Question: My wife has hx of anxiety from learning disability and lack of coping skills from abusive childhood. After a hospital stay in 2008 and 2004 which she was in for a severe panic frozen in fear episode. the hospitalization in 2008 and 2004 made her condition so considerably worse. she stayed in bed in 2009 for 3 months and would not leave the house and in addition they send her home medicated with 8 different psch drugs totaling over 1500mg, which included her seroquel,cymbalta,valium in addition to remeron,abilify,lexapor,ambien, halol. this is insane. They of course diagnosed her with every disease in the book. I was told that by a psychiatr that each hospitalization regresses her and is not good. It is now 2014, after a kind doctor got her of most of the stuff in 2009, she has been good on the following daily meds untill now the following; On 200mg seroquel, 4mg valium, bedtime daily. On 50 mcg synthroid, and was on 60 mg cymbalta daytime for last 8 yrs. she began a tapered down from 60 mg to 20 mg over last 12 months, 10mg every 3 months due to a bad constipation problem. Last 3 months she looked terrible, her therapist even said so. And said you looked better on your 30mg now on 20 you don't look good. Went to family doc, he gave her tylenol 3 (30/300) 2x a day for pain and ativan 0.5mg 1x A day. This was 2 months ago. Since 7 days ago she is depressed, paranoid, panic stricken, will not get out of bed till afternoon, eats when she wants to, watchs tv, plays with the cat. But the most serious she will not leave the house out of fear and panic, again, says shes scared. Please help. She will not survive a hospitalization, in 2009 she was home treated and turned around, psychiatrist got her to leave the house, it cost me$$$ for home visits. I now increased her cymbalta back to 30mg and seroquel to 300mg for sleep. she is not suicidal. The other psychiatrist is long gone, don't have the$$$ for home stuff again. IAM SCARED PLEASE HELP I DON'T WANT TO LOSE MY WIFE. The last times they threatened with state hospital for insane because insurance would not pay for 2wks each time we were lucky she got discharged. IAM SCARED IAM AFRAID THEY GO AWAY FOR GOOD. PLEASE HELP .

What is the time frame for showing improvement/increase the dose? She has been on both increases for only 4 days. She now has soft stool at 4 am last two days, is this from the seroquel and/or cymbalta increase also her sleep time has decreased or insomnia increase since 300mg seroquel increase. At what point should the cymbalta go back up to 60mg for the depression? Finally is the bipolar disorder. Also was all this triggered by the taper?

Thank you for your patience. Iam trying to understand why not increase the antidepressant cymbalta if and i believe you are correct she is very depressed with this psychotic systems, should we not get the depression out of the way also? Also when do I have to worrie about her developing serotonin syndrome. is this syndrome dangerous? Also we forgot to address the 4mg valium at bed and 6mg Valium daytime she takes daily is this ok to take, is it alot? Finally is the gastric distress from the meds, she went again and has soft stool/light diarrea, any serjjestions of how to aleviate this? Forgot in mention her TSH is 4.3, could this intensify the depression? Iam so worried, thank you again for your patient, I don't want to lose my wife. P.S Just as Iam writing you I hear her getting up and watching TV. Its 1:30pm she got up. Do you have fath she will be OK? Is she a lost cause? Thank You Again dear Doctor, God Bless You

What did you mean half dose day night i believe there is a typo. Can you specify the dosages in numbers. Also doc did prescibe lipator over last 12 months. Could this be a contributing factor to her problems, can she take it with all these meds, also if you want to get off does one have to taper or can one just stop after taking it so long

Doc I don't know if these are suicide thoughts but she said she had a dream of standing on a railway track and getting hit by a train. She also said her whole brain is in a fog, she doesn't know anything how to cook, her phone number, tv does't interest her, she has no will to get better, she dosn't know how to get better, she says she is so sick all her muscles hurt. She says she is to stupid to get better, she cant talk she says. I asked again if she wants to hurt herself, she said she don't know how. Then I angry and pressured her and she got angery and made a gesture with her hand flat across her neck, she said its to hard to get better. She said she's given up on life its to hard to get better, brain in a fog. Is this depression really worse than I thought, Should I put the cymbalta to 60mg, she's been on the 30 for 4 days. I opened the door and showed it to her and she stuck her head outside but thats about it. Still lying on the couch. What should I do?

Was Shopping and a MD in the store said cymbalta contains Duloxatine That she is suffering from discontuation syndrome and to maybe go up to 60 mg cymbalta, just his brief recomindation, What is duloxatine? And what does it do. What is discontuation syndrome? could this be whats causing this problem?, we did taper the cymbalta 10mg every 3 months it was slow. Does depression cause Psychosis or visa versa? The major concern with her is still being scared, especially going to the hospital, constantly on her mind, took extra valium in day time seemed to calm her down for 2-3 Hrs, then had to take another one. She said this morning she sleep because she had to take 10mg of ambiem and it got her sleep. And the said something interesting "i really have to take a shower and I really have to go out to the store, but Iam afraid to shower and go out? What does this mean? What side effects can I expect from the seroquel increase? Will it effect her sleep is it Why she said the 300mg last week got her sleep for only 2 days the none? Does seroquel cause insomnia. P.S. she still has sweats. ThankYou

What do mean as gradual, can you give me numbers, there is only 30 and 60 of cymbalta. she took an extra 30 mg cymbalta this am, she never got into the shower, got panicky, however she did get up to have the other half of her subway sandwich. Went back to bed. Is it possible lithium might help, don't have any but how does this drug work. Question , what if this event was triggered by event that recalled something from childhood will these drugs still work?

Is the fact that she has limited learning skills,(only went to the 9th grade, in special class), is mentally emotionally underdeveloped, ( mentally challenged person, or retarded), she has no social skills (parents were cruel and had her locked, up isolated) during childhood, parents breaking her toys, killing her pet cat, father alcoholic, possible sexual abuse. Is this why she finds the world so hard to deal with? Also she seems according to her last inhospital psychiatrist in 2008, she regresses almost back into an infant stage While she was being treated, it made it very difficult to treat her, none of the meds worked, they gaveup, thats why they threatened her with State Psychiatric Hospital of the Insane. After which time she came around almost same day. But at the same time when they discharge her to out patient, she returns home and goes right back into bed again, won't shower, or leave house. She says she cannot deal with the programs, has nothing to say, she knows she has a learning problem. But each Hospital insists on there process of : 1- heavy medication to get the patient stable; 2- transfer to long outpatient program, or semi-long term (30 days) in patient residence. All in all she always returns home to bed? To help you answer, a short HX; 1- 1994 we got married, had a home, became very stressful, sort out psychiatry help, prescribed: ambien, Xanax, Prozac, Zoloft. shortly after attempted suicide took all pills, Hospitalized( inpatient,2wks, inpatient residence 4wks, released after her not getting better) got home with just ambien, valium. Saw therapist. Ok for 10 yrs. why don'know. 2- 2004 brother died, went to er for insomnia/depressed, admitted to psych ward, given valiums, ambiens, seroquel(25mg), released after 1 wk. same condition readmitted same hospital, same drugs plus remeron, zoloft, etc. released after 2 wks, told to go report to outpatient hospital following monday, did not go told by staff if not could be back in, took drug overdose of all remeron at home. Readmitted for 4wks, more drugs (as I described in the initial question on this site) given, frozen in fear, stayed in bed, transfered to inresidence longer term facility, facility changed all meds around, was on ambien, valium, buspar, when unable to do learning tasks and other mental/educational excersies forced to clean tiolets and substandard duties, frozen in fear,took attorney to release her, came home , stayed in bed-situation identical to what I have now. 2005 -after 5 months of attempted home care, still not going out, admitted to diff psych hospital, was placed on ambien,valium, cymbalta, lithium kicker, under care of kind india doctor Dr XXXXXXX discharged to out patient, pickup at home program. Completed cured, was seeing diff therapist, on remeron, cymbalta, seroquel, valium, ambien. Fine for 3 yrs. 2008- Nov bought new home, had to move, had to pack, make difficult decsion, rushed, stressful for wife, alot of responsibility for her, had argument with my father. Wk later overdosed on all her meds. Admitted to hospital, under care of diff psychiatrist (above one that stated she regresses, also said "not a med I can give you your depression is from outside not in, she has Personality Disorder), tried meds, frozen in fear,this time almost all types,flat effect. released to outpatient, did not go. same thing hid in bed would not go out, frozen in fear. I had to admit her to inpatient residence facility, meds, all kinds given including lexapor,abilify, halol, flat effect, hiding in bed, frozen in fear,psych recommended ECT, not done, responded to some meds, (I think they just gave up) , released her to outpatient for 4 wks in 2009. 2009 - had to drive her too scared to drive) completed only 2.5 wks, came home, back in bed (same situation as now), frozen in fear,anxiety. After 2 months able to contact dr XXXXXXX Came to home, kept her on valium, upped seroquel, cymbalta, added lithium. She was home treated for 4 wks , therapist and him came to home, (as stated it in my first conver with you) cost me $$$. After 4 wks she was fine, went out, not frozen in fear. Took her off lithium, stayed on cymbalta,seroquel, valium, ambiem.Good for 4yrs. 2013 -brings us up to our current situation, you know about the taper. She still fine till about Dec 2013, however still fine. Was going out not frozen in fear. Seeing kind therapist specility, child therapy. 2014 Mar- down to 20mg cymbalta, however did discussed responsibilities of new home, on my wifes insistance, showed her what to do, father spoke with her over phone nonconfrontational. This was last week Monday, she was outgoing wk ago from today. Following day, depressed, frozen in fear, extremely anxiety ridden, kept saying "what am going to do when you die" I can,t take care of this place, your father is a nosey body, etc. Now all she things about how she is not going to get better, being hospitalized, all the depression talk, she wants to die, However on that note, from past episodes, she relates dieing with pill overdose, but I HAVE ALL THE PILLS LOCKED UP IN A SAFE, and only leave her 2 days supply, thats it tops, thats only 2-cymbaltas pills,2- seroquels pills, 6 2mg Valium pills, thats it. Again sorry for the lenghty essay. What are your thoughts? PS Dr XXXXXXX is retired .

Again I thank you for your patience, its hard for me. There must be typo what did you mean there is no need to decrease dose of antidepressant at which she improves, she is on 30 now I didn't decrease it? Also you said Valium 4mg at day night and 6 mg at night, I believe you said earlier on 4 or 2 mg at night because of the seroquel and 6 mg at day for her daytime anxiety. You did not say whether there is a personality disorder also, or if her underdevelopment issues, may make treatment difficult. PS she took a 0.5 ativan this am and for some reason the panic attack subsided. the depression is still there , however her panic diminished. She has the anxiety without the panic, for that she took the Valium. I would not be supprised and you know this from your experience the docs may presciribe 25mg or 50mg seroquel daytime in addition to what you have recommended to combat the panic/Anxiety. Don't be suprised if her family doctor/therapist my reccommend to ativan/valium dose increase to get her out of the house to see them in the office. As you know from your profession they are mission driven, to get her in a way sedated so I can drive her to them. I guess I can't blame them. As a side note Do you know a DR Kuljit Singh? he is from india. Are you here in the US, are you also from india? You are very smart, I thank you from the bottom of my heart for helping me .