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Suggest Treatment For Depression And Anxiety
Question: Dear Sir,
I confused. Please help me to make a good decision. I am 30 now. I am jobless, but hopping that I will easily got one if I am in good shape of mind. I am preparing for the competitive exams. I have discontinued my antidepressant medication one month before in the hope of good cognitive ability and memory power, even though the anti depressants rescued me from my pit. Without my doctors consent I quit and drop the medicines. But however I managed the withdrawal symptoms. But now I doubt my decision. So please help me and guide me.
I have a long history of illness so I presented myself in two parts psychologically and medically.
Medical History:
1. 1999: I have social phobia since my age 15 but untreated. I had worries about small penis, lack of social interactions, tremors on neck when facing trouble situation, afraid of being identified as virility less boy. so i tried to hide secretly but eventually friends comes to know and they comment about it,so i felt like less man.
2. 2001:As worries grown up at my age 18 I received some treatment for auxiliary symptoms of social phobia , insomnia (alphrazolam, after that clonazepam) that was enough for that time
3. 2002: With these thoughts going to college is not easy and my nightmare is that there are girls in the college should not be know about me as looser. They should see me as a hero according to my fantasies. But in reality I am afraid to what I hide.So I cut my college mostly and occasionally used clonazepam and alphrazolam to manage situation under my control. If I control my tremor and anxiety I can successfully manage to show my confidence and skills. All I afraid is the anxiety and tremor when speaking with girls, stage, very few friends. not single girl friend.
4. But on and after college I had faced some XXXXXXX persons and their style of proposal. My friends told me they also been in a kind of situation. But that not compromise me. It’s give me panic about my look. I thought I look like XXXXXXX or feminine looking guy. And this is added to my panic pack. But so far the clonazepam and propanolol saves me.
5. 2007 : I was jobless(afraid of interview), worried much by the inferior thoughts I began loosing control over my thoughts, i afraid i shake in head that will definitely happened.one time when speaking with my friends I spoke mistakenly .that was my friend asking me about when to marriage but i without understanding about the question replied “who him” and pointing to the near friend ( I ment that is he asking about his marriage, but they consider it I marriage him) they silently went and spread the rumor all over to my friends.
6. That’s it, I burst. I can’t stop trembling if I think of trembling(on neck and head). When I am like that I cant speak to anybody freely and they suspect me more like” does his character change truly and the rumor is correct”. So I cant go out, speak to any of my friends, and my panic attacks started. Weired thoughts, insomnia, fear, changed personality and character broken me down. Clonazepam and propanolol didn’t work now.
7. But till 2010 I cant explain my situation and how I troubled with my problems to any doctor so I can’t get the proper medicine. After long search on the net I found that ssri I good medicine and will help me. And go straightly and ask about it. And got it.
8. 2011: I am using nexito ls(escitalopram 10+clonazepam.25)for 3 years. That greatly recovers me and allows me to understand the reality about what I worried. That matures me and I am in good shape now. But the problem is my doctor who prescribed the medicine is shifted to another state so I took it the medicines without doctors advice.
9. 2014: So happy now I thought when I should stop this medicine because I think I developed good and the medicine makes me drowsy and dull so I cant prepare for my job examination. So I went to the psychiatrist and told my problem. And he began to change expand medications. He added first set with escitalopram 10, clonazepam .25, mirtazapine 15, and modofil 100. I told him the mirtaze first seems good but later gives aggressiveness.
10. So he change medice and gave me desvenlafaxine 50, mirtaze15, etizolam .5, and agomelatine, modofil. (50 days)
11. I thought that was too much for me and ask him how long should I took this med . and he told me as long as needed. What is this answer. already I am fine before comes to him.i just feel drowsy and interest less in any thing that’s all. So I quit him and withdraws the medicines with the help of local neurologist and medicine(flupentizol+melitracine for 20 days). He advised me another month of that medicine but I refused to take it more
Now I am out of medicine for 40 days. And I am using clonazepam .5 for maintenance. But it seems that I am addicted to that and have lot of withdrawal problem with it.
Now I am worry about did I do wrong, should I continue medicine for more? Because I have a long history and I still have to face something serious like job searching, marriage etc...
So please tell me sir, should I resume the medication. If yes then
1. what is the good medicine for me (among the lot I have taken which is actually good for me and with less withdrawal and side effects)
2. who will be the best choice in doctors(neuro, psycho,)
3. who to decide when I stop the medicines
4. what about cognitive impairment by the medicines
please see my previous questions if any doubts thank you
I confused. Please help me to make a good decision. I am 30 now. I am jobless, but hopping that I will easily got one if I am in good shape of mind. I am preparing for the competitive exams. I have discontinued my antidepressant medication one month before in the hope of good cognitive ability and memory power, even though the anti depressants rescued me from my pit. Without my doctors consent I quit and drop the medicines. But however I managed the withdrawal symptoms. But now I doubt my decision. So please help me and guide me.
I have a long history of illness so I presented myself in two parts psychologically and medically.
Medical History:
1. 1999: I have social phobia since my age 15 but untreated. I had worries about small penis, lack of social interactions, tremors on neck when facing trouble situation, afraid of being identified as virility less boy. so i tried to hide secretly but eventually friends comes to know and they comment about it,so i felt like less man.
2. 2001:As worries grown up at my age 18 I received some treatment for auxiliary symptoms of social phobia , insomnia (alphrazolam, after that clonazepam) that was enough for that time
3. 2002: With these thoughts going to college is not easy and my nightmare is that there are girls in the college should not be know about me as looser. They should see me as a hero according to my fantasies. But in reality I am afraid to what I hide.So I cut my college mostly and occasionally used clonazepam and alphrazolam to manage situation under my control. If I control my tremor and anxiety I can successfully manage to show my confidence and skills. All I afraid is the anxiety and tremor when speaking with girls, stage, very few friends. not single girl friend.
4. But on and after college I had faced some XXXXXXX persons and their style of proposal. My friends told me they also been in a kind of situation. But that not compromise me. It’s give me panic about my look. I thought I look like XXXXXXX or feminine looking guy. And this is added to my panic pack. But so far the clonazepam and propanolol saves me.
5. 2007 : I was jobless(afraid of interview), worried much by the inferior thoughts I began loosing control over my thoughts, i afraid i shake in head that will definitely happened.one time when speaking with my friends I spoke mistakenly .that was my friend asking me about when to marriage but i without understanding about the question replied “who him” and pointing to the near friend ( I ment that is he asking about his marriage, but they consider it I marriage him) they silently went and spread the rumor all over to my friends.
6. That’s it, I burst. I can’t stop trembling if I think of trembling(on neck and head). When I am like that I cant speak to anybody freely and they suspect me more like” does his character change truly and the rumor is correct”. So I cant go out, speak to any of my friends, and my panic attacks started. Weired thoughts, insomnia, fear, changed personality and character broken me down. Clonazepam and propanolol didn’t work now.
7. But till 2010 I cant explain my situation and how I troubled with my problems to any doctor so I can’t get the proper medicine. After long search on the net I found that ssri I good medicine and will help me. And go straightly and ask about it. And got it.
8. 2011: I am using nexito ls(escitalopram 10+clonazepam.25)for 3 years. That greatly recovers me and allows me to understand the reality about what I worried. That matures me and I am in good shape now. But the problem is my doctor who prescribed the medicine is shifted to another state so I took it the medicines without doctors advice.
9. 2014: So happy now I thought when I should stop this medicine because I think I developed good and the medicine makes me drowsy and dull so I cant prepare for my job examination. So I went to the psychiatrist and told my problem. And he began to change expand medications. He added first set with escitalopram 10, clonazepam .25, mirtazapine 15, and modofil 100. I told him the mirtaze first seems good but later gives aggressiveness.
10. So he change medice and gave me desvenlafaxine 50, mirtaze15, etizolam .5, and agomelatine, modofil. (50 days)
11. I thought that was too much for me and ask him how long should I took this med . and he told me as long as needed. What is this answer. already I am fine before comes to him.i just feel drowsy and interest less in any thing that’s all. So I quit him and withdraws the medicines with the help of local neurologist and medicine(flupentizol+melitracine for 20 days). He advised me another month of that medicine but I refused to take it more
Now I am out of medicine for 40 days. And I am using clonazepam .5 for maintenance. But it seems that I am addicted to that and have lot of withdrawal problem with it.
Now I am worry about did I do wrong, should I continue medicine for more? Because I have a long history and I still have to face something serious like job searching, marriage etc...
So please tell me sir, should I resume the medication. If yes then
1. what is the good medicine for me (among the lot I have taken which is actually good for me and with less withdrawal and side effects)
2. who will be the best choice in doctors(neuro, psycho,)
3. who to decide when I stop the medicines
4. what about cognitive impairment by the medicines
please see my previous questions if any doubts thank you
Brief Answer:
You can take paroxetine
Detailed Answer:
HI
Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query.
After reading your case history, i can say few things about you. One, you have cluster c personality traits and second you have anxiety disorder. In that case, quitting medications could lead to relapse, so better to take them for years. I would suggest for more than 10 years or may be life long. That would help to control symptoms and keep you in good shape.
Now coming to your queries:
I would prefer paroxetine in your case. It is a SSRI and a very good antidepressant. Among antidepressants, it has very good effect on anxiety symptoms. It would help in controlling both depressive and anxiety symptoms. It has better effect than escitalopram. In your case, you got good response with escitalopram, but i would prefer paroxetine, due to more anxiety symptoms in your case and it has best response on anxiety symptoms.
Better to consult a psychiatrist about treatment. Psychiatrists have good knowledge about the disorder and they can give you better advise. I don't know your experience with psychiatrist, but psychiatrist are specialized in such cases and whenever you need help or face any problem, you could consult a psychiatrist. Never stop your medications without consultation. If you stop them abruptly, either you would get relapse or withdrawal. So, better to stop or taper down with psychiatrist consultation.
Antidepressant helps to improve cognitive functioning, but continuous use of benzodiazepine like clonazepam or etizolam, it could effect on cognitive function. Better to take them on sos basis to avoid dependence or cognitive impairments. You can try also try some relaxation exercise, that would help to control anxiety symptoms.
In case, you have more query, you can ask.
Regards
Dr. Abhishek Kapoor
Psychiatrist
You can take paroxetine
Detailed Answer:
HI
Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query.
After reading your case history, i can say few things about you. One, you have cluster c personality traits and second you have anxiety disorder. In that case, quitting medications could lead to relapse, so better to take them for years. I would suggest for more than 10 years or may be life long. That would help to control symptoms and keep you in good shape.
Now coming to your queries:
I would prefer paroxetine in your case. It is a SSRI and a very good antidepressant. Among antidepressants, it has very good effect on anxiety symptoms. It would help in controlling both depressive and anxiety symptoms. It has better effect than escitalopram. In your case, you got good response with escitalopram, but i would prefer paroxetine, due to more anxiety symptoms in your case and it has best response on anxiety symptoms.
Better to consult a psychiatrist about treatment. Psychiatrists have good knowledge about the disorder and they can give you better advise. I don't know your experience with psychiatrist, but psychiatrist are specialized in such cases and whenever you need help or face any problem, you could consult a psychiatrist. Never stop your medications without consultation. If you stop them abruptly, either you would get relapse or withdrawal. So, better to stop or taper down with psychiatrist consultation.
Antidepressant helps to improve cognitive functioning, but continuous use of benzodiazepine like clonazepam or etizolam, it could effect on cognitive function. Better to take them on sos basis to avoid dependence or cognitive impairments. You can try also try some relaxation exercise, that would help to control anxiety symptoms.
In case, you have more query, you can ask.
Regards
Dr. Abhishek Kapoor
Psychiatrist
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Sir,
It’s very grateful to have your support. I visited a new doctor today and told him my situation. In my town there is only one doctor available. He is new and must have the same age as me.I was little shy about to told the full history of illness. Instead I told him how long I have been on depressant and why did I took it for ,uncontrolled social anxiety, recent medication changes and withdrawal. I told him that after withdrawal I was on clonazepam .5 for 2months, and (escitalopram 5mg, mirtazapine 7.5 for past 3 days on my own because there are no doctors available in the mean time). And I told him that I afraid about my decision about medicine withdrawal.
He suggest me to take mirtazapine 7.5 with clonazepam .25 for 15 days.
So I have some more doubts , I want to reassess my details sir,
1) I doubts my doctors decision, because I didn’t told him how long I have been worried and in what ways. So he can’t observe me completely, he thinks that i am willing to stop taking medication.but i am not i am only worried about what is right. So what should I do about medication?
2) Now I am not having any panic when meeting strangers, but I worry about shaky symptoms. If it’s not come I am all right.
3) I am rationalized much more now than when I was depressed.
4) Sleeping cycle is not good, daytime sleeping and night time tiredness
5) Considering above that how strong you recommend me to take antidepressant for more years.
6) Paxil is not available around here I think, but I didn’t ask the doctor to prescribe it to me because most of them will upset when we suggest. in that case Can you suggest other medication over that or recommend the same again
7) I like the clonazepam for its effectiveness but I didn’t like for its addictions. I have used maximum .5mg a day. Even this little amount gives me strong anxiety when withdraw. I am now .25mg at night. Should I stop it right now on?
8) What is the medicine I should take now? Or best for me ?
It’s very grateful to have your support. I visited a new doctor today and told him my situation. In my town there is only one doctor available. He is new and must have the same age as me.I was little shy about to told the full history of illness. Instead I told him how long I have been on depressant and why did I took it for ,uncontrolled social anxiety, recent medication changes and withdrawal. I told him that after withdrawal I was on clonazepam .5 for 2months, and (escitalopram 5mg, mirtazapine 7.5 for past 3 days on my own because there are no doctors available in the mean time). And I told him that I afraid about my decision about medicine withdrawal.
He suggest me to take mirtazapine 7.5 with clonazepam .25 for 15 days.
So I have some more doubts , I want to reassess my details sir,
1) I doubts my doctors decision, because I didn’t told him how long I have been worried and in what ways. So he can’t observe me completely, he thinks that i am willing to stop taking medication.but i am not i am only worried about what is right. So what should I do about medication?
2) Now I am not having any panic when meeting strangers, but I worry about shaky symptoms. If it’s not come I am all right.
3) I am rationalized much more now than when I was depressed.
4) Sleeping cycle is not good, daytime sleeping and night time tiredness
5) Considering above that how strong you recommend me to take antidepressant for more years.
6) Paxil is not available around here I think, but I didn’t ask the doctor to prescribe it to me because most of them will upset when we suggest. in that case Can you suggest other medication over that or recommend the same again
7) I like the clonazepam for its effectiveness but I didn’t like for its addictions. I have used maximum .5mg a day. Even this little amount gives me strong anxiety when withdraw. I am now .25mg at night. Should I stop it right now on?
8) What is the medicine I should take now? Or best for me ?
Brief Answer:
You can try venlafaxine
Detailed Answer:
Hi
Mirtazapine is a good antidepressant, but it would not helpful in anxiety symptoms. You need antidepressant to control anxiety. With mirtazapine, you would get sound sleep, but with that there is no need to take clonazepam at night. You should try another antidepressant like venlafaxine. It is best antidepressant among SNRIs and is very effective in controlling anxiety symptoms. You need antidepressant for years. Since childhood, you have anxiety symptoms. In that case, better to take antidepressant for at least 4 to 5 years or more. You can also take clonazepam on sos basis to control anxiety or get sleep. That would avoid tolerance and dependence pattern.
In case, you need further help, you can ask.
Regards
Dr. Abhishek Kapoor
Psychiatrist
You can try venlafaxine
Detailed Answer:
Hi
Mirtazapine is a good antidepressant, but it would not helpful in anxiety symptoms. You need antidepressant to control anxiety. With mirtazapine, you would get sound sleep, but with that there is no need to take clonazepam at night. You should try another antidepressant like venlafaxine. It is best antidepressant among SNRIs and is very effective in controlling anxiety symptoms. You need antidepressant for years. Since childhood, you have anxiety symptoms. In that case, better to take antidepressant for at least 4 to 5 years or more. You can also take clonazepam on sos basis to control anxiety or get sleep. That would avoid tolerance and dependence pattern.
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
Answered by
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