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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4026
Experience:  MD Psychiatry
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I suffer from anxiety and no pick me up. In the past I also

Customer Question

I suffer from anxiety and no pick me up. In the past I also suffered from OCD. I used to take Citalopram 60 mg, Lamictal 200 mg, and Geodon 160 mg. I went to my psychiatrist with the wish to get off of the medicines because I wish to have another child. Doctor tapered Citalopram last September and I stopped the medicine in December. Oh yes, I am also bipolar so SSRIs cause me to have mania. Citalopram he believed was causing some mania. I used to aggressively work out at the gym from August to December. Doctor tapered Lamictal in January and I no longer take that. I currently take Geodon 80 mg and Lorazepam .5 mg daily.I have reduced amount of depression. I am getting treated with TMS. I used to suffer from depression. Geodon is anti-maniac and anti-depressant. It has taken away all of the mania in me. Even before I started the SSRIs, I had some inhibitory mania that got me through life. But I am missing the energy to do stuff. That puts me into depression and anxiety. I want to take some SSRI in low dose to push me up. I am asking you for name of some SSRI that I can ask my doctor to prescribe me. I can wait on having another child. But first I want to get well.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Vikas replied 1 year ago.

Dr Vikas :

Hello ! Thank you for your question, I’m Dr. Vikas (M.D Psychiatry) and I’ll try to help you today.

Dr Vikas :

You can specifically discuss with your doctor about trying Fluoxetine (Prozac) or Sertraline (Zoloft). Both of them are activating SSRI antidepressants and can be a good option in your case.

Dr Vikas :

For Prozac, the dose range is from 20-60 mg per day and for Zoloft, the dose range is from 50-150 mg per day.

Dr Vikas :

Other than SSRIs, a SNRI antidepressant like Desvenlafaxine (Pristiq) can also be a good option. The daily dose range is 50 mg once a day in single dose.

Expert:  Dr. Vikas replied 1 year ago.
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Customer: replied 1 year ago.
Do Prozac and/or Zoloft cause mania in a bipolar person?
Expert:  Dr. Vikas replied 1 year ago.
Hello Stacy,

Thanks for your reply. There are chances that SSRI antidepressant like Zoloft or Prozac can cause manic switching in a Bipolar patients specially if that patient is not taking a mood stabilizer.

In fact, nearly all antidepressant can cause antidepressant induced mania specially in a patient suffering from Bipolar disorder but the risk is comparatively low in your case as you are already taking Geodon as a mood stabilizer.

As seen in clinical practice by us, Desvenlafaxine (Pristiq) and Bupropion (Wellbutrin) are two such medicines with which there are comparatively low chances of antidepressant induced mania.

Wellbutrin is also an activating antidepressant so you can discuss with your doctor about Wellbutrin or Pristiq also if you are much concerned about aggravation or precipitation of manic symptoms due to an antidepressant.
Customer: replied 1 year ago.
Do you think I can replace Geodon with Lamictal?
Expert:  Dr. Vikas replied 1 year ago.
Stacy, Lamictal (Lamotrigine) is a first line medicine for treating Bipolar depression. It is specially useful for the depressive phase of Bipolar illness and can also prevent future manic or depressive episodes.

If you are getting good results with Geodon then in my view you should continue it. For depressive symptoms, adding Lamictal by your doctor is a better option than adding an antidepressant to Geodon.

So to summarize, a combination of Geodon + Lamictal can be a better option than Geodon + antidepressant for treating your current depressive symptoms.
Customer: replied 1 year ago.
My doctor has prescribed Lexapro 5 mg. So now I am on 4 medications: Lorazepam .5 mg, Lexapro 5 mg, Buspirone 15 mg, and Geodon 80 mg. After 6 weeks I am going to stop taking Lorazepam. So then I will be on 3. Are these three safe in pregnancy as I am thinking of becoming pregnant in future.
Customer: replied 1 year ago.
Relist: Answer quality.
Customer: replied 1 year ago.

My doctor has prescribed Lexapro 5 mg. So now I am on 4 medications: Lorazepam .5 mg, Lexapro 5 mg, Buspirone 15 mg, and Geodon 80 mg. After 6 weeks I am going to stop taking Lorazepam. So then I will be on 3. Are these three safe in pregnancy as I am thinking of becoming pregnant in future.

Expert:  Camille-Mod replied 1 year ago.

Hi,

My name is XXXXX XXXXX I’m the moderator for this topic. I noticed that you have opted out your professional. If you are still waiting for an answer, I will try to find a new professional to assist you! Please keep in mind that sometimes finding the right professional can take a little longer than expected. All of our professionals come on at varying times, so sometimes it’s a bit difficult to predict. Either way....If you would prefer not to wait, please feel free to let me know, and I will cancel this question for you. Thank you.

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Expert:  Dr. Kaushik replied 1 year ago.

Greetings !

 

Welcome to the site.

 

I am Dr. Kaushik and i believe i can help you with your query.

 

I have gone through your dialogue with the previous expert and i can understand your concerns about the possible ill effects of these drugs on pregnancy.

 

Well, you see like almost all the psychotropic medications these three medications namely Geodon, Buspirone and Lexapro are teratogenic in nature meaning that they can cause deformities in the fetus if taken during pregnancy , especially the risk is very high during the first trimester ( i.e first 3 months of pregnancy), so you shall have to stop all of them before planning for pregnancy or else an alternative to this will be to use them at lowest possible doses and that too under the watchful supervision of your doctor with periodic monitoring of fetus by your doctor.

 

So i will suggest that in order to plan for pregnancy since you will have to remain abstinent from these drugs for at least first 3 months of pregnancy and even after that the drugs will be limited in their use as far the doses are concerned , so it is best for you to first become absolutely symptom free and then proceed with pregnancy so that your pregnancy is uneventful and safe for yourself as well as for the baby and you can pass the stipulated risky phase without the use of drugs.

 

I hope this helps.

 

Wish you all the best.

 

Please kindly leave a Positive rating if you are satisfied with the answer.

 

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: 4026
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you
Customer: replied 11 months ago.
I currently take Lorazepam .5 mg and Lexapro 10 mg in mornings. And with dinner, I have Lorazepam .5 mg, Buspirone 15 mg, and Geodon 60 mg now. There were some changes to my medicines. I stopped taking the morning 15 mg Buspirone. Dr increased Lexapro by 5 mg. Yesterday reduced Geodon to 60 mg because 80 mg was making me very sleepy in mornings. I know now I have a possibility of getting mania because increased Lexapro and decreased Geodon. But I will do my best to control my anger. And will not just focus on one thing in my day. Can you give me some tips?

And for pregnancy, my psychiatrist will stop Lorazepam. I will be left on Lexapro 10 mg, Buspirone 15 mg, and Geodon 60 mg. Are these in low dose?
Expert:  Dr. Kaushik replied 11 months ago.
Greetings !

Welcome to the site.

Well I believe all your drug doses are adequate to prevent mania from developing but I will ask you to request your doctor to at least allow you to take lorazepam 0.5 mg on PRN Basis that is using the drug as and when required at times of impending anger or heightened irritability.

No, if you are planning for pregnancy then these drugs at their respective doses are not low enough to provide safety for pregnancy especially in the first trimester.

If at all the need is there during pregnancy then only Gordon at dose of 20 mg once a day is to be given along with 5 mg of buspirone under strict vigilance as even at such low doses these drugs are teratogenic but the risk shall decrease with this dosage.

Now as far as countering your anger is concerned apart from taking lorazepam 0.5mg PRN at times of. anger what else you can do is that you can start using meditation or yoga to gain control over your anger plus you can practice venting out your anger by writing your angry outbursts in a diary at the time of flare up rather than using verbal or physical expression of the same , this way you shall be able to channelize your anger peacefully without hurting anyone.

I hope this helps.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

Regards
Customer: replied 11 months ago.

So sorry for pressing the wrong rating. I gave you excellent rating, but the computer was asking for more money. So I was just experimenting that if I press any other button, will the computer still ask for money. Can you delete the bad service remark? That is by mistake.

Customer: replied 11 months ago.

This is an error Dr. Kaushik. You gave an excellent answer. Sorry my daughter was messing with my computer.

Customer: replied 11 months ago.

I will give you excellent rating. I have one more concern. I get my daughter ready for her school and drop her. Then I come home and pass my time. I try to go to the gym at 3 p.m. before picking up my daughter from school at 4:30. I have started losing motivation of going to the gym lately.


 


This can be compared with last year when I used to go to the gym five days a week and that too for about 2 hours. I lost 25 pounds by going to the gym last year. I was on Citalopram 20 mg, Lamictal 200 mg, and Geodon 80 mg. I had mania in me even my psychiatrist noted that is when he tapered Citalopram and stopped it. I used to just focus on one thing back then so much of losing weight and going to the gym.


 


My doctor today has increased my Lexapro from 5 to 10 mg as of the 22nd. Why am I not motivated to go to the gym like before. My doctor even decreased my Geodon from 80 to 60 mg last night. This medicine caused me sleepiness in the morning. I don't have even little mania to take me to the gym. I got up today and got my daughter ready for her school. Dropped her and went for shopping. I feel like sitting home and relaxing. Am I falling into depression? Or is Lexapro going to take more time to show the effects of 10 mg? Or is it I might not get mania in one day? It could take 3-4 days.


 


What do you think is happening to me Dr. Kaushik?

Expert:  Dr. Kaushik replied 11 months ago.
Well actually the lack of motivation could be attributable to a combination of substandard dose of lexapro of 5 mg that you were taking and only recently you had been placed on 10 mg dose which shall take 2 weeks at least to start making it' s impact on your mood and motivation and 80 mg of Gordon was quite possibly too much for you and taking away your motivation and enthusiasm and causing a sort of mental dullness which was preventing you to carrying out your desired activities.

As of now it does not appear like you are falling in depression since other than the gym activity you have been able to carry out other errands and routine activities efficiently which would not have been possible if you were falling into depression.

I will suggest that you should patiently wait for 1 -2 weeks for the revised drug doses to bring back balance in your life as it used to be earlier and kindly discuss my previous suggestions with your doctor.

I hope this makes sense to you.

Please kindly change my negative rating to positive as it would reflect badly on my profile.

Take care.

Regards.
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4026
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you

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