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Suggest Treatment For Severe Depression ,anxiety And Panic Attacks
Question: I have severe depression, anxiety disorder and panic attacks. I've been seeing a psychiatrist for many years and take medication. I started seeing a therapist a few years ago. This week I had some extremely upsetting things occur. Among them, I told my therapist, I wouldn't be seeing him any longer. I'm definitely not any better. Medication is no longer helping and I've pretty much given up hope of getting better. My therapist emailed me and I'm including his email below.
Yesterday was bad. I took some medicine and went to bed. This morning I feel as if my insides are shaking. My hands are trembling. I feel a weakness in my chest, arme and legs and I'm extremely upset.
I've never felt like this before. Can you help?
XXXXXXX
This is a follow-up response to confirm I have received your written decision to terminate services. I will honor what you require.
If you so desire, I will provide alternate referrals to providers.
I am no doctor. There is no ethical conundrum. I do not agree with your decision to terminate services.
I hope you will re-consider and begin attending sessions again.
I will gladly re-schedule regular appointments for you if you give me permission.
You are a good man and I have greatly enjoyed your input and insights.
Please re-consider.
Even if you maintain your current stance I would like you to consider at least one more telephone contact.
With Great Respect,
XXXXXXX
Yesterday was bad. I took some medicine and went to bed. This morning I feel as if my insides are shaking. My hands are trembling. I feel a weakness in my chest, arme and legs and I'm extremely upset.
I've never felt like this before. Can you help?
XXXXXXX
This is a follow-up response to confirm I have received your written decision to terminate services. I will honor what you require.
If you so desire, I will provide alternate referrals to providers.
I am no doctor. There is no ethical conundrum. I do not agree with your decision to terminate services.
I hope you will re-consider and begin attending sessions again.
I will gladly re-schedule regular appointments for you if you give me permission.
You are a good man and I have greatly enjoyed your input and insights.
Please re-consider.
Even if you maintain your current stance I would like you to consider at least one more telephone contact.
With Great Respect,
XXXXXXX
Brief Answer:
revise drugs, espically propanolol
Detailed Answer:
Hello,
Your current prescription for both psychiatric meds and for hypertension needs revision.
I would even say that you should go back to a cardiologist or your GP who is treating you for hypertension and get them changed. Please ask him to reduce propanolol. Propanolol is itself capable of giving anxiety, feeling of restlessness an palpitation at such high dosage. If possible he may shift you to a different class of drug altogether ( like an ACE inhibitor or a good combination). I would definitely like to know your blood pressure readings three times a day to check any fluctuations which might be behind the current problem.
If propanolol is being used only for psyhciatric managment then this dosage is a mistake. Should be reduced.
Now, regarding psychiatric meds- you are taking armodalfinil ( possibly as an activator from leathgy); symbalta, bupropion. These current regimn is not working and more over are not given in adequate dosage.
You are hypertensive, and have prominent anxiety symptoms-- I think you will have good response to sertraline or paroxetine. You should discuss these two molecules with your treating team. Both are good and will help you in handling both anxiety and sadness. with response the need for ativan will not be there.
Try to reduce and stop symbalta ( it is a very mild drug which is not suitable in your case presently).
The dosage of sertraline should go upto 100-150mg to give adequte response.
Please donot loose hope, you will be fine.
Taking several drugs always complicate the treatmen, so try to minimise no. of drugs first.
Your complaint of inability to work is more related to weakness and anxiety state. please increase water and salad use in daily diet. This will surely help you.
you seem to have a good therapist, try to connect back with him. Therapy along with meds help everyone to recover faster. Regular supportive sessions are required by anyone who is under some stress and relapse. So, even though you moved out of therapy ( many people do this on and off, especially under fresh relapse) you may re-start that.
Please ask more questions for clarification.
wish you good luck and good health!
Dr. Manisha Gopal
MD Psychiatry
revise drugs, espically propanolol
Detailed Answer:
Hello,
Your current prescription for both psychiatric meds and for hypertension needs revision.
I would even say that you should go back to a cardiologist or your GP who is treating you for hypertension and get them changed. Please ask him to reduce propanolol. Propanolol is itself capable of giving anxiety, feeling of restlessness an palpitation at such high dosage. If possible he may shift you to a different class of drug altogether ( like an ACE inhibitor or a good combination). I would definitely like to know your blood pressure readings three times a day to check any fluctuations which might be behind the current problem.
If propanolol is being used only for psyhciatric managment then this dosage is a mistake. Should be reduced.
Now, regarding psychiatric meds- you are taking armodalfinil ( possibly as an activator from leathgy); symbalta, bupropion. These current regimn is not working and more over are not given in adequate dosage.
You are hypertensive, and have prominent anxiety symptoms-- I think you will have good response to sertraline or paroxetine. You should discuss these two molecules with your treating team. Both are good and will help you in handling both anxiety and sadness. with response the need for ativan will not be there.
Try to reduce and stop symbalta ( it is a very mild drug which is not suitable in your case presently).
The dosage of sertraline should go upto 100-150mg to give adequte response.
Please donot loose hope, you will be fine.
Taking several drugs always complicate the treatmen, so try to minimise no. of drugs first.
Your complaint of inability to work is more related to weakness and anxiety state. please increase water and salad use in daily diet. This will surely help you.
you seem to have a good therapist, try to connect back with him. Therapy along with meds help everyone to recover faster. Regular supportive sessions are required by anyone who is under some stress and relapse. So, even though you moved out of therapy ( many people do this on and off, especially under fresh relapse) you may re-start that.
Please ask more questions for clarification.
wish you good luck and good health!
Dr. Manisha Gopal
MD Psychiatry
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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