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: 4020
Experience:  MD Psychiatry
9385906
Type Your Mental Health Question Here...
Dr. Kaushik is online now
A new question is answered every 9 seconds

Cipralex, Duloxetine, Anxiety

Resolved Question:

Good morning doctor, i'm a 29 years old man, that suffers of general anxiety disorder from 2006. I've been treated with cipralex, with increasing doses until we reached 20mg in 2010, and after three years of good health, with my psychiatrist, we decided to decrease the doses and suspend it. This happened in august 2013. During these three years i attended BCT. In september I had another crisis, so we decided to re-introduce cipralex. I was very bad for 5 weeks, during which i felt also depressed due to the situation. My doctor introduced duloxetine, 30mg and raised cipralex to 25mg. Starting from the 6th week of therapy things went better, until now: after three weeks of good shape, last tuesday i felt again anxiety, probably because (according to what my psychiatrist said) i was exposed to a situation stronger than i could face, because even if it's true that i was better, i was not completely restored, and this complete restorement needs more than three weeks. So, in conclusion, he raised cipralex again, to 30mg a day. What is your opinion? I know you can't know every detail of my history, but i'd like to know if is a good theory the one my doctor explained me about the fact that a complete restorement needs many time, and even if i felt very better in the last three weeks, on the "inside", my body and mind were still working to repair the damages of the anxiety attack of september. Thanks Sorry for my english, i'm italian. :)

Submitted: 9 months ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 9 months ago.
Greetings !

Welcome to the site.

I am Dr. Kaushik and i am a psychiatrist and i believe i can help you with your problem.

Well you see your doctor is right to some extent as far as his theory goes as full recovery from anxiety would require longer than 3 weeks more so when the stressful situation this time around was way more than ever before so his comment on you taking more time to overcome this anxiety completely is right however i have a problem with the choice of medications that he has been using for your condition because first of all cipralex has a maximum safe dose of 20 mg / day, any dose above this dose shall not provide any extra benefit plus it may lead to side effects owing to an overdose.

Secondly the use of duloxetine with cipralex is risky because their combination has the potential to precipitate a serious life threatening condition called as Serotonin syndrome due to excess of serotonin levels in the brain brought about by these two drugs when used together.

So to summarize i will say that,

-- Your doctor's theory about slight delay in recovery this time around is mostly correct and can be accepted.

-- However i will like you to discuss with him his strategy of using an overdose of cipralex and duloxetine as an addition which may lead to a serious condition like Serotonin syndrome. A much safer and effective drug to add to cipralex is Buspar ( buspirone) at dose of 10 mg twice a day or Klonopin ( clonazepam) at dose of 0.5 mg twice a day. Either of these drugs can be used as a replacement of duloxetine for augmenting and potentating the action of cipralex without the need to raise the dose of cipralex to 30 mg which is an overdose, so ask your doctor to choose any one of these drugs for use with cipralex which shall not be increased to a dose more than 20 mg/ day.

I hope this makes sense and gives you a sense of direction to move in.

Wish you all the best.

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

Regards.
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4020
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you
Customer: replied 9 months ago.

Thank you doctor, I really appreciate your answer.


 


Anyway i really trust my doctor, he knows me since 2006. I know (he explained me) that maximum safe dose of cipralex is 20, in fact i did an electrocardiogram to check Qtc time (I don't know if it's the same in english language, but i'm sure you understand what i mean) and it is all ok.


The raising to 25 and then 30 is temporary. My doctor also said that in the past he used doses up to 40 mg without any problem. His target is to return to 20mg that is a dose that kept me good for three years, before gradually suspending it, but he said that in case of suspension and a successive re-taking of a drug, sometimes it happens that you need higher doses because the body develop a sort of resistence to the drug.


 


I'm also aware of the Serotonine syndrome, but am I wrong thinking that in case it would have been happened soon after using the both of them together? Now it's quite a month and we did non have any problem.


 


Anyway his intention is to remove duloxetine as soon as possible (he gave me this drug because of a secondary depression situation caused by the re-happening of the anxious-panic state). We also tried venlafaxine before duloxetine, but it gave me disturbing side effects so we changed to that drug.


 


My concern were more on the first part of your answer, and i'm happy you agree in the statement that after six weeks of very bad feelings, three weeks of goodness are not enough to consider the situation closed, so a little step back is possible and i don't have to have too much fear of it.


 


By the way, if the situation does not solve, when i'll see again my doctor i'll ask him about these other two drugs you suggested.


 


Thank you again


 

Customer: replied 9 months ago.
Relist: Other.
I'd like another consult

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