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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2253
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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My daughter has been on citalipram for 20 yrs and following

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My daughter has been on citalipram for 20 yrs and following a brain tumour and removel - steroids sent her sky high and so she was put on olanzapine and mirtazipine to bring her down - she then hit rock bottom with depression and anxiety. The latter two drugs have made her life agitated with panic attacks and miserrably flat hence she wants to start weaning herself cutting olanzapine in half for a while and see how she goes. Any tips would be gratefully received she is also about to embark on emdr and also cognitive behaviour therapy - she longs to feel strong happy and able to make decisions without panic attacks and anxiety. I intendc to go and stay with her whilst she tries to come off these drugs.
Dr Vikas :

Hello

Dr Vikas :

Is it possible for you to mention the dose of medicines she is currently taking?

Dr Vikas :

was she diagnosed as suffering from Bipolar disorder after steroid treatment?

Customer:

Yes she was diagnosed as being bipolar after taking these drugs. She has suffered from depression in the past when her husband left her but she has not been diagnosed as bipolar before - I do not know the dose of these drugs as I am in a different place but could get them tonight and come back to you. Citalapram was for her first depression when her husband left and then the steroids - high dose to alleviate the pressure on the brain in order to operate and then olanzapine to bring her down and mirtazapine followed for panic attacks and anxiety which we feel could be from the olanzapine. I would like to know a safe way to help her off these drugs little by little - she is looking to have EMDR treatment and Cognitive behavior therapy in order to help to get back to herself - thank you !! She hasnt started these yet but just about to - i.e. taking responsibility to help her condition as medication seems to make things worse not better'

Customer:

There is no information at present and I have to go out now - I will log on when I come home this evening. Dr.Vikas has not posted anything yet but I expect he has gone to consider ca\refully - I await his response

Dr Vikas :

Thanks for you reply. For stopping Mirtazapine and Olanzapine a simple strategy could be to start tapering down by reducing 25 % or 50 % per week depending on the toleribility of patient. For example, if a patient is taking 30 mg of Mirtazapine, he or she can start tapering by decreasing the dose to 15 mg, take it for a week then again reduce the dose to 7.5 mg, take it for another week followed by discontinuation.

Dr Vikas :

Similarly for Olanzapine, assuming that a patient is taking 10 mg per day, he or she can reduce the dose to 5 mg, take it for a week, then again reduce the dose to 2.5 mg, take it for a week followed by discontinuation.

Dr Vikas :

Please note that, tapering rate varies from individual to individual and can be slower or faster depending on the toleribility of patients. In any case, if a patient start experiencing discontinuation symptoms while tapering or after stopping the medicine, the simple strategy to control these symptoms is to restart the previous tolerated dose and then start tapering more slowly.

Dr Vikas :

Please take her doctor consent before tapering down these medicines.

Dr Vikas :

Now regarding her anxiety and panic attack symptoms, a benzodiazepine like Clonazepam can be very helpful if she experience occasional anxiety other wise a SSRI antidepressant like Lexapro will be more useful if she has frequent anxiety attacks.

Customer:

Does a patient go cold turkey and do you stick with it - or is there the incliniation to immediately to reach for the tablet and is there aanything like rescue remedy or st johns wort that could help to calm things down. What do you think of her trying the two therapies she wishes to embark on for anxiety and depression - thank you. Is both together ok - one with one therapist and one with another!!

Dr Vikas :

No, abruptly stopping (cold turkey) any antidepressant or antipsychotic like Olanzapine is not recommended as it may lead to discontinuation / withdrawal symptoms.

Dr Vikas :

Unfortunately there is no rescue remedy to avoid discontinuation symptoms and the best option is to taper down slowly.

Dr Vikas :

Psychotherapy specially CBT can be helpful in her case in my view. I don't think that EMDR is of very much help but can be tried.

Customer:

Thank you but what I mean is if she gets a bit jittery do I just hold her and try to keep her calm to persevere or go straight back on to same dose or maybe half dose - and do you think the therapies will help

Dr Vikas :

For anxiety and panic attacks, a mouth dissolving preparation of Clonazepam in low dose can be very useful. It can control her anxiety symptoms very quickly as it bypass gastric metabolism.

Dr Vikas :

It is not very troublesome to taper down Olanzapine or Mirtazapine as noted clinically so you need not to worry much about it.

Dr Vikas :

CBT will definitely help

Customer:

Thank you for your help - are there any other tips - anything else I can do or she can do - are we on the right track to come off these drugs and is it reasonably easy to succeed.

Dr Vikas :

There are some relaxation techniques which she can try to control her anxiety and panic attacks.

Dr Vikas :

I am giving you a few links below.

Dr Vikas :

These techniques specially, progressive relaxation technique and deep breathing can be very helpful if she has not tried them yet.

Dr Vikas :

Psychotherapy can be useful in mild to moderate cases but a combination of medicines along with Psychotherapy can be more beneficial.

Customer:

Thank you - you have been very good and carefully encouraging - one llast thing: She has tried to take responsibility to get better by taking the initiative with a cbt therapist next friday and she is going back to another lady who recommended trying her speciality EMDR - does it matter if she tries them both - and not necessarilly disclosing one to the other!!!She is keen on CBT - I think intuitively but the other therapist thinks she has some ptsd and emdr would remove that - she is keen to do everything she can but does not want to miss out by szaying no to either one - and do they need to know about each other

Dr Vikas :

Well, it is a complicated situation. In my view, both of her therapist should know about this if she plans to try both the therapy.

Dr Vikas :

It is better to focus on single therapy at a time.

Dr Vikas :

are you there/

Dr Vikas :

I guess, you are not online right now.

Dr Vikas :

If you have any other doubt, please feel free to ask further.

Dr Vikas :

Otherwise, if you are satisfied with this answer please rate one of the positive ratings (3,4,5 / smiley faces) as this is the only way how we are compensated for our time and expertise.

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Kind regards

Vikas

Customer:

You have been fantastic - is there anyway I can get back to you in the future if I need to ask you anymore questions or is it just who is available on the day

Customer:

Is it possible to contaact you personally through this method in the future or can one only take pot luck on the day - you have beeen excellent and thank you - wENDY

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