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Doctor Rao
Doctor Rao, Doctor
Category: Mental Health
Satisfied Customers: 641
Experience:  MBBS,MD,DPM,MRCPsych
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Sir, I would like to have a discussion with you plz.

Customer Question

Sir, I would like to have a discussion with you plz.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Doctor Rao replied 2 years ago.

Doctor Rao : Hi are you online
Customer:

Hello Sir, very good morning

Doctor Rao : Good morning. How can I help?
Customer:

as you can guess that my repeated asking is also a part of my obsessions

Customer:

Sir, I visited another psychiatrist today and she prescribed the following :

Customer:

1) Fluvoxamine 50 mg daily for 5 days and then 100 mg daily afterwards.


2) Pregabalin 75mg daily


3) Clonazepam 1mg sos.

Customer:

and has called me up after 7 days

Doctor Rao : Well it is important to clarify issues when necessary, but I have to be honest with you that you might not learn new things by repeated asking.
Doctor Rao : Ok
Customer:

the fact that she has stopped Aripiprazole 15mg totally

Customer:

Now, sir, I m very confused whether to go with Fluvoxamine or Clomopramine ?
Which one is superior for me as I have very deep-rooted obsessions.

Doctor Rao : What was the rationale for doing this? Have you showed her the reports from chennai and Gauhathi hospitals
Customer:

yes sir

Customer:

she just saw the reports , not seriously

Customer:

I m very confused whether to go with Fluvoxamine or Clomopramine ?
Which one is superior for me as I have very deep-rooted obsessions.

Customer:

sir, plz dont be angry with me

Customer:

i really need help from experts like you

Customer:

there r no good psychiatrists here

Doctor Rao : Professionally I have too be honest with you. Different Doctors have different experiences and expertise with drugs. Most of Thea rmedications belong to group of medications.So, it is not like one is superior to other in efficacy but the difference would be in side effect profile. Having said hat Clomipramine and fluvoxamine belongs to different class of drugs. Bth are licences for OCD symptoms.
Customer:

so, will you not recommend one , sir

Customer:

plz suggest me the better one

Customer:

thinking abt my other symptoms too

Customer:

like

Customer:

GAD

Customer:

De-realization

Doctor Rao : No.dont get me wrong. I am not at all angry with you. I am just being honest. That is why I kept stressing the importance of sticking to be psychiatrist and follow his/ her advcie for atleast few months before even deciding whether the medications are helpful or not.
Customer:

panic attacks

Customer:

depression

Customer:

severe anxiety

Customer:

the above problems have also to be addressed

Doctor Rao : Yes. I am sure you do remeber that we have had this discussion couple of times. We agreed for a medication regime which yu were going to discuss with the local sychiatrist and follow. I am also saying that bth Clomipramine and fluoxetine bth are helpful for depression,panic attacks and OCD symptoms. But, the key issue is yu have to stick to one medication for atleast 6 weeks.if yu keep swapping the tablets you won't see the benefits. It is because for antidepressants to show good effect 70 percent of the brain receptors should be occupied and the way it will happen is by taking them for atleast six weeks
Customer:

i c

Customer:

ok, lewts discuss the medications for me sir please, this will be a final discussion with you sir for the time being :

Doctor Rao : So as much as you anxious to get immediate benefit you are delaying th eresponse yourself by changing the medications often and seeing different Doctors who Kees changing the medications .
Customer:

1) CLOMIPRAMINE OR FLUVOXAMINE OR FLUOXETINE OR PAROXETINE ??

Customer:

PLZ TELL ME THIS ONE

Customer:

considering all my conditions

Doctor Rao : Either Clomipramine or fluoxemine ( you told me hat fluoxetine did not find much helpful)..Paroxetine although helpful for panic attack, has some what high withdrawal symptoms if you want to come off from it.
Customer:

then sir, clomipramine or fluvoxamine

Customer:

oops

Customer:

sorry

Customer:

clomipramine will be good sir ?

Customer:

but what abt my other anxiety problems

Doctor Rao : Well,both are effective. As far as the experience goes, Clomipramine is widely tried. And also believe that you are already taking this
Doctor Rao : Pregabalin would be helpful for other anxiety symptoms.
Customer:

will GAD, be cured by clomipramine ?

Doctor Rao : Rather than Clomipramine Pregabalin is more helpful.but for bsessions Clomipramine is superior
Customer:

ok, so first drug is clomipramine (this one is decided)....now lets come to the anti-psychotic

Customer:

whether Aripiprazole is more suitable or me or Amisulpiride , considering my treatment resistant anxiety disorders

Customer:

i was afraid , u left the chat

Customer:

plz dont be angry with me

Customer:

i just need to confirm the meds and then i shall strongly discuss this with my doctor

Doctor Rao : Again both are effective. But you are already taking Aripiprazole and we have discussed hat you haven't tried the safe maximum dose. The key principle in treating difficult conditions is simplifying the medication regime,trying all the medications used to safe maximum dose before adding anothe rmedications or changing medication.
Customer:

plz suggest oen , sir

Customer:

one

Customer:

better one, i mean

Doctor Rao : Dont apolizize . You want to kow which is best for you.i can appreciate that but you need to stick tone medication combination regime for atleast few moths before changing.
Customer:

thanks a lot for understanding me sir

Doctor Rao : First try Aripiprazole to safe maximum dose.again it is widely used than Amisulpiride and have less side effects.
Customer:

ok sir

Customer:

second drug has been finalized

Customer:

its Arip

Doctor Rao : For the time being ...
Customer:

finally, i shall need pregabalin and clonazepam, which we had already discussed

Doctor Rao : Yes. But Clonazepam only when necessary and your aim should be gradual reduction of this with a view to stop in few months.
Customer:

Sir, i apologise, but i still have one doubt

Doctor Rao : Go on, don't apolizize every time,please note that I am not doing it for free..
Customer:

:)

Doctor Rao : If I can be helpful I will
Customer:

i have so many severe anxiety disorders

Customer:

and Paroxetine addresses so many of them

Customer:

will Paroxetine be better top take or Clomipramine will be better to take.......

Customer:

i read that Paroxetine controls OCD too

Customer:

does Paroxetine control OCD properly ?

Doctor Rao : If you want my honest answer medication are part of the solution for anxiety or depressive illness. The combination of CBT and medication has superior effect. I know you have mentioned that you did nt find CBT useful int he past. You seemed very comforttable in using computers and havng fine access, so, why don't you consider online CBT course which canbe done at your pace or Reading self help books which would help to change the thinking pattern there by helping anxiety.
Customer:

where can i find that sir

Customer:

something called brain...

Doctor Rao : Paroxetine,fluoxetine,fluvoxamine ..these are all belong to same class of medications, which means acts on same receptors and efficacy is more or less similar. If one is not at all helpful,the chances of other working are not great although we can not say with hundred percent confidence. Yes, Paroxetine is useful for OCD symptoms in theory. Clomipramine belong sto separate class of medication which acts of different receptors along with serotonin receptors.
Customer:

ok, i shall go with clomipramine

Customer:

sir, finally

Doctor Rao : Yes.the selfhelp book that can be useful is Overcoming Depression: A self- help guide using Cognitive Behavioural Techniques Paul Gilbert (Author)
Customer:

ok sir

Doctor Rao : The website that is helpful for CBT is google MoodGym.
Customer:

ok sir

Customer:

finally

Customer:

plz suggest me one medication for my memory....

Customer:

i have a weak memory and lack concentration

Customer:

i have been evaluated by psychologist

Doctor Rao : Finally,please exercise some patience,take medicatin religiously and gve the medication enough time before deciding it is working or not. Also try the self help book or online resource
Customer:

and its confirmed that i have impairment of visual learning n memory, verbal llearning n memory

Customer:

psychologist have told me that

Doctor Rao : We do know that in people who have high anxiety and depression, have some memory problems. You do not need any medication for memory per we and thereis no medication hat would improve memory at your age. Antidepressants do indirectly effect by improving the mood and anxiety
Customer:

will MODAFINIL help me sir

Doctor Rao : If that is the case rather than relying on medications, make your tasks simple and small.make sure you maintain the diary and put some reminders in your phone.so, try these no pharmacological methods
Customer:

so, modafinil not required ?

Doctor Rao : No.
Customer:

ok sir, thanks a lot....i shall take CLOMIPRAMINE, ARIPIPRAZOLE, PREGABALIN, CLONAZEPAM religiously for 1 month and then I shall contact you Sir with my progress

Doctor Rao : Dont try any other medications for memory or anything.first concentrate on the medications suggested. Even some websites cliamng modafinil is helpful for cognition, there is no real massive scientific evidence to suppo especially at your age
Customer:

i see

Doctor Rao : Sure. Clonazepam,take only when needed or attempt to reduce gradually
Customer:

ok sir

Doctor Rao : I wish you all the best.
Customer:

i shall get back to you after 1 month with my progress

Customer:

thanks a lot

Doctor Rao : Stick to this regime,stick to one Local Doctor
Customer:

it was really very very nice to have talked with you

Customer:

ok sir

Customer:

i m going to avoid the doctor who had stopped Arip\

Doctor Rao : No problem.all the best. Good totals to you too.take care.bye for now. Thank you
Doctor Rao : Good to talk to you too, spell mistake
Customer:

hahaha

Customer:

good bye sir

Doctor Rao, Doctor
Category: Mental Health
Satisfied Customers: 641
Experience: MBBS,MD,DPM,MRCPsych
Doctor Rao and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.

Dear Sir,


 


I have just one question to ask. Plz do help me.


 


1) Which anti-psychotic among Aripiprazole and Risperidone is better for severe Anxiety and at what dose ?


 


Thanks a lot and waiting in great anticipation for your kind response.


 

Expert:  Doctor Rao replied 2 years ago.
Hi,
Neither of them can be used purely for the anxiety. They are useful for mood stabilizing,some paranoia and also as an adjuvant to antidepressant medication to control depression nd anxiety. Aripiprazole in the Beginning can make a person slightly restless which can be confused with increased anxiety. But in the longterm the restlessness decrease and help for augmentation.

Risperidone in most of the cases did not have that problem of anxiety in the Beginning and also is a good adjuvant.

If it is Aripiprazole the dose ranges from 5 mg to 20 mg. if it is Risperidone the dose range from 1 mg to 6 mg per day. So, depending on the situation you can discuss with your Doctor. If I remember well, you have mentioned Quetiapine did not agree with your body,otherwise it is also a good alternative.

I hope you are feeling improvement and sticking with one Doctor which is important.

If you find this helpful. All the best.
Thank you
Customer: replied 2 years ago.

Thanks a lot Sir. I shall get back to you as soon as I can. Thanks indeed.

Expert:  Doctor Rao replied 2 years ago.
No problem. All the best. Thank you
Customer: replied 2 years ago.
Sir,

I have just another last question to ask , can the following meds be taken together.

1) Prothiaden 75mg
2) Paroxetine 37.5mg

If yes, then, are the combination of dosages correct ?
Expert:  Doctor Rao replied 2 years ago.
Hi,
I would restrict my answer tot he question in specific than repeating what I have said before.
The medications you have mentioned is not a regularly used combination as One belongs to Tricyclic antidepressant group and another belongs to Selective serotonin receptor inhibitor group. However, I am aware that is combination is sometimes used by the Psychiatrists across the world.

Next coming to doses, Prothiaden can be taken between 25 mg to 150 mg (with usual dose about 75 mg to 100 mg but helpful to start at low dose if your Doctor want to combine ). Paroxetine dosage is not 37.5 mg.. The usual dose range is between 20 mg to 50 mg. it doesn't come in 37.5 mg dose as far as I am aware.

It is very important that if you take these mediation, it should be with the advise and monitoring by the local psychiatrist who can supervise side effects and progress.

I wish you all the best.

If you find the answer helpful,please provide Positive feedback.
Thank you

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Doctor Rao
Doctor Rao
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MBBS,MD,DPM,MRCPsych