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Suggest treatment for severe depression and anxiety

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Posted on Mon, 18 Jul 2016
Question: y dad was undergoing treatment for alcohol deaddiction , depression and anxiety.

Recently he got extreme confusion.

Since last days he was on -
Etizola plus 5, XXXXXXX la 50 mg, baclofen 20 mg extended release, monotop 50mg, genecephal trio in morning and
Excit plus, desvenlafaxine 100mg,oliza 5, monotop 50 and felicita tab in night.

And cyptan and neurofit syrup twice a day.

His condition is not severe now. He is calm and not agitated like before.

But he is still in confusion. Confused about doing anything simple.

2 days ago , etizola plus,excit plus, XXXXXXX la 50 in morning,monotop in evening are removed from treatment . and newcita 20 extended release in night is added.

So why his confusion is still not going. Will his new treatment will help?
doctor
Answered by Dr. Chintan Solanki (49 minutes later)
Brief Answer:
wait, needs routine blood investigations

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us back. I can understand your concern for your father.

He was on multiple medications and multiple drugs are likely responsible for his confusion (in medical term it is called - delirium). It is better to stop/reduce drugs in such cases and that has been done.

In such cases routine blood investigations should be done like CBC, RFT, LFT and electrolyte as sometime changes in these parameters (may be due to drug interactions) can lead to confusion and we need to correct that parameter.

If investigations are not done , please go for it once. He is improving so need to worry.

Feel free to ask further.

Regards,

Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Chintan Solanki (4 hours later)
After confusion only sgot ,sgpt and sugar were tested. And these were fine including sgot.

He was also given drips for electrolytes correction. But it was not tested.

I will get other test done too.

So now coming to current medication.
Are these medicines good enough to cure delirium or there is need to change something?I want to list down his symptoms -

1. He has illogical fears.like he said - if he goes out of house police will catch him. While in bus, if he speaks or talk people will beat him.

2. He goes outside and even in market in whatever clothes he is wearing.

3.he says something which does not make sense at that point. And which is not true but something which his own mind made.

Good things are -

He is not stubborn , irritated and agigated like before.

He will do as we told we to do. Do not argue.

Hope this help you to advice me more clearly
doctor
Answered by Dr. Chintan Solanki (3 hours later)
Brief Answer:
low dose anti psychotic or benzodiazepine medicine

Detailed Answer:
Hello,

Thanks for follow up and information. If already pints are given, electrolytes would come normal. However you can go for investigations, I mentioned, for assurance.

In general to treat delirium treatment of the cause of delirium is needed. For symptomatic improvement and behavioral disturbance low dose anti psychotic medicines like olanzapine, quetiapine or haloperidol should be used in low dose or benzodiazepine medicine like lorazepam can be sued.

If these symptoms of fearfulness or suspiciousness are there first time, I also recommend going for brain scan-MRI to rule out any neurological problem. And if these are recurrent symptoms, anti psychotic medicines will treat them.

Revert back to me with reports and ask his doctor about my suggestions.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (45 hours later)
is CT scan of head is different than MRI ?

his CT scan was done which came normal.

yes his fearfulness or suspiciousness is first time.

he was in confusion since last 3-4 months. but we didn't knew it is some condition. also we didnt knew what is going in his mind.

its 15 days ago, when his confusion got very severe, then we noticed. and taken to psychiatrist.

its been around 17 days since then. his severe confusion is not there now. but he is still confused.

i would say he has recovered only 15-20 %.

that's why i am worrying if he is under right treatment or not.

how long it may take to get confusion away?
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
dementia should be ruled out

Detailed Answer:
Hi XXXXXXX

Thanks for asking your doubts.

CT scan is used for evaluation of head injury or acute infarct (stroke). While for most of the other neurological abnormality and brain tissue evaluation MRI is used.

This long lasting confusion with fearfulness suggests possibility of dementia. XXXXXXX Mental Status Examination (MMSE) and MRI should be done in his case as per my opinion. You can ask his psychiatrist about this aspect or else you can consult neuro-physician once. After diagnosis specific treatment can be done.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Suggest treatment for severe depression and anxiety

Brief Answer: wait, needs routine blood investigations Detailed Answer: Hello XXXXXXX Thanks for writing to us back. I can understand your concern for your father. He was on multiple medications and multiple drugs are likely responsible for his confusion (in medical term it is called - delirium). It is better to stop/reduce drugs in such cases and that has been done. In such cases routine blood investigations should be done like CBC, RFT, LFT and electrolyte as sometime changes in these parameters (may be due to drug interactions) can lead to confusion and we need to correct that parameter. If investigations are not done , please go for it once. He is improving so need to worry. Feel free to ask further. Regards, Dr.Chintan Solanki.