Brief Answer:
As below.

Detailed Answer:
Hi XXXX

The situation that you mention is indeed extremely stressful. But I am happy to note that you have not let it overwhelm you and are still in control.

I would suggest that you start the breathing exercise I mentioned in one of my earlier answers. It can be performed by everyone and is safe as well as effective. You will notice an instant relief in your mental state. Do it frequently, maybe 8 to 10 times a day, and especially before relatively stressful situations like a talk with the boss etc. It simply requires you to take long and deep breaths slowly, taking at least twice the time to exhale than to inhale. It can be done anywhere and in any position, whether sitting, standing or lying down. Do it for one to two minutes, though actually you can do it for as long as you like.

You should continue with the medicines you are on, taking care not to miss any of the doses. I do not feel that a hike in the dose is necessary at present and I have a feeling that you will manage to come out of this. However, hiking the dose is an option that is available to us and can be resorted to whenever required. There is one suggestion that may make a difference. You are currently taking 0.5 mg Rivotril at night. You can try taking 0.25 mg twice a day instead of taking 0.5 mg at night. This will control the daytime anxiety better without having to increase the dose. However, if this hampers your sleep at night then it will be better to continue with 0.5 mg at night and supplement it with 0.25 mg or 0.125 mg in the morning on a SOS basis (as and when required). Rivotril is also available in double scored tablets of 0.5 mg strength and can therefore be split to 0.125 mg which will be one-fourth of the 0.5 mg tablet.

Please do not hesitate to do the breathing exercise. You can also do more complicated relaxation exercises when you get the time. But the breathing exercise that I have mentioned is simple, can be done anywhere in any situation and by anyone. And it works.

It is said that whatever happens, happens for the best. I too hope that things will work out for you. Please let me know if there is any problem. I'll do what I can to help you.

Take care.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
As below.

Detailed Answer:
Hi XXXX

If you feel that the dullness is affecting your performance at work and thereby risking your job further, then I would suggest that you do not wait to hike up the medicines.

Of bupropion and escitalopram, I would prefer to hike bupropion for two reasons. One, it has suited you better than Cipralex. Secondly, it is a stimulating antidepressant and should combat lethargy faster and better than Cipralex. It can be hiked to 450 mg per day. The only problem is that splitting of tablets would not be a good idea. The 450 mg XL preparation (Forfivo XL 450 mg) is not available everywhere. Taking one and half of 300 mg XL would mean splitting it, which is not recommended. I would suggest that you take one tab each of 300 mg XL and 150 mg XL. Once hiked, the dose should be continued for at least a few months.

If by any chance you feel that it is not low mood that is creating problems for you but just anxiety, then hiking Rivotril may help for a short term. Whatever change you make in the medicines, try the breathing exercise. It will help you.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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