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Suggest Ways To Manage Extreme Agitations
Question: My problem is that I am suffering from extreme agitation from the moment I wake up to the moment I go to bed. I suffer from anxiety and depression and I don't know if the agitation comes from having depression. I have tried the following medications but none have helped with the agitation except for the benzodiazepines which did provide relief, but I now have a tolerance to them:
Antidepressants: Mirtazapine, phenelzine, tranylcypromine, dosulepin, amitriptyline, citalopram, escitalopram, fluoxetine, sertraline, venlafaxine, lofepramine
Antipsychotics: Risperidone, olanzapine, quetiapine
Benzodiazepines: Lorazepam, clonazepam, diazepam, alprazolam
Beta blockers: Propranolol
What medications would you recommend I try next?
Also I would appreciate your opinion on the drugs that I have been looking into, these are:
Haloperidol and Chlorpromazine and
Carbamazepine and Divalproex sodium and Lamotrigine
Which of these drugs would you argue would work best for agitation? Also would you recommend that I take more than one of these drugs? Also is it likely that one of the older antipsychotics will provide any benefit when the newer ones that I tried did not?
Antidepressants: Mirtazapine, phenelzine, tranylcypromine, dosulepin, amitriptyline, citalopram, escitalopram, fluoxetine, sertraline, venlafaxine, lofepramine
Antipsychotics: Risperidone, olanzapine, quetiapine
Benzodiazepines: Lorazepam, clonazepam, diazepam, alprazolam
Beta blockers: Propranolol
What medications would you recommend I try next?
Also I would appreciate your opinion on the drugs that I have been looking into, these are:
Haloperidol and Chlorpromazine and
Carbamazepine and Divalproex sodium and Lamotrigine
Which of these drugs would you argue would work best for agitation? Also would you recommend that I take more than one of these drugs? Also is it likely that one of the older antipsychotics will provide any benefit when the newer ones that I tried did not?
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks for your question.
I recommend you ask a psychiatrist about starting an MAOi antidepressant, which is a class commonly reserved for treatment-refractory depression. You have tried a couple, but not selegiline. I would give that a try.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Consultation
Detailed Answer:
Hello, and thanks for your question.
I recommend you ask a psychiatrist about starting an MAOi antidepressant, which is a class commonly reserved for treatment-refractory depression. You have tried a couple, but not selegiline. I would give that a try.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Yogesh D
Many thanks for your reply.
Can I ask why you think that selegiline will help with my agitation problem? Is there any evidence for this belief and do you have any experience in using this drug for treatment in agitation?
Also is it likely that the drug will help me considering I have already tried two maoi antidepressants and they didn't help for agitation or depression?
Also am I not correct in saying that usually mood stabilisers are tried first for the treatment of agitation? And what do you think of the drugs that I listed as ones that might be helpful?
Can I ask why you think that selegiline will help with my agitation problem? Is there any evidence for this belief and do you have any experience in using this drug for treatment in agitation?
Also is it likely that the drug will help me considering I have already tried two maoi antidepressants and they didn't help for agitation or depression?
Also am I not correct in saying that usually mood stabilisers are tried first for the treatment of agitation? And what do you think of the drugs that I listed as ones that might be helpful?
Brief Answer:
Followup
Detailed Answer:
Agitation is a symptom, not a diagnosis. It appears you have been diagnosed with depression. Agitation when associated with depression is well-treated with an antidepressant, rather than a mood stabilizer. Selegiline may be more effective than other MAOi drugs you have tried. I would try this before thinking about a mood stabilizer or antipsychotic.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
Agitation is a symptom, not a diagnosis. It appears you have been diagnosed with depression. Agitation when associated with depression is well-treated with an antidepressant, rather than a mood stabilizer. Selegiline may be more effective than other MAOi drugs you have tried. I would try this before thinking about a mood stabilizer or antipsychotic.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Many thanks for your reply.
You kindly answered my first question but did not answer the others. I will copy and paste them below for you to answer again. Please try to give as much information in your answers as you can (I will really appreciate it). Here they are again:
"Is there any evidence for this belief and do you have any experience in using this drug for treatment in agitation?"
"Also is it likely that the drug will help me considering I have already tried two maoi antidepressants and they didn't help for agitation or depression?"
"Also am I not correct in saying that usually mood stabilisers are tried first for the treatment of agitation? And what do you think of the drugs that I listed as ones that might be helpful?"
You kindly answered my first question but did not answer the others. I will copy and paste them below for you to answer again. Please try to give as much information in your answers as you can (I will really appreciate it). Here they are again:
"Is there any evidence for this belief and do you have any experience in using this drug for treatment in agitation?"
"Also is it likely that the drug will help me considering I have already tried two maoi antidepressants and they didn't help for agitation or depression?"
"Also am I not correct in saying that usually mood stabilisers are tried first for the treatment of agitation? And what do you think of the drugs that I listed as ones that might be helpful?"
Brief Answer:
Followup
Detailed Answer:
I believe I did answer the others, but I will expand my answers.
"Agitation when associated with depression is well-treated with an antidepressant, rather than a mood stabilizer."
In other words, agitation related to depression will not respond to a mood stabilizer, so I do not believe that belief is correct.
"Selegiline may be more effective than other MAOi drugs you have tried."
Sometimes selegiline is more effective than other MAOi's, so I believe it is worth trying.
"I would try this [selegiline] before thinking about a mood stabilizer or antipsychotic."
Mood stabilizers are not used first for the treatment of agitated depression. They are only used for agitation in bipolar disorder or personality disorders. The drugs you list are mood stabilizers and antipsychotics, none of which are typically effective in the treatment of agitated depression, only agitation related to bipolar disorder, personality disorders, or in the case of antipsychotics, psychotic disorders.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
I believe I did answer the others, but I will expand my answers.
"Agitation when associated with depression is well-treated with an antidepressant, rather than a mood stabilizer."
In other words, agitation related to depression will not respond to a mood stabilizer, so I do not believe that belief is correct.
"Selegiline may be more effective than other MAOi drugs you have tried."
Sometimes selegiline is more effective than other MAOi's, so I believe it is worth trying.
"I would try this [selegiline] before thinking about a mood stabilizer or antipsychotic."
Mood stabilizers are not used first for the treatment of agitated depression. They are only used for agitation in bipolar disorder or personality disorders. The drugs you list are mood stabilizers and antipsychotics, none of which are typically effective in the treatment of agitated depression, only agitation related to bipolar disorder, personality disorders, or in the case of antipsychotics, psychotic disorders.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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