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Suggest treatment for severe depression while on Lamitor, Zosert and Clonax Md

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Posted on Wed, 15 Jun 2016
Question: http://doctor.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=211661
my history is in the link

Sir,Assalamualikum.
0n 18.04.2016 my doctor prescribed me below mentioned medicines for my Depression Recurrent:-
1.Lamitor DT 25mg half 25 mg for 3 days morning and 25 mg for next 4 days and then continue with 50 mg for one month (with the advice that if skin rashes occur within first 7 days then stop immediately. I took the medicine for 7 days as per doctor's advice but no skin rashes occurred but still i stopped the medicine because of some more dangerous side effects such as liver and kidney problems etc.can happen by taking this drug which i read on internet.
2. Zosert 100 mg morning and Zosert 100 mg evening.(taking this regularly)
3. Clonax 0.25 at bed time.
Note: I am not feeling well/ happiness, not interested in going to shop,not want to talk with any body and remains silent all the time in my bedroom and not sleeping well. some nights i could not slept for a second.
Sir,In view of the above information kindly advise me in detail and also befits of Lamitor and thanks.
With regards,
XXXXXXXXXXXXXXXXXXXXXXX
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
I recommend mirtazapine

Detailed Answer:
Hello XXXXXXXXXX

Thanks for writing to us. I can understand your concern. I read your history from other link.

Lamotrigine is overall good drug and used in resistant depression as well as in bipolar depression. Your depression seems to be recurrent but not resistant (as you were stable only on sertraline) and not bipolar (there is no history of mania or hypomania). In that case if I were your treating doctor I want to add SNRI drug like mirtazapine to SSRI drug (sertraline).

Lamaotrigine can cause skin reaction but that is very rare. Whatever you read about kidney and liver side effects those are also very rare. No need to worry about the same. But you may need daily 100 mg dose for good effect. You can restart lamotrigine as per your doctor’ instruction and should wait for 4 weeks to get optimum effects or other option is you can ask your doctor to prescribe mirtazapine. Its other advantage is it helps in sleep and you can get better sleep by taking night dose of mirtazapine.

Hope I have answered your query, I will be happy to help further.

Regards,

Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (50 minutes later)
SIR,
THANKS FOR REPLYING.SHOULD I TAKE LAMOTRIGINE- 100 OR MIRTAZAPINE-100 WITH ZOSERT-200 OR BOTH?KINDLY EXPLAIN IN DETAIL HOW TO TAKE ( DAILY TIMING) AND HOW LONG MONTHS ABOUT THE SAID DRUGS.
WITH REGARDS
XXXXXXX


doctor
Answered by Dr. Chintan Solanki (34 minutes later)
Brief Answer:
either lamotrigine or mirtazapine, not both

Detailed Answer:
Dear Mr.XXXXXXXXXX,

Thanks for follow up. You should restart lamotrigine as before and gradually you can reach to 100 mg in 20 days. You should continue zosert. If you do not want to take lamotrigine you can start mirtazapine. You can ask your doctor for prescription of mirtazapine. Initially for 10 days take 7.5 mg before going to bed and then increase the dose to 15 mg before going to bed. You should continue zosert with it. Common side effects are dry mouth, constipation and increase appetite (weight gain) which can be prevented with healthy lifestyle.

If still any query there, I will be happy to answer. If not, you can close the discussion and give your feedback and rating so I can improve my service.

In future if you wish you can contact me directly with following link:
http://bit.ly/drchintansolanki

by clicking on 'Ask me a question' on same page with three follow up questions.

All the best and take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (29 minutes later)
SIR,
Q.NO.1.SHOULD I TAKE ZOSERT-200 ONE TIME OR ZOSERT 100 MORNING AND EVENING.I KNOW THIS DRUG HAS TO BE TAKEN FOR LIFE TIME.

Q.NO.2. I REMEMBER THAT I WAS TAKING mirtazapine SOME LONG YEARS BACK.THEN SHOULD I TAKE Lamaotrigine MORNING TIME AS PER MY DOCTORS PRESCRIPTION. BUT KINDLY TELL ME SHOULD I HAVE TO TAKE THIS DRUGLamaotrigine FOR LIFE TIME .

KINDLY REPLY FOR ABOVE TWO QUESTIONS SEPARATELY

WITH REGARDS
KHURSHID

doctor
Answered by Dr. Chintan Solanki (6 minutes later)
Brief Answer:
100 mg zosert morning and evening

Detailed Answer:
Hello,

Thanks for questions.

Ans 1: I recommend taking zosert 100 mg morning and evening to maintain drug level round the clock. When you have more 3 episodes of depression at least one anti depressant drug should be continued for lifelong to prevent relapse.

Ans 2: Lamotrigine also can be taken 50 mg morning and evening when you reach 100 mg dose. With 50 mg dose you should take 25 mg in morning and evening. At present it is not confirmed that you have to take lamotrigine for lifelong. After complete improvement when you remain 100% stable for 6 months we can attempt to reduce and stop lamotrigine. If attempt goes successful, zosert only you need to take otherwise effective minimum dose of lamotrigine should also be continued for long.

Do not hesitate to clear doubt if any.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (10 hours later)
SIR,
IF YOU DO NOT MIND FOR YOUR INFORMATION I AM A SMOKER.I CONSUME ABOUT 20 CIGARETTES EACH DAY.

CAN I TRY TO GIVE UP SMOKING AT THIS STAGE OF DEPRESSION. WILL QUITTING OF SMOKING HELP ME IN CONTROLLING MY DEPRESSION TO SOME EXTENT. KINDLY GUIDE ME ACCORDINGLY

WITH REGARDS
XXXXXXXXXX
doctor
Answered by Dr. Chintan Solanki (12 hours later)
Brief Answer:
yes quitting smoking of course help

Detailed Answer:
Hi,

Sorry for delayed response

20 cigarettes per day is pretty high intake. Stopping the smoking not only will help in depression but will help in many other aspects of physical health. Smoking is the most important factor in world's top five cancer related death. It is the important risk factor in cardiac diseases.

It is difficult to stop 20 cigarettes without medicines I guess. You need bupropion, anti anxiety medicines (like propranolol, etizolam or clonazepam) and nicotine pastilles/gums to prevent withdrawal symptoms and stop smoking. Please consult your psychiatrist, decide plan for deaddcition and move ahead.

Wish you good health.

http://bit.ly/drchintansolanki
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Chintan Solanki

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Practicing since :2007

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Suggest treatment for severe depression while on Lamitor, Zosert and Clonax Md

Brief Answer: I recommend mirtazapine Detailed Answer: Hello XXXXXXXXXX Thanks for writing to us. I can understand your concern. I read your history from other link. Lamotrigine is overall good drug and used in resistant depression as well as in bipolar depression. Your depression seems to be recurrent but not resistant (as you were stable only on sertraline) and not bipolar (there is no history of mania or hypomania). In that case if I were your treating doctor I want to add SNRI drug like mirtazapine to SSRI drug (sertraline). Lamaotrigine can cause skin reaction but that is very rare. Whatever you read about kidney and liver side effects those are also very rare. No need to worry about the same. But you may need daily 100 mg dose for good effect. You can restart lamotrigine as per your doctor’ instruction and should wait for 4 weeks to get optimum effects or other option is you can ask your doctor to prescribe mirtazapine. Its other advantage is it helps in sleep and you can get better sleep by taking night dose of mirtazapine. Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki.