Good Afternoon Doctor - I Changed Quitipin 100 To Quitipin

Posted on Sun, 17 Feb 2019

Question: Good afternoon doctor - I changed quitipin 100 to quitipin sr 50 + qitipin plain 100 on 19th XXXXXXX nìght and then to quitipin sr 100 and quitipin plain 50 on 21st XXXXXXX night. My sleep is still the same. I wake up every two hours still. But I must say that anxiety is much better (very little anticipatory anxiety is still there). I am thinking of making quitipin sr 150 tonight. In XXXXXXX you dont get 150 sr, wondering if it is available in XXXXXXX (or any other part of northern India)?.
I have following questions:
- is improvement in anxiety because of reduced mirtaz (from 37.5 to 30) or changing quitipin to quitipin sr ?
-you had told me to reduce mirtaz futher from today (thinking of making it 15+7.5+1/2 of 7.5 (doing it gradually as i am sensitive to even changes changes), should i reduce mirtaz and switch to quitipin 150 sr, both changes tonight or i was thinking of changing quitipin from (from 100sr+50plain) to 150 sr and wait for two days to see how i feel and then reduce mirtaz, if required?
also little worried that reducing mirtaz may increase my anxiety?
Also, is there any contact number of yours that i can have to consult you directly after fixing up the timing? pls advise

Follow up: Dr. Seikhoo Bishnoi (0 minute later)

Good afternoon doctor - I changed quitipin 100 to quitipin sr 50 + qitipin plain 100 on 19th XXXXXXX nìght and then to quitipin sr 100 and quitipin plain 50 on 21st XXXXXXX night. My sleep is still the same. I wake up every two hours still. But I must say that anxiety is much better (very little anticipatory anxiety is still there). I am thinking of making quitipin sr 150 tonight. In XXXXXXX you dont get 150 sr, wondering if it is available in XXXXXXX (or any other part of northern India)?.
I have following questions:
- is improvement in anxiety because of reduced mirtaz (from 37.5 to 30) or changing quitipin to quitipin sr ?
-you had told me to reduce mirtaz futher from today (thinking of making it 15+7.5+1/2 of 7.5 (doing it gradually as i am sensitive to even changes changes), should i reduce mirtaz and switch to quitipin 150 sr, both changes tonight or i was thinking of changing quitipin from (from 100sr+50plain) to 150 sr and wait for two days to see how i feel and then reduce mirtaz, if required?
also little worried that reducing mirtaz may increase my anxiety?
Also, is there any contact number of yours that i can have to consult you directly after fixing up the timing? pls advise

Answered by Dr. Seikhoo Bishnoi (31 minutes later)

Brief Answer:
You can make changes form today only.

Detailed Answer:
Hello again

If you are not getting 150 SR then you can take 100 and 50 SR tablets. These are easy to found.

You can reduce the Mirtazapine from today only and also make 150 SR of Quetiapine. No need to get worried. This would not cause any issues.

Reduction in Mirtazapine and also to some extent Quetiapine both are resulting in relatively better sleep quality and this is the probable reason you are feeling better.

Just stop anticipating. Don’t think that you will not get good sleep. Just take your medicines and remain relaxed. Everything will be alright.

Reducing Mirtazapine will not result in relapse of anxiety.

Due to HCM policies I can’t provide the number. Please excuse me for this.
Thanks

Above answer was peer-reviewed by : Dr. Kampana

Answered by Dr. Seikhoo Bishnoi (0 minute later)

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Seikhoo Bishnoi (30 hours later)

My email is: YYYY@YYYY , wondering if we can connect through email. Thank you

Follow up: Dr. Seikhoo Bishnoi (0 minute later)

My email is: YYYY@YYYY , wondering if we can connect through email. Thank you

Answered by Dr. Seikhoo Bishnoi (11 hours later)

Brief Answer:
You can contact me in emergency

Detailed Answer:
Hello again

Yes you can contact me in emergency.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Answered by Dr. Seikhoo Bishnoi (0 minute later)

Brief Answer:
You can contact me in emergency

Detailed Answer:
Hello again

Yes you can contact me in emergency.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (6 hours later)

Thank you doctor. I made quitipin 150 sr night before last night from 100sr +50 plain. And other medicines are mirtaz 30, amitryn 310 in the night and duolextine 60 and betacap tr 20 in the morning. You have asked me to start reducing mirtaz from 30 to 15 + 7.5 +1/2 of 7.5, am feeling more or less ok, wondering if I should reduce mirtaz from tonight.

Follow up: Dr. Seikhoo Bishnoi (0 minute later)

Answered by Dr. Seikhoo Bishnoi (6 hours later)

Brief Answer:
Reduce the dose gradually

Detailed Answer:
Hello again

Yes you should reduce the dose of Mirtazapine but please wait for a couple of days and then reduce its doses again. This will result in smooth tapering.

Thanks

Above answer was peer-reviewed by : Dr. Raju A.T

Answered by Dr. Seikhoo Bishnoi (0 minute later)

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Seikhoo Bishnoi (2 hours later)

Thank you doctor. What I wanted to check with you was : do I need to reduce mirtaz below 30 mg at all if I am more or less ok. Pls advise

Follow up: Dr. Seikhoo Bishnoi (0 minute later)

Thank you doctor. What I wanted to check with you was : do I need to reduce mirtaz below 30 mg at all if I am more or less ok. Pls advise

Answered by Dr. Seikhoo Bishnoi (14 hours later)

Brief Answer:
Yes you should reduce.

Detailed Answer:
Hello again

It’s better if you reduce the dose. This will make sleep better and one dose of drug will decrease. You can give this a try.

Thanks

Above answer was peer-reviewed by : Dr. Kampana

Answered by Dr. Seikhoo Bishnoi (0 minute later)

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Seikhoo Bishnoi (2 days later)

Good evening doctor - on your advise I reduced mirtaz from 30 to 15+7.5 +1/2 of 7.5 on Friday night, keeping other medicines same i.e. quitipin 150 sr, amitryn 310 in the night and betacap tr 20 and duolextine 60 in the morning. I have observed the following :

My anticipatory anxiety is better. I had a meeting in the morning, did not anticipate much about it but was getting physical symptoms i.e. losing control on words as well as difficulty in pronouncing long words. I woke up in between but in the morning today was feeling refreshed. I must say, it was one of the better mornings I have had in the past. I am confused, as on one hand am better as far as anticipatory anxiety is corned but getting these physical symptoms on the other hand.

Wondering what is causing it!

Pls advise.

Follow up: Dr. Seikhoo Bishnoi (0 minute later)

Answered by Dr. Seikhoo Bishnoi (4 hours later)

Brief Answer:
Try to ignore these symptoms.

Detailed Answer:
Hello again

Please try to ignore these symptoms. You are just becoming aware of body changes. Slight body symptoms are normally seen and there is no need to get worried for that. Try to bring the dose to 15+7.5 as soon as you can. In coming days you will be relaxed and the physical symptoms will remit.

If needed you can use Betacap and/or Etizolam on sos basis.

Thanks

Above answer was peer-reviewed by : Dr. Prasad

Answered by Dr. Seikhoo Bishnoi (0 minute later)

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Seikhoo Bishnoi (27 minutes later)

Am already taking betacap 20 in the morning. Also doctor - while picking up my tea cup in the meeting, I felt as if my hands would shake and was using both the hands to pick up the cup. They did not shake but the thought of them shaking was troubling me. It has happened earlier also but the intensity was more today. Since I have had an anxiety attack with my boss and my boss earlier has seen my hands shaking, may be his presence was making me more conscious. Do you think reducing mirtaz is helping me with anticipatory anxiety and reducing it further would help me better with the physical symptoms? Pls advise..

Follow up: Dr. Seikhoo Bishnoi (0 minute later)

Answered by Dr. Seikhoo Bishnoi (29 minutes later)

Brief Answer:
Just reassure yourself and try to remain relaxed.

Detailed Answer:
Hello again

You are in good position, perform well in your job, do you really think anxiety has harmed you? Anticipation that you might develop anxiety is bothering you. You should realise and also reassure yourself that this is an illness and you have to overcome this.

Just ask yourself, even if your boss see that your hands are shaking even then what will happen? You might be having anxiety attack and this is normal. Even research says that anxious people perform well in their professional life.

So stop thinking about this. Yes reducing the Mirtaz doses will definitely make your functioning better. Just stop anticipating. Try to remain normal, even if people come to know about your anxiety even then that is ok. The physical symptoms will decrease progressively. No need to get worried.

Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Answered by Dr. Seikhoo Bishnoi (0 minute later)

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Above answer was peer-reviewed by : Dr. Prasad