Mental Health

Have Mental Health Questions? Ask a Psychiatrist Online

Ask an Expert,
Get an Answer ASAP!

Mental Health
This answer was rated:

My partner is a 56 year old male who was admitted to

Hospital for 9 weeks, 11...
My partner is a 56 year old male who was admitted to Hospital for 9 weeks, 11 weeks ago, with severe depression/heightened anxiety/ and suicidal ideation. He was prescribed Sertraline which was gradually increased to 300mgs/mane. After 6 weeks, he was prescribed Seroquel - 25mgs/nocte - in addition to the Sertraline, to address his still-heightened anxiety. Almost immediately after he started taking the Sertraline, he developed symptoms of severe diarrhoea. He was kept on the same medication routine ie gradual increase of Sertraline, in the hope that the symptoms of the diarrhoea would settle. He has now been experiencing debilitating diarrhoea for at least 9 weeks. He has had the usual medical tests to exclude any medical reason for this, and his Sertraline has been reduced to 200mgs to see if this would lessen the diarrhoea. The diarrhoea remains constant. I am a Mental Health Social Worker myself, so am familiar with the usual treatments for anxiety/depression. I am also aware that diarrhoea can be a side-effect with some of the SSRI medications. I noticed on this web-site that a combination of a lower dose of Sertraline combined with Mirtazapine (Avanza) had been recommended in a similar situation with the explanation that the Mirtazapine would augment the effects of the Sertraline as well as counteracting the side-effects of the Sertraline (in this case - diarrhoea). Apart from the diarrhoea, my partner is not experiencing any other commonly documented side-effects of the Sertraline such as insomnia or sexual side-effects. He is, however, feeling chronically "unwell" with the diarrhoea. Could you please comment on the efficacy of combining Sertraline with Mirtazapine in this situation.
Show More
Show Less
Ask Your Own Mental Health Question
Answered in 3 hours by:
5/2/2013
DrRussMd
DrRussMd, Doctor
Category: Mental Health
Satisfied Customers: 65,665
Experience: MD, BA psychology, Emphasis on addictions, depression, anxiety, ADHD, etc.
Verified
Hello from JA
It is possible to do this but not optimal.
Treating a side effect with a third drug opens the way to more drug interactions and side effects.

Ideally the sertreline, which is not an SSRI but an anti psychotic, would be changed.

OK. If you have further questions or details, use reply to expert.

Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.

Ask Your Own Mental Health Question
Customer reply replied 4 years ago

Hello, I assume you meant to say that it is the seroquel which is the anti-psychotic and which would be changed. I probably had not made it clear in my question, but I had assumed that the seroquel would be stopped, and replaced by the avanza (mirtazapine) ie having a combination of 2 anti-depressants, (sertraline and mirtazapine), rather than an anti-depressant and an anti-psychotic. I was not considering the introduction of a third medication. I was wanting your comment on the efficacy of this (new combination) as a means of managing and quelling the diarrhoea (as seemingly had been suggested some time ago on this site to another similar question). I await your reply. Thank you.

You are correct.
Sertraline and mirtazapine.
It is still not optimal, and it is still trying to treat a side effect of one with the other.
In fact, the idea is somewhat erroneous in general as mirtazapine causes constipation in 13% of patients, so trying to exploit this will not necessarily work. In fact, it cause diarrhea in 9% of patients, so I find the whole plan erroneous.
Moreover, the combination has a rare risk of causing seritonin syndrome which is life threatening.
I would rather switch the sertraline, one way or another.
Rely on a single agent if possible, and there are many many choices.
This needs to be handled based on his exam, and a good psychiatrist should be able to tailor one or 2 meds to him, or add a different med tot he seroquel.
OK. If you have further questions or details, use reply to expert.
Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.
Ask Your Own Mental Health Question
Customer reply replied 4 years ago

Thank you for this very detailed response. My concern is that there are not many anti-depressants that do not have diarrhoea as a possible side-effect. If there is one that in your experience, works well with patients with a particular sensitivity to diarrhoea, I would appreciate to know which med that is. Thank you again for your thoughtful response. I will be giving you a high rating.

In fact it is unpredictable, as this has to be tailored and individual reactions are often not what is expected.

Lexapro, an SNRI, has about half the diarrhea effect of sertraline, as one example.
Celexa an SSRI, has about 1 or 2% less.
Viibryd, very new, supposedly less...

So it is somewhat an educated guess at this point.

OK. If you have further questions or details, use reply to expert.

Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.

DrRussMd
DrRussMd, Doctor
Category: Mental Health
Satisfied Customers: 65,665
Experience: MD, BA psychology, Emphasis on addictions, depression, anxiety, ADHD, etc.
Verified
DrRussMd and 87 other Mental Health Specialists are ready to help you
Ask your own question now
Ask DrRussMd Your Own Question
DrRussMd
DrRussMd
DrRussMd, Doctor
Category: Mental Health
Satisfied Customers: 65,665
65,665 Satisfied Customers
Experience: MD, BA psychology, Emphasis on addictions, depression, anxiety, ADHD, etc.

DrRussMd is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

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 MollPretoria, 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!

ClaudiaAlbuquerque, NM

Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion.

KevinBeaverton, 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.

ElanorTracy, 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.

JulieLockesburg, 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 StefanieTucson, 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 VPhoenix, AZ

< Previous | Next >

Meet the Experts:

Dr. Keane

Dr. Keane

Therapist

1,379 satisfied customers

Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.

TherapistMarryAnn

TherapistMarryAnn

Therapist

4,021 satisfied customers

Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.

Dr. Olsen

Dr. Olsen

Psychologist

2,336 satisfied customers

PsyD Psychologist

Norman M.

Norman M.

Principal psychotherapist in private practice. Newspaper contributor, over 2000 satisfied clients on JA

2,246 satisfied customers

ADHP(NC), DEHP(NC), ECP, UKCP Registered.

Dr. Michael

Dr. Michael

Psychologist

2,177 satisfied customers

Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.

Steven Olsen

Steven Olsen

Therapist

1,728 satisfied customers

More than twenty years of expertise in counseling, psychological diagnosis and education

Anna

Anna

Mental Health Professional

1,656 satisfied customers

Licensed Clinical Social Worker with 29 years in addictions and mental health.

< Previous | Next >

Related Mental Health Questions
I suffer from anxiety, and have been taking Ativan 0.5mg,
I suffer from anxiety, and have been taking Ativan 0.5mg, one a day for 23 years. Recently my doctor told me, (because of some anxiety issues) I could take up to three of my 0.5mg Ativan. Is there a p… read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
768 satisfied customers
Severe anxiety, by- polar manic depress. 6 years, being in
severe anxiety, by- polar manic depress. JA: How long have you been dealing with this? Is there anything in particular that seems to make the symptoms better or worse? Customer: 6 years, being in the … read more
Dr. Kaushik
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
204 satisfied customers
I have daily anxiety and daily erratic irritability. Which
Hello i have daily anxiety and daily erratic irritability. Which daily supplements/vitamins can help decrease these symptoms? I am just looking for a vitamin to add to my diet that can help with these… read more
Linda D.
Linda D.
Master\u0027s Degree
794 satisfied customers
Just having really bad insomnia feel like I'm never getting
Just having really bad insomnia feel like I'm never getting sleep no energy, hallucinations and delusions since I was a teenager, and recently been biting my tongue non stop … read more
Dr. Kaushik
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
204 satisfied customers
I have anxiety and recently think it is playing tricks with
Second opinion] Hi. I have anxiety and recently think it is playing tricks with my eyes. Is this possible? Sometimes feel things are moving when there not etc. Thank you… read more
Dr. Kaushik
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
204 satisfied customers
I have anxiety and recently think it is playing tricks with
Hi. I have anxiety and recently think it is playing tricks with my eyes. Is this possible? Sometimes feel things are moving when there not etc. Thank you… read more
Dr. Phil, MD
Dr. Phil, MD
Internal Medicine Physician
Doctoral Degree
2,677 satisfied customers
I've been taking Prozac and Buspar for some anxiety and
I've been taking Prozac and Buspar for some anxiety and depression. My therapist just added Abilify to help with some lingering depression. At first she was going to add Wellbutrin but decided on Abil… read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
768 satisfied customers
I have issues with anxiety. I meet with a behavioral
I have issues with anxiety. I meet with a behavioral therapist and have practices to help with my anxiety, but I'm feeling super anxious with some current ongoing stress that may continue for the next… read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
768 satisfied customers
Is this a paid service? History of depression and anxiety.
Past 8 months. Relationship problems make it worse.… read more
Therapist Leslie
Therapist Leslie
Masters, Professional Psychology
5 satisfied customers
I suffer from social anxiety, insomnia, panic attacks, and
Hi, My name is***** suffer from social anxiety, insomnia, panic attacks, and ocd. I had a doctor for a while, when i had health insurance. I lost my insurance, and she changed practices and can't see … read more
JohnMichaels,MS,LPC
JohnMichaels,MS,LPC
Counselor
Master\u0027s Degree
170 satisfied customers
I have generalized anxiety disorder with panic attacks at
I have generalized anxiety disorder with panic attacks at times. For the most part I have improved a great deal through BCT and other lifestyle changes. I had it terrible after I quit smoking for abou… read more
Linda D.
Linda D.
Master\u0027s Degree
794 satisfied customers
OKMH1212211 I have an extreme medically diagnosed anxiety
OKMH1212211 Hello. I have an extreme medically diagnosed anxiety disorder. Recently, it's been getting worse. Everything makes me anxious and I have panic attacks regularly. I am allergic to all SSRIs… read more
Dr. Ravoof
Dr. Ravoof
Doctoral Degree
1,923 satisfied customers
Im stopping 25mg zyprexa used for insomnia and dr prescribed
Im stopping 25mg zyprexa used for insomnia and dr prescribed me restoril and cogentin as a replacement will i have any withdrawls … read more
Dr. Scott
Dr. Scott
Doctor
1,028 satisfied customers
I've had anxiety due to trauma... I've had anxiety due to
Hello, I've had anxiety due to trauma... Hello, I've had anxiety due to trauma in the city I lived in, I moved out to a different city, I accidentally spoke to somebody associated with the trauma , in… read more
Vakul Aren
Vakul Aren
Consultant Physician
Post graduation (Liverpool, U.K.)
3,983 satisfied customers
I'm experience what I believe to be adjustment anxiety. I've
I'm experience what I believe to be adjustment anxiety. I've moved a long distance for the first time in 40 years. I have to telecommute for my job but only a few days a month. I have one daughter who… read more
LeahMSWuofm
LeahMSWuofm
Clinical Social Worker
Master\u0027s Degree
768 satisfied customers
I have anxiety issues as well as insomnia and I no longer
I have anxiety issues as well as insomnia and I no longer have a PCP and am looking for a good dr … read more
Dr. Mo
Dr. Mo
Board Certified Physician
MD
1,777 satisfied customers
I I have extreme anxiety especially social anxiety I over
I I have extreme anxiety especially social anxiety I over worry about everything and I have PTSD from being stabbed and assaulted I've been prescribed Xanax for years and I got up to 2 mg which was wo… read more
Vakul Aren
Vakul Aren
Consultant Physician
Post graduation (Liverpool, U.K.)
3,983 satisfied customers
I was dx with add, ocd tendencies and anxiety 10 years ago.
I was dx with add, ocd tendencies and anxiety 10 years ago. I stopped the adderal.meds bc if the crash they caused. I hear there is a time release that works good but in a new state and need doc tnst … read more
llw26
llw26
Private Practice
Doctoral Degree
11 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x