Have Mental Health Questions? Ask a Psychiatrist Online
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Well everything else seems to be appropriate in your drug regime except for the fact that she has added nortriptyline 25 mg twice a day
what should have been done sir
kindly help me, i m in crisis
which i am not comfortable with since first of all nortriptyline being a TCA class anti depressant comes with a slew of side effects ranging from sexual dysfunction to ECG changes etc and on top of this it is not supposed to be given when escitalopram is being used because their use together can lead to a life threatening situation called as Serotonin syndrome.
You may mention to her this that the combination of escitalopram and nortriptyline may precipitate a life threatening serious complication due to excessof serotonin levels in the body caused by this combination which will land you in emergency.
so i personally do not approve of use of nortriptyline with escitalopram , any one of these shall be used , preferably escitalopram both because it is
i must discuss this with her
better in effiacy
plus it has least side effects .
as compared to nortriptyline.
do u remember my earlier drug regimen
i am afraid i do not remember , can you please revise it now.
please follow this link ,
as this will tell you where this regime is going wrong by using both escitalopram and nortriptyline together.
You may in fact show that to your psychiatrist as well if the need arises.
i will do that
as i m in a crisis\
Sir, u had suggested the following meds
please go ahead.
1) Duloxetine 60mg ( x------x------1 )
2) Aripiprazole 10mg ( 1------x------1 )
3) Lamotrigine 200mg ( x------x------1 )
4) Clonazepam 1.5 mg ( 1---x----1 )
5) Pregabalin 150mg ( x-----x-----1 )
Sir, i have a few things to narrate
I like Duloxetine better than escitalopram
i mean , i feel more comfortable
sir, now, coming to the mood stabilizer phase
whi will be better for me ?
Lithium or Lamotrigine
r u there sir ?
i have tremendous depression
i am assessing ..
so this may take a minute.
now hear me out ..
you can keep cymbalta as it is and choose not to use escitalopram
aripiprazole has been approved by the doctor herself , but her dose is 15 mg as opposed to mine of 20 mg in two divided doses of 10 mg each.
so you may start taking 20 mg at night and after 1 month you may consider coming down to 15 mg once symptoms are better .
clonazepam also has been retained by her so you may continue take 1 .5 mg twice a day and after 1 month reduce it's dose to 1 mg twice a day as she has suggested.
As far as mood stabilizer is concerned , lithium is better in efficacy but it has a lot of side effects
ranging from hypothyroidism ,
neurological symptoms like tremors , loss of balance and poor coordinatin , etc
on top of this there looms a constant fear while using it about lithium toxicity
and therefore every 3--6 months serumk levels of lithium are to be checked for toxicity
so basically due to so many side effects this drug although being effective has gone out of favor
instead ask doctor to replace lamotrigine with either sodium valproate or divalproex sodium.
but lamotrigine has not been tried yet sir....
sodium valproate can be used enchorate chrono or valprol or valtec cr 300 - 500 mg twice a day.
you had recommended it and today i discussed it with my doc\
and if you choose divalproex then it is available as divaa od 250 mg -750 mg / day
dayo OD is another brand of the same drug
which one will be superior for me sir.....divalproate or lamotrigine for my recurrent depression
so sodium valproate or divalproex will be supperior any day as compared to lamotrigine
loss of interest
yes for that also.
it will act as an augmenting agent to counter your depressive features .
so, lamotrigine is inferior to valproate
for my low mood etc
i dont have mania
i have recurrent depressive features
low mood...lack of interest in studies...
i have considered that too before answering.
plz suggest be how to take Divalproex
it is readily used for depression along with a chief anti depressant like escitalopram or cymbalta.
i mean the dsosage
It will be better if you taking long acting version of divaloproex such as Divaa OD or Dayo OD which is to be taken only once a day starting at dose of 250 mg for 1st week , then 500 mg for 2nd week
and 3rd week and then 750 mg from 4th week onwards and maintain on this .
what should be the final dosage of Divaa OD
/ day as a single morning dose.
i weigh 104 KG sir
yes no problem
morning dose ?
this will be suitable for your weight.
yes morning dose after or with breakfast.
but it causes sedation, isn't it , sir
and i have studies hanging over my head
oh, ok, i m sorry sir
do not worry.
i have not encountered many people who have taken this drug and had complained of sedation.
now what abt Pregabalin.....whether to take it or not sir.....i have severe GAD.......
You may come off it .
it really helped my anxiety
i think the revised drug regime will bypass the need for it's use.
i know ..
so what you can do is to taper it slowly.
Thanks a lottttttt :)
while allowing the newer drug regime settle and take over and control your anxiety and depression and schizophrenic symptoms.
I hope this helps.
one t6hing sir
last thing sir
regards XXXXX XXXXX memory
working memory impairment
visual learning and memory
in schizophrenia new learning skills and memory generally impaired.
so, there is no cure
so, sir, should i stay away from my academic persuits
improvement can be seen once your associated depression lifts plus the mentioned drugs will help in improving learning and memory ability.
academic pursuits may lead to unnecessary stress and pressure as they come with lot of demanding schedule and this may precipitate a long dormant schizophrenia and convert into full blown.
plus the cognition/ thinking rarely can reach previously high levels.
so if you ask me , i will say that you should train yourself for survival in a job or profession where less amount of higher mental functioning is required.
I get yr point sir
Thanks a lot for your time and valuable input sir
i am sorry if you got discouraged a bit , i am just placing facts.
i understand sir
at the end of the day you will be able to perform in whichever field if you are healthy both physically and mentally , therefore have some realistic and achievable goals in life.
i hope this makes sense to you.
wish you all the best.
thanks a TON
I went to see my PsyDoc and gave her your opinion today...but she is becoming a little bit rigid in her prescription. She bluntly told me that nothing will happen. Thats why I m thinking of seeing a new PsyDoc. Presently, I am thinking of taking your recommendations to a new PsyDoc.
Sir, I have just one little bit of confusion. For my very low mood....is Divalproex better than Lamotrigine....i have been on both earlier. Kindly guide me Sir. (I have just one sided severe depression and no mania at all).
If there is no bipolar depression then lamotrigine perhaps will do more good than divalproex for unipolar depression, so you shall use lamotrigine.
You may seek help from a new psychiatrist who is open minded and flexible but you may find it difficult to convince a psychiatrist to follow your recommendations completely so even if a psychiatrist is willing to follow some of the recommendations then you shall accept that and go ahead with him/ her.