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Suggest Treatment For Severe Depression

Posted on Thu, 11 Dec 2014

Question: Hi. I live in a place where it's very hard to get a psychiatrist. I've been diagnosed by my family doctor as having major depression (30 years). I am seeing a therapist but am concerned about the mix of medication I'm taking-at XXXXXXX zopiclone, abilify, effector, vivante and quétaine. My doctor does his best but has to look on the Internet every time he prescribes something. Meanwhile, I have less and less energy and motivation, am gaining weight and had to take a leave from work. Can you help?

Answered by Dr. Ravi Soni (54 minutes later)

Brief Answer:
Hi, Prozac will be better choice here

Detailed Answer:
hi, thanks for your query. Welcome to HCM.

I have read your concerns and shall answer accordingly.

according to your past ans current medications, I can assume that your diagnosis would not be simple depression, because you have been given mood stabilizer and antipsychotic in addition to antidepressants. SO you have probably treatment resistant depression or bipolar depression. Simple depression wont last this long.

Because you need drug that wont cause weight gain I would suggest you to take Prozac. You can discuss about it with your doctor. Adding bupropion will help you in gaining motivation and energy. Nuvigil [armodafinil is also a good drug, you have taken it previously]

My suggestion of drug combination would be Prozac [20 to 40], Bupropion [150 to 300], Ativan [2 mg at night for sleep], Quetiapine [100 to 300 mg at night].
This drug combination will be best for you. It does not cause weight gain also.
I can not understand about the vivante [I can't find it's name].

These drugs will also increase your motivation and energy level.

Hope I have answered your query. If you have further question then feel free to ask. Wish you good health.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ravi Soni (17 minutes later)

Thank you for you prompt reply.
Vycanse is also know as lisdexamphetamine. It actually seems to be to only one that's giving me a mood lift.

Sorry, forgot to mention that I also take 2mg of abilify. I live in Quebec, Canada-land of free health car but the means that it takes months to get a doctor's appointment and up to a year to get a psychiatrist. So it's been difficult to get my message straightened out.
Thank you for your help.
XXXX

Answered by Dr. Ravi Soni (9 hours later)

Brief Answer:
Vycanse is for increasing your motivation

Detailed Answer:
Hi, thanks for writing again.

Vycanse is a good drug which is primarily used in the treatment of ADHD in children but it can as be used as a augmenting agent in Resistant depression.

If you are taking vycanse then there is no need of taking bupropion. Quetiapine will help you in sleep as well as in your depression. Abilify 2 mg is not sufficient dose and 2 mg wont do anything in your depression. It should be at least 5 mg in a day during morning hours.

So, here my suggestion will be Prozac [20 to 40], Vycanse as per your dose, Ativan [2], Quetiapine [100 to 300 mg]. Discuss all about this with your family doctor.

Hope I have answered your query. If you do not further query then close the discussion and rate the answer.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Ravi Soni (8 hours later)

Thank you. That sounds reasonable. I will be seeing my doctor on the 25th and will pass on your suggestions.
Again, thank you.
XXXX

Answered by Dr. Ravi Soni (57 minutes later)

Brief Answer:
You are welcome

Detailed Answer:
Hi, Thanks for your words.

If you have further query in future, It will be my pleasure to help but now if you do not have further query then close the discussion and rate the answer.

Wish you good health.

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

Above answer was peer-reviewed by : Dr. Vaishalee Punj