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: 4026
Experience:  MD Psychiatry
9385906
Type Your Mental Health Question Here...
Dr. Kaushik is online now
A new question is answered every 9 seconds

Today I went to my PsyDoc to discuss abt your recommendations.

Customer Question

Today I went to my PsyDoc to discuss abt your recommendations. She prescribed me a new set of meds :

1) Aripiprazole 15mg (x-----x-----1)
2) Escitalopram 20mg (x-----x-----1)
3) Intalith CR 450mg (1----x----1)
4) Clonazepam 1mg (1------x-------1)
5) Nortriptylene 25mg (1----x-----1)

Sir, is this a superior combination compared to my previous medication for my schizophrenic depression with severe GAD.
Submitted: 11 months ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 11 months ago.

Dr. Kaushik :

Greetings !

Dr. Kaushik :

Welcome to the site.

Customer:

hello sir

Dr. Kaushik :

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

Customer:

what should have been done sir

Customer:

kindly help me, i m in crisis

Dr. Kaushik :

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.

Customer:

i c

Dr. Kaushik :

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.

Customer:

ohhhhhhhhhhhh

Dr. Kaushik :

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

Customer:

i must discuss this with her

Dr. Kaushik :

better in effiacy

Dr. Kaushik :

plus it has least side effects .

Customer:

sir

Dr. Kaushik :

as compared to nortriptyline.

Customer:

do u remember my earlier drug regimen

Dr. Kaushik :

i am afraid i do not remember , can you please revise it now.

Customer:

sure

Dr. Kaushik :

http://www.mayoclinic.com/health/serotonin-syndrome/DS00860/DSECTION=causes

Dr. Kaushik :

before that

Dr. Kaushik :

please follow this link ,

Dr. Kaushik :

as this will tell you where this regime is going wrong by using both escitalopram and nortriptyline together.

Dr. Kaushik :

You may in fact show that to your psychiatrist as well if the need arises.

Customer:

sure

Customer:

i will do that

Customer:

as i m in a crisis\

Customer:

Sir, u had suggested the following meds

Dr. Kaushik :

please go ahead.

Customer:

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 )

Customer:

Sir, i have a few things to narrate

Customer:

I like Duloxetine better than escitalopram

Customer:

i mean , i feel more comfortable

Customer:

sir, now, coming to the mood stabilizer phase

Customer:

whi will be better for me ?

Customer:

Lithium or Lamotrigine

Customer:

r u there sir ?

Dr. Kaushik :

yes.

Customer:

i have tremendous depression

Customer:

n anxiety

Dr. Kaushik :

i am assessing ..

Customer:

ok

Dr. Kaushik :

so this may take a minute.

Customer:

sure sir

Dr. Kaushik :

yes..

Dr. Kaushik :

now hear me out ..

Customer:

sure sir

Dr. Kaushik :

you can keep cymbalta as it is and choose not to use escitalopram

Customer:

ok

Dr. Kaushik :

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.

Customer:

yes

Dr. Kaushik :

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 .

Customer:

ok

Dr. Kaushik :

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.

Customer:

ok

Dr. Kaushik :

As far as mood stabilizer is concerned , lithium is better in efficacy but it has a lot of side effects

Dr. Kaushik :

ranging from hypothyroidism ,

Dr. Kaushik :

liver impairment,

Dr. Kaushik :

kidney impairment,

Dr. Kaushik :

ECG changes

Dr. Kaushik :

skin rashes.

Customer:

ok

Dr. Kaushik :

neurological symptoms like tremors , loss of balance and poor coordinatin , etc

Customer:

ic

Dr. Kaushik :

on top of this there looms a constant fear while using it about lithium toxicity

Customer:

ic

Dr. Kaushik :

and therefore every 3--6 months serumk levels of lithium are to be checked for toxicity

Customer:

my God

Dr. Kaushik :

so basically due to so many side effects this drug although being effective has gone out of favor

Dr. Kaushik :

instead ask doctor to replace lamotrigine with either sodium valproate or divalproex sodium.

Customer:

but lamotrigine has not been tried yet sir....

Dr. Kaushik :

sodium valproate can be used enchorate chrono or valprol or valtec cr 300 - 500 mg twice a day.

Customer:

you had recommended it and today i discussed it with my doc\

Dr. Kaushik :

and if you choose divalproex then it is available as divaa od 250 mg -750 mg / day

Dr. Kaushik :

dayo OD is another brand of the same drug

Customer:

which one will be superior for me sir.....divalproate or lamotrigine for my recurrent depression

Customer:

low mood

Dr. Kaushik :

so sodium valproate or divalproex will be supperior any day as compared to lamotrigine

Customer:

loss of interest

Dr. Kaushik :

yes for that also.

Dr. Kaushik :

it will act as an augmenting agent to counter your depressive features .

Customer:

so, lamotrigine is inferior to valproate

Customer:

for my low mood etc

Customer:

i dont have mania

Customer:

i have recurrent depressive features

Customer:

without mania

Dr. Kaushik :

yes.

Customer:

low mood...lack of interest in studies...

Dr. Kaushik :

i have considered that too before answering.

Dr. Kaushik :

yes.

Customer:

i c

Customer:

plz suggest be how to take Divalproex

Dr. Kaushik :

it is readily used for depression along with a chief anti depressant like escitalopram or cymbalta.

Customer:

i mean the dsosage

Customer:

i c

Dr. Kaushik :

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

Dr. Kaushik :

and 3rd week and then 750 mg from 4th week onwards and maintain on this .

Customer:

what should be the final dosage of Divaa OD

Customer:

oh, ok

Dr. Kaushik :

750 mg.

Dr. Kaushik :

/ day as a single morning dose.

Customer:

i weigh 104 KG sir

Dr. Kaushik :

yes no problem

Customer:

morning dose ?

Dr. Kaushik :

this will be suitable for your weight.

Dr. Kaushik :

yes morning dose after or with breakfast.

Customer:

but it causes sedation, isn't it , sir

Dr. Kaushik :

Not really.

Customer:

and i have studies hanging over my head

Customer:

oh, ok, i m sorry sir

Dr. Kaushik :

do not worry.

Dr. Kaushik :

i have not encountered many people who have taken this drug and had complained of sedation.

Customer:

now what abt Pregabalin.....whether to take it or not sir.....i have severe GAD.......

Dr. Kaushik :

You may come off it .

Customer:

it really helped my anxiety

Dr. Kaushik :

i think the revised drug regime will bypass the need for it's use.

Dr. Kaushik :

i know ..

Customer:

ok

Dr. Kaushik :

so what you can do is to taper it slowly.

Customer:

ok sir

Customer:

Thanks a lottttttt :)

Dr. Kaushik :

while allowing the newer drug regime settle and take over and control your anxiety and depression and schizophrenic symptoms.

Dr. Kaushik :

I hope this helps.

Customer:

one t6hing sir

Customer:

last thing sir

Dr. Kaushik :

what ?

Customer:

regards XXXXX XXXXX memory

Customer:

working memory impairment

Customer:

visual learning and memory

Dr. Kaushik :

in schizophrenia new learning skills and memory generally impaired.

Customer:

oic

Customer:

so, there is no cure

Customer:

so, sir, should i stay away from my academic persuits

Dr. Kaushik :

improvement can be seen once your associated depression lifts plus the mentioned drugs will help in improving learning and memory ability.

Dr. Kaushik :

well

Dr. Kaushik :

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.

Customer:

i c

Dr. Kaushik :

plus the cognition/ thinking rarely can reach previously high levels.

Customer:

i c

Dr. Kaushik :

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.

Customer:

i c

Customer:

I get yr point sir

Customer:

Thanks a lot for your time and valuable input sir

Dr. Kaushik :

i am sorry if you got discouraged a bit , i am just placing facts.

Customer:

i understand sir

Dr. Kaushik :

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.

Dr. Kaushik :

i hope this makes sense to you.

Dr. Kaushik :

wish you all the best.

Customer:

thanks sir

Customer:

thanks a TON

Dr. Kaushik :

you're welcome.

Dr. Kaushik :

Take care.

Dr. Kaushik :

Warm regards.

Customer:

yup

Customer:

Warm 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
Expert:  Dr. Kaushik replied 11 months ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Customer: replied 11 months ago.

Dear Sir,


 


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).


 


kind regards



 

Expert:  Dr. Kaushik replied 11 months ago.

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.

 

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