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What Is The Proper Care For Extreme Anxiety While On Citalopram And Lorazepam?
Question: Mom is on .25 mg. 2 x day plus Citalopram 10 mg. 2 x day.Showing extreme anxiety. Wahat is proper care for this situation?
.25 mg lorazapam 2 x day po bid and citalopram .10 mg 2 x day po daily
.25 mg lorazapam 2 x day po bid and citalopram .10 mg 2 x day po daily
Brief Answer:
Information
Detailed Answer:
Hello and welcome,
Did your mother just begin taking citalopram recently or has she been on this for a long time? Because citalopram can cause agitation.
Do you have any idea why she is extremely anxious (was there some situation that set this off) and how long has it been going on?
What other medications is she taking and what other health problems does she have?
Also, how long has she been taking lorazepam?
Any additional information you can provide will be helpful.
Information
Detailed Answer:
Hello and welcome,
Did your mother just begin taking citalopram recently or has she been on this for a long time? Because citalopram can cause agitation.
Do you have any idea why she is extremely anxious (was there some situation that set this off) and how long has it been going on?
What other medications is she taking and what other health problems does she have?
Also, how long has she been taking lorazepam?
Any additional information you can provide will be helpful.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Mom has been under psychiatric care for 50 years. Dr prescribed lorazepam about 1 year ago and added citalopram about 5 months ago. She also takes a thyroid supplement. T-3 @ 1.5 gr8. She was shorted on this for 4 days about 3 weeks ago. The dose has been corrected but her anxiety continues. We took her back to the D.O. and he added magnesium 8 days ago. Still no improvement.
Brief Answer:
Thoughts on this
Detailed Answer:
You say that your mom has been under psychiatric care for 50 years. Is there an underlying diagnosis that she's been treated for over these 50 years or has it always been anxiety? I am a little confused by this because she was prescribed the benzodiazepine lorazepam just 1 year ago. And I'm not sure when the anxiety started for this current episode. Also, is it anxiety, such as worries, or is it agitation? So I'll do my best here in providing information based on what you've provided.
1. Most psychiatric illnesses can have a manifestation of anxiety. It's possible that her underlying psychiatric illness is needing to be addressed.
2. Dementia can also cause anxiety.
3. If it hasn't been checked in the past 2 months, I'd check her TSH level regardless of the blip of being off levothyroxine for 4 days. Abnormal levels can cause anxiety. Some people need a lower replacement dose of thyroxine even if the labs look good - best to treat the clinical symptoms rather than the labs - but the labs will give a general picture of where things are at.
4. Heart irregularities such as atrial fibrillation can cause agitation/anxiety as can diabetes, and lung diseases such as COPD.
5. Metabolic abnormalities can cause agitation and anxiety and a metabolic panel can be drawn when checking the TSH.
6. In extreme anxiety, a low dose of an atypical antipsychotic can be very helpful, and can also augment the benefits of the SSRI (in this case citalopram).
7. If there was any increase in anxiety that correlated with citalopram, I'd switch to it's daughter compound, escitalopram (Lexapro) as it tends to have fewer side effects.
8. Any as needed medications that are stimulating, such as decongestants, can cause agitation.
9. Sleep disturbances can increase the problem.
Without knowing her full medical and psychiatric history, I'd put my best guesses on the thyroid problem.
Thoughts on this
Detailed Answer:
You say that your mom has been under psychiatric care for 50 years. Is there an underlying diagnosis that she's been treated for over these 50 years or has it always been anxiety? I am a little confused by this because she was prescribed the benzodiazepine lorazepam just 1 year ago. And I'm not sure when the anxiety started for this current episode. Also, is it anxiety, such as worries, or is it agitation? So I'll do my best here in providing information based on what you've provided.
1. Most psychiatric illnesses can have a manifestation of anxiety. It's possible that her underlying psychiatric illness is needing to be addressed.
2. Dementia can also cause anxiety.
3. If it hasn't been checked in the past 2 months, I'd check her TSH level regardless of the blip of being off levothyroxine for 4 days. Abnormal levels can cause anxiety. Some people need a lower replacement dose of thyroxine even if the labs look good - best to treat the clinical symptoms rather than the labs - but the labs will give a general picture of where things are at.
4. Heart irregularities such as atrial fibrillation can cause agitation/anxiety as can diabetes, and lung diseases such as COPD.
5. Metabolic abnormalities can cause agitation and anxiety and a metabolic panel can be drawn when checking the TSH.
6. In extreme anxiety, a low dose of an atypical antipsychotic can be very helpful, and can also augment the benefits of the SSRI (in this case citalopram).
7. If there was any increase in anxiety that correlated with citalopram, I'd switch to it's daughter compound, escitalopram (Lexapro) as it tends to have fewer side effects.
8. Any as needed medications that are stimulating, such as decongestants, can cause agitation.
9. Sleep disturbances can increase the problem.
Without knowing her full medical and psychiatric history, I'd put my best guesses on the thyroid problem.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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