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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suffer From Mood Swings. Need Anti-anxiety Drugs? Taking Warfarin After A Stroke. Any Help?

My elderly mother is in a nursing home. She is on a number of drugs including warfarin. She is 11 yrs post stroke. The nursing home wants to give her either an anti anxiety drug or an anti depressant like Cymbalta to `level her moods.` She appears not to like being left alone as she constantly calls for help for minor things like a sip of water or for someone to move the remote closer. (She is not ambulatory). she has some pain and gets Tylenol regularly. It is not that I am anti such meds, I just am worried about the interactions. The staff didn`t mention there could be an interaction with the warfarin she takes (she is on about 9 meds including Toviaz) but they also thought that she would need to take the `mood`drug for at least 3 to 4 weeks to see if there were any side effects and or the med worked. My mother is not presently cognitively impaired. What do you think?
Tue, 23 Apr 2013
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Psychiatrist,  's  Response
Hi Jack.yelling,

Welcome to HCM Forum,

I can understand how you might be feeling knowing that she is being prescribed one more drug in addition to 9 medicine.
Considering that trivial irritability(appears not to like being left alone as she constantly calls for help for minor things like a sip of water or for someone to move the remote closer),pain not much relived even after good painkiller- this can be sign of anxiety/depression secondary to medical illness.Considering bed bound for prolonged time and post stroke, chances of depression rises ( area of stroke in brain can also lead to depression)

Cymbalta (Duloxetine) is kind of medicine can serve to improve all mentioned problem ( not only will elevate mood but also will help to alleviate pain also). There are lot of safest option among drugs available now with nearly no side effects and minimal or no drug - drug interaction.
So its important to start such kind of medicine by consulting to psychiatrist (expert in knowing details of Psychiatric drugs) who after knowing condition and ongoing drugs can prescribe appropriate drug with no harm to patient.
Its important to know that while considering any treatment doctor always think of risk-benefit ratio and treats accordingly.Depression if present slows response of illness to ongoing medicine and ultimately affects recovery - so whenever patient not show intended improvement that time also psychiatric evaluation must be done.

I hope this will help to you.

Best regards.
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Suffer From Mood Swings. Need Anti-anxiety Drugs? Taking Warfarin After A Stroke. Any Help?

Hi Jack.yelling, Welcome to HCM Forum, I can understand how you might be feeling knowing that she is being prescribed one more drug in addition to 9 medicine. Considering that trivial irritability(appears not to like being left alone as she constantly calls for help for minor things like a sip of water or for someone to move the remote closer),pain not much relived even after good painkiller- this can be sign of anxiety/depression secondary to medical illness.Considering bed bound for prolonged time and post stroke, chances of depression rises ( area of stroke in brain can also lead to depression) Cymbalta (Duloxetine) is kind of medicine can serve to improve all mentioned problem ( not only will elevate mood but also will help to alleviate pain also). There are lot of safest option among drugs available now with nearly no side effects and minimal or no drug - drug interaction. So its important to start such kind of medicine by consulting to psychiatrist (expert in knowing details of Psychiatric drugs) who after knowing condition and ongoing drugs can prescribe appropriate drug with no harm to patient. Its important to know that while considering any treatment doctor always think of risk-benefit ratio and treats accordingly.Depression if present slows response of illness to ongoing medicine and ultimately affects recovery - so whenever patient not show intended improvement that time also psychiatric evaluation must be done. I hope this will help to you. Best regards.