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Suggest Treatment For Severe Depression
Question: Dear Sir
Patient is 75years old, retired Bank Manager, was active throughout his life and even few days back he used to take bath very early and do religious acts, go to worship; everything was fine. Medically he is on medication for CAD (taking Revilol XL 100, Ecosprin) and also on medication for (Seizures, first TIA happened in 2006) he has been taking Dilantin, Frisium and Folvite, he went through other attack when Doctor reduced dose of Dilantin in 2013. Since than he is on 1 dilantin in morning and 2 at night. Few days back he went into a mode where he just started speaking useless stuff, like I don't have anything in me, I am useless etc. etc.
So we sent to DM neurology he suggested Sove 5 (1D) and Etinaz 0.25 (3 times a day). But he didn't improved so we went to other popular MD medicine doctor, he suggested MRI, MRI is perfect in order, except aging issues, no other complicated issues. He suggested to contact other DM neurology (he suggest EEG followed by blood tests (RFT, T3, T4, TSH, Dilantin level) all tests and EEG is in order, no complication and out of range values. Doctor reduced Dilantin from 300mg daily to 250mg, within two days of this on 18 of this month he had other Fit.
We went to doctor again he said it is not due to decrease in medicine but some other factor. So he added Levipil250 (2 a day). Now also he is behaving same way, speaking something weird.
Kindly suggest next course of action, is it a case of psychiatry or neurology. Please help in this regard and suggest.
Regards
XXXXX
Patient is 75years old, retired Bank Manager, was active throughout his life and even few days back he used to take bath very early and do religious acts, go to worship; everything was fine. Medically he is on medication for CAD (taking Revilol XL 100, Ecosprin) and also on medication for (Seizures, first TIA happened in 2006) he has been taking Dilantin, Frisium and Folvite, he went through other attack when Doctor reduced dose of Dilantin in 2013. Since than he is on 1 dilantin in morning and 2 at night. Few days back he went into a mode where he just started speaking useless stuff, like I don't have anything in me, I am useless etc. etc.
So we sent to DM neurology he suggested Sove 5 (1D) and Etinaz 0.25 (3 times a day). But he didn't improved so we went to other popular MD medicine doctor, he suggested MRI, MRI is perfect in order, except aging issues, no other complicated issues. He suggested to contact other DM neurology (he suggest EEG followed by blood tests (RFT, T3, T4, TSH, Dilantin level) all tests and EEG is in order, no complication and out of range values. Doctor reduced Dilantin from 300mg daily to 250mg, within two days of this on 18 of this month he had other Fit.
We went to doctor again he said it is not due to decrease in medicine but some other factor. So he added Levipil250 (2 a day). Now also he is behaving same way, speaking something weird.
Kindly suggest next course of action, is it a case of psychiatry or neurology. Please help in this regard and suggest.
Regards
XXXXX
Brief Answer:
It is cotard syndrome, please visit a psychiatrist
Detailed Answer:
Dear XXXXXXX
Thanks for using Healthcaremagic.
I have read your your query and reviewed the attached reports.
The talking of nothing is there in me, I am useless, I am going to die, I am guilty, done something sinful are indicative of cotard syndrome a kind of severe depression.
Cotard syndrome is best treated by psychiatrist. I am surprised to see that no antidepressant was prescribed by even neurologist despite being the mainstay of treatment for cotard syndrome.
I will request you to see a geriatric psychiatrist or atleast a psychiatrist if geriatric psychiatrist is not available in your city. He will prescribe some medication or may decide to take the patient for electro-convulsive therapy (ECT) as ECT is the most effective and rapid treatment for the treatment of cotard syndrome.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards.
It is cotard syndrome, please visit a psychiatrist
Detailed Answer:
Dear XXXXXXX
Thanks for using Healthcaremagic.
I have read your your query and reviewed the attached reports.
The talking of nothing is there in me, I am useless, I am going to die, I am guilty, done something sinful are indicative of cotard syndrome a kind of severe depression.
Cotard syndrome is best treated by psychiatrist. I am surprised to see that no antidepressant was prescribed by even neurologist despite being the mainstay of treatment for cotard syndrome.
I will request you to see a geriatric psychiatrist or atleast a psychiatrist if geriatric psychiatrist is not available in your city. He will prescribe some medication or may decide to take the patient for electro-convulsive therapy (ECT) as ECT is the most effective and rapid treatment for the treatment of cotard syndrome.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Doctor
Thanks for suggestion, meanwhile we visited Psychiatrist and he prescribed following to be taken for 5 days:
Syrup Valence (500mg) 2.5 ml BD
Liquid Sizoden (1 mg/ml) 2 2 4 drops
Kindly review and suggest, also request environmental changes to be done and food to be given. Also he is in trouble having sleep and stool pass.
Regards
XXXX
Thanks for suggestion, meanwhile we visited Psychiatrist and he prescribed following to be taken for 5 days:
Syrup Valence (500mg) 2.5 ml BD
Liquid Sizoden (1 mg/ml) 2 2 4 drops
Kindly review and suggest, also request environmental changes to be done and food to be given. Also he is in trouble having sleep and stool pass.
Regards
XXXX
Brief Answer:
It will be better if he receives antidepressant
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I understand the rationale for sizodon and Valalnce syrup considering his seizure episodes and cotard syndrome but I am baffled to know that antidepressant is missing.
I also understand that sizodon have some anti depressant properties but I feel it will be better if he receives antidepressant along with current treatment.
The only rationale for absence of antidepressant I can make from the current prescription is probably patient not accepting tablets and no syrup form is available for any antidepressants. It is possible that your psychiatrist is hoping for some improvement before prescribing oral medication for depression on next visit.
I must acknowledge my limitation as I am sitting hundreds of kilometers away without any knowledge of patients condition. Since your psychiatrist examined the patient and I hope he took best decision according to patient condition.
I hope this helps you.
Thanks and regards.
It will be better if he receives antidepressant
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I understand the rationale for sizodon and Valalnce syrup considering his seizure episodes and cotard syndrome but I am baffled to know that antidepressant is missing.
I also understand that sizodon have some anti depressant properties but I feel it will be better if he receives antidepressant along with current treatment.
The only rationale for absence of antidepressant I can make from the current prescription is probably patient not accepting tablets and no syrup form is available for any antidepressants. It is possible that your psychiatrist is hoping for some improvement before prescribing oral medication for depression on next visit.
I must acknowledge my limitation as I am sitting hundreds of kilometers away without any knowledge of patients condition. Since your psychiatrist examined the patient and I hope he took best decision according to patient condition.
I hope this helps you.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks Doctor
It indeed is a great help, just last query:
1. How to resolve sleeplessness?
2. Any food precautions?
3. Chances of coming back to normal life (most important query) and time taken for these kind of revivals.
Regards
XXXX
It indeed is a great help, just last query:
1. How to resolve sleeplessness?
2. Any food precautions?
3. Chances of coming back to normal life (most important query) and time taken for these kind of revivals.
Regards
XXXX
Brief Answer:
Slow but steady works
Detailed Answer:
Hello,
Thanks for follow up.
Regarding sleeplessness Sove 5 is the first option. In case he does not respond to that than we can add etinaz 0.5 mg at night. In case he has sleep onset but not able to maintain than sove 6.25 mg will be better alternative. Lastly the speep problem rexolves with treatment of cotard syndrome.
The food precautions should be continued for CAD. No extra precautions required.
The problem in old age is multiple medications due to comorbid illnesses. Due to this reason one is not supposed to start high dose from the day one. The principle is start low and go slow.
Alike depression in young age, majority of patients respond well within 4-12 weeks although they take slightly longer time in compare to young patients due to above said reason.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
Slow but steady works
Detailed Answer:
Hello,
Thanks for follow up.
Regarding sleeplessness Sove 5 is the first option. In case he does not respond to that than we can add etinaz 0.5 mg at night. In case he has sleep onset but not able to maintain than sove 6.25 mg will be better alternative. Lastly the speep problem rexolves with treatment of cotard syndrome.
The food precautions should be continued for CAD. No extra precautions required.
The problem in old age is multiple medications due to comorbid illnesses. Due to this reason one is not supposed to start high dose from the day one. The principle is start low and go slow.
Alike depression in young age, majority of patients respond well within 4-12 weeks although they take slightly longer time in compare to young patients due to above said reason.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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