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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4036
Experience:  MD Psychiatry
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My mother is 72 years old, she has been diagnosed with Hashimotos

Customer Question

My mother is 72 years old, she has been diagnosed with Hashimoto's Disease. Mom is currently on a synthetic thyroid med. The symptoms that have caused the family to drag her from dr to dr are short term memory loss and anxiety. The PCP prescribed Xanax and put her through cognitive testing to rule out Alzheimer's and dementia as a cause for the short term memory loss. The cognitive testing has ruled out any neurological issues. We are now working with a diagnosis of generalized anxiety disorder, which in my unprofessional opinion is the same as saying Mom has a virus. The PCP started her on a generic version of buspar in addition to the xanax, three days later we also added the generic version of zoloft to the cocktail.

At this point our concerns about her short term memory loss are taking a backseat to the anxiety. Since beginning the anti-depressants two weeks ago, her anxiety is magnified ten fold. The PCP says she has to stick it out 4-6 weeks. Help!
Submitted: 5 years ago.
Category: Mental Health
Expert:  Ralph LMHC replied 5 years ago.

Hello I am sorry my computer froze. You said your mother is seeing a GP, yet she is uffering from depression and sever anxiety. I would suggest that you have her seen by a psychiatrist who is the mosyt adept with psychotopic drugs. Dhe should not have to tough it out unless rhere is some overrinding reason. Psychiatrist often use benzodiapines (antianxiety pills) for a short time to cover the anxiety caused by the antidepressant, or consider another antidepressant with less side effects.

 

Please click green "ACCEPT" button on this page if you are satisfied with my answer so that I get credit for my work. Your feedback and bonuses are always welcome. As always you can email for further info.

 

 

Ralph LMHC

 

 

 

 

Customer: replied 5 years ago.
The crazy part of this is that she isn't being treated for depression. My Mom isn't depressed. The drugs that have been prescribed are the PCP's way of treating the anxiety. Is it true that these drugs are used to treat anxiety and that she needs to suffer for 4-6 weeks to see if they work? I agree that she needs to be treated by a doctor that has expertise in these drugs, but is it possible that its the drugs that are making her this sick. I don't think that it is a coincidence that the symptoms increased dramatically with the anti-depressents. My mother recently started seeing a clinical psychologist to deal with the anxiety, it seemed to be going well without meds until the PCP decided drugs were the answer. Will the psychologist be able to refer her to a psychiatrist, because the PCP is over estimating her own expertise.
Expert:  Ralph LMHC replied 5 years ago.

Hello, the antidepressant meds also have an anti anxiety effect so taht might be the reason that they are being prescribed. Hashimoto's dideade is a thyroid disorder and the medication for anxiety might be adding to her anxiety. I still believe if she has anxiety due to a medical disease or another reason, the proper person to prescribe because he/she is more familiar is a psychiatrist. Many physician prescribe psych meds, but usually after the regimen is established by a psychiatrist who specializes silely is psyc meds not all available meds. Is her Hashimoto's disease being treated by an encocrinologist, it usually is.

 

Please click green "ACCEPT" button on this page if you are satisfied with my answer so that I get credit for my work. Your feedback are always welcome. As always you can email for further info.

 

 

Ralph LMHC

 

 

Customer: replied 5 years ago.
No she is strictly being treated by her PCP, who doesn't think that the Hashimoto's is a big deal. I'm worried. The anxiety is constant, I don't know how much more she can take. Thank you.
Expert:  Dr. Kaushik replied 5 years ago.
Hi there !

Welcome to Just answer !

Since you have opted out on the previous expert so i shall be fielding your question.

Kindly answer a few questions.

1) what is your mother 's present problem that is troubling her the most -- is it the Anxiety and short term memory loss ? Kindly confirm ?

2) Since when ( duration ) is she having the present medications ?

KiNDLY answer the queries against their numbers and i shall get back to you with an appropiate reply.

Regards...
Customer: replied 5 years ago.
The anxiety is the issue right now. The anxiety seemed to come and go, but there seemed to be a pattern. Early in the day my mother is at her worst as the day goes on things seem to improve.

She was prescribed Xanax .25 mg almost eighteen months ago, she would take half a tablet as needed. In the past three months the Xanax is being administered daily.

July 2nd Mom's primary care prescribed the generic version of buspar, I'm not sure of the exact dosage, but it was given twice a day. Four days later the generic version of zoloft was added, I believe 75 mg. After two days on the Zoloft, she was experiencing headache, increased anxiety, insomnia, loss of appetite and diarrhea. My Dad took her off the Zoloft and things improved.

Consulted with the PCP who told him that she didn't feel it was possible for my Mom to be experiencing side effects after only two doses. Mom needed to be put back on the Zoloft and give it a minimum of 4 to 6 weeks.

Mom has been on the meds for about two weeks. The anxiety is constant, she cries alot. Complains of feeling the anxiety in her chest and arms, has started sleeping during the day. I have asked if she is sleeping at night, she says that she thinks so. Up until two weeks ago my folks walked five miles a day, she has been unable to do that this past week. Needless to say with the anxiety so high all the time she is constantly fatigued and her short term memory is in the toilet.
Customer: replied 5 years ago.
The anxiety is the issue right now. The anxiety seemed to come and go, but there seemed to be a pattern. Early in the day my mother is at her worst as the day goes on things seem to improve.

She was prescribed Xanax .25 mg almost eighteen months ago, she would take half a tablet as needed. In the past three months the Xanax is being administered daily.

July 2nd Mom's primary care prescribed the generic version of buspar, I'm not sure of the exact dosage, but it was given twice a day. Four days later the generic version of zoloft was added, I believe 75 mg. After two days on the Zoloft, she was experiencing headache, increased anxiety, insomnia, loss of appetite and diarrhea. My Dad took her off the Zoloft and things improved.

Consulted with the PCP who told him that she didn't feel it was possible for my Mom to be experiencing side effects after only two doses. Mom needed to be put back on the Zoloft and give it a minimum of 4 to 6 weeks.

Mom has been on the meds for about two weeks. The anxiety is constant, she cries alot. Complains of feeling the anxiety in her chest and arms, has started sleeping during the day. I have asked if she is sleeping at night, she says that she thinks so. Up until two weeks ago my folks walked five miles a day, she has been unable to do that this past week. Needless to say with the anxiety so high all the time she is constantly fatigued and her short term memory is in the toilet.
Expert:  Dr. Kaushik replied 5 years ago.
Hi there ,

Welcome to Just answer !

Well, the fact that your mother has not been able to get relief from anxiety despite being on the drugs for quite a while is because , firstly after using a benzodiazepine like zanax ( alprazolam ) , one should not use buspar , because the prior use of zanax or any other benzodiazepine , reduces the anti anxiety effect of buspar , so that was the reason , why buspar did not act the way it should have acted , and relieved your mother's anxiety , so it was a case of bad drug selection , if your doctor wanted to start your mother on an anti anxiety drug he should have started her on another benzodiazepine such as Klonopin or ativan or valium , etc.

Secondly your mother have been kept on a substandard dose of zanax , all this while , a dose of 0.25 mg , does not have the capacity to treat an anxiety disorder .

Thirdly , although zoloft ( sertraline ) is an ssri anti depressant , which is quite commonly used in anxiety disorder , but from what you have mentioned , it is quite clear that your mother is neither tolerating well nor responding well to the drug , so it is quite suggestive in itself , that your mother needs to be switched over to any other anti depressant.

So, above mntioned are the reasons as to why your mother's anxiety has not improved with the drugs that she has been taking.

Now, i shall mention below the treatment regime for your mother's anxiety , which you need to discuss with her doctor , who may scrutinize it if he pleases and then start on thsi regime , i am quite sure that this is going to help your mother in recovering from anxiety.

1) Switch over to another anti depressant from zoloft , because it has only shown side effects so far , and no positive effects . So anti depressants , to which your mother can switch over to are -- Paxil CR or Prozac or Effexor XR .aNY ONE OF THESE NEEDS TO be chosen by the doctor and its dose and time of intake is to be decided by him.

2) Stop zanax ( anyways 0.25 dose is so less to have any positive effect on anxiety) and Continue on Buspar , but see to it that you are having an adequate dose ( usually people are given 5 mg of buspar 2-3 times a day), the dose may be increased if no effect has been shown so far .

3) Start on Trazadone ( atypical anti depressant ) , which is also effective n treating anxiety as an assisting drug to the above mentioned ssri anti depressant .This trazodone needs to be given at night , before bedtime , and it also helps in getting a sound sleep , becuase of its sedative action.

So, i summarize the revised regime that your mother needs to be started on , after you have discussed this with her doctor-- A combination of 3 drugs-- 1 SSRI/ SNRI Anti depressant such as either paxil or prozac or effecxor , 1 anti anxiety drug and Trazodone .

I hope this helps..

I wish your mother rapid recoevry and i am quite positive that after starting on the above mentioned regime and continuing on it for 2-3 months your mother will feel very comfortable and recovered from anxiety , but she and you need to be patient for the first 2-3 weeks as this much time is required by these psychiatry drugs to reach their peak in the body.

Please press the ACCEPT button if you are satisfied with the answer as only then will i be credited for my service.

Regards..

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