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Suggest Appropriate Treatment For Depression
Question: I asked my previous question about my 23 year old on 3 anti-depressant medicines for his depression. I was concerned about it and just found out the doses he is on and would like more feedback. I have told him he needs to get evaluated but he still hasn't done it. He is on 75 mg venlafexine 1x day, 150 mg welbutrin XL 3x daily and lexipro 10 mg 1x daily. Please advise.
Brief Answer:
Please see details below.
Detailed Answer:
Hi,
I do appreciate your concern for your son. And I would say you are extremely right in being concerned about the medications that he is on.
You have mentioned that he is suffering from OCD and depression. I would have liked to know the exact symptoms that he is suffering from and since when is he having the symptoms.
He is on three anti-depressants which doesn't make sense. Combination of anti-depressants are prescribed only when initial single drug therapy doesn't work. He is on three o them and none of them at its maximum dose.
Had I been your son's psychiatrist, I would have advised to start with a single antidepressant. In your son's case, since he is supposed to have depression with OCD, the first choice drug would be a selective serotonin reuptake inhibitor (SSRI). He is on lexapro (escitalopram) 10 mg per day which is an SSRI. So, I would have considered increase in escitalopram initially to 20 mg /day and wait for few weeks for its response. If he responds, the same dose will have to be continued. Otherwise, another drug like sertraline or fluvoxamine can be considered, after tapering and stopping escitalopram.
The other two drugs and be tapered and stopped as it is not worth considering poly-pharmacy at this stage. Regarding venlafaxine, it is an effective anti-depressant, however, not very effective for OCD. Bupropion (wellbutrin) is also an anti-depressant but not used for OCD. They can be tapered and stopped.
I would suggest that you advise your son to meet a psychiatrist soon and get changes in his medications.
I do hope that you found the information helpful. Please feel free to ask any further query that you might have.
Best wishes,
Dr. Sunil Gupta
Please see details below.
Detailed Answer:
Hi,
I do appreciate your concern for your son. And I would say you are extremely right in being concerned about the medications that he is on.
You have mentioned that he is suffering from OCD and depression. I would have liked to know the exact symptoms that he is suffering from and since when is he having the symptoms.
He is on three anti-depressants which doesn't make sense. Combination of anti-depressants are prescribed only when initial single drug therapy doesn't work. He is on three o them and none of them at its maximum dose.
Had I been your son's psychiatrist, I would have advised to start with a single antidepressant. In your son's case, since he is supposed to have depression with OCD, the first choice drug would be a selective serotonin reuptake inhibitor (SSRI). He is on lexapro (escitalopram) 10 mg per day which is an SSRI. So, I would have considered increase in escitalopram initially to 20 mg /day and wait for few weeks for its response. If he responds, the same dose will have to be continued. Otherwise, another drug like sertraline or fluvoxamine can be considered, after tapering and stopping escitalopram.
The other two drugs and be tapered and stopped as it is not worth considering poly-pharmacy at this stage. Regarding venlafaxine, it is an effective anti-depressant, however, not very effective for OCD. Bupropion (wellbutrin) is also an anti-depressant but not used for OCD. They can be tapered and stopped.
I would suggest that you advise your son to meet a psychiatrist soon and get changes in his medications.
I do hope that you found the information helpful. Please feel free to ask any further query that you might have.
Best wishes,
Dr. Sunil Gupta
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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