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Suggest Treatment For Psychotic Symptoms, Paranoia And Depression

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Posted on Tue, 17 Mar 2015
Question: i am on 5.75mg risperdale 40mg cipralex and 300mg bupropion.i started bupropion in december 2012 with 150mg & i increased it later to 300mg.cipralex i started years before 2012, i increased it gradually from 10mg to 20 to 30 to 40mg.i started risperdale in april 2005 and i was in 5.75mg in december 2012.i started to gradually decrease it to 2mg and i started to feel psychotic symptoms then i increased it to 5.75mg gradually,my body more or less tolerated the increase from 2mg to 5.75 mg nicely cause i was used to taking risperdale 2005 to 2012.the only side effect that i have for a second time is itchiness,i guess it ll stop in time.now i like to decrease bupropion to 150mg for the next 10 days and replace it by 15mg mirtazapine after that.should i drop the cipralex to 30mg or should i stay on 40mg cipralex .my paranoia started in 1999 my depression started in 2000.i am 31.

i understand now that query means question.i am scared of the feasible fatal qt prolongation that may be caused by taking cipralex mirtazapine risperdale together. is it frequent? does ecg assist to predict how likely it is.is 40mg cipralex 5.75mg risperdale & 15mg mirtazapine safe to take together,40mg cipralex is high
risperdale i am able to tolerate up to 5.75mg some persons that are in a more severe psychosis may take as far as 8mg twice daily.mirtazapine 15mg is the starting dose,cause u are a psychiatrist I need ur advice.
doctor
Answered by Dr. Sunil Gupta (2 hours later)
Brief Answer:
Please see details below

Detailed Answer:
Hi,

Thanks for following up. I went through your question. From what you have mentioned, I could make out that you are suffering from depression and some psychotic symptoms for which you are on treatment with Rsiperidone, Cipralex(40 mg/day) and Bupropion (300mg/day).

I really would have liked to know the exact symptoms that you manifest. In addition, I would have liked to know if you are visiting a psychiatrist for your medicines.

Regarding your question about cipralex, bupropion and mirtazapine, let me start by first telling you that all three are anti-depressants. The maximum recommended dose of cipralex is 20 mg/day. So, i am not sure why you are taking 40 mg/day (there must be reasons). In that case, anyway it is recommended that you bring down the dose to 20 mg/day gradually. You can decide to decrease bupropion to 150 mg/day thereafter.

Regarding starting mirtazapine, I assume that you want to do that because you still are having depressive symptoms. It would be a good choice to start with. You can start with 7.5 and then gradually build up the dose. But I will simultaneously try to taper and stop one of either bupropion and cipralex. The one which showed completely no response for you can be stopped.

The most important thing is to discuss the options with your psychiatrist so that he can guide you better as he will know which drug showed better response for you and supervise the cross tapering of medicines.

Regarding the chances of prolonged qt, you don't have to worry much. You just need to have baseline ECG and have follow up ECGs. If at baseline, it is normal, you can start with mirtazapine. And then , monitoring can be done everytime medicine dose is increased.

And ya, query means question.

I do hope that I was able to answer your question. Please feel free to ask any further doubt if you have any.

Regards,

Dr. Sunil Gupta
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sunil Gupta (39 minutes later)
when my symptoms started in 2000(depression) i had suicidal thoughts sadness,boredom,inability to enjoy studying my lessons,later the suicidal thoughts were eliminated by taking medications.the sadness is also eliminated.yet i have loss of concentration obsessional thought that later developed to listening my thoughts followed by hearing voices,i have slowed thinking since december 2012,i started hearing voices since i started to decrease the risperidone from 5.75 mg to 2mg since december 2012,so I increased it back since may 2014.for the cipralex increasing from 30mg to 40mg didn't make any change.starting bupropion in december 2012 was accompanied by decreasing risperidone so depression started to be replaced by psychosis and there is some overlap between the two so my depression also started.I have a psychiatrist yet he isn't nice he told me to decrease risperdale in december 2012 and made me suffer.before december 2012 i was in a different outpatient resident clinic .i saw several residents changing every 4 or 6 months they were less experienced than him yet they were nicer than him.they honestly told me that risperdale though it is more sedative than abilify it is more effective ,the psychiatrist I saw after december 2012 said i disagree.an honest nice resident,Dr Li had told me that abilify when taken alone isn't as effective as risperdale,my experience approved that risperdale is more effective at least for me.interms of effectiveness i read that mirtazapine is the most effective.according to ur advice i ll decrease bupropion to 150mg and then stop it and start mirtazapine 15mg ,i could decrease cipralex gradually to 20mg

so next 10 days

i ll take bupropion 150mg cipralex 30mg risperidone 5.75mg
next 10 days i ll take

cipralex 20mg mirtazapine 15mg and risperidone 5.75mg

and wait for a month and if no change in crease mirtazapine to 30mg.I am getting a new psychiatrist in August yet I am vacationing in the states in July.is there a stimulant that i could take to avoid sedation during school time so I may study,i meant a stimulant that isn't addictive that doesn't have serious sideeffects or serious interactions or that doesnt aggravate acid reflux of the stomach
doctor
Answered by Dr. Sunil Gupta (20 minutes later)
Brief Answer:
Stimulants not recommended

Detailed Answer:
Hi,

Thanks for following up. To start with let me clear a few things. Effectiveness of a medicine varies person to person. So, in your case, risperidone is more effective. In anyone else, even abilify (aripiprazole might be more effective). Since in your case, risperidone is able to take care of your symptoms, it is the best drug for you.

Regarding the anti-depressants, I agree with the schedule that you have proposed. It seems good enough and I do hope that mirtazapine is able to take care of your symptoms.

Regarding starting a stimulant, frankly I would advise against so. Stimulants can worsen your psychosis. Any of the stimulants that you will use have that possibility. It might help in keeping you active, but considering that the cost will be worsening of psychosis, its definitely not recommended. If even after that you want to try a stimulant, modafinil at low dose (50 mg/day) ca be tried and response assessed.

I hope that I was able to help you in some way. In case you have any further questions, please feel free to ask. I will be glad to answer them. In case you don't have any, please close the discussion and rate the answer.

Best wishes for a speedy recovery,

Dr. Sunil Gupta




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sunil Gupta (8 minutes later)
i have only 20 mg pills of cipralex at home ,i used to take 2 of them to make the 40mg,the tablets have groove yet cipralex couldn't be chewed so i am afraid breaking the 20mg into 2 to take 1 and a half tablet to make a 30 mg couldn't assist me ,cause i guess breaking a tablet is same as chewing it so if i drop from 40mg of cipralex to 20mg before staying on 30mg is that too abrupt of a decrease in doseage.
doctor
Answered by Dr. Sunil Gupta (7 minutes later)
Brief Answer:
It will be too abrupt.

Detailed Answer:
Hi,

Thanks for following up. I can understand your concern regarding breaking up cipralex.

The groove is given so that you can break the medicine into two if required. I would not recommend going down to 20 mg straight away. That will be too abrupt and cause some amount of discontinuation symptoms in form of anxiety. You can very well break the tablet in half and take 30 mg. It will still be effective. So, don't worry about that.

Please let me know if there is anything else I can help you with. I will be glad to do so.

Best wishes,

Dr. Sunil Gupta



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Sunil Gupta (12 minutes later)
interaction wise bupropion and mirtazapine taken together are less serious than mirtazapine and cipralex, what if i stop cipralex gradually and take 150mg bupropion and 15mg mirtazapine.
doctor
Answered by Dr. Sunil Gupta (10 minutes later)
Brief Answer:
Please see details below

Detailed Answer:
Hello,

Thanks for following up.

You can select either of cipralex or bupropion to continue with depending on which gave you better response. In general, I have more faith on cipralex as an anti-depressant.

Regarding side effect and interaction profile, there is nothing much to worry about. Cipralex with mirtazapine do give a very good response in my patients. Personally, I would prefer that. But as I have said in my earlier reply, it all differs person to person. So, you won't know until you try.

So, I would advise to go along with what you are comfortable with and then wait for the response. I really hope, you have respond really well to whatever you decide to be on.

I do hope that my answers are helping you with your doubts. Please let me know if I can be of any more help.

Best wishes,

Dr. Sunil Gupta



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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Sunil Gupta

Psychiatrist

Practicing since :2005

Answered : 637 Questions

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Suggest Treatment For Psychotic Symptoms, Paranoia And Depression

Brief Answer: Please see details below Detailed Answer: Hi, Thanks for following up. I went through your question. From what you have mentioned, I could make out that you are suffering from depression and some psychotic symptoms for which you are on treatment with Rsiperidone, Cipralex(40 mg/day) and Bupropion (300mg/day). I really would have liked to know the exact symptoms that you manifest. In addition, I would have liked to know if you are visiting a psychiatrist for your medicines. Regarding your question about cipralex, bupropion and mirtazapine, let me start by first telling you that all three are anti-depressants. The maximum recommended dose of cipralex is 20 mg/day. So, i am not sure why you are taking 40 mg/day (there must be reasons). In that case, anyway it is recommended that you bring down the dose to 20 mg/day gradually. You can decide to decrease bupropion to 150 mg/day thereafter. Regarding starting mirtazapine, I assume that you want to do that because you still are having depressive symptoms. It would be a good choice to start with. You can start with 7.5 and then gradually build up the dose. But I will simultaneously try to taper and stop one of either bupropion and cipralex. The one which showed completely no response for you can be stopped. The most important thing is to discuss the options with your psychiatrist so that he can guide you better as he will know which drug showed better response for you and supervise the cross tapering of medicines. Regarding the chances of prolonged qt, you don't have to worry much. You just need to have baseline ECG and have follow up ECGs. If at baseline, it is normal, you can start with mirtazapine. And then , monitoring can be done everytime medicine dose is increased. And ya, query means question. I do hope that I was able to answer your question. Please feel free to ask any further doubt if you have any. Regards, Dr. Sunil Gupta