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Suggest Treatment For Severe Anxiety And Depression
Question: Dear Doctor - Its been a long time since we last spoke. I am still fighting my anxiety/depression. The history of my medication is given below:
- My doctor started with 10mg prozac, gradually stepped up to 30 (20 in the morning and 10 in the night) as i was feeling drowsy with 30 in the morning. Actually she had put me on daxid 25, could not handle it because it gave me major stomach problems, on your advice last time, i started with 10 prozac, and convinced my doctor to continue with that
- met her yesterday, she asked me to take prodep 30/40 alternate days, yesterday i took 20 in the morning and 10 in the night and am supposed to take 40 today
-mirtaz 15 in the night
-olimelt 1/2 of 2.5 (i was on 3.75 of olimelt for a long time), my doctor reduced it 2.5 for a week and added buspin 5mg, next week she reduced olimlet to 1/2 of 2.5 and made buspin 10
-with 5 buspin, i was ok. but with 10 buspin, i started getting major stomach cramps, heavy sedation, drowsiness, blurred vision and sleeplessness, dry lips. spoke to my doctor she made 5 mg for one day and then 1/2 of 5 mg from yesterday
-Along with that i am taking etizolam 0.25 in the morning, and 0.5 in the night, betacap tr 25 and inderal 10 sos
-my symptoms are : anxiety/anxiety attacks/anticipatory anxiety/racing thoughts....though the intensity some days is more, other days is less but symptoms still exist
i have the following questions:
After the change of medication yesterday, i did not sleep a wink, with stomach cramps and acidity - is it due to the sudden reduction in buspin, have read on the net that buspin does not cause withdrawal symptoms, was wondering why is this happening to me? and what would your advice be?
since i have been on prodep 30 mg (20/10, mor/eve)for a long time without any major issues, can making it 40 now cause stomach and sleep problems as i have read on the net that it can gives stomach and stomach problems? and should i make it 40 everyday take 20 in the morning and 20 in the night or 30/40 alternate days. does it give such problems to everyone or for some people it can help with stomach and sleep problems
Need your urgent advice. Regards, XXXXXXX
- My doctor started with 10mg prozac, gradually stepped up to 30 (20 in the morning and 10 in the night) as i was feeling drowsy with 30 in the morning. Actually she had put me on daxid 25, could not handle it because it gave me major stomach problems, on your advice last time, i started with 10 prozac, and convinced my doctor to continue with that
- met her yesterday, she asked me to take prodep 30/40 alternate days, yesterday i took 20 in the morning and 10 in the night and am supposed to take 40 today
-mirtaz 15 in the night
-olimelt 1/2 of 2.5 (i was on 3.75 of olimelt for a long time), my doctor reduced it 2.5 for a week and added buspin 5mg, next week she reduced olimlet to 1/2 of 2.5 and made buspin 10
-with 5 buspin, i was ok. but with 10 buspin, i started getting major stomach cramps, heavy sedation, drowsiness, blurred vision and sleeplessness, dry lips. spoke to my doctor she made 5 mg for one day and then 1/2 of 5 mg from yesterday
-Along with that i am taking etizolam 0.25 in the morning, and 0.5 in the night, betacap tr 25 and inderal 10 sos
-my symptoms are : anxiety/anxiety attacks/anticipatory anxiety/racing thoughts....though the intensity some days is more, other days is less but symptoms still exist
i have the following questions:
After the change of medication yesterday, i did not sleep a wink, with stomach cramps and acidity - is it due to the sudden reduction in buspin, have read on the net that buspin does not cause withdrawal symptoms, was wondering why is this happening to me? and what would your advice be?
since i have been on prodep 30 mg (20/10, mor/eve)for a long time without any major issues, can making it 40 now cause stomach and sleep problems as i have read on the net that it can gives stomach and stomach problems? and should i make it 40 everyday take 20 in the morning and 20 in the night or 30/40 alternate days. does it give such problems to everyone or for some people it can help with stomach and sleep problems
Need your urgent advice. Regards, XXXXXXX
Brief Answer:
Dose can be increased to 40 mg without any worries.
Detailed Answer:
Hello thanks for asking again
Buspirone is a drug that doesn't cause dependence and dose reduction from 10 to 5 mg would not cause any withdrawal symptoms. The symptoms of stomach cramps, acidity you are having are occurring probably due to some other reasons most probably due to anxiety itself.
No as you are taking Fluoxetine since a good long time so increasing the dose to 40 mg would not cause any significant stomach problems. No need to worry. Abrupt increase in significant doses causes side effects but increasing from 30 to 40 would not cause any symptoms. In fact this would help you a lot with better anxiety control. Better to take one capsule/tablet in morning and one afternoon (preferably) or evening. Most of the patients of mine on Fluoxetine report insomnia and restlessness after taking drug in night so should be avoided taking in night time. You can take 30/40 on alternate days for about 2 weeks and then can increase it to 40 every day.
Thanks. I am sorry for late reply because of busy schedule.
Dose can be increased to 40 mg without any worries.
Detailed Answer:
Hello thanks for asking again
Buspirone is a drug that doesn't cause dependence and dose reduction from 10 to 5 mg would not cause any withdrawal symptoms. The symptoms of stomach cramps, acidity you are having are occurring probably due to some other reasons most probably due to anxiety itself.
No as you are taking Fluoxetine since a good long time so increasing the dose to 40 mg would not cause any significant stomach problems. No need to worry. Abrupt increase in significant doses causes side effects but increasing from 30 to 40 would not cause any symptoms. In fact this would help you a lot with better anxiety control. Better to take one capsule/tablet in morning and one afternoon (preferably) or evening. Most of the patients of mine on Fluoxetine report insomnia and restlessness after taking drug in night so should be avoided taking in night time. You can take 30/40 on alternate days for about 2 weeks and then can increase it to 40 every day.
Thanks. I am sorry for late reply because of busy schedule.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear doctor - I was on 30 prodep for a very long time. Then the doctor made it 30/40 alternate days. Started giving me major stomach problems I.e. cramps, pain, burning sensation and acidity. The doctor then made it 30 and added amitryn 5 mg, along with mirtaz 15, olimelt 1.25mg, etizolam 0.5 in the night and 0.25 in the morning, betacap tr 20 in the morning. My symptoms are anxiety attacks, anticipatory anxiety. Adding amitryn 5 in the night to these medications started giving me weird and horrible dreams and the stomach problem did not improve. Yesterday, she made mirtaz 15+1/2 of 7.5 and cut on amitryn and made prodep 20. I slept well last night but the stomach problem started again after having prodep 20 after breakfast. Somehow these SSRIs don't suit me. Though I was OK with 30 mg prosep for sometime, now my stomach can't take even 20. I have the following doubts :
Since SSRIs don't suit me, what else can I try for my low confidence and anxiety?
Can I do away with prodep 20 and how gradually should it be done?
My doctor feels that a mood stabiliser shall help me, I am on 1.25 olimelt that was brought down from 3.75 as it was causing weight gain and sugar problems, she feels may be quetiapine 25 will help me instead of olimelt, this change she will do in my next meeting
Do you think mirtaz 15+1/2 of 7.5 and quetiapen will take care of my symptoms and I do away with prodep as I am a sufferer of IBS and prodep tends to aggravate it
Also once I am on mirtaz and quetiapen, can I do away with etizolam as I have been taking it for a very long time and my doc feels I need to gradually stop it
Need you advice on the above concerns. Pls help
Since SSRIs don't suit me, what else can I try for my low confidence and anxiety?
Can I do away with prodep 20 and how gradually should it be done?
My doctor feels that a mood stabiliser shall help me, I am on 1.25 olimelt that was brought down from 3.75 as it was causing weight gain and sugar problems, she feels may be quetiapine 25 will help me instead of olimelt, this change she will do in my next meeting
Do you think mirtaz 15+1/2 of 7.5 and quetiapen will take care of my symptoms and I do away with prodep as I am a sufferer of IBS and prodep tends to aggravate it
Also once I am on mirtaz and quetiapen, can I do away with etizolam as I have been taking it for a very long time and my doc feels I need to gradually stop it
Need you advice on the above concerns. Pls help
Brief Answer:
Quetiapine also causes weight gain and increases the risk of diabetes.
Detailed Answer:
Hello again
- If SSRIs are causing significant problems then other option is to ask for increase in dose of Mirtazapine. This will have positive effects on your mood but this might increase the nightmares, which are already creating problem. Newer drugs as Tianeptin or Vilazodone can be tried. Vilazodone has recently launched in market and has great efficacy and less side effects. The drug can be tried for your symptoms. You can discuss about this drug with your doctor.
- Prodep 20 is very low dose. You can take 10 mg for 2 more weeks and then can stop easily. The drug will not cause withdrawal.
- Quetiapine is also a second generation antipsychotic (SGA) and is known to cause weight gain, though not as severe as caused by Olanzapine. But in my opinion 25 mg will cause almost same weight gain as 2.5 mg Olanzapine. Though it has not been standardised. Drugs like Aripiprazole can be tried, which is also a SGA but safe in terms of weight gain or diabetes risk.
- Yes this combination should help you but as I have mentioned already, 25 mg Quetiapine also causes weight gain. But the combination is a good option because other drugs are either not responding or resulting in side effects.
- Yes once your symptoms remit then you can gradually taper the doses of Etizolam.
Please remain strong and try to ignore minor issues. Ignoring minor bodily problems will finally result in improvement in your anxiety.
Thanks. Still have more doubts please ask again.
Quetiapine also causes weight gain and increases the risk of diabetes.
Detailed Answer:
Hello again
- If SSRIs are causing significant problems then other option is to ask for increase in dose of Mirtazapine. This will have positive effects on your mood but this might increase the nightmares, which are already creating problem. Newer drugs as Tianeptin or Vilazodone can be tried. Vilazodone has recently launched in market and has great efficacy and less side effects. The drug can be tried for your symptoms. You can discuss about this drug with your doctor.
- Prodep 20 is very low dose. You can take 10 mg for 2 more weeks and then can stop easily. The drug will not cause withdrawal.
- Quetiapine is also a second generation antipsychotic (SGA) and is known to cause weight gain, though not as severe as caused by Olanzapine. But in my opinion 25 mg will cause almost same weight gain as 2.5 mg Olanzapine. Though it has not been standardised. Drugs like Aripiprazole can be tried, which is also a SGA but safe in terms of weight gain or diabetes risk.
- Yes this combination should help you but as I have mentioned already, 25 mg Quetiapine also causes weight gain. But the combination is a good option because other drugs are either not responding or resulting in side effects.
- Yes once your symptoms remit then you can gradually taper the doses of Etizolam.
Please remain strong and try to ignore minor issues. Ignoring minor bodily problems will finally result in improvement in your anxiety.
Thanks. Still have more doubts please ask again.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Since I am not able to handle prodep 20, can I stop it and start taking mirtaz 15+1/2of7.5 and quetiapen 25? What would your advice be?
Brief Answer:
Yes, you can go with this combination
Detailed Answer:
Hello again
Yes you can go with this combination without worries. Slight withdrawal will be compensated by doses of Mirtazapine. No need to worry.
Thanks
Yes, you can go with this combination
Detailed Answer:
Hello again
Yes you can go with this combination without worries. Slight withdrawal will be compensated by doses of Mirtazapine. No need to worry.
Thanks
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Went to see my doc yesterday, she has made the following changes:
Stopped prodep 20
Increased mirtaz to 22.5 from 15+1/2of7.5 in the night
Added quetiapen 1/2 of 25 morning/eve
Stopped 1/2 of 0.5 etizolam in the night and continued with 0.5 mg of etizolam in the morning
Olimelt 1/2 of 2.5 in the night, she continued with
Woke up today morning feeling constipated. stomach pain, burning sensation continues, I have following doubts:
Is increased mirtaz adding to constipation?
I am also getting burning sensation on the tongue, is it mirtaz or quetiapen causing this?
Can quetiapen give stomach problems like constipation, burning sensation?
Is it advisable to take quetiapen in the morning?
Are my stomach problem and constipation related to withdrawal of prodep?
Should I continue with mirtaz 15+1/2of 7.5?
Can I skip morning dose of quetiapen to see how I feel?
Pls advise.
Stopped prodep 20
Increased mirtaz to 22.5 from 15+1/2of7.5 in the night
Added quetiapen 1/2 of 25 morning/eve
Stopped 1/2 of 0.5 etizolam in the night and continued with 0.5 mg of etizolam in the morning
Olimelt 1/2 of 2.5 in the night, she continued with
Woke up today morning feeling constipated. stomach pain, burning sensation continues, I have following doubts:
Is increased mirtaz adding to constipation?
I am also getting burning sensation on the tongue, is it mirtaz or quetiapen causing this?
Can quetiapen give stomach problems like constipation, burning sensation?
Is it advisable to take quetiapen in the morning?
Are my stomach problem and constipation related to withdrawal of prodep?
Should I continue with mirtaz 15+1/2of 7.5?
Can I skip morning dose of quetiapen to see how I feel?
Pls advise.
Brief Answer:
Quetapine might cause constipation.
Detailed Answer:
Hi again
- Both Mirtazapine and Quetiapine are known to cause constipation. Since you were taking Mirtazapine already so most likely cause of constipation is Quetiapine. Tolerance to this side effect will develop in few days, no need to worry.
- Increase in dose of Mirtazapine could be the cause of the burning sensation on tongue, as increase serotonergic transmission can result in burning.
- Quetiapine can cause constipation but at such low doses it can't result in burning sensation.
- The drug should be preferably taken in evening hours.
- No this is not related to withdrawal of Prodep.
- Yes continue to take this dose without worries. The symptoms will reduce in some days.
- Though subjective improvement might be seen. But I don't think this would help much. Yes you can take 25 mg whole dose in evening.
tHANKS.
Quetapine might cause constipation.
Detailed Answer:
Hi again
- Both Mirtazapine and Quetiapine are known to cause constipation. Since you were taking Mirtazapine already so most likely cause of constipation is Quetiapine. Tolerance to this side effect will develop in few days, no need to worry.
- Increase in dose of Mirtazapine could be the cause of the burning sensation on tongue, as increase serotonergic transmission can result in burning.
- Quetiapine can cause constipation but at such low doses it can't result in burning sensation.
- The drug should be preferably taken in evening hours.
- No this is not related to withdrawal of Prodep.
- Yes continue to take this dose without worries. The symptoms will reduce in some days.
- Though subjective improvement might be seen. But I don't think this would help much. Yes you can take 25 mg whole dose in evening.
tHANKS.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So I should continue with mirtaz 22.5 and quetiapen 25 in the evening. I was thinking of gradually increasing mirtaz to 22.5 from 15+1/2of 7.5 and quetiapen from 12.5 to 25. What would be your advice and how many days should I give to reach these dosages of mirtaz and quetiapen?
Brief Answer:
Continue with the same doses.
Detailed Answer:
Hello again
- You should continue with Mirtaz 22.5 mg and 25 mg Quetiapin. No need to increase the dose gradually because you are already taking Mirtaz since long.
- Wait for at least 1-2 weeks. Though this can't be specified but the side effects will reduce. Increase the water intake to reduce the constipation.
Thanks.
Continue with the same doses.
Detailed Answer:
Hello again
- You should continue with Mirtaz 22.5 mg and 25 mg Quetiapin. No need to increase the dose gradually because you are already taking Mirtaz since long.
- Wait for at least 1-2 weeks. Though this can't be specified but the side effects will reduce. Increase the water intake to reduce the constipation.
Thanks.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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