endocrinologist for it. 2) Regarding your problems and complaints of mood and anxiety, it is very evident that your previous condition has relapsed. Here restarting the course is indicated. However instead of citalopram that you were prescribed before, i suggest you to discuss drugs like sertraline with your treating psychiatrist as they have a better efficacy and side effect profile. Wellbrutin can be continued like before. A short course of benzodiazepines can be indicated. I would suggest you to consult a local psychiatrist soon and discuss these suggestions with him. Hope to have given you a useful advice. Kindly revert back for further queries.