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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for severe depression and anxiety

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3498 Questions

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Posted on Fri, 3 Mar 2017 in Brain and Spine
Question: I recently had a neuropsychological evaluation and the test scores are very confusing. If I submit a copy of them, can you please translate in to layman terms so I can understand where I am in the scheme of things?
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Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Do not score well in depression and anxiety part, cognitive tests not bad.

Detailed Answer:
I read your question and reviewed that report you provide.

There are several neuropsychological tests evaluating your cognitive functions as well as some tests aimed at evaluating depression, anxiety and sleep.

Most tests results are given in Raw and T column. The Raw are the actual points you score, while T means T score, which is more significant as it shows where you stand in comparison to other people of your same group (similar age, sex etc). So if you are at a T score of 50 it means that you score as the average person of your age scores. Values over 50 are better than average, if under means lower than average. Usually values of +/- 10 (40-60) are considered average, it's more than that which has any significance.
So judging from your T score values things do not look bad, for the most part you score inside the average, often even better.

Where you seem to not do well though is in the sections evaluating depression, anxiety and sleep which indicate that you have considerable anxiety and depression issues which should be addressed.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 28 hours later
My diagnosis is CADASIL (diagnosed DNA test March 2007) but I had TBI and multiple micro-bleed strokes from a car accident in 1995 (and was diagnosed with persistent post-concussive disorder, PTSD, back then.) I understand all these diagnoses cause mood disorders, and I have a lot of psycho-social stressors (my husband is 68 and has severe vascular disease, Agent Orange). What can I do about these moods, which won't worsen CADASIL, since many drugs do? I tried Valproate but had 3 micro-bleeds right away, and had to discontinue. Anti-depressants don't work. At my age CADASIL worsens. I am now trying CBD during the day on my own volition, and CBD/THC at night, but in small doses as I am very sensitive to medications. I take Xanax in .50 doses, never more than 1 mg a day because it is bad for my memory and balance, and I think causes some depression, and those are being affected. I see the difference in me even though you say the test results are mostly normal, but the testing is an artificial construction and my concentration is impaired above what I expected from the test results. The neurologists here won't see me because they say there is no treatment or cure for CADASIL. What can I do?
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Answered by Dr. Olsi Taka 12 hours later
Brief Answer:
Read below

Detailed Answer:
Thank you for the additional information. I understand the difficult situation you are in. I also understand the neurologists as CADASIL is a frustrating condition as there really is no known cure, one can only try to cope with the symptoms as they come. However I still find unacceptable for them not to see you - I guess that's the US system, one can't choose his patients where I live. I am afraid I am not aware of finding a way around that though, you should discuss with your primary physician about what other possibilities the system offers, perhaps a psychiatrist may also be able to help you.

Your remarks about the care needed with medications which can have side effects on central nervous system are correct, one must search a balance between addressing symptoms and avoiding cognitive side effects.
CBD should be continued. In terms of medications I am afraid antidepressants are the most suitable ones. I do not know which ones you have tried. The most recommended are the SSRI group like citalopram, starting by the smallest dose and increasing gradually if needed.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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