 
                            Have Hypothyroidism, Panic Disorder, Mild Depression, Cervical Can And Venous Thrombosis. Any Medication?
 
 
                                    
                                     Mon, 5 Nov 2012
                                                
                                            
                                                Answered on
                                                
                                                Mon, 5 Nov 2012
                                                
                                            
                                                Answered on
                                             
                                             Mon, 26 Nov 2012
                                                
                                                
                                                Last reviewed on
                                                
                                                Mon, 26 Nov 2012
                                                
                                                
                                                Last reviewed on
                                             
                                            Steroids ( like Medrol) have to be used with caution, especially in patients with medical and psychiatric co-morbidities as it can have adverse effects. Steroids have been found to cause exacerbations of underlying psychiatric problems and can cause mood instabilities, worsening of anxiety, etc. So, my prediction is that the flushing, pounding of the heart, nervousness, etc. could very well because of Medrol worsening your underlying panic / anxiety problems.
Regarding the possible potassium depletion, steroids can have a side effect of causing fluid and electrolyte imbalances. But this shouldn't be a major problem as long as you keep yourself adequately hydrated.
Regarding the Topamax, since the medication is being gradually tapered, it is unlikely to result in any problems. So, you don't have to worry about that.
Another concerning thing about your medication is the thrice daily dose of Ativan. Ativan is a short acting benzodiazepine which is not recommeded for continuous usage (even for panic / anxiety disorders). It can not only cause habituation but also cause withdrawal symptoms due to its short duration of action. So, I would advise you to discuss this with your doctor and consider alternative treatment options.
Wish you all the best.
- Dr. Jonas Sundarakumar
Consultant Pychiatrist
 
  
 Yes, I don't see any significant indication for taking steroids in your situation, especially considering the possible side effects that it is causing. I also think it's a better idea to very gradually come off the Ativan also. (I'm quite surprised to hear that you were prescribed 5 times a day of Ativan previously) But, it would be best to do these dose adjustments in consultation with a psychiatrist to prevent any withdrawal symptoms or rebound anxiety.
Since you are not much in favour of taking medication continuously, you also can try psychotherapy. There are effective psychotherapy techniques like CBT, relaxation therapies, etc. which can give you good results. Of course, this requires a dedicated therapist as well as persistent efforts from your side also.
I would also suggest that you try XXXXXXX breathing, yoga, etc. in addition to your medication. At least 30 minutes of exercise a day is a must for you, which will not only help you with your obesity and hypothyroidism, but also help you with your anxiety as well.
Wish you all the best.
- Dr. Jonas Sundarakumar
Consultant Pychiatrist
 
  
 It's good that you have stopped the Medrol and hopefully your symptoms should decrease gradually. In the furture also, it would be better to avoid steroid meedications, unless clearly necessary.
Regarding your concern about Ativan, when it is gradually tapered down, there is no risk of seizures. Another method to wean a person off thrice a day doses of Ativan safely, without withdrawal effects is to temporarily substitute it with a once a day dose of a longer acting benzodiazepine (like Clonazepam), which in turn can be tapered down slowly and stopped later. You can discuss these options with your doctor.
Also, regarding the Topiramate, you needn't worry much because 50 mg a day is a minimal dose and stopping is unlikely to produce any withdrawal effects. Maybe, you can continue alternate day doses for a week and then stop.
Wish you all the best.
- Dr. Jonas Sundarakumar
Consultant Pychiatrist
 
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