Hat Are The Best Medicines For Depression And Cognitive Enhancement?

Posted on Fri, 1 Nov 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 1 Nov 2013 Answered on

Wed, 18 Dec 2013 Last reviewed on

Question : I am undergoing treatment for psychosis and mood disorders for the past 14 years. I no longer have the positive symptoms of psychosis but have mood related problems such as mania and depression and some cognitive impairment due to little drowsiness caused by these mediicines. I am taking Oleanzapine 5 mg Risperidone 4 mg elicia 8 mg in night and 4 mg in the morning, lonazep 2 mg morning and night, bextol 2 mg in the morning. What are the best medicines for depression and cognitive enhancement? I am also taking lopez 2 mg morning and night, lonazep 2 mg morning and night, sodium vaporate 500 mg AT night and modafilin 200 mg morning and bextol 2 mg in the morning. Please suggest whether any other medicines will be suitable for me for mania and depression and a cognitive enhancer which does not induce mania or psychosis.

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer: Hello Detailed Answer: Welcome to Health Care Magic You have been taking treatment for psychosis and mood disorders. You are having more negative symptoms and your mood symptoms are under control. There is only mild cognitive impairment. You are taking Olanzapine 5 mg, Resperidone 4 mg and Elicia 12 mg, Clonazepam 4 mg, Lorazepam 2 mg, Sodium Valproate 500 mg, Modafinil 200 mg, Tryhexiphenidyl 2 mg per day. See you are currently taking three anti-psychotic drugs. Resperidone, olanzapine and elicia. See these are very good medicines for control of psychosis and mood symptoms but as per my opinion and also as per guideline multiple antipsychotics use is not advisable. Even 4 mg Resperidone will cause almost same control as all these medicines together. Consult your doctor to cause change in your prescription. The excess cognitive decline is occurring due to use of multiple drugs most probably. You are taking 4 mg Clonazepam and also 2 mg Lorazepam which are causing excessive sedation and cognitive decline. Even use of single drug can control excitement and will result in good sleep. There are many medicines that can be used in depression and cognitive decline like amisulpride. The drug is an antipsychotic drug but it is a very useful drug for control of negative symptoms and it also cause improvement in cognitive symptoms. The cognitive problems you are facing are not due to disease itself but they are due to negative symptoms. Control of negative symptoms will cause improvement in cognitive decline. Hope this helps you, if you have more questions you can ask again. Thanks

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

Follow up: Dr. Seikhoo Bishnoi (20 hours later)

HI Doctor, Thanks for your reply. Since I am taking many medicnes for psychosis, bipolar and depression at night, I don't get depressed at night because after taking these prescribed medicines, I fall asleep within 30 minutes and have good sleep between 9 pm to 6 am, My problem is for controlling of of mood disorder and depression in day time and the medicines taken during day time for depression and mood disorder should not cause drowsiness or sedation because I have joined some career enhancement professional courses and I should be alert between 9 am to 9 pm. My Doctor tried serta but it caused psychosis. Afterwards, my doctor tried nexeto 10 mg but it increased my mania. Can you please suggest an anti-depressant which does not cause drowsiness and sedation during day time and which can be taken in the morning and afternoon and the medicine should not increase my mania or increase my psychosis. Please suggest an appropriate anti-depressant which can be taken in the morning and afternoon. Thanks and Regards, Mr. XXXXX

Answered by Dr. Seikhoo Bishnoi (37 hours later)

Brief Answer: Hello again Detailed Answer: There are many anti-depressants that don't cause drowsiness in day time like some SSRIs as escitalopram (nexito), fluoxetine etc. But as you have also experienced there is risk of aggravation of mania. There are many other drugs that can be used in bipolar disorder with depression like lamotrigine. This drug is very effective in depression and control the mood symptoms effectively. The side effect of drowsiness is also not very significant and can be tolerated. Inspite of modafinil you can go for armodafinil. The drug is improved derivative of modafinil and is better tolerated. There is no need to take the drugs in morning you can continue to take your drugs in evening as armodafinil will take care of drowsiness in day time. Mirtazepine at high doses like 15-30 mg don't cause much sedation as compared to 7.5 mg doses. You can consult with you doctor for that. Amisulpiride is an anti-psychotic drug that can be used to improve negative symptoms in depression. The drug is also very effective in bipolar depression and it also don't increase the risk of mania. The drug is free of serious side effects and is better tolerated. This can be taken in both morning and evening. Thanks, hope this helps you, if you have more questions you can ask again.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Seikhoo Bishnoi (19 days later)

Hi, I have uploaded my latest blood test based comprehensive checkup Aaroggyam 1.7a package report administered to me by Thyrocare. Please analyze the report and suggest to me any possible abnormal values / potential future diseases / complications based on the blood test report and the potential medications that will help me address these issues without having drug contractions with my psychiatric drugs. Regards, XXXXX

Answered by Dr. Seikhoo Bishnoi (19 hours later)

Brief Answer: Hello again Detailed Answer: I have gone through the reports and after reading the report I can conclude that most of lab parameters in this report are in normal range apart from minor changes in some levels. Thyroid function tests are in normal range apart from a little change in TSH levels and as the T3, T4 levels are in normal range so there is no need to worry. To be on safer side you can go for thyroid function tests after three months. The levels of HsCRP are high and this may predict the risk of coronary artery diseases but most of commonly used parameters are in normal range still I would advise you to keep control over fat and refined carbohydrates intake. Exercise daily. There is no need to worry for that. VLDL are also in high range but you have to follow dietary control for that. For these values there is no need to consult a doctor. Your blood picture denotes microcytic hypo chromic anaemia or simply iron deficiency anaemia. Hb is in lower range for males and also the size of Red blood cells is low so as per my opinion you should start taking green vegetables and citrus fruits in diet. You can take ferrous sulfate capsules or syrup daily for that. Apart from that most of the report is normal. Thanks

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

Follow up: Dr. Seikhoo Bishnoi (19 hours later)

Hi Doctor, Thanks for your re-assuring report that most of the negative indicators in the report can be treated by altering my diet and I can take these tests after three months and then decide to go for medications in case there is increase in the negative parameter values. One test report indicated that I have a high risk of Arthritis. Already, I am taking Bexol DT 2 Mg, and Indral 40 mg daily for my mild tremors. I am also taking one capsule of Renerve Plus daily. Do you suggest that I consult an Ortho regarding my Arthirisis high risk profile report. Regards, XXXXX.

Answered by Dr. Seikhoo Bishnoi (33 hours later)

Brief Answer: Hello again Detailed Answer: There is no need to consult a orthopedic doctor acutely as mild variations are some times seen in normal persons also. Try to modify your diet and if possible start taking calcium supplementation and Vitamin D supplements. This will help in normal bone metabolism also. Rest be assured there is nothing abnormal in report. Thanks

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

Follow up: Dr. Seikhoo Bishnoi (2 days later)

Hi Doctor, Thanks for your positve outlook and quick response to my question. Last week due to A NEGATIVE drug interaction with OFFIN 400 MG, prescribed by my General Physicial for stomach upset, which I took twice daily for 2 days, my psychotic symptoms have increased. I am having both posiive and negative symptoms and extreme agitation, anger and irritability over small issues. My pSYchiatrist has given me Elicia 4 mg 1-0-2, Sizopon Plus 0-0-1, Oleaanzapine 5 mg 1-0-2 and Lopez 2 mg 1-0-1, Bextol 2mg 1-0-0 and Lonazep 1 mg as SOS to be taken when I have panic attacks. Which is the best combination of anti psychotic medicines which I can discuss with my doctor so that I can quickly within four weeks have control over positive and negative symptoms and also have good mood elevalation without entering into mania. Regards, XXXXX

Answered by Dr. Seikhoo Bishnoi (40 hours later)

Brief Answer: Hello again Detailed Answer: For quick relief you have been prescribed good drugs. They will control positive symptoms effectively. Apart from that for negative symptoms you can discuss for amisulpiride drug. It is also an anti psychotic and it can control the negative symptoms. the drugs take about 4-6 weeks to show full effect so please wait for that period. But the positive symptom will come under control in a week. Thanks

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