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Dr. K
Dr. K, Psychiatrist
Category: Mental Health
Satisfied Customers: 358
Experience:  15 years clinical experience in all areas of psychiatry. Holistic and practical approach.
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I got depression 25years ago, it recovered in half a year without

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I got depression 25years ago, it recovered in half a year without any medication. At the end of 2009, I had the second outbreak of depression that is more severe than the first one, both depressions were caused by long term and excess anxiety. I have been on zolof of 300mg increase from 200mg since three weeks ago. Although I can function very well routinly, but I still got hot rash on my upper back sometimes. My question is how long I should take medication this time? is hot rash still the remaining symptom of anxiety or depression or something else? I have been told Cranial Electrotherapy Stimulation (CES) is widely used and prove effective in the states for the treatment of mood disorders such as anxiety, depression, and insomnia, is it true? In my case, can I use it?
Submitted: 6 years ago.
Category: Mental Health
Expert:  Dr. K replied 6 years ago.
Those are great questions.

As far as how long to take the medications, there is no exact answer, but I have a lot of information that can help you make the best decision. 1st, having 2 severe episodes of depression can predispose you to having another up to 90%. That's a reason to consider staying on the medication long term.

On the other hand, you weren't a patient in the studies that showed a 90% relapse. So there is no way to know what your future holds.

In general, I tell all my patients that they shouldn't try getting off medications like zoloft until they have been feeling well for at least 6-12 months (for less severe cases I'm ok with 6 months and for more severe cases at least 12). One theory of antidepressants compares them to priming a well. By staying on the medicine 6-12 months, you sort of get the brain's natural momentum going in a positive way and you are less likely to have a depression relapse.

Also, should you decide to get off medications, do it a time in your life when things seem quite stable & you're not expecting stress. For example, if you lowered your zoloft from 300 to 250mg, and then a encountered a huge stress (e.g. death of a loved one)...and then got more depressed...it would be hard to know how much was related to the med change versus the stress. In a situation like that I would tell you to go back to 300mg until you had processed the grief.

Next, for a medication like zoloft I would suggest lowering the dose by 35-50mg every 1-3 months. If you're not having side effects, going more slowly with the dose reduction is always safer.

As far as the rash, if you never had it before going up on the dose, I would suspect that it's a medication side effect. If the depression & anxiety seem to be well treated on your current dose, there is no reason to think the rash is a residual symptom of depression or anxiety.

Transmagnetic Cranical Stimulation has recently been approved by the US FDA for treatment of depression. However, it is not widely practiced yet so I can't give you a lot of feedback on it. It seems to have minimal side effects, so you if you can afford it & find a place to get it I don't think you have much to lose.

ECT (shock therapy) can definitely have more severe side effects so I wouldn't try that except as a last resort.

Finally, make sure you treat yourself holistically. I have seen many patients get better with meds like zoloft...but then they ignore trying to balance their lives with: nutrition, exercise, stress management, psychotherapy, and relaxation therapy.

The last 2 treatments I mentioned are proven by sophisticated studies using brain scans (CT, MRI, EEG, pet scans) to improve brain function.

Also, by formal relaxation therapy I mean yoga, meditation, or similar methods. Having relaxing hobbies is also important, but not quite the same as formal relaxation therapy.

Also, I want to point out the the maximum FDA approved dose of zoloft is 200mg. I have prescribed higher doses, but only when the patient realizes this. Sometimes using a higher than FDA approved dose seems like a better idea rather than adding a 2nd medicine or switching to a different medicine (especially if the medicine seems to helping, but not 100%).

I hope this answers your question. If not, please let me know what clarification you need. Good luck & take care.
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Please let me know if you need more information. We can continue the dialog until you are satisfied. Once your are happy with the answers don't forget to hit the ACCEPT button & provide expert feedback. Also remember that this is not an official doctor patient relationship and not a substitute for a full live psychiatric evaluation. Thank you for using justanswers.com
Customer: replied 6 years ago.

Thank you so much for your very helpful information.

 

First of all, I would be sorry for the mistakes I made, currently I take 150mg (three pills) rather than 300mg. I started 150mg three weeks ago, because I felt my emotion got more often unstable than I used to be, I took two pills for a long time with satisfactory effect untill around three weeks ago. Even when I was good, I felt unreasonably down occasionally, and I got sweat on my up back right since I took zolof more than one year ago. Af first, I thought it might be the side effect of zoloft, but after I increase the dosage to three pills, the sweating got better, so I guess it might not be the side effect of the drug. I found it is more difficult for me to cope with the stress than the time before I got ill, may I ask whether I can redjust my dosage from time to time according to the change of my emotional condition? say sometimes from three pills to two, or from two to three, if so how long is the minimum duration? you said having two episode of depression, I should consider to take drug long term, what do you mean long term? all my life or several years, since the relapse rate is 90%, scaringly high.

Expert:  Dr. K replied 6 years ago.
Keep in mind that every time you adjust a dose (say from 100mg to 150mg or vice versa), it takes a full month for the effect of the dose change. In fact, some research shows that the full effect can take 2-3months...so you don't want to change dose too frequently. You want to find a dose & stick with it.

And despite all the advice I give you, you should try to never change the dose without consulting with your own prescribing doctor.

Long term will vary from person to person. Some people can wean off medications as early as 6 months after a constant dosage...some after a 1 year or 2 year...and some people need them for the rest of their lives.

Again, in order to maximize your chances of doing well with a dose change make sure to follow the previous advice I gave you about treating yourself holistically.

Is there anything else I can help with? If not, please hit the ACCEPT button.
_____________________________________________________________________
Please let me know if you need more information. We can continue the dialog until you are satisfied. Once your are happy with the answers don't forget to hit the ACCEPT button & provide expert feedback. Also remember that this is not an official doctor patient relationship and not a substitute for a full live psychiatric evaluation. Thank you for using justanswers.com
Customer: replied 6 years ago.
with depression, am I more vulnerable to the future life crisis even with medication than the people without it?
Expert:  Dr. K replied 6 years ago.
Research shows that staying on medication will reduce the chances of having a relapse in depression compared o people that don't stay on it.

But again, I have seen many people relapse with depression even on medications when they don't pursue other positive health activities (like the ones I mentioned before).

Is there anything else I can help with? If not, please hit the ACCEPT button.
_____________________________________________________________________
Please let me know if you need more information. We can continue the dialog until you are satisfied. Once your are happy with the answers don't forget to hit the ACCEPT button & provide expert feedback. Also remember that this is not an official doctor patient relationship and not a substitute for a full live psychiatric evaluation. Thank you for using justanswers.com
Customer: replied 6 years ago.
can I stay on life long medication without worrying about toxic effect?
Expert:  Dr. K replied 6 years ago.
As of now, there are no definite known long term side effects of antidepressants. If you have bipolar disorder, there is an increased chance of mania (which can be counteracted by anti-manic medications).

There have been a couple research studies showing a possible increased risk of cataracts, glaucoma, or loss of bone density with anti-depressants.

But in order to become scientific fact, something must be proven with multiple studies. So I wouldn't use these studies as a reason to not take the medications. I would just make sure to get regular check ups with a family doctor and psychiatrist to address any concerns you might have regarding possible long term side effects.

I hope that makes sense...if not, let me know.

Is there anything else I can help with? If not, please hit the ACCEPT button.
_____________________________________________________________________
Please let me know if you need more information. We can continue the dialog until you are satisfied. Once your are happy with the answers don't forget to hit the ACCEPT button & provide expert feedback. Also remember that this is not an official doctor patient relationship and not a substitute for a full live psychiatric evaluation. Thank you for using justanswers.com
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