How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Kaushik Your Own Question

Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4037
Experience:  MD Psychiatry
9385906
Type Your Mental Health Question Here...
Dr. Kaushik is online now
A new question is answered every 9 seconds

i am treatment resistant....have gad, bipolar,depression,57

Resolved Question:

i am treatment resistant....have gad, bipolar,depression,57 yrs old not too functional.....i take 300mg lithium,2mg of klonopin9dr says its too much?>gabapentin 300mg and some sleeping pill. is there any new adjunct drugs out that work with lithium
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 your condition and I empathize with you.

 

Well yes you can use Lamictal ( lamotrigine ) , which is also a mood stabilizer as an augmenting agent for Lithium. The effective dose for lamictal as an augmenting agent in a bipolar disorder is 100-400 mg / day .

 

Another alternative that can be used instead is another mood stabilizer Topamax ( Topiramate) at dose of 75-150 mg / day .

 

So you shall discuss both these drug options with your prescribing doctor for using one of them as an augmenting agent for lithium so as to potentate it's efficacy against your symptoms of bipolar disorder.

 

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..

 

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4037
Experience: MD Psychiatry
Dr. Kaushik and 2 other Mental Health Specialists are ready to help you
Customer: replied 1 year ago.

DR...do you think 2 mg of klonepin is good for gad, panic attacks.....the DR is trying to get me off a benzodiazipine, however isnt the big picture, and my ability to be somewhat functional being comprized. what is a good and effective substitute

Expert:  Dr. Kaushik replied 1 year ago.

Klonopin is an effective drug to manage GAD and panic attacks but the dose is variable from person to person plus klonopin cannot be kept for long term treatment because of it's tendency to make the consumer dependent on it.

 

So one important reason why your doctor seems to be adamant in continuing on this drug is because of the addiction / dependency risk that this drug carries , so I can acknowledge his intentions to put you on an effective but not addictive drug.

 

A good effective and safe alternative for klonopin to manage GAD, panic attacks would be Abilify ( aripiprazole ) at a modest dose of 10-15 mg/ day to be taken at night only.This is an anti psychotic drug but at this dose it is known to produce good anti anxiety effects too thereby making it effective in your case. In addition to this abilify being an anti psychotic will prevent manic episodes from developing.

 

So abilify seems to be a well rounded drug for managing your conditions of anxiety and panic attacks plus bipolar.

 

So to summarize -

 

Lamictal or Topamax ( preferably lamictal) as an augmenting agent for bipolar disorder and klonopin being replaced by abilify for controlling your anxiety , panic attacks and also contributing towards your bipolar disorder.

 

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.

 

Regards..

 

 

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education