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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2219
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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My 78 yo father has mod to severe major dep with 1 psychotic

Resolved Question:

My 78 yo father has mod to severe major dep with 1 psychotic episode. No prior he. Onset 2 yrs ago. Lexapro 20 mg and risperdone .5 mg. appetite is back but not much else. Anxiety, irritable, doesn't initiate conversation, hopeless, needs prompts with ADLs. Refuses to be involved in prior activities. Recently retired judge. Is there any better medication or should we up the dosage.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Vikas replied 1 year ago.

Dr Vikas :

Hello

Dr Vikas :

Since when he is taking Lexapro?

Customer: Fall 2011 at 10 mg. Spring 2012 upped to 20 mg.
Dr Vikas :

Thanks for your reply.

Customer: Mild improvement with increased dosage. Good physical health other than diabetes (started insulin last year).
Dr Vikas :

Do you think that he is still depressed?

Customer: Yes!
Dr Vikas :

and what about his psychotic symptoms, are they under control?

Customer: Yes.
Dr Vikas :

In that case, since he is still depressed, it is possible that he is not responding adequately to Lexapro now.

Dr Vikas :

The usual dose range of Lexapro is from 10-20 mg per day and in elderly patients the recommended dose is usually 10 mg per day.

Dr Vikas :

As he is already on 20 mg per day, so there can be two possible options, either his doctor can augment the effect of current antidepressant by adding another antidepressant or switch over to another antidepressant.

Dr Vikas :

In elderly patients, usually multiple medicines are avoided so switching over to another antidepressant appears to be a better alternative in my view.

Dr Vikas :

Lexapro is a SSRI antidepressant and patients who are not responding adequately to SSRI antidepressant respond better to SNRI antidepressant which acts on 2 neurotransmitter in comparison to SSRI antidepressant.

Dr Vikas :

In his case, you can discuss with his doctor about trying Pristiq (Desvenlafaxine) which is a SNRI antidepressant and can be a good option in his case.

Dr Vikas :

would like to know your opinion on my suggestion.

Dr Vikas :

are you there?

Customer: Yes. I asked if risperdone could be adding to lethargy? Is the pristig a new drug.
Dr Vikas :

well, Risperidone is a sedating antipsychotic and can cause lethargy but . 5 mg is a very low dose comparatively. Also, he must be taking it at night probably.

Dr Vikas :

Pristiq (Desvenlafaxine) is a comparatively newer antidepressant and is some what similar to Effexor (Venlafaxine)

Customer: Side effects? Recommended dosage? Does he have to go back to psychiatrist or can regular nag home doc prescribe?
Dr Vikas :

Pristiq can be prescribed in a singly daily dose of 50 mg per day and is sufficient in most patients.

Dr Vikas :

In my view, his psychiatrist opinion should be taken while switching over to a new antidepressant.

Customer: If this new med doesn't help do we give up? He is resistant to talk therapy. Are ECTs still done?
Dr Vikas :

this new medicine will work, don't worry about it. Honestly speaking, selecting an antidepressant is a hit and trial method. If this antidepressant doesn't work, some other will work surely.

Dr Vikas :

ECTs are still given but in selective cases mostly.

Dr Vikas :

as seen in clinical practice, most patients respond well to a SNRI antidepressant :)

Customer: Ok. Will try. Thank you so much!
Dr Vikas :

You are most welcome.

Dr Vikas :

Do you have any other question to ask?

Customer: Does this med address anxiety too?
Dr Vikas :

yes, it is useful for both depression and anxiety symptoms.

Customer: Ok. I am done. Thanks!
Dr Vikas :

:)

Dr Vikas :

Thanks for coming to JA.

Dr Vikas :

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Dr Vikas :

Please take a moment to rate the answer.

Dr Vikas :

Kind regards

Dr Vikas :

Vikas

Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2219
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
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Dr. Vikas
Dr. Vikas
Associate Professor
1813 Satisfied Customers
MBBS ; M.D Psychiatry, MS. Health Informatics