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Suggest Treatment For Insomnia, Depression And Suicidal Thoughts
Question: Dear Dr. Bienenfeld: I am in a bind. I am scheduled to see a new psychiatric resident at XXXXXXX Israel next Monday, XXXXXXX 26. In the meantime I am dealing with an insomnia attack that came on in December, which I have treated with 10 mg haldol, 75 mg thorazine, 2 mg orap and 2 mg ativan. I have been on medication or 36 years. I came off haldol last year, but in a rebound the haldol was needed again for sleep. The problem is it makes me very depressed, and two days ago I was suicidal. We tried seroquel, which improves my mood the next day, at 50 mg, but it made me incredibly restless, even with the requip I take with my current evening medication menu. I would like to try the seroquel again, and grin and bear it with the RLS, in a low dosage of 25 mg. Can I take 8 mg of requip as needed, and increase the thorazine to 200 mg and the orap to 4 mg, and do away with the haldol? I don't want to live with this doom and gloom feeling brought about as a chemical side-effect. Thanks, XXXXXXX Castagnaro
Brief Answer:
You should not self medicate or modify the dose on your own.Visit ER.
Detailed Answer:
Dear XXXXXXX
Thanks for asking on HealthcareMagic.
Your question has been posted on a common pool where Dr. Bienenfeld might not be available to answer your queries and so I am trying to help you out. I am sorry to hear that you are facing issues with your sleep. Requip contains a medicine called ropinirole and should be taken only under the guidance of your treating physician The other medicines too are to be taken only as per your doctor's advice and you should not try to modify the dose without discussing with your doctor. In case you feel that you really need some urgent intervention, please visit the emergency room (ER) of a hospital and get the matter discussed. Also tell them about the gloomy situation that you are in, and the suicidal ideation that you are having.
I understand that the situation could be a result of side effect of such medicines but you should not self medicate or modify the dose on your own. These are medicines that could complicate the situation if not taken in the right manner.
Regards
Dr. Kunal Saha
You should not self medicate or modify the dose on your own.Visit ER.
Detailed Answer:
Dear XXXXXXX
Thanks for asking on HealthcareMagic.
Your question has been posted on a common pool where Dr. Bienenfeld might not be available to answer your queries and so I am trying to help you out. I am sorry to hear that you are facing issues with your sleep. Requip contains a medicine called ropinirole and should be taken only under the guidance of your treating physician The other medicines too are to be taken only as per your doctor's advice and you should not try to modify the dose without discussing with your doctor. In case you feel that you really need some urgent intervention, please visit the emergency room (ER) of a hospital and get the matter discussed. Also tell them about the gloomy situation that you are in, and the suicidal ideation that you are having.
I understand that the situation could be a result of side effect of such medicines but you should not self medicate or modify the dose on your own. These are medicines that could complicate the situation if not taken in the right manner.
Regards
Dr. Kunal Saha
Above answer was peer-reviewed by :
Dr. Raju A.T
I realize you say not to self-medicate, but I am not going to the ER either, because I might be hospitalized instead of given some advice--I don't trust those ER rooms. I will continue to modify my dosage until I feel fine, which I have done in the past. I am simply concerned about the RLS paradox effect with the seroquel, which could solve my problem in and of itself, but instead makes it worse with RLS. I only have until next week to continue to feel miserable before my next appointment. The problem is sleep, finding the right medicine for sleep that does not have depressive side-effects or causes RLS before falling asleep. There may be a medicine, but the doctors can't locate it yet, despite all these years of attempts.
Brief Answer:
The dose of Ativan may perhaps be modified but a ER visit is recommended
Detailed Answer:
Thanks for writing back.
I understand your situation and your fears too. But let me assure you that the people in the ER are there to help you and not to put you in distress.
You would surely admit that you are currently in distress with your symptoms, sleeplessness and RLS. So, if even they decide to admit you, it is to help you out. I understand that such an act can be a further disrupter in your regular life, but surely you will understand that it has already been disrupted with the symptoms that you are unable to control.
I fear that manipulating the doses improperly could actually add to your distress rather than relieving them.
For example, perhaps the dose of Seroquel has been increased more than it was required and has resulted in the restlessness. I would recommend a moderate dose. I would not insist you to manipulate the dose of Requip too. Rather, you can increase the dose of Ativan if you feel. The next thing that I would perhaps have modified the dose of, would have been Thorazine.
You need not really feel miserable till the scheduled appointment arrives. There are people eager to help you. Once again, let me request you to see a doctor.
Regards
Dr. Kunal Saha
The dose of Ativan may perhaps be modified but a ER visit is recommended
Detailed Answer:
Thanks for writing back.
I understand your situation and your fears too. But let me assure you that the people in the ER are there to help you and not to put you in distress.
You would surely admit that you are currently in distress with your symptoms, sleeplessness and RLS. So, if even they decide to admit you, it is to help you out. I understand that such an act can be a further disrupter in your regular life, but surely you will understand that it has already been disrupted with the symptoms that you are unable to control.
I fear that manipulating the doses improperly could actually add to your distress rather than relieving them.
For example, perhaps the dose of Seroquel has been increased more than it was required and has resulted in the restlessness. I would recommend a moderate dose. I would not insist you to manipulate the dose of Requip too. Rather, you can increase the dose of Ativan if you feel. The next thing that I would perhaps have modified the dose of, would have been Thorazine.
You need not really feel miserable till the scheduled appointment arrives. There are people eager to help you. Once again, let me request you to see a doctor.
Regards
Dr. Kunal Saha
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
I attempted emailing beforehand, but the email did not go through. In this case scenario, a minor manipulation of the dosage served its purpose. I took 25 instead of 50 mg of seroquel and did not experience RLS last night and had a better day today, more psychologically functional. I also changed the haldol from 1 mg to 3 mg, since it had been at 5-10 mg, and was responsible for my depression, although it is necessary for sleep. That is the downside of haldol, but not taking too much of it with the other meds can be manageable. It is not preferable to go to the ER thinking I will be helped when for all intents and purposes, things would no doubt worsen, since I am not in a delusional or psychotic state. This depression lifted over the past three days, and was chemically induced, so changing the meds improved my mood. I am done with this case now. Thank you, XXXXXXX
Brief Answer:
Glad to know that things have improved
Detailed Answer:
Thanks for writing back.
I am glad to know that you are feeling much better. As I mentioned, the dose of Seroquel needed to be moderated. Modifying the dose of Halodol has also been reasonable. But these are medicines that change the balance of neurotransmitters in our brain and thereby can cause destabilizations from depression to psychosis. A doctor would have a better knowledge and can do the dose modification after closely monitoring. That was the reason I insisted that you visit a doctor. I understand your apprehensions about visiting the ER. Anyway, if you feel that things are fine, it is indeed relieving.
Regards
Dr. Kunal Saha
Glad to know that things have improved
Detailed Answer:
Thanks for writing back.
I am glad to know that you are feeling much better. As I mentioned, the dose of Seroquel needed to be moderated. Modifying the dose of Halodol has also been reasonable. But these are medicines that change the balance of neurotransmitters in our brain and thereby can cause destabilizations from depression to psychosis. A doctor would have a better knowledge and can do the dose modification after closely monitoring. That was the reason I insisted that you visit a doctor. I understand your apprehensions about visiting the ER. Anyway, if you feel that things are fine, it is indeed relieving.
Regards
Dr. Kunal Saha
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Above answer was peer-reviewed by :
Dr. Shanthi.E
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