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Doctor Rao
Doctor Rao, Doctor
Category: Mental Health
Satisfied Customers: 641
Experience:  MBBS,MD,DPM,MRCPsych
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I am 61 have depression with anxiety. On prozac, ativan and

Customer Question

I am 61 have depression with anxiety. On prozac, ativan and serequel. Depression does not seem to want to lift. Any advice ?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Doctor Rao replied 1 year ago.

Doctor Rao : Hi are you online
Customer:

yes

Doctor Rao : Thanks. Can u tell me the doses of the three medications you are on?
Customer:

60 mg of Prozac , im

Doctor Rao : Ok
Customer:

60 mg prozac, 1 mg ativan 3times a day and 1 25 mg serequel at bedtime

Doctor Rao : Ok. One tablet of 25 mg at night or 125 mg is Seroquel at night?
Customer:

one tablet of 25 mg at night

Doctor Rao : Ok. That is a low dose. You are on maximum dose of Prozac 60 mg, so it can not be increased further. Yu are also on Ativan 1 mg three times means it is not helpful to increase but at some point looking at gradual tapering, Ofcourse not Neil you start feeling better.
Doctor Rao : There are two ways of dealing with this.
Doctor Rao : 1. For Seroquel the optimum antidepressant adjuvant dose is around 300 mg per day. So, one option is to gradually increase the Quetiapine (Seroquel) by 25 mg to 50 mg up to the target dose if required. In this process our experience is Quetiapine is also helpful fr anxiety,so, the Ativan dose can be looked at as in the long term Ativan is not helpful because of the Tolerance and dependence.
Doctor Rao : 2. Continue with low dose of Quetiapine and change of antidepressant Prozac to medication like Wellbutrin which is helpful for anxiety and depression. Wellbutrin is helpful for anxiety,so, the hope is that again in the longterm you can simplify the medication regime by gradual tapering off Ativan and also can look in to see whether you need to continue on Seroquel because f the wellbutrins effects on anxiety and depression.
Doctor Rao : I also want to I form you that when we look at depression we would take the following in to account.
Doctor Rao : I would briefly mention what we look in a person when looking at the cause as it is important to treat the problem.I want you to understand the Depression and anxiety model. We generally look in to Depression by three factors.1. Predisposing factors (the factors that might make you vulnerable, example, family history of depression Etc)2.Precipitating factors (the factors that might bring the illness to surface Ex-alcohol or drug abuse,financial or relationship problems or any deaths in Te family)3.Perpetuating factors (The factors that might maintain the illness, ex-ongoing Psychosocial problems,financial problems,other physical illnesses like diabetes, Hypertension or other chronic medical conditions)If you are having any unaddressed/ongoing perpetuating factors we need to be mindful that the effectiveness of antidepressants would be partial.So, if you have it is important to look in to addressing them or minimizing their effect if possible.
Doctor Rao : Hi, are you receiving my messages? Please confirm.
Customer:

Yes and I thank you very much for it. Yes there are underlying factors I am trying to workon. And a history of depression in family. I also suffer from OCD

Doctor Rao : Ok. So,please look in to this as well. The best evidence so far for treatng depression,anxiety,OCD is the combination of medication and psychological treatments like Cognitive behavioural therapy.
Doctor Rao : If you have any constarints for sychological therapy in the form of either resources or time constraints may the better place to start is with self help books. Once book that is useful is Overcoming Depression: A self- help guide using Cognitive Behavioural Techniques [Paul Gilbert (Author)
Customer:

I am aware of CB therapy and when can see another doctor for it

Customer:

Will look for book

Doctor Rao : Please do. There are also some online site that might offer CBT for example like MoodGym. So,please look at them.
Doctor Rao : I hope you find the answer helpful.
Doctor Rao : Please do not hesitate to ask me for more information if requred
Customer:

Also will work on changing my med use to a more simplfied program. And again thank you so much for your help I am very grateful.

Doctor Rao : You are wellcome. I really hope you would start feeling better.please continue to be positive .I wish you all the best.
Doctor Rao, Doctor
Category: Mental Health
Satisfied Customers: 641
Experience: MBBS,MD,DPM,MRCPsych
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