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What are more aggressive antidepressants helpful for a person eager

Answered by
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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 2812 Questions

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Posted on Fri, 28 Dec 2018 in Mental Health
Question: What are more aggressive antidepressants helpful for a person eager to get well ?
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Follow up: Dr. Ashok Kumar 0 minute later
What are more aggressive antidepressants helpful for a person eager to get well ?
doctor
Answered by Dr. Ashok Kumar 2 hours later
Brief Answer:
Consultation

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns about your daughter who is suffering with severe depression with severe hypothyroidism with PCOS.

Regarding the antidepressant I feel Desvenlafaxine can be the first choice provided it was not used in the past. This is based on the fact that among the available antidepressants it has tolerable side effects and efficacy is better in compare to many antidepressants (Theoretically it is as good as others but practically we are seeing better improvement). In addition it causes activation which can be helpful to deal with lack of energy.

In case this has already been tried I do not think there is any harm with use of TCAs. They are as good as other antidepressants (Theoretically) but better than many SSRIs and SNRI when you use them in practically. However the effect on lack of energy is need to be seen as no antidepressant from TCA category harbours any such effect.

However I feel she can respond with addition of Modafinil or armodafinil with current regiment. As I can see that her main problem is lack of energy this can be handled with use of either Modafinil or armodafinil.

In case she is not comfortable in addition another set of medications Bupropion can be used as primary antidepressant.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Ashok Kumar 0 minute later
Brief Answer:
Consultation

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns about your daughter who is suffering with severe depression with severe hypothyroidism with PCOS.

Regarding the antidepressant I feel Desvenlafaxine can be the first choice provided it was not used in the past. This is based on the fact that among the available antidepressants it has tolerable side effects and efficacy is better in compare to many antidepressants (Theoretically it is as good as others but practically we are seeing better improvement). In addition it causes activation which can be helpful to deal with lack of energy.

In case this has already been tried I do not think there is any harm with use of TCAs. They are as good as other antidepressants (Theoretically) but better than many SSRIs and SNRI when you use them in practically. However the effect on lack of energy is need to be seen as no antidepressant from TCA category harbours any such effect.

However I feel she can respond with addition of Modafinil or armodafinil with current regiment. As I can see that her main problem is lack of energy this can be handled with use of either Modafinil or armodafinil.

In case she is not comfortable in addition another set of medications Bupropion can be used as primary antidepressant.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ashok Kumar 22 hours later
Hello Doctor

thanks for your reply
She used venlaflaxine and bupropion for a while before with no effect at all
She also used prozac for few years. Initially it worked but later it stopped working and and recently when she used she developed drowsiness I am
Surprised
Pl let us know the following

1. How to start with a low dose TCA and increase can she use depsonil?
2 can an addition of prozac help to enhance the positive effects with a low dose TCA
3 let us know about modafinil
4. How to taper the dose of ecitalopram she is using now
5 can we continue aripiprazole and what about it

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Follow up: Dr. Ashok Kumar 0 minute later
Hello Doctor

thanks for your reply
She used venlaflaxine and bupropion for a while before with no effect at all
She also used prozac for few years. Initially it worked but later it stopped working and and recently when she used she developed drowsiness I am
Surprised
Pl let us know the following

1. How to start with a low dose TCA and increase can she use depsonil?
2 can an addition of prozac help to enhance the positive effects with a low dose TCA
3 let us know about modafinil
4. How to taper the dose of ecitalopram she is using now
5 can we continue aripiprazole and what about it

doctor
Answered by Dr. Ashok Kumar 13 hours later
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

1. Yes depsonil can be used for this purpose. The staring dose is 25 mg at bedtime which should be increased with increment of 25 mg every 3 days. The optimum dose for most patients is 75-100 mg, so once the target dose is reached a wait period of two weeks can be observed before increasing it further.

2. I do not think So.

3. Modafinil is attention and concentration improving medication which probably acts with increase dopamine transmission. It is generally used for treatment of residual symptoms of depression such as lack of attention and concentration, brain fog, lack of energy and improves the daytime performance. I generally start with 100 mg per day early in morning and if no effect is evident by third day dose is increased 200 mg per day.

4. It can be decreased by 25 % every week. It will take around three to four weeks to discontinue.

5. Considering the recurrent nature of depression I feel there is need to continue at least one augmenting agent. Ariprazole is one such augmenting agent.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ashok Kumar 0 minute later
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

1. Yes depsonil can be used for this purpose. The staring dose is 25 mg at bedtime which should be increased with increment of 25 mg every 3 days. The optimum dose for most patients is 75-100 mg, so once the target dose is reached a wait period of two weeks can be observed before increasing it further.

2. I do not think So.

3. Modafinil is attention and concentration improving medication which probably acts with increase dopamine transmission. It is generally used for treatment of residual symptoms of depression such as lack of attention and concentration, brain fog, lack of energy and improves the daytime performance. I generally start with 100 mg per day early in morning and if no effect is evident by third day dose is increased 200 mg per day.

4. It can be decreased by 25 % every week. It will take around three to four weeks to discontinue.

5. Considering the recurrent nature of depression I feel there is need to continue at least one augmenting agent. Ariprazole is one such augmenting agent.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar 14 hours later
Hello thanks for your reply
she is already using Vyanese for focus prescribed by local doctor
we went to a local GP with the above mentioned symptoms PLUS
and also that the effect of Vyanese is wearing off just within 2 hrs and then crash and followed by anxiety for which she had go take alprazolam

then the GP prescribed Bi Phentin (methyl phenidate -sustained release)
Now we have the following questions
1. with this she has a low but sustained peak of stimulation
at the same time she has constant drowsiness and I wonder why ?!!!
this was followed a slow crash again and had to take alrpazolam

2. how can we minimize the crash effects

3. we live in canada and the local doctors are very reluctant to start her on older medicines like tricyclcs
do u think your prescription is valid in Canada?
for TCA and Modafinili?

thanks

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Follow up: Dr. Ashok Kumar 0 minute later
Hello thanks for your reply
she is already using Vyanese for focus prescribed by local doctor
we went to a local GP with the above mentioned symptoms PLUS
and also that the effect of Vyanese is wearing off just within 2 hrs and then crash and followed by anxiety for which she had go take alprazolam

then the GP prescribed Bi Phentin (methyl phenidate -sustained release)
Now we have the following questions
1. with this she has a low but sustained peak of stimulation
at the same time she has constant drowsiness and I wonder why ?!!!
this was followed a slow crash again and had to take alrpazolam

2. how can we minimize the crash effects

3. we live in canada and the local doctors are very reluctant to start her on older medicines like tricyclcs
do u think your prescription is valid in Canada?
for TCA and Modafinili?

thanks

doctor
Answered by Dr. Ashok Kumar 5 hours later
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

1. Although I do not have exact idea why she suffers with drowsiness but considering the fact that she is known case of PCOS, she might be overweight or may be suffering with obstructive sleep apnea leading to daytime drowsiness. I must acknowledge here that the ongoing drowsiness with use of Vavanse can not be explained on the basis of any of the current medications.

2. I think the Vavanse need to be avoided as there is little rationale in improving a patient for two hours and than causing drowsiness for longer duration. Instead of it adderall can be tried as the response varies from individual to individual. However I feel that Modafinil can be better alternative as it is non habit forming and long duration of action.

3. Unfortunately I am not registered in Canada so my prescription no value in your country of residence.

I hope this answers you.
Thanks again.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ashok Kumar 0 minute later
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

1. Although I do not have exact idea why she suffers with drowsiness but considering the fact that she is known case of PCOS, she might be overweight or may be suffering with obstructive sleep apnea leading to daytime drowsiness. I must acknowledge here that the ongoing drowsiness with use of Vavanse can not be explained on the basis of any of the current medications.

2. I think the Vavanse need to be avoided as there is little rationale in improving a patient for two hours and than causing drowsiness for longer duration. Instead of it adderall can be tried as the response varies from individual to individual. However I feel that Modafinil can be better alternative as it is non habit forming and long duration of action.

3. Unfortunately I am not registered in Canada so my prescription no value in your country of residence.

I hope this answers you.
Thanks again.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar 2 days later
Please let us know how much is the working does of methylphenidate

The local doctor prescribed that in the place of vyanese.
After 2 hrs my daughter feels drowsy and the effect weans off and slogs then onwards with out much stimulation
How to maintain constant alertness?

Lack of focus and lack of energy and some sort of adhd seems to be my daughter’s other problems. Stimulants help her to some extent and she is eager to get better

Thanks
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Follow up: Dr. Ashok Kumar 0 minute later
Please let us know how much is the working does of methylphenidate

The local doctor prescribed that in the place of vyanese.
After 2 hrs my daughter feels drowsy and the effect weans off and slogs then onwards with out much stimulation
How to maintain constant alertness?

Lack of focus and lack of energy and some sort of adhd seems to be my daughter’s other problems. Stimulants help her to some extent and she is eager to get better

Thanks
doctor
Answered by Dr. Ashok Kumar 9 hours later
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

The optimum dose of Methylphenidate remains somewhere between 10 to 70 mg per day. There is no formula to suggest optimum dose for individual patient but the titration often helps in determining the working dose for individual patient. Most XXXXXXX patients respond somewhere between 10-50 mg as per my own experience.

Since your daughter have the effect of medication for just two hours, there is definite need to up the medication dose provided her psychiatrist is keen on continuing methylphenidate.

To maintain her energy and alertness we need the stimulants and I do not think we have other choice in this regard.

I hope this helps you further.
If you have any further query, I would be glad to help you.

Since this is last follow up allowed for the current thread, in future if you wish to contact me, you can use the below mentioned link:

http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Ashok Kumar 0 minute later
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

The optimum dose of Methylphenidate remains somewhere between 10 to 70 mg per day. There is no formula to suggest optimum dose for individual patient but the titration often helps in determining the working dose for individual patient. Most XXXXXXX patients respond somewhere between 10-50 mg as per my own experience.

Since your daughter have the effect of medication for just two hours, there is definite need to up the medication dose provided her psychiatrist is keen on continuing methylphenidate.

To maintain her energy and alertness we need the stimulants and I do not think we have other choice in this regard.

I hope this helps you further.
If you have any further query, I would be glad to help you.

Since this is last follow up allowed for the current thread, in future if you wish to contact me, you can use the below mentioned link:

http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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