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What Causes Anxiety,depression And PTSD?

Posted on Thu, 3 Jul 2014

Question: Hello, I am a 25 yo F pharmacist. I have been diagnosed with anxiety, depression, and PTSD from childhood abuse. For the past 5 years my PCP's and suspected possible ADD and/or bipolar disorder. I have been on every SSRI and most SNRI's (cymbalta and venlafaxine). They mostly caused me a lot of fatigue and I was unable to function. My symptoms are mostly depression and irritability. I periodically have anger issues and nightmares, which I know are PTSD-related. I currently take prazosin for the nightmares. I am so tired during the day it is hard to function. I sleep around 8 hours a night. I saw a psychiatrist recently and he was unable to make a diagnosis or a medication suggestion. My PCP then prescribed me adderall 10mg IR daily for the fatigue. It has helped a lot for the irritability and I have felt very well since being on it. It wears off shortly though as the adderall should be taken BID. I still notice feels of depression on it. I am unsure if a mood stabilizer would be key here? My current medications; adderall 10mg IR daily, lorazepam 0.25mg daily, prazosin 1mg qhs. I am not sure if I may have ADD and/or bipolar 2 disorder? I seem to be in more of a depressed phase throughout the year. Although, the days I am irritable and restless, I tend to drive erratically and make fast-paced/risky decisions. I am always bored, and I cannot find anything to hold my interest for very long. I procrastinate on everything; bills, etc. I have another psychiatrist appointment coming up. No one seems to be able to diagnose me or suggest appropriate treatment. I have been to 4 doctors about this situation.

Answered by Dr. Abhishek Kapoor (1 hour later)

Brief Answer:
You can try paroxetine

Detailed Answer:
HI
Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query.

I think, you have depressive disorder. Low mood easy irritability, decrease concentration, fatigue or decrease sexual desire etc are symptoms of depression. In that case, you need antidepressant with low dose benzodiazepine. There is no need to take adderall. It could increase your anxiety symptoms or could lead to dependence in your case. If you do not have history of any manic episode in form of overtalkativeness, sleeplessness, increase energy, increase sexual desire etc, then you have unipolar depressive disorder.

You have mentioned that you have been on number of antidepressant like cymbalta or venlafaxine, but nothing worked. You should try paroxetine. It is one of good antidepressant that help to control depression as well as anxiety disorder. If you do not get relief with antidepressant, that mood stabilizer or psychotherapy could be another option to add in to the treatment plan. Rest, you can discuss with your psychiatrist.

In case, you need further help, you can ask.

Regards
Dr. Abhishek Kapoor
Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Abhishek Kapoor (21 hours later)

I have already tried paroxetine. It did not help me after 12 weeks of use. I still have considerable depression and fatigue. What would be another alternative?

Answered by Dr. Abhishek Kapoor (2 hours later)

Brief Answer:
You can try des-venlafaxine

Detailed Answer:
Hi

Another alternative in your case is des-venlafxine or mirtazepine. Des-venlafaxine is SNRIs, but it does not have side effects of venlafaxine. Mirtazapine is sedative antidepressant and it would help to improve your appetite. Beside antidepressants, you can try mood stabilizer like lithium or valproate.

If you have more query, you can ask.

Regards
Dr. Abhishek Kapoor
Psychiatrist

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Abhishek Kapoor (25 hours later)

Hello again,

I was wondering if bupropion IR twice daily with buspar for anxiety could be used in my case? bupropion IR seems to be activating and could help with my fatigue. Would any medication be needed for sleep? trazodone possibly?

Answered by Dr. Abhishek Kapoor (1 hour later)

Brief Answer:
You can try this drug coombination

Detailed Answer:
Hi

You can try buprorion and buspirone. Both are effective in anxiety disorder. With them, you can have sedative antidepressant like trazodone or mirtazapine for sleep. You can also try benzodiazepine on sos basis for anxiety or sleep. Better to do some relaxation exercise. That would help to keep drugs in limit and also to control underline anxiety.

In case, you need further help, you can ask.

Regards
Dr. Abhishek Kapoor
Psychiatrist

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar