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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4085
Experience:  MD Psychiatry
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Hi ~I lost my husband very shockingly a year ago~ he died right

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Hi ~I lost my husband very shockingly a year ago~ he died right in front of me without being sick~ to our knowledge~ then an autopsy was done and he had cancer and a bad heart~ yet no tests showed this a month before~I sold my beautiful Country Home and moved to another Province to be near my only child and son~ as staying a Winter alone there would have been too hard~I stayed with my son and his family for 6 weeks until my Condo was ready~his Japanese wife was not nice to me and since I moved out I have had no contact with her for 6 months~ my son continues to help me and is very good this way and yet I feel so alone and sad~my Doctor put me on 25 mg of co- quietiapine a day in the morning along with PMS clonazepam.5 mg. this does not sound like a lot~ then at Noon I am to take one and one half of the clonazepam alone~ at bedtime I take two quietiapine of 25 mg and one clonazepam of one mg and a mylan-zopiclone and I have to admit I sleep so well and have pleasant dreams~ but when I take my morning dose I often feel so tired all day~ some days I feel great~ why would it differ and what can I do to stop the tiredness~ would skipping the morning dose be safe~or take it at another time~I normallay feel much better at night and tend to stay up late~ I sleep in more or less to pass the time~ as the day is too long otherwise~the question is what can I do to overcome the extreme fatique~ during the day~ but some days are okay~ what would I be doing differently~I make myself do all my house jobs and look after myself and cat~ I try not to lie down during the day~I have to find a Doctor here~ but I have been dealing with high eye pressure too and seeing a Specialist about this here right now~then I will seek out a Psychiartrist~ I have OCD tendencies~does this medication help this~ as it scares me when I read what it does help- like Bipolar~ three other Doctors told me I do not have this~ thus will not prescribe an anti depressant~ as my mother and other family members have bipolar and I could go too high~so they say~I hope that you can help until I see a Professional~mine gave me enough medication to last a while~Martha
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 1 year ago.

Hi there,

 

Welcome to Just answer !

 

I am sorry to learn about the tragic loss of your beloved husband and I empathize with you. God bless his soul.

 

Now coming back to your question , I will like to address two important things here--

 

1) You are taking Quetiapine 25 mg in the morning which has sedative action therefore it is possibly the reason why you feel so sloppy and lethargic in the morning , so I will suggest that you stop taking the morning dose and continue on the night time dose only, in fact the 25 mg of morning dose can be added to the night time dose.

 

2) Actually quetiapine is given in once in a day dosing , usually at night owing to it's sedative action which can be useful in providing a good night sleep plus it has a long half life which is sufficient to cover full 24 hrs in a single dose.

 

So to summarize--

 

-- You shall come off quetiapine dose in the morning by taking it on alternate days for 1 week and then stop it , this is a safe way to withdraw from quetiapine without having to face any withdrawal side effects.

 

-- Meanwhile you shall continue on the 50 mg night time dose which may be raised after withdrawal of morning dose to 75 mg.

 

-- Clonazepam shall be continued as it is being taken right now.

 

 

Kindly discuss this with your treating doctor and carry out the changes and you shall appreciate improvement in your morning time lethargy and sloppiness within a week or two.

 

I hope this helps.

 

Wish you all the best.

 

Please kindly leave a Positive rating if you are satisfied with the answer as only then will I be credited for my service.

 

If there is any further assistance needed please feel free to ask using the reply button.

 

Regards..

 

 

Customer: replied 1 year ago.

Thanks Doctor Kaushik~I want to Thank you for making me feel that I am not abnormal~ I also know maybe that I take the Morning dose much later than I originally did~ the Doctor had me take it at 9 AM~I had checked myself into the hospital in my former Province~ they had us up early~ now I stay in bed longer to more or less not make the day too long~ I would reach over at 9 and take the medication at 9 as before~ I found that make me not want to get up at all~ so then I started taking it around eleven and then to add to it I would take my one o'clock clonazepam~ as I did in the hospital~I maybe had too much all at once and too close together~I guess I did not know if one could change the schedule of the times~this maybe explains why I always feel better late at night ~ when it is all worn off~the present sleep one seems perfect~would eventually cutting out one 25 mg of quietiapine hurt~I know I should have a Doctor right now here~ it takes a while to get a Specialist~ such as you are~ I do not trust GP's with such medication~ maybe I am wrong~ but my mother was Bipolar and my father OCD~I think~ there are a few who have Bipolar in my family now and GP's made them worse~especially my poor mother~ anyway does quietiapine also help OCD~ what is your expert opinion on marijuana~I took that at one time and I never felt better~ but now that I live alone and it being illegal~ except for medical reasons~ I am scared to take it now~here it seems given more for cancer patients~to cope with pain~ but it sure relaxed me a ways back when my husband was alive~ I think I have OCD~ although most Doctors just call me a Perfectionist~ this last one said there was a grey area~ what does that mean~anyone would be upset the shock I endured and I had no family support~ Thanks again so much~ as I know that you read my information well and answered extremely well~ I hope that I can get a good Psychiatrist here~like you~Martha~

Expert:  Dr. Kaushik replied 1 year ago.

Well I will not suggest you to indulge in use of marijuana because of it has high risk for abuse and potential for addiction which may further complicate your clinical picture , so kindly refrain from using this substance.

 

Now as far as your doctor saying it is a gray area , in clinical terms it means that the conclusive diagnosis is not clear, it is like may or may not be situation , so basically the doctor was not sure about OCD diagnosis , which is surprising since there is nothing to be unsure about as far as OCD goes.

 

So I will suggest you below mentioned points which you shall try to embark upon so as to overcome your condition.

 

-- Get in touch with a psychiatrist as soon as possible and get yourself assessed first for ocd and bipolar disorder and get started on an anti depressant drug such as Prozac ( fluoxetine ) at dose of 40-80 mg / day , to be taken in the morning as single dose. Whoever says that anti depressants cannot be taken in bipolar disorder is wrong as an anti depressant drug + anti psychotic drug combination quite commonly is used as a ploy to tackle bipolar symptoms including depression.

 

-- Meanwhile you stop the morning dose of quetiapine as mentioned above and just stick to the night time dosing and other drugs.

 

-- So basically you need to be placed on a combination of Prozac + quetiapine + clonazepam which shall be formidable to counter both ocd and bipolar if it is proved to be present in the first place.

 

I hope this helps.

 

Kindly discuss this with your doctor and seek referral for a seasoned psychiatrist who shall be more likely to appreciate these intricacies of bipolar and ocd management.

 

Wish you all the best.

 

Please kindly leave a Positive rating if you are satisfied with the answer as only then will I be credited for my service.

 

Regards..

Customer: replied 1 year ago.

Hi Again Dr. I am sorry to ask so many questions~ but four Psychiatrists have told me I am NOT Bipolar and none could come up with OCD either~ it is me who says I am~ although I do not have all of the awful symptoms~ I just want things always RIGHT~ these Doctors say that because of my Bipolar Background~ such as my mother having it~ I could go too high on an anti- depressant~even this last Doctor agreed on that~I also do not believe I am Bipolar~I know the symptoms quite well~as I lived with it all my life~ maybe I did not word it properly~ so if I am NOT Bipolar~ which I am quite sure I am not~but have a family background of it~ this is what the other Doctors felt~do you disagree with them ~I am in grief right now more than anything and feel very lonely~you sure deserve a Positive reading putting up with me~:-) Eaglewings Martha~

Expert:  Dr. Kaushik replied 1 year ago.

Well if you are not bipolar and if it is only family history of bipolar disorder which is being taken into account , then I agree with the doctors as sometimes use of anti depressant drug may precipitate manic episode ( part of bipolar disorder ) in those who have familial predisposition such as seen in your case.

 

So taking into account all of this I will say that you just stick to quetiapine at night time dosing and do not add any anti depressant but clonazepam shall be continued as it is being used.

 

I hope this helps.

 

Wish you all the best.

 

Regards..

 

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4085
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you
Customer: replied 1 year ago.

Boy do you deserve a Bonus~ I shall not take a quietiapine tomorrow morning~ but the next day~RIGHT~and so on for a week~ but continue with the clonazepam~~ as she prescribed already~ do they make you tired as well~ anyway one Doctor said my sleep combination was like a sledgehammer dose~ 2 quietiapine and one clonazepam~1 mg and then the 1 zopiclonepam is in there as well at 7.5~it puts me to sleep gradually and if I wake up I can use the washroom and so on and not be too tired or stumble around and yet go back to sleep normally~ I have pleasant dreams and do not wake up thinking of everything~ do you still feel that I should add another 25 mg of quietiapine to all that or just skip that one~it may take me a while to get to a Psychiatrist ~ is why I am pesting you for now~ I never go high for one thing~ is why they all said I was not Bipolar~my symptoms are far different from my mother and brother etc~ they took lithium~ it ruined my brother's kidneys however~even a GP agreed that I should not go on an anti- depressant with my family background~I find it rather odd~ as if I do not have it what does family background got to do with it~if an anti- depressant helped~anyways I shall accept that~ I notice the day time clonazepam are only a .5 and not a1 like at night~thanks again so much and hopefully this shall be my last question~ Martha~I am sick and tired of being so tired~

Expert:  Dr. Kaushik replied 1 year ago.

If you are going to add 25 mg of Quetiapine to the night time quetiapine dose then you will have to stop zolpidem and clonazepam night time doses as quetiapine at 75 mg dose will be alone sufficient for a good night refreshing sleep.

 

I hope this helps.

 

Regards..

Customer: replied 1 year ago.

I think I would rather stick with the present night time dose for now~as it seems to work so well~maybe when I get a Doctor they can advise me what to do~honestly right now I would not mind getting an anti- depressant~ and go High~this does not seem to make sense~ just because I have a family history~I read once that it can take 9 Psychiatrists to figure OCD out~ none of mine picked up on it~ so you are very smart if you can~ I guess we tend to not tell some symptoms~ first of all out of embarrassment and some we do not realize as being abnormal~it seems and maybe you noticed also~people with OCD and Bipolar ~ as many many famous people are~ seem to be extra intelligent~ many famous people had these disorders~I was so tired at the hospital the day the Doctor gave me a test ~they were giving me too many drugs~ yet I made almost perfect on a test given to me and also years ago when I did a detailed one~ 500 questions or more I did very well~ they almost laughed at me~my family members who have it are also very intelligent~even skipping grades~ especially with OCD~is there a reason for this~ here I go again with yet another question~I almost feel like just quitting quietiapine entirely during the day from now on~ would the withdrawal symptoms be hard to handle~ Martha~Hopefully last question :-)

Expert:  Dr. Kaushik replied 1 year ago.

Well the withdrawal symptoms my develop if you stop the morning dose abruptly without tapering it but these withdrawal symptoms can be endured if one has patience and secondly these withdrawal symptoms are temporary / self limiting as they subside on their own in a few days.

 

Regards..

Customer: replied 1 year ago.

I am curious to what the withdrawal symptoms would be and would they be worse then the terrible fatigue I feel taking them~ would an afternoon time be better than morning~and if I stay on my present night medication would I just stop the one extra~or still add it to the night one~Many thanks for all your help~it is morning now and I did not take the quietiapine~ only the other clonazepam~thus far I don't have that horrible fatigue~ but hate to start back tomorrow~ one does not even feel like living when feeling so tired~before I checked myself in the hospital I was on ativan from out patients and a sleep pill called temazepam~ it did not seem to give me a full night's sleep ~would that have caused my extreme tiredness back then or stress from the death~ my son and grandsons came for almost a month and they stayed up all night at times making noise~I was exhausted ~thus was so thankful for a good night combination~ funny how that Doctor had me on quietiapine in the mornings~ you would think she should know~ as I slept a lot in the hospital too~during the day~maybe getting up and moving around helps too and not laying in bed~ Martha~

Expert:  Dr. Kaushik replied 1 year ago.

Hello,

 

First of all it is not necessary that all those who stop quetiapine abruptly shall undergo withdrawal side effects , only a few patients go through it but it is better to be aware of it so as to avoid it.

 

Secondly the withdrawal side effects are not something severe and can be endured with some patience and these may include -- brief period of nausea , dizziness, insomnia , which shall get corrected on their own within a few days time.

 

And again I will reiterate that the withdrawal symptoms not necessarily develop , most people bypass them even upon stopping the quetiapine abruptly but it is required for a user to adopt to the right protocol of weaning the drug so as to remove even slightest of possibility of having these withdrawal side effects.

 

Regards..

Customer: replied 1 year ago.

Thanks again for your expert advice~I already pushed the Happy button last night~I did not take the quietiapine this morning ~ as I said~and thus far do not feel fatigued~ but will my anxiety get bad~ I forgot to tell you that she also prescribed another quietiapine cut in half~ so if needed during the day ~I assume for anxiety~ I could take that~ they sure were small~so they must be for anxiety~ which I experience~I am in a completely different environment now and feel so lonesome for my husband~ we had no children together~ so my son is from another marriage~ it is hard to lose a mate and move all at the same time ~ as you would know~I had to give up a beautiful country home and now am in a Condo~I have no money issues however~I just wonder if the other drug would handle any anxiety I may experience~clonazepam I mean~why would she prescribe the half of the quietiapine for anxiety~what would you suggest I do with the extra tablet~ would taking it at night along with the other drugs hurt~I think you said it would sort of last in one's system for a time~ so hopefully the night ones would handle anxiety for the next day~ would an occasional drink of wine hurt~ she said No alcohol~ if I get up during the night and feel I will not go back to sleep~ I occasionally take a half quietiapine then~or if I experience anxiety during the day~no wonder I was tired~I forgot to tell you this part~I hate to take another tomorrow~ yet I can't take a chance of those side effects~ especially insomnia~Martha~Would this Doctor not realize that I would be tired taking this during the day~I don't think taking an ativan would be a good mix~ as I have some left~???for anxiety I mean~

Expert:  Dr. Kaushik replied 1 year ago.

You should not take the extra quetiapine that the doctor has given you and should strictly stick to night time dosing . Quetiapine as told earlier is capable enough to produce it's effect whole day after once a day intake , so taking another dose of it will not amount to any improvement in anxiety, all the more it may precipitate drowsiness.

 

However at times of uncontrolled overwhelming anxiety you may take half of clonazepam which shall take care of it.

 

No alcohol to be taken in any form with these drugs.

 

No since you are placed on clonazepam , Ativan should not be taken with it.

 

I hope this helps.

 

Regards..

Customer: replied 1 year ago.

Thanks so much~ I do not have half pills of the clonazepam extra ~it is half of the quietiapine that she prescribed for in between~maybe to ween off I could take one of these tomorrow instead of a whole quietiapine~ I just hate to go back to being tired again~Martha~

Expert:  Dr. Kaushik replied 1 year ago.

Yes you can do that to wean yourself off the morning dose.

 

Regards..

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Dr. Kaushik
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