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Suggest Treatment For Irritability While Having Persistent Anxiety And Depression

Posted on Tue, 4 Apr 2017

Question: I had been taking an antidepressant (Prozac) for over 14 years when this past fall, I felt more depressed and anxious. Prozac years ago was prescribed for General Anxiety Disorder and Depression. Thinking it may no longer be working, I asked my doctor to switch my meds. He tried Zoloft which did not work. It made me irritable. I then tried Viibryd (sp) which also made me irritable. After several weeks, I have come off of the antidepressants (a very very hard six weeks) and my doctor is trying Buspirone. However, after a week on this med, I am much more on edge, anxious and mostly very irritable, unable to "handle" the least little thing. Ativan calms me but I don't want to take that all the time. Background: This past year, I have had a stressful time in my job as a hospice social worker and in caring for both elderly parents (in a facility) but moving them, etc. and taking to doc appts. I am seeing a therapist (as of 2 months ago). The irritability is horrible right now and is my main concern. I seem to be unable to a handle anything and am picking fights with my husband which is very very unusual behavior. Thank you!

Answered by Dr. Seikhoo Bishnoi (40 minutes later)

Brief Answer:
Irritability is due to persisting anxiety and depression

Detailed Answer:
Hello thanks for asking from HCM.

I can understand your concern. Your main concern is irritability which is resulting in problems in your social, occupational and personal life. Irritability is due to persisting anxiety nd depressive symptoms. Prozac, Zoloft, Vibryd etc all drugs are serotonergic medications and help in controlling anxiety and depression. But these drugs are not useful in exacerbation of symptoms like irritability, in your case. Ativan or lorazepam is a benzodiazepine drug. It can control acute exacerbations.
You can use this drug on SOS basis. There are other drugs like propranolol or atenolol which can be used in place of Ativan. These can help you in controlling irritability. These drugs can be used on regular basis without abuse potential and serious side effects.
If this option does not work, then other option is to add some augmentation drugs along with Prozac like Bupropion. It can control your symptoms effectively.
Please consult your doctor regarding all these options. Your irritability will reduce.

Thanks and Take care. You are welcome to ask follow up doubts.

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

Follow up: Dr. Seikhoo Bishnoi (7 minutes later)

Thank you so much. This answer helps clarify my question and concerns. In the meantime, in your opinion should I continue the Buspar and take the Ativan as needed until I can see my doctor or should I discontinue the Buspar altogether? It has only been one week since I began taking it and exactly the same amount of time that I am feeling horribly tired and irritable.

Answered by Dr. Seikhoo Bishnoi (8 hours later)

Brief Answer:
No need to take Buspar.

Detailed Answer:
Hello again,

You can take Ativan on SOS basis and no need to take Buspar as in low doses the drug has not much efficacy. Ativan will definitely control the symptoms. This will not cause irritability.

Thanks. Take care

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

Follow up: Dr. Seikhoo Bishnoi (8 hours later)

Thank you Dr. Bishnoi. I have another question. I am trying desperately to feel "mentally" better again. I am hoping to see my doctor tomorrow to discuss another option for me. After reading your answers, I feel more confident that I truly need to be on some sort of anti-depressant that addresses the "anxiety issue" as well. (1) Since Prozac was very effective for me along with Ativan (.5 - 1 mg) to help with sleep at night), would it possibly be effective for me to again?
Since November/December 2016 I have just been beside myself in dealing with going off and trying new meds; side effects of the meds and withdrawal symptoms!
(2) should I seek out a Psychiatrist rather than an Internal Medicine Doc?
Thank you again for your professional advice. I am most appreciative.

Answered by Dr. Seikhoo Bishnoi (7 hours later)

Brief Answer:
Please consider consulting a psychiatrist.

Detailed Answer:
Hello again

Yes as Prozac and Ativan resulted in relief in past so these drugs should be tried first. The drugs will be effective for you again.

Better to consult a psychiatrist for opinion rather than an internal medicine specialist because your main issues are related to irritability. Treatment of stress and irritability would help to control your symptoms.

Thanks.

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

Follow up: Dr. Seikhoo Bishnoi (6 hours later)

I spoke with my doctor today and he suggested that i stop the buspar and start taking celexa. I will try but will consult with psychiatrist if this doesn't work. Thank you for your help.

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
Celexa is also a SSRI drug.

Detailed Answer:
Hello again

Celexa or Citalopram is also a SSRI drug like Prozac and will definitely act in your symptoms. You can start taking this without any worries.

Thanks.,

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

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