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Suggest Treatment For Recurrent Depression
Question: I XXXXX XXXXXXX (shopkeeper) of 57 years old, suffering from depression occasionally from last 25 years when militancy started in kashmir. I used different antidepressant medicines but can not write names because i have less memory and also i lost my all prescriptions Two and half years back i got depression attack and my doctor prescribed me zosert 50 mg. daily at night and some sleeping tablet for 15 days after that my doctor increased the dose of zesort 50 mg. to zosert 100 mg. to take daily after dinner for 2 months and was feeling very happy, sleeping well (without any sleeping tablet), thinking well and working properly. I continued it for 2 months and then myself reduced zosert 100 mg. to zosert 50 mg. and was enjoying the life happily, was going mosque daily 5 times for prayers without any sleeping tablet up to 30/07/2015 ( for more than two years) But suddenly on 01/08/2015 i found myself very un happy, no interest in any activity, no interest in meals, not sleeping well and like to remain alone lying in my bedroom , not like/want to talk to anybody. Negative thoughts coming to my mind but no thoughts of suicide and i was thinking that i can never be happy / work again .I was not able to go to mosque for prayers. Then i increased my dose of Zosert 50 mg. to 100 mg. daily after dinner and Ativan 2mg. at night up to 15/08/2015 ( for 15 days) but no progress, then i again increased the dose of Zosert 100 mg. to 200 mg. taking daily after dinner and Ativan 2mg at night for sleeping Few days after now i am feeling some relief, going to mosque daily 5 times for prayers which is adjacent to my residence but yet i am not interested in going to shop. In view of above statement kindly advise me in detail should i continue the Zosert 200mg./Ativan 2mg or reduce the dose or any other medication you feel better for me, with diagnoses. For your information sir i am not well educated but i hope you will understand my problem. With regards, XXXX Dated :05/08/2015
Brief Answer:
200 mg of little high for your age, your treatment need optimization.
Detailed Answer:
Dear XXXXX,
It is a wise step to ask a query here about your medication.
I understand your concern.
With history it is obvious that you are suffering from Recurrent Depression.
In this case a person suffers from depression again and again after a period of remission. This is happening in your case as you have suffered multiple times during last 25 years. All symptoms which you described above points towards onset of a fresh depressive episode.
The current dose of 200 mg of Zosert (Sertraline) is the maximum licensed dose in many countries for treating depression, but due to your age it needs to be reduced. In this type of psychiatric illness it is better to add few other medicines for long time. Increasing the dose of SSRI like Zosert (sertraline) may produce more adverse effects like dryness of mouth, constipation, restlessness and even medicine induced switch to Manic phase (unusual happy mood).
It is better to add a mood stablizer in the form of Tablet Lithium/ Lamotrigine/ Carbamazapine/Divalproex Sodium to your therapy. But these medication should be started under supervision of an expert.
I advise you to continue the medicine at dose of 150 mg per day. Do not increase it further as. You may need to be prescribed few other psychotropics as advised above for better remission of depression and prevention of recurrence of another episode of depression.
200 mg of little high for your age, your treatment need optimization.
Detailed Answer:
Dear XXXXX,
It is a wise step to ask a query here about your medication.
I understand your concern.
With history it is obvious that you are suffering from Recurrent Depression.
In this case a person suffers from depression again and again after a period of remission. This is happening in your case as you have suffered multiple times during last 25 years. All symptoms which you described above points towards onset of a fresh depressive episode.
The current dose of 200 mg of Zosert (Sertraline) is the maximum licensed dose in many countries for treating depression, but due to your age it needs to be reduced. In this type of psychiatric illness it is better to add few other medicines for long time. Increasing the dose of SSRI like Zosert (sertraline) may produce more adverse effects like dryness of mouth, constipation, restlessness and even medicine induced switch to Manic phase (unusual happy mood).
It is better to add a mood stablizer in the form of Tablet Lithium/ Lamotrigine/ Carbamazapine/Divalproex Sodium to your therapy. But these medication should be started under supervision of an expert.
I advise you to continue the medicine at dose of 150 mg per day. Do not increase it further as. You may need to be prescribed few other psychotropics as advised above for better remission of depression and prevention of recurrence of another episode of depression.
Above answer was peer-reviewed by :
Dr. Shanthi.E
kindly advise the zosert 150mg for how long time to continue
No advise for ativan 2mg as mentioned in the above question.
Kindly advise the dose of mood stabilizer medicines.
with regards
No advise for ativan 2mg as mentioned in the above question.
Kindly advise the dose of mood stabilizer medicines.
with regards
Brief Answer:
Ativan for 1 week then gradually tapered, rest medicine for many months/yrs
Detailed Answer:
Dear XXXXX,
Thanks for follow up question.
The medicine Ativan (Lorazepam) is a benzodiazepine group of medicine which is used for inducing sleep and reducing anxiety for a short period of time. This medicine has abuse and addiction potential, hence it should be given under supervision of a doctor for a short period period only.
You may continue Ativan at dose of 2 mg at night for next 07 days, then you should reduced to 1.5 mg at night for next 07 days, 1 mg at night for next 07 days, 0.5 mg at night for next 07 days and then stop.
Zosert has to be continued at this dose at least for next 10-12 weeks and thereafter dose reduction may be tried. But it should be continued at lower doses for years.
Any of the above mood stabilizer may be used after consultation with a psychiatrist. This platform does not permit to prescribe the drug doses. Further there is need of regular follow up with some investigations. So any new prescription without examining you may be dangerous to your health.
I have advised you about the dose of drugs you are using, since you were already on these medications. I have suggested you few medicines for augmentation of therapy. My purpose was to motivate you to discuss these issues with you primary psychiatrist. I never want you to self medicate.
A Mood stabilizer should be continued for years as it is meant to prevent recurrence of another episode of depression.
You have also mentioned date 15 Aug 2015 in your description, that is yet to come (in near future). So please clarify whether it is a typing error?
I am awaiting answer and I welcome any further query.
Ativan for 1 week then gradually tapered, rest medicine for many months/yrs
Detailed Answer:
Dear XXXXX,
Thanks for follow up question.
The medicine Ativan (Lorazepam) is a benzodiazepine group of medicine which is used for inducing sleep and reducing anxiety for a short period of time. This medicine has abuse and addiction potential, hence it should be given under supervision of a doctor for a short period period only.
You may continue Ativan at dose of 2 mg at night for next 07 days, then you should reduced to 1.5 mg at night for next 07 days, 1 mg at night for next 07 days, 0.5 mg at night for next 07 days and then stop.
Zosert has to be continued at this dose at least for next 10-12 weeks and thereafter dose reduction may be tried. But it should be continued at lower doses for years.
Any of the above mood stabilizer may be used after consultation with a psychiatrist. This platform does not permit to prescribe the drug doses. Further there is need of regular follow up with some investigations. So any new prescription without examining you may be dangerous to your health.
I have advised you about the dose of drugs you are using, since you were already on these medications. I have suggested you few medicines for augmentation of therapy. My purpose was to motivate you to discuss these issues with you primary psychiatrist. I never want you to self medicate.
A Mood stabilizer should be continued for years as it is meant to prevent recurrence of another episode of depression.
You have also mentioned date 15 Aug 2015 in your description, that is yet to come (in near future). So please clarify whether it is a typing error?
I am awaiting answer and I welcome any further query.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Sir,
sorry Kindly read 30/06/2015 instead of 30/07/2015 and 01/07/2015 instead of 01/08/2015 and 15/07/2015 instead of 15/08/2015..
you have to prescribe me some safe mood stabilizer medicine with instructions because you are now my permanent online doctor and i assure you i will strictly follow your advice.
with thanks
sorry Kindly read 30/06/2015 instead of 30/07/2015 and 01/07/2015 instead of 01/08/2015 and 15/07/2015 instead of 15/08/2015..
you have to prescribe me some safe mood stabilizer medicine with instructions because you are now my permanent online doctor and i assure you i will strictly follow your advice.
with thanks
Brief Answer:
Ok I understand
Detailed Answer:
Ok I understand your concern. thanks for giving me the honour. The safer mood stabliser in your age should be Sodium Divalproex. Unfortunately current law does not allow a prescription of mood stablizers online and so is the dispensing of these drugs over the counter without a physical prescription. You should speak to your current Psychiatrist for a safe dose. I am sure this will help you.
I am determined to help you and I assure that I will be definitely guiding you.
Wait for my reply.
Ok I understand
Detailed Answer:
Ok I understand your concern. thanks for giving me the honour. The safer mood stabliser in your age should be Sodium Divalproex. Unfortunately current law does not allow a prescription of mood stablizers online and so is the dispensing of these drugs over the counter without a physical prescription. You should speak to your current Psychiatrist for a safe dose. I am sure this will help you.
I am determined to help you and I assure that I will be definitely guiding you.
Wait for my reply.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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