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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4087
Experience:  MD Psychiatry
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hi just wanted to speak to a psychiatrst. i have mixed mood

Resolved Question:

hi just wanted to speak to a psychiatrst. i have mixed mood states with rapid cycling of mood and energy from hour to hour. do many people have this . also what is the best line of treatment for it .
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 2 years ago.

Hi there,

 

Welcome to Just answer !

Rapid cycling mood swings / bipolar disorder is not that common and thus finds difficulty to manage it.

 

for answering the second question ,kindly tell me what all drugs you are currently on?

 

Regards..

Customer: replied 2 years ago.
just on parnate at the moment doc , have tried different amts and ive found 30mg suits me the best, XXXXX XXXXX was working quite well and had some stabilizing effect but had problems with work ive since rectified . back on 30 now only 2 days and finding it hard but all going well this time ill get there. seem to reach stable moods but only fleeting then down ruminating and ocd again.but with time i hope this will be ironed out
Expert:  Dr. Kaushik replied 2 years ago.

ok..

thanks for the reply..

 

just ask your doctor to add a mood stabilizer for your rapid cycling mood state and the best drug for that would be valproate at a dose of 250 mg twice a day which may further increased to 500 mg twice a day after 2 weeks..

 

Also, somehow i am not too convinced with the use of parnate in your condition at all but since you have benefitted from it so why not use it ..

 

Kindly discuss this with your doctor ..

 

I hope this helps..

 

Regards..

Customer: replied 2 years ago.
ok doc ill suggest it to him , he tried cymbalta and epilium chrono but it did me no good. made me very depressed and prob more unstable. i dont suffer mania or hypo mania its more agravated or dysmorpic depression. with lamictal be of any use as i dont want the horrible effects of the cymbalt epilum mix or is valportate the best option
Expert:  Dr. Kaushik replied 2 years ago.

if you do not get switched to mania or hypomania in that case lamictal should be the best choice , better than valproate .. A dose of 50-150 mg of lamictal would be just fine to maintain your mood..

 

Regards..

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4087
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
hi doc i was just wondering would lamictal cause much of a mood destabilization until it kicked in while on parntate . could it be used to treat agriveated or dismorphic depression on its own so iv an idea when i see my doc -peter
Expert:  Dr. Kaushik replied 2 years ago.

No lamictal will not cause any mood de-stabilization , in fact on the contrary it will stabilize your mood ..

 

Yes , lamictal will manage your dysphoria but you should know that dysphoric mood is different from depression , which alone this drug cannot manage as it will require an anti depressant like fluoxetine if you switch to bipolar depression..

 

But , yes this lamictal stabilize your mood , manage your dysphoria , prevent switch to both mania or depression , so as of now it is a good choice in your condition..

 

I hope this helps..

 

Regards..

Customer: replied 2 years ago.
thats great information doc thank you. my mood is predominantly depressed with ocd and constant mixing from almost normal when the anti d kicks in then gone again into depression ocd very quickly . it is never manic or even hypo manic .unless i go too hi on the anti d or a wrong stabilizer is used . so hopefully i can do well on the parnate and lamictal mix for this one ?
Expert:  Dr. Kaushik replied 2 years ago.

yes..i think this will be good for you..

 

Otherwise an alternate to thic combination is ..

 

Fluoxetine 20 - 40 mg/ day , olanzapine 5-10 mg / day and lamictaL 50-150 mg/ day ..

 

If tried this combination , this will effectively control your ocd , mixed mood state and depressive overlay..

 

Kindly discuss this drug regime with your doctor and hopefully he will see reason in this very effective , tried and tested combination for the likes of your case ..

 

Regards..

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4087
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
hi doc it s peter here again . how are you. just need some advice . not doing good on the parnate. i reduced my dose as i seemed to be a bit too over stimulated at 40mg.i had previously uped it to 40 from 30mg due to a slide into depression from pushing myself at work, physically and the pressure from trying to take over the business.which im in no state to do. but it didnt really suit me so a week ago i cut down to 30 again . i have done best at this amt although most times are awful,i did do alot better until over doing it in work / work situation. i left my job due to the above problems.i am now on 30mg 8 days and am not doing well the anxiety is cripplying. and i can t see my doc till tuesday to add lamictal to help.do you think the anti d effect can come back still to help me. At this stage i just want to try the combination you said although a bit weary of the sedation and emotinal blunting of an anti - psychotic. but it has to be better than what ive suffered through in the last 2 years. thandks doc . kind regards
peter
Expert:  Dr. Kaushik replied 2 years ago.

Yes , there will be some anti depressant effect at 30 mg of parnate, but it would not be sufficient enough to manage your depression for a longer duration , so it is about time to move on to the mentioned above drug regime , but as of now since there is no other alternative then you will have to endure depression with only a little bit of help from parnate .. I am sorry but i do not think this drug can produce the same effects as it used to earlier , more so because after long usage of this drug your body has become resistant against it .

 

So, you may just use it to buy some time till you meet your doctor and get your regime changed to a more effective one.

 

I hope this helps..

 

Wish you all the best..

 

 

Regards.

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4087
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
hi doc its peter here i was talking to you a while ago about adding lamical to the parnate , which my psychatrist has done , so will give this a shot first seehow i get on , good results so far it only on 25mg 5 days and alredy i feel it is slowely starting to stabilize my mood and definitly stoping the dismorphia,how ever i am finding it difficut to sleep at night as at the same time i went on lamital i stopped taking dolmatil or sulpiride not sure what its brand name is XXXXX XXXXX took it in the evening to relax me , is it ok to start it up again till i get a better sleeping pattern, also just getting over a viral infection and cold which hasnt helped.
Expert:  Dr. Kaushik replied 2 years ago.

Hi there,

 

Welcome back,

 

You see dogmatil (sulpride) is an anti psychotic drug and although it will bring sleep to you as it has sedative effects but it will not be right to start on it for imporving sleep as this drug has its own set of side effects too which may mess up your recovery which is now happening.

 

So, i suggest that you ask your doctor to prescribe you ambien (zolpidem) at 10 mg dose at bedtime which is a sleep aid drug , and is non addictive as well, so it shall be a better choice here.

 

However, if for some reason you cannot get it prescribed then you may use a low dose of dogmatil at 25 mg . that woud be half of 50 mg tablet to be taken at night but for a short duration only.

 

But , i still would first suggest the use of ambien 10 mg at bedtime for some time till your sleep gets back to noemal pattern instead of dogmatil for more serious side effects like tremors , dystonia , extrapyramidal side effects , etc that it can produce.

 

I hope this helps..

 

Wish you all the best..

 

 

Regards.




Customer: replied 2 years ago.
hi doc thanks for your knowledge in this area which has helped me greatly. i am currently taking zopiclone tablets for sleep at two 7.5 mg each. it is the max .however i find that even at this amount they do not sedate or calm me enough to sleep on there own for more than 3 - 4 hours and then i wake up and my mind is racin. would ambien be added to these or could i change from the zopiclone , i currently take them too early as im so bad like 6 in the evening to relax. benzos just pull me into depression so i cant use them ,what do you think
Expert:  Dr. Kaushik replied 2 years ago.

Well, you should use ambien ( generic - zolpidem) at dose of 10 mg at bedtime instead of zopiclone , this ambien / zolpidem is better sedative than zopiclone and is not a benzodiazepine so it has no addictive potential and abuse potential also and neither it leads to depression..

 

I hope this helps..

 

Wish you all the best..

 

 

Regards.

 

Customer: replied 2 years ago.
ok doc that sounds great . will i have any problems stopping the zopiclone as im taking it nearly 3 years. also what time should i take the lamictal for best benifit currently taking it just before i go to bed
Expert:  Dr. Kaushik replied 2 years ago.

wELL, YOU NEED TO TAPERT THE ZOPICLONE BY REDUCING IT TO HALF FIRST AND CONTINUING ON IT FOR 3 DAYS AND THEN STOP IT COMPLETELY..

 

yOU SHALL TAKE LAMICTAL IN THE MORNING AFTER BREAKFAST FOR BETTER RESULTS AS AFTER FOOD IT WILL STAY IN YOUR BODY FOR LONGER DURATION AND PRODUCE PROLONGED EFFECTS ..

 

BUT IF MORNING DOSE OF LAMICTAL MAKES YOU DROWSY AND SLOPPY THEN YOU SHALL CONTINUE TAKING IT AT BEDTIME IN THE NIGHT.

 

I hope this helps..

 

Wish you all the best..

 

 

Regards.

 

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4087
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
hi doc peter here. i have stopped taking the dogmatil and am currently on the zopiclone till i see my doc in a few days time when i will ask him for the ambien to replace it . unfortunatly however i havent been doing as good on the lamictal parnate front the last 3 days. i feel very spaced out and my mood seems to be pulled down, the dismorphia is back a little but i am still a bit calmer and grounded and less aggresive.just feel downer and more negative and groggy. do you think the zopiclone could be the cause for this or is it just a phase ill have to go through till the lamictal kicks in. i was very happy with the results in the first 5 days but now its not good, thanks doc peter
Expert:  Dr. Kaushik replied 2 years ago.

Hi Peter,

 

Well, do not worry , your present symptoms of low mood , feeling spaced out , groggy ,etc are most likely withdrawal side effects of dogmatil which you have recently stopped , and not due to zopiclone and these symptoms will get over on their own once dogmatil is completely washed off your system, which will be like in another 4-7 days time , and once this happens then you will no longer be experiencing these symptoms as basically withdrawal side effects are self limiting symptoms which occur when there is either fast withdrawal or abrupt stoppage of the drug and they subside on thier own once the body becomes adjusted to the absence of that drug.

 

So relax , have patience for another 4-7 days you will start feeling better soon.

 

I hope this helps..

 

Wish you all the best..

 

Warm regards..

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4087
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
oh thats a relief doc i did not like what was happening at all thanks so much for that, just one more question doc , neither myself or my local gp are over the moon about been on parnate,and prefferable would like to change to a safer less side effect ssri like prozac or lexapro. in a month or so when lamictal es really working well would it be benifical for me to change to this safer ssri
Expert:  Dr. Kaushik replied 2 years ago.

Give lamictal another 2 weeks for it to be working well enough and then you can change to lexapro or prozac , preferrably lexapro as it is more effective than prozac..Start on 5 mg single daily dose of lexapro to begin with and then after 1 week raise the dose to 10 mg single daily dose to be taken preferrably in the morning. The dose of lexapro can be raised to a maximum dose of 20 mg , as per the need.

 

Regards

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4087
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you

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