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Suggest Treatment For Depression And Acute Anxiety
Question: I am XXXXXXX XXXXXXX a 30 Years Male.
Heard a lot about you, wanted to meet in person but since I am in XXXXXXX and also I want a second opinion from you, I am writing to you through this online medium.
Please try to treat this in person consultation and provide your precious time to study my problem in detail as I am suffering very bad and dying a slow death due to my issues.
I have attached all Doctors Prescriptions from sept 2013 till last visited – 23/12/14 as psychiatry.pdf file in my profile
From Sept 2013 to Sept 2014 – Dr. XXXXXXX Bannerjee (EX NIMHANS) after that Dr. XXXXXXX XXXXXXX Ganjoo.
I am taking anti depressants since past 8-9 Years may be more for depression.
First went to a psychiatrist in my home town (on my own)– Hissar while I was in college for OCD symptoms (Now when I think of it , I feel that was my biggest mistake since I think I did not needed the medication then and things cud have been corrected by counselling alone ).These medicines became like a joo which sucks all of your blood till you die . I could not quit because no doctor ever advised so and due to my lazy attitude sometimes of not regularly visiting a doctor. This is a part of old story which has little importance now but I wanted to mention here so you have all the details.
Now coming to my current problem - Since July 2013, I am suffering from acute anxiety. The past Year has been very struggling. I was in consultation with Dr XXXXXXX Bannerjee(an expert psychiatrist) and we tried most of the available medicines in conventional medicine or alopathy(you will see this in the attached file, except TRIMA that is a MAOI because that was not available in market ).Some of the medicines we tried were - Duzela,serta,bupron,tryptomer,pexep cr .And i have even changed the doctor since even after consulting for an year i had no positive effect and even the doctor was tired of changing medicines.When i changed doctor, the initial medicine the second doctor gave - stablon and serenace had a very positive effect and i was very happy that finally something was working on me.But then that also started to fade away within few days and also there was side effect of constant whole day sleep effect .but then when he switched to the main medicine - Duzella - 20 mg which the first Doc - Dr XXXXXXX had already tried but this doctor said that i should trust him and it would work.When Stablon and serenace were removed completely and duzella was 20 I did not feel any good or improved but there was no physical side effect also but then after 2 weeks, he put me on Duzela 40 mg – this had major physical discomfort like strange pain in chest and body discomfort overall also the anxiety was rather increased.When I complained this to the Dr, he switched back to the comfortable dose of stablon ,serenace and duzela 20 mg.After my visit , he counseled me and got me convinced that duzela is a very good drug and I should trust him on this and continue for another 2-3 weeks which I am doing now.
Currently :
I do not feel good,My thinking is confused,have anxiety ,no happy feelings,strained head .My stomach is not in good condition.I have problems going for passing stool in the morning , the intestine is literally squeezed and tightened also because of this the motion is not satisfying.My head is strained most of the times.My back is so stiff always.All these symptoms do not occur when some medicine suits me and as far as I can remember there have been only two combinations so far :
Stablon,Serenace but then they caused a lot of sleep which disturbs my work, and rexipra 20 .But eventually to any medicine my body becomes so adjusted after a certain period of time that the positive effect starts to fade away.
It has been so many doctors now that I am seriously tired and my internal motivation of doing anything in life has almost died.My sole aim is to get rid of all medicines and be a happy person.
It’s hard to write everything in here but have tried my best to cover major aspects and also the attached prescriptions from past 1 year should give you some insight into my history.
I haven’t mentioned about my personal life because that would be another chapter in itself and I am not comfortable writing so much in very detail .only if it would have been in person this was easy.
But in Short, I am generally dissatisfied with my marriage because I think that was a wrong decision but now things are not bad at all and my views have changed a lot. Also my mother is living with us since Aug 2013 and things got disturbed again but then again they are settling down slowly and now to a comfortable stage.
So that was all I could write for now, please let me know if you feel that you would not be able to do justice to me through online and meeting you in person is the only solution or if that’s not the case a solution to my miseries .
Heard a lot about you, wanted to meet in person but since I am in XXXXXXX and also I want a second opinion from you, I am writing to you through this online medium.
Please try to treat this in person consultation and provide your precious time to study my problem in detail as I am suffering very bad and dying a slow death due to my issues.
I have attached all Doctors Prescriptions from sept 2013 till last visited – 23/12/14 as psychiatry.pdf file in my profile
From Sept 2013 to Sept 2014 – Dr. XXXXXXX Bannerjee (EX NIMHANS) after that Dr. XXXXXXX XXXXXXX Ganjoo.
I am taking anti depressants since past 8-9 Years may be more for depression.
First went to a psychiatrist in my home town (on my own)– Hissar while I was in college for OCD symptoms (Now when I think of it , I feel that was my biggest mistake since I think I did not needed the medication then and things cud have been corrected by counselling alone ).These medicines became like a joo which sucks all of your blood till you die . I could not quit because no doctor ever advised so and due to my lazy attitude sometimes of not regularly visiting a doctor. This is a part of old story which has little importance now but I wanted to mention here so you have all the details.
Now coming to my current problem - Since July 2013, I am suffering from acute anxiety. The past Year has been very struggling. I was in consultation with Dr XXXXXXX Bannerjee(an expert psychiatrist) and we tried most of the available medicines in conventional medicine or alopathy(you will see this in the attached file, except TRIMA that is a MAOI because that was not available in market ).Some of the medicines we tried were - Duzela,serta,bupron,tryptomer,pexep cr .And i have even changed the doctor since even after consulting for an year i had no positive effect and even the doctor was tired of changing medicines.When i changed doctor, the initial medicine the second doctor gave - stablon and serenace had a very positive effect and i was very happy that finally something was working on me.But then that also started to fade away within few days and also there was side effect of constant whole day sleep effect .but then when he switched to the main medicine - Duzella - 20 mg which the first Doc - Dr XXXXXXX had already tried but this doctor said that i should trust him and it would work.When Stablon and serenace were removed completely and duzella was 20 I did not feel any good or improved but there was no physical side effect also but then after 2 weeks, he put me on Duzela 40 mg – this had major physical discomfort like strange pain in chest and body discomfort overall also the anxiety was rather increased.When I complained this to the Dr, he switched back to the comfortable dose of stablon ,serenace and duzela 20 mg.After my visit , he counseled me and got me convinced that duzela is a very good drug and I should trust him on this and continue for another 2-3 weeks which I am doing now.
Currently :
I do not feel good,My thinking is confused,have anxiety ,no happy feelings,strained head .My stomach is not in good condition.I have problems going for passing stool in the morning , the intestine is literally squeezed and tightened also because of this the motion is not satisfying.My head is strained most of the times.My back is so stiff always.All these symptoms do not occur when some medicine suits me and as far as I can remember there have been only two combinations so far :
Stablon,Serenace but then they caused a lot of sleep which disturbs my work, and rexipra 20 .But eventually to any medicine my body becomes so adjusted after a certain period of time that the positive effect starts to fade away.
It has been so many doctors now that I am seriously tired and my internal motivation of doing anything in life has almost died.My sole aim is to get rid of all medicines and be a happy person.
It’s hard to write everything in here but have tried my best to cover major aspects and also the attached prescriptions from past 1 year should give you some insight into my history.
I haven’t mentioned about my personal life because that would be another chapter in itself and I am not comfortable writing so much in very detail .only if it would have been in person this was easy.
But in Short, I am generally dissatisfied with my marriage because I think that was a wrong decision but now things are not bad at all and my views have changed a lot. Also my mother is living with us since Aug 2013 and things got disturbed again but then again they are settling down slowly and now to a comfortable stage.
So that was all I could write for now, please let me know if you feel that you would not be able to do justice to me through online and meeting you in person is the only solution or if that’s not the case a solution to my miseries .
Brief Answer:
Duloxetine is probably not helping you
Detailed Answer:
Hello,
Thanks for choosing health care magic for posting your query.
I have gone through your question in detail and I can understand what you are going through.
I understand that you have already tried plenty of antidepressants for your depression and anxiety. From the side of your psychiatrist it true that many drugs may not act initially but then after a trial of two or more drugs, the first drug can again be tried and sometimes the first drug starts working. Only on this principle, your psychiatrist has probably tried duloxetine again. However if this is not helping you second time as well, then it would be wise to stop it again.
I have gone through your prescriptions and a lot many medicines have been tried on you. But resistant cases of mixed anxiety depression do require plenty of permutation and combinations. Following are my suggestions:
1) Always consider cognitive behavioural therapy along with the medical therapy as the case is resistant.
2) Clomipramine ( a TCA and a good antiobsessinal and anti anxiety med) has not been tried on you and I would suggest that this can work for you. This can be started at 25 mg and then can gradually be built up.
3) Ketamine injection therapy, a new therapy for depression and anxiety is showing good response among the resistant cases. I have personally tried it on 7 of my patients and they have showed good response. If nothing is working, this can be also given a try.
4) Rather than working on only antidepressants, augmentation with antipsychotics like olanzapine or quetiapine can also help in the treatment plan. Addition of haloperidol has helped you, likewise olanzapine and quetiapine can also help you.
These are the suggestions that are coming to my mind. Please discuss these options with your treating psychiatrist.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy
Wish you good health,
Kind regards
Dr. Srikanth Reddy M.D.
Duloxetine is probably not helping you
Detailed Answer:
Hello,
Thanks for choosing health care magic for posting your query.
I have gone through your question in detail and I can understand what you are going through.
I understand that you have already tried plenty of antidepressants for your depression and anxiety. From the side of your psychiatrist it true that many drugs may not act initially but then after a trial of two or more drugs, the first drug can again be tried and sometimes the first drug starts working. Only on this principle, your psychiatrist has probably tried duloxetine again. However if this is not helping you second time as well, then it would be wise to stop it again.
I have gone through your prescriptions and a lot many medicines have been tried on you. But resistant cases of mixed anxiety depression do require plenty of permutation and combinations. Following are my suggestions:
1) Always consider cognitive behavioural therapy along with the medical therapy as the case is resistant.
2) Clomipramine ( a TCA and a good antiobsessinal and anti anxiety med) has not been tried on you and I would suggest that this can work for you. This can be started at 25 mg and then can gradually be built up.
3) Ketamine injection therapy, a new therapy for depression and anxiety is showing good response among the resistant cases. I have personally tried it on 7 of my patients and they have showed good response. If nothing is working, this can be also given a try.
4) Rather than working on only antidepressants, augmentation with antipsychotics like olanzapine or quetiapine can also help in the treatment plan. Addition of haloperidol has helped you, likewise olanzapine and quetiapine can also help you.
These are the suggestions that are coming to my mind. Please discuss these options with your treating psychiatrist.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy
Wish you good health,
Kind regards
Dr. Srikanth Reddy M.D.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the answer,
I am experiencing extreme sleep effect during the day since i am on Duzela.
Discussed this earlier with my Psychiatrist and he suspected this to be a haloperidol effect.Now that i am only on Duzela-20,still the sleep effect is killing my work.as soon as i sit against my laptop and stare the screen, i get this uncontrollable dizziness. What do you think , can this be due to Duzela? i mean i am not using any other related drug. Also please suggest a withrawal plan .
I am experiencing extreme sleep effect during the day since i am on Duzela.
Discussed this earlier with my Psychiatrist and he suspected this to be a haloperidol effect.Now that i am only on Duzela-20,still the sleep effect is killing my work.as soon as i sit against my laptop and stare the screen, i get this uncontrollable dizziness. What do you think , can this be due to Duzela? i mean i am not using any other related drug. Also please suggest a withrawal plan .
Brief Answer:
Its duzela
Detailed Answer:
Hello
Seranace (haloperidol) is a non sedating antipsychotic. It will never cause sedation. Its duzella which is causing sedation. Twenty mg is the least dose of duloxetine available in the market. It would be wise to take half tablet per day for 30 days and then take half tablet alternate day for next 30 days and then stop the medicine.
This way it will not cause any withdrawal side-effect.
Keep your treating psychiatrist informed about the medicine changes.
Kind regards
Dr. Srikanth Reddy MD
Its duzela
Detailed Answer:
Hello
Seranace (haloperidol) is a non sedating antipsychotic. It will never cause sedation. Its duzella which is causing sedation. Twenty mg is the least dose of duloxetine available in the market. It would be wise to take half tablet per day for 30 days and then take half tablet alternate day for next 30 days and then stop the medicine.
This way it will not cause any withdrawal side-effect.
Keep your treating psychiatrist informed about the medicine changes.
Kind regards
Dr. Srikanth Reddy MD
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi , since duzela is a capsule , i cant make it half .can you suggest a way to taper in that case !
Brief Answer:
Not possible in some countries
Detailed Answer:
Hello
IN some countries duzella is available as tablets and then it is possible. But as the medicine that you are taking is a capsule, the better way would be to take it on alternate day for next 10 days and then to stop it.
Do keep your doctor informed about all the changes that you are making in your treatment.
Kind regards
Dr. Srikanth Reddy
Not possible in some countries
Detailed Answer:
Hello
IN some countries duzella is available as tablets and then it is possible. But as the medicine that you are taking is a capsule, the better way would be to take it on alternate day for next 10 days and then to stop it.
Do keep your doctor informed about all the changes that you are making in your treatment.
Kind regards
Dr. Srikanth Reddy
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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