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Suggest Treatment For Depression
Question: My father is feeling very low in mood and not able to get out of his bed.This has been the situation for the past 10 months now during which he was treated for depression with different anti depressants to no effect.The anti depressants have made him even worse and he also developed suicidal tendencies.The major issues he thinks he has is that he has no money and is financially broke which is just the opposite, we are more than okay.He is becoming more paranoid and hates taking anti depressants and thinks he will never get better.He also had a injury to his nose cause by hitting through a door after which his symptoms of depression and paranoia started.Although we also had a death in the family (our grandmother ) but his symptoms started earlier.Also he had similar a depression episode 22 years back but he recovered in a few months.Kindly help!!
Brief Answer:
Please see details below.
Detailed Answer:
Dear Mr. XXXXXXX
I went through your query in detail and can understand your concern regarding your father's condition. Depression is terrible condition to suffer from. However, with adequate treatment, I am sure your father will be able to overcome depression.
From what you have mentioned, your father seems to be suffering from depression with psychotic symptoms. Psychotic symptoms are in form of the delusion of poverty in which he feels he has no money. In addition, he is manifesting the negative thinking pattern that is characteristic of depression.
You have mentioned that he is currently on Manicarb (lithium), zapiz (clonazepam) and nexito (escitalopram). I would have wanted to know the exact dose and duration of the medications. Escitalopram is an anti-depressant, and clonazepam is an anti-anxiety drug and sedative. Lithium is a mood stabiliser and is also used in case of resistant depression.
Had I been your father's treating psychiatrist, I would have advised admission considering the fact that he is not responding well to medications and also having side effects with medications. I would have started him on one of the anti-depressants like escitalopram or venlafaxine together with an anti-psychotic drug like olanzapine to take care of the delusions.
In current scenario, I would like to know the dose he is currently on. Escitalopram can be given at a maximum dose of 20 mg/day. In addition I would like to have the serum levels of lithium to make sure it is at an adequate dose. If Escitalopram has already been on maximum dose for 3-4 weeks, I would consider changing the anti-depressant to something like venlafaxine.
I would also evaluate him for any possible medical comorbidity to rule out any other reason for the resistance to treatment like hypothyroidism or vitamin B12 deficiency.
Finally, there is an option of electro-convulsive therapy (ECT) if none of the medications are able to help him take care of depression. ECT is a very safe and very very effective mode of treatment for depression and can definitely be considered as an option.
I do hope I was able to answer your query. Please let me know if you have nay further queries.
Wishing your father a very speedy recovery,
Dr. Sunil Gupta
Please see details below.
Detailed Answer:
Dear Mr. XXXXXXX
I went through your query in detail and can understand your concern regarding your father's condition. Depression is terrible condition to suffer from. However, with adequate treatment, I am sure your father will be able to overcome depression.
From what you have mentioned, your father seems to be suffering from depression with psychotic symptoms. Psychotic symptoms are in form of the delusion of poverty in which he feels he has no money. In addition, he is manifesting the negative thinking pattern that is characteristic of depression.
You have mentioned that he is currently on Manicarb (lithium), zapiz (clonazepam) and nexito (escitalopram). I would have wanted to know the exact dose and duration of the medications. Escitalopram is an anti-depressant, and clonazepam is an anti-anxiety drug and sedative. Lithium is a mood stabiliser and is also used in case of resistant depression.
Had I been your father's treating psychiatrist, I would have advised admission considering the fact that he is not responding well to medications and also having side effects with medications. I would have started him on one of the anti-depressants like escitalopram or venlafaxine together with an anti-psychotic drug like olanzapine to take care of the delusions.
In current scenario, I would like to know the dose he is currently on. Escitalopram can be given at a maximum dose of 20 mg/day. In addition I would like to have the serum levels of lithium to make sure it is at an adequate dose. If Escitalopram has already been on maximum dose for 3-4 weeks, I would consider changing the anti-depressant to something like venlafaxine.
I would also evaluate him for any possible medical comorbidity to rule out any other reason for the resistance to treatment like hypothyroidism or vitamin B12 deficiency.
Finally, there is an option of electro-convulsive therapy (ECT) if none of the medications are able to help him take care of depression. ECT is a very safe and very very effective mode of treatment for depression and can definitely be considered as an option.
I do hope I was able to answer your query. Please let me know if you have nay further queries.
Wishing your father a very speedy recovery,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the answer
Manicarb 300 mg twice daily,zapiz 0.5 mg twice daily and nexito 10 mg once at night is the dosage for the week.
The antidepressant you mentioned were already administered we have been to 5 doctors already each have prescribed antidepressant of no use. The drugs seems to have more side effects than good along with suicidal tendencies. Although the suicidal tendencies have declined now but still he cannot get himself out of bed. The medicines have made him worse.So we now think of getting him of meds since the aggression he developed was only after the meds.The ECT treatment you mentioned have their own side effects like memory loss. He is functioning in the sense he knows what is going on and eating normally but only thing is he doesn't talk. We need something other than drugs and ECT. Do things like omega 3 ,physical exercise can help to overcome depression.Meds have made his depression worse
Manicarb 300 mg twice daily,zapiz 0.5 mg twice daily and nexito 10 mg once at night is the dosage for the week.
The antidepressant you mentioned were already administered we have been to 5 doctors already each have prescribed antidepressant of no use. The drugs seems to have more side effects than good along with suicidal tendencies. Although the suicidal tendencies have declined now but still he cannot get himself out of bed. The medicines have made him worse.So we now think of getting him of meds since the aggression he developed was only after the meds.The ECT treatment you mentioned have their own side effects like memory loss. He is functioning in the sense he knows what is going on and eating normally but only thing is he doesn't talk. We need something other than drugs and ECT. Do things like omega 3 ,physical exercise can help to overcome depression.Meds have made his depression worse
Brief Answer:
Please see details below.
Detailed Answer:
Dear Mr. XXXXXXX
Thanks for following up. I can understand that you are quite dejected with the fact that till now, the treatment being provided to your father has not been helpful. However, treatment for depression can often be tricky. Most of the medications need adequate time and dosing to show response and we need to be patient about them. Considering the severity of depression, anti-depressants are definitely required for him.
Regarding your current medications, if your father has been on nexito for just one week, it should be continued for another 1-2 weeks and according to response, dose can be further hiked. Ant-depressants usually require 2-3 weeks to how response.
Regarding ECT, I can understand your concern regarding the side effects of memory loss. But this memory loss due to ECT is completely reversible once the ECTs are stopped.
The other treatment options include psychotherapy. But that wont be a feasible option due to two reasons. One he is not talking much and secondly he is having delusions.
Coming to your query regarding omega 3 fatty acids, they are not shown to be better than placebo in clinical studies and can only be helpful if used as adjuvants to anti-depressants.
Physical exercise will definitely be helpful, again as adjuvant to medications. You can start with simply asking him go for morning walks. They help a person feel better in depression.
So, my recommendation will still be anti-depressants under a proper supervised care. Of course the final decision will be yours, but I will definitely urge not to take him off medications.
I do hope that your father recovers soon enough.
Best wishes,
Dr. Sunil Gupta
Please see details below.
Detailed Answer:
Dear Mr. XXXXXXX
Thanks for following up. I can understand that you are quite dejected with the fact that till now, the treatment being provided to your father has not been helpful. However, treatment for depression can often be tricky. Most of the medications need adequate time and dosing to show response and we need to be patient about them. Considering the severity of depression, anti-depressants are definitely required for him.
Regarding your current medications, if your father has been on nexito for just one week, it should be continued for another 1-2 weeks and according to response, dose can be further hiked. Ant-depressants usually require 2-3 weeks to how response.
Regarding ECT, I can understand your concern regarding the side effects of memory loss. But this memory loss due to ECT is completely reversible once the ECTs are stopped.
The other treatment options include psychotherapy. But that wont be a feasible option due to two reasons. One he is not talking much and secondly he is having delusions.
Coming to your query regarding omega 3 fatty acids, they are not shown to be better than placebo in clinical studies and can only be helpful if used as adjuvants to anti-depressants.
Physical exercise will definitely be helpful, again as adjuvant to medications. You can start with simply asking him go for morning walks. They help a person feel better in depression.
So, my recommendation will still be anti-depressants under a proper supervised care. Of course the final decision will be yours, but I will definitely urge not to take him off medications.
I do hope that your father recovers soon enough.
Best wishes,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The doctor has continued the same medication for another two weeks. My father has shown some improvement though like is aggression is under control and even he speaks very less says he's getting better sleep with this medication.The doctor says that nexito takes at least 2 weeks to show effect.But he still has thought and worries about money and still feels to lie down all day.
Brief Answer:
He will improve gradually.
Detailed Answer:
Dear Mr. XXXXXXX
Thanks for following up. I am glad to note that your father has started showing some improvement in symptoms and that he is able to sleep better. I would agree with your doctor regarding the decision to continue with nexito at the same dose for another two weeks. He is absolutely right when he says that nexito or for that matter any anti-depressant shows at least 2 week to start showing response.
With time, the depressive symptoms that your father is having will go off. He will start feeling better and his worries will slowly disappear. At this point I would just advise you to be patient. Following two weeks, your psychiatrist will reassess the symptoms of your father and accordingly decision to increase the dose or to continue at the same dose can be taken.
I do hope that your father attains good health as soon as possible. Please let me know if I can be of further help to you.
Best wishes,
Dr. Sunil Gupta
He will improve gradually.
Detailed Answer:
Dear Mr. XXXXXXX
Thanks for following up. I am glad to note that your father has started showing some improvement in symptoms and that he is able to sleep better. I would agree with your doctor regarding the decision to continue with nexito at the same dose for another two weeks. He is absolutely right when he says that nexito or for that matter any anti-depressant shows at least 2 week to start showing response.
With time, the depressive symptoms that your father is having will go off. He will start feeling better and his worries will slowly disappear. At this point I would just advise you to be patient. Following two weeks, your psychiatrist will reassess the symptoms of your father and accordingly decision to increase the dose or to continue at the same dose can be taken.
I do hope that your father attains good health as soon as possible. Please let me know if I can be of further help to you.
Best wishes,
Dr. Sunil Gupta
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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