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How to overcome my depression symptoms?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At April 22, 2017
Reviewed AtJanuary 18, 2024

Patient's Query

Hello doctor,

I am a 42 year old male. I feel extremely weak after sleeping in the afternoon on weekends. And even after taking breakfast I feel sleepy, and I sleep off. I got a kidney transplant done five years back, and I am under psychiatric treatment from the past 15 years. I currently take the following medicines Nexito 20 mg, Quitipin 25 mg, and Modafinil 25 mg. How to overcome the ongoing depression symptoms?

Hello,

Welcome to icliniq.com.

I can understand your concern. You are on 20 mg Nexito (Escitaprolam), Modafinil 25 mg, and 25 mg Quetiapine, even with these medicines, your symptoms are persistent. So, some minor changes in medicines will help you to come out of these symptoms. In suggest try taking Amisulpride 25 to 50 mg in place of Quetiapine, it will help in reducing these negative symptoms. This will reduce the daytime sedation too. The dose of Modafinil can be increased to 100 mg in the morning after breakfast. This will improve the daytime alertness and will surely improve your functioning. I advise you to get your thyroid function test and vitamin B12 levels done. Hypothyroidism and low vitamin B12 levels are common reasons for persistent depressive symptoms. Include Vitamin B12 and Omega-3 fatty acid supplements in your diet, and you will surely see improvements. Please follow these steps, and consult your treating doctor about the dose adjustments. For more information consult a doctor back. Thank you.

Patient's Query

Thank you doctor,

But, I am taking Modafinil 50 mg. Do I still need to increase the dosage?

Hello,

Welcome back to icliniq.com.

  • Yes, even if you are taking 50 mg Modafinil, increase it to 100 mg after consulting your doctor. This will make your functioning better. For further queries consult a doctor.

Patient's Query

Thank you doctor,

Now my concern is that if I argue with a member of my family, especially at night, there is an extreme feeling of something unusual like afraidness from my heart area. Secondly, I get jerks during the whole night of the argument, and I cannot sleep.

Hello,

Welcome back to icliniq.com.

You are suffering from mood disturbance, and depressive symptoms are persisting. This is occurring because of poor response to medicines. Inability to suppress unwanted thoughts after arguing with some family member and then emotional reactivity are happening because of depressive symptoms only. You have to accept that these changes are happening because of depression, and with the treatment, you will be fine. For poor sleep and anxiety during sleep after some argument, you can think of taking drugs like Clonazepam in a dose of 0.25 to 0.5 mg on an SOS basis, or you can take 50 mg of Quetiapine instead of 25 mg on that particular day. This will help in early and refreshing sleep, and you will wake up refreshed. With time your depressive symptoms will start decreasing. Just do not lose hope. Thanks. Take care.

Patient's Query

Thank you doctor,

I am giving my past medical history. I have done a kidney transplant nine years back. I was under psychiatric treatment for 19 years. I am currently taking Nexito 20 mg once daily at night, Quitipin 25 mg once daily at night, and Modalert 50 mg once daily after breakfast.

1. how can I avoid jerks especially felt during my weekend (on Saturday and Sunday) while sleeping in the afternoon? It remains pretty frustrating.

2. At night, before sleeping, if I take Quietipin 50 instead of 25 mg after a particular event of arguments that happens by chance, will it bring relief to me and sleep? Secondly, will it make me afraid of taking Qutiepin 50 instead of 25 when the dose has been doubled without asking my psychiatrist? I do not think that it will become a big issue.

3. You have been advised to increase the dose of Modafinil from 50 to 100. This has also to be asked from my doctor. 50 mg has not brought any relief. Now I have to visit my doctor at the end of this month.

4. Feeling of loneliness is a huge issue for me. Every time especially at home, while just relaxing, I have high insecurity, and I start to have all the thoughts of the past and what will happen in the future? These are some issues to be resolved from your side. Please suggest good pranayama or yoga for this particular disorder.

Hello,

Welcome back to icliniq.com.

The sudden jerks that are not continuous but are occurring more during weekends are most likely due to anxiety. In anxiety, sudden muscle twitches are seen, resulting in distress, which further worsens the jerks. Increasing the dose of Quetiapine to 50 will not cause any significant issue. There is nothing to worry. This will improve your sleep, and you will feel better. The drug will not cause any adverse effects on your health. 50 mg dose of Modafinil is very low, and increasing the dose to 100 mg will help you. This will reduce your daytime drowsiness, and you should feel better. There is no harm in increasing the dose to 100 mg. These anticipatory thoughts that what will happen to you and in the future along with loneliness are due to persistent depressive symptoms only. Try to remain calm and remain hopeful. With your treatment, you will feel better. Yoga and pranayam will help in improving fatigue and will supplement the actions of the medicines. Thanks. Take care.

Patient's Query

Thank you doctor,

After increasing Quetiapine to 50 mg from 25 mg from the last two to three days, I observe that I feel sleepy ​while driving a car from home to the office in the morning. Hence I am once again reverting Quetiapine to 25 mg. Your confirmation as for the same quantity of Quetiapine 25 is asked.

Hello,

Welcome back to icliniq.com.

Yes, increasing the dose to 50 might make you sleepy in the morning hours. But this sleepiness will decrease in some days, and there is nothing to worry. If you were sleeping well with a 50 mg dose, then better continue on the same dose. This will surely help you. A dose of 25 mg is a low dose. But yes, if you reduce the dose to 25 mg even then, it would not cause any harm. To avoid sleepiness caused by an increased dose of Quetiapine, you can take Modafinil 100 mg in the morning hours. This will make you alert and will prevent sleep. Thanks. Take care.

Patient's Query

Thank you doctor,

My psychiatrist has advised me to stop Modafinil 50 as I did not find any relief within 25 days of starting. So I stopped the next day on his advice and increased the dose of quetiapine from 25 to 50 mg on the same day. Regards.

Hello,

Welcome back to icliniq.com.

Modafinil does not directly help to reduce the symptoms but helps to improve functioning. The drug helps to maintain daytime alertness and thus supplements the actions of antidepressants. So you can talk with your doctor again and, if possible, restart with a 100 mg dose. The sleepiness you are having could be due to the stopping of Modafinil. So if possible, start the drug again. The drug is safe to use. You can reduce Quetiapine to 25 without worries. Thanks and take care.

Patient's Query

Thank you doctor,

I have reduced the dose of Queitipin from 50 to 25 mg at night. I did not feel any sleepiness while driving the car in the morning. I mailed to my psychiatrist regarding restarting Modalert 100 mg, but there was no reply from his side. How can myoclonic jerks be avoided or controlled, which I observe during sleep on weekdays in the afternoon?

I cannot get up early in the morning as I want to do some yoga or pranayama. Due to the worst symptoms of this disease, especially in the morning, it becomes difficult to wake up. Would you please suggest some remedial measures regarding this problem? Whenever I listen to old songs while driving the car, there is a feeling that makes me think about the past, which is very painful. It accounts for depressive symptoms, but what can be the remedial measures to be taken? Thanks and regards.

Hello,

Welcome back to icliniq.com.

To prevent exacerbation of anxiety symptoms and jerks, you should practice yoga and progressive muscle relaxation exercises. PMR (progressive muscle relaxation) is a relaxation exercise that helps in reducing anxiety. In this exercise, starting from head to toe, muscle groups are made to contract and then relax slowly. With practice, individuals learn to differentiate between anxiety and relaxed situations. You can learn the details online. This will surely help you. PMR before sleep will reduce your anxiety, and then the myoclonic jerks like symptoms you are having will decrease. Worsening of mood while listening to songs is due to persisting depression. With proper treatment, this worsening will reduce. Thanks and take care.

Patient's Query

Thank you doctor,

Can I consult any psychologist online? Would it be a better option?

Hello,

Welcome back to icliniq.com.

Yes, you can consult back, and they will provide you best advice. If you need to clarify more doubts, you can ask again. Thanks and take care.

Patient's Query

Thank you doctor,

Encorate Chrono 400 mg twice daily was prescribed by my doctor for myoclonic jerks and Etilaam 0.5 at night for anxiety problems. Shall I start taking these tablets within a day or two? As I am taking Nexito 20 (Escitalopram) and Qutiepin 25 once a day, both at night before sleeping, can I take Etilaam 0.5 at night? After that, with both Nexito and Qutieipin 25, can I add these tablets? I am a little bit afraid. If Encorate Chrono 400 is not available, can I take 200 (two) mg tablets? Any extra advice, please mention. Regards.

Hello,

Welcome back to icliniq.com.

Thanks for asking again. Yes, you can take Encorate Chrono with the medicines you are taking. There are no severe drug interactions. There is nothing to worry about. The dose of 400 mg is not high and is safe to use. You can even take 200 mg twice a day or together with two tablets too. You are taking Nexito 20 in the evening, and in my opinion, you should switch it to morning hours. For some days, you might suffer increased drowsiness, but that will become normal in some days. Taking a tablet in the morning hours will make your sleep refreshing. You can take Etizolam on an SOS basis for control of anxiety and also for sleep. Thanks. Take care.

Patient's Query

Thank you doctor,

Today I have started taking Encorate Chrono 400 from the morning. Do I need to take them twice daily? And most probably, I will be starting Etilaam 0.5 mg from today night. What benefit does intake of Encorate Chrono 400 bring? Are they safe for kidney transplant patients? Regards.

Hello,

Welcome back to icliniq.com.

I am sorry for the late reply. Yes, Encorate is safe to use in a renal transplant patient. Baseline liver function tests have to be done before starting this drug. This drug should be used with caution in hepatic impairment. The drug will help in the stabilization of mood and will potentiate the actions of antidepressants. You can take 400 mg once a day, and after a couple of weeks, the dose can be increased to twice a day. Thanks and take care.

Patient's Query

Thank you doctor,

I have started taking Encorate Chrono 400 (Sodium valproate 266 and Valproic acid 116). It has been three days of taking it. Is this the right medicine with the right salt? I get scared sometimes after taking Encorate Chrono as it is a new medicine. What effect will it have on kidney transplantation? This is my doubt about the Chrono tablet. How to solve this? I am also taking it with Nexito, Queitiepin and Etilaam. Will this Chrono tablet bring any relief, and in how many days? These are some doubts which need clarification. Regards.

Hello,

Welcome back to icliniq.com.

Yes, Encorate is a safe drug. There is nothing to worry about. The salt is correct, and you will start seeing improvement in a couple of weeks. Please do not remain stressed. The drug is safe to use and has no severe side effects. The drug will supplement the actions of antidepressants too. So there is no need to doubt this drug. Thanks and take care.

Patient's Query

Thank you doctor,

Please find an enclosure here with the prescriptions of my Psychiatrist for your understanding. I have been under his treatment for four years back to date. Earlier I was under treatment from a different psychiatrist. I have been on various antidepressants since then. I have also started taking Etilaam 0.5 mg at night daily. I also feel tired when I continuously talk to somebody for more than five minutes. Forgetfulness, agitation, and frustration are also there. How to get rid of them? Thanks and regards.

Hello,

Welcome back to icliniq.com.

I reviewed the prescriptions, and more or less, you were given different antidepressants (Escitalopram and Desvenlafaxine), and then low-dose antipsychotics were added. Based on the prescription and history of our conversations, it is clear that your principal diagnosis is a depressive disorder. Your depressive symptoms are under control, but some symptoms like daytime drowsiness are troubling.

For persistent drowsiness, I advise you to restart Modafinil. The drug will supplement the actions of antidepressants and reduce daytime drowsiness and improve functioning. Encorate addition is a good step. Though you never showed any symptoms of bipolar disorder, many psychiatrists still prefer it to use in resistant depressive symptoms. The drug will also reduce the need to increase the dose of antidepressants. You can continue to take Nexito as advised.

The tiredness when somebody is talking to you is probably occurring due to persistent anxiety. Etilaam would make you relaxed, and you will feel better. Just try to remain calm while talking to anyone. Avoid thinking that others are judging you. This will make you relaxed, and you will be more active in conversations. Thanks. Take care.

Patient's Query

Thank you doctor,

My day time sleepiness is very disturbing. I feel like sleeping and I am not able to complete my pending work. I am suffering from this issue for many years and there is no relief. Please suggest a suitable remedy. My psychiatrist also advised me to take Nexito in the morning hours but I tried and could not do it due to scaredness. Is any method there? Already 4 tablets are given to me, Nexito, Etizolam, Queitiepin and Encorate. Modafinil will be the fifth one. Already there are many tablets, these 4 tablets which I think are sufficient for the depressive treatment. The more the tablets the more will be the dependence and addiction and this will thus become difficult to stop them. I only want my life to be smooth without drowsiness. I am also able to carry out my day-to-day work as a normal person. Can I think of marriage as I am all alone only with my father? Regards.

Hello,

Welcome back to icliniq.com.

First of all, please do not think that you will become dependent on these medicines. These are safe to use and do not cause dependence. Though Etizolam has mild abuse potential and other drugs are secure. If you are sleeping well and have a refreshing sleep, then the option is to quit the Quetiapine. Stopping Quetiapine will not only decrease one drug but will also reduce daytime sedation. Encorate is already working as supplementation for antidepressants apart from mood stabilization, which could become a good option for you. If you have not got your thyroid status done, then get that checked, please. Hypothyroidism is an important cause of daytime sleepiness and symptoms like reduced energy. Apart from this, as discussed earlier, you can discuss with your doctor to restart Modafinil and maintain its doses at 100 mg per day. This would make the daytime functioning better. Take Vitamin B12 supplements, and these will help you in depression. Please do not remain depressed. With proper medicines, you will be alright. Thanks.

Patient's Query

Thank you doctor,

Kindly see my report of thyroid function as I was admitted to the hospital for a severe UTI. I think this will give you the idea. Secondly, I have mailed to my psychiatrist about starting Modafinil and stopping Quetipin. If there is no reply from his side, shall I follow your advice of starting Modafinil and stopping Quetipin? If any mail is received from his side, I will let you know. Your valuable advice is needed. Regards.

Hello,

Welcome back to icliniq.com.

Yes, please try to get your psychiatrists advise for Modafinil and stop the Quetiapine. This will not only reduce one drug that might be contributing to drowsiness. Also starting Modafinil would make you more active functionally. Please take adequate doses at least 100 mg in morning after breakfast. Thanks and take care.

Patient's Query

Thank you doctor,

My psychiatrist has advised me to stop Queitiepin and not to start Modafinil. I think you have reviewed my thyroid function test. Tablet Neurobion forte has been suggested as a vitamin B 12 supplement. Regards.

Hello,

Welcome back to icliniq.com.

Good to know that you can now stop Quetiapine. Even if he does not want you to start Modafinil, stopping the Quetiapine will reduce your daytime drowsiness. Vitamin B12 will also help in supplementing the actions of antidepressants and will also help in reducing fatigue. Please get new thyroid hormone levels ((T3 (tri-iodothyronine), T4 (thyroxine), TSH (thyroid-stimulating hormone)) done. In the attachment, there is no report attached. Give the sample after overnight fasting. Do not take tea or water in the morning. Regards.

Patient's Query

Thank you doctor,

I am again attaching the thyroid function test done when I was admitted due to a severe UTI, along with the two prescriptions of my psychiatrist, which were left out somehow when the earlier prescriptions were enclosed for your understanding. Is Neurobian Forte the right choice? I once tried to shift Nexito in the morning but could not do it out of fear, and please suggest a method free of fear. Please ignore if I submitted the same report twice. After analyzing the thyroid function test, please suggest if there is still the need for this test again. Regards.

Hello,

Welcome back to icliniq.com.

Yes, your T3 is a little low, but TSH is normal, so there is no harm in getting your thyroid checked again. Yes, please get your thyroid checked again. You can start taking Neurobion Forte. This will surely help you. If you are comfortable taking Nexito in the evening, then no need to worry about that. Due to anxiety, you have fear. With time this will decrease. Keep in mind that shifting the drug in the morning will add to pharmacodynamics only and will have positive effects on anxiety. Thanks and take care.

Patient's Query

Thank you doctor,

Today I had shouting arguments with a person from my section, and when it was happening, I got shivering. Kindly suggest the remedy. Regards.

Hello,

Welcome back to icliniq.com.

It is acceptable to develop shivering during any anxiety-provoking situations. This should not be a matter of worry. Due to autonomic outbursts, you have these symptoms. After any such problems, please try to remain calm, sit still, and think about the situation and you will realize that you have anxiety for no reason. You can go to the canteen and drink a glass of water slowly over two minutes and take slow and deep breaths. This will reduce the heart rate, and you will function better. Try not to think that other people are judging you or are aware of your anxiety. Everyone has anxiety to some extent, and this is a normal thing. But realizing this and then losing my mind over this results in distress. So remain relaxed and focus on your work. Thanks and take care.

Patient's Query

Thank you doctor,

Again this has happened and now for a short duration. I do not know how to manage this. I have stopped Queitipin.

Hello,

Welcome back to icliniq.com.

First of all, you have to accept that such reactions are seen in most people and there is no need to get worried about that. The response you showed was also acceptable, but you have just developed awareness of the symptoms. This awareness results in anticipation that you are anxious, and you will get such episodes in the future also. Try to suppress the anticipation. But if you could not, then accept that this is just anxiety, and you will not think about this after the said event. With medicines, you will be able to function normally, and your anxiety will definitely decrease. So keep taking medicines and remain relaxed. Green tea can help to make you relaxed, and your anxiety will decrease. If you can take green tea now, then that would also reduce the anxiety. Thanks. Take care.

Patient's Query

Thank you doctor,

You are right, but after that incident, I keep on thinking of that incident or argument, and then, it gets difficult to get rid of. It seems that the person with whom I had a fight and his colleagues are against me as their reaction indicates their behavior. Then it also gets difficult to work in that cell with that person, and that person seems normal after hurting me. My mind keeps on repeating that he is hurt. How to live peacefully in this situation? Regards.

Hello,

Welcome back to icliniq.com.

First of all, as I have mentioned earlier too that do not feel embarrassed about this. Everyone has such kind of thoughts. Every person anticipates every person has repetitive thoughts, every person has worries, anxiety, and all. These are normal things. You should not get worried about this.

We take the example of the current argument. You have mentioned that you keep on thinking about the incident repeatedly, and then you start thinking that people are against you. This results in more anxiety and more worries and thus worsening of relationship. All these things end you in a vicious cycle of worries-anticipatory thoughts-negative thoughts. You have to break the cycle. Try to give importance to good things and learn to suppress the negatives of others. This will make you happier.

Just try to remain calm in situations and make a habit of keeping the office in office only. When you return home, give time to yourself rather than thinking about unnecessary trivial things. This increases the anxiety only. You can relax by listening to music, or by exercise or by yoga. All these things will release endorphins in your brain, making you happier and more confident. Just learn what to keep in mind and whatnot. I hope you understand what I mean to say. Thanks and take care.

Patient's Query

Thank you, doctor,

I could not sleep most of the night, and I did not know the reason. I think Etilaam has not worked when it should have been. Will Neurobion Forte work? I will always check and recheck the new medicines given to me by the psychiatrist because of their effect on kidney transplants. I do not know how to get out of this. Will restarting Queitpin provide some benefits when used in combination with Etilaam?

Hello,

Welcome back to icliniq.com.

Wait for a few more days, and this will allow to wean off the effects of Quetiapine which has been stopped recently. Etilaam is a safe drug and does not cause any severe effects. It can be used in renal conditions, too, in low doses. So please do not remain worried. Checking the impact of a drug on the renal system considering you as a transplant patient is normal and acceptable. But once you have inspected the effects, please make a habit of avoiding checking these again and again. I hope you understand what I mean to say. Learn to believe your doctor. The doctor will prescribe any drugs that will be safe for you only. So do not remain stressed. Yes, Neurobion will work, but that will take some time. Avoid taking the drug in the evening hours and preferably take it in the daytime with water. I do not think restarting the Quetiapine is a good idea. This will add to drowsiness only. Wait for the effects of Etilaam to start kicking in. Just remain hopeful and confident. You will come out of your symptoms. Stop thinking that you will not sleep with Etilaam only. The drug will improve your symptoms. Thanks. Take care.

Patient's Query

Thank you, doctor,

Now at night, after taking Etilaam 0.5 and Nexito at 10 PM, it is observed that I am falling asleep after a long duration. I seem to sleep one or two hours of going to bed. If I go at 11 PM, it becomes 12.30 PM because of running thoughts that are difficult to control. When etilam was added, I got good sleep for a few days, but as I mentioned above, now it takes time to sleep. As said by you, everybody feels anxiety symptoms, but it is much more painful in this disorder because of its nature. After trying many courses of meditations on the art of living, I realized this issue. Please help.

Hello,

Welcome back to icliniq.com.

Thanks for asking again. On considering your current situation, one option is to divide the dose of Escitalopram into two times, that is 5 mg in the morning and 5 in the evening. Take the tablet immediately after meals. Avoid going to bed directly and, if possible, have a walk for around half-hour. The time of 15 to 20 minutes before going to bed, take Etizolam. This will make you relaxed and will help in sleep onset. The rumination thoughts coming into your mind during bedtime are resulting in difficulty in sleep onset. Control your thoughts and do not try hard to get sleep. Avoid thinking about getting sleep. Just remain relaxed. Do not think that if you fail to get sleep, you will not function normally. Sleep is a spontaneous phenomenon, and if your body needs sleep, it will sleep. Just remain relaxed, and everything will be fine. Another option is to replace Etizolam with Clonazepam. This drug has more prolonged action and greater efficacy. You can talk with your doctor about that too. Thanks.

Patient's Query

Thank you doctor,

Escitalopram is 20 mg. Now, please tell me how to divide. If it gets too late to sleep, it gets too late to get up. I want to get up early and go for a morning walk because I can not go properly. I might continue taking etizolam and will start with walking. I started taking Neurobion forte once daily. Is it safe for renal transplant? Regards.

Hello,

Welcome back to icliniq.com.

In that case, you can divide the dose to 10 mg in the morning and 10 mg in the evening. Taking 20 mg of drug in the evening is one of the probable reasons for late insomnia. In some time, if needed, medication can be taken in 15 mg doses. Take Etizolam as advised. In some time, you will see improvement. Just remain relaxed, a morning walk or evening walk will help relax your mood, and you will feel better. Etizolam is safe to use, so you need not worry. Neurobion is also safe to use. Thanks.

Patient's Query

Thank you doctor,

I might be doing this shifting of Nexito 10 mg twice a day from Saturday onwards. Due to this problem, avoiding yoga or morning walks or any physical exercise may result in other issues that may add to other problems I have. So I want to ultimately become normal and act like a normal while in the office, at home, or somewhere else. I avoid matrimonial alliances which are contacting me due to low confidence. I want to sort out this problem as soon as possible. Regards.

Hello,

Welcome back to icliniq.com.

Yes, you will be completely normal with the drug treatment. Do not remain distressed. You have depression, and with treatment, the symptoms will remit. Start taking Escitalopram in morning and evening doses, and this will make your sleep better. The daytime drowsiness will also reduce. Apart from this, do not avoid any social things. You might face distress initially, but with time you will enjoy everything. You have nothing organic, so avoiding matrimony proposals would only make things worse. Do not lose confidence. Just keep one thing in mind that you have depression, and this will reduce with treatment. There is no need to worry. Just do not lose confidence and remain relaxed. Accept the illness and do not feel bad about the illness. Thanks and take care.

Patient's Query

Thank you doctor,

Thanks for replying to my every message with good answers. Shall I start taking Etizolam in the morning apart from the night at 9 PM? I think Etizolam is an addiction. All the medicines are also to be continued long. Shall I also switch over to Nexito 10 mg twice daily? Encorate Chrono 400 is also continuing. Kidney Transplant is also another factor that also comes into the picture while in depressive disorder.

Hello,

Welcome back to icliniq.com.

There is no need to start taking Etizolam in the morning. The drug will reduce anxiety and will aid in sleep in the evening. This medicine taken for long without proper supervision of a psychiatrist could result in increased abuse potential. But the drug is safe to use and has minimal abuse potential. Yes, Nexito (Escitalopram) 10 mg twice daily is my advice. Continue to take Encorate as advised. You have a depressive disorder and renal transplantation aggravated the symptoms. The history of renal transplantation itself is an independent risk factor for depression. But no need to remain depressed. You are doing fine on medicines except in some episodic exacerbations. These are everyday things, and no need to worry about that. Continue to take medication as advised and avoid overthinking and overanalysis. With time you will be fine. Do not forget exercise and yoga. Thanks and take care.

Patient's Query

Thank you doctor,

1. I am going to start taking Nexito 10 mg twice daily from tomorrow. What beneficial effects will it have, and can it be taken out of fear?

2. Today, while I was sitting and working on my chair, I suddenly got hit on my back and realized that person to whom I argued opened my almirah for taking for some material, and then it happened. I do not know whether it is intentional or not. But the feeling of hitting is still there, and I am realizing some breaths up and down and feeling very bad about that person. Please help. Regards.

Hello,

Welcome back to icliniq.com.

Yes, you should start taking 10 mg twice a day. This will help in refreshing sleep without awakening. You will not have morning drowsiness, and improvement in functioning should occur. The weird thought while going to bed will also decrease. Try to avoid any anticipation in your mind. Sometimes we assume wrong about someone without any proof. This probably happened today. Why would he intentionally hit you? Both of you are not school-going kids but are professionals. You are mature, and this is just in your mind only. Try to suppress your thoughts. Just focus on yourself and your work. Efficient work will help in the progress, and you will stop thinking about these things. Just focus on yourself. Don't forget yoga or exercise to remain healthy. Thanks and Take care.

Patient's Query

Thank you doctor,

I will start Nexito 10 mg twice daily at 9 AM and 9 PM. Yes, I have some fear feeling when going to bed at night. Even after taking Etilaam, it is also there. With Neurobian forte and Encorate Chrono, I feel that whether it is safe or not. Again these thoughts keep coming in. Regards.

Hello,

Welcome back to icliniq.com.

Yes, there will be no problem in taking the drug in twice-daily doses. The intrusive thoughts for Encorate or Etilaam or Neurobion coming in your mind are due to anxiety only. Just remain assured that these drugs are safe and are free of severe side effects. Please stop anticipating. You will feel better with medicines. Thanks and take care.

Patient's Query

Thank you doctor,

Should sertraline be started in place of Escitalopram as suggested by the doctor? It is safer than Escitalopram for the renal problem and will also help get early in the morning as advised by the doctor. Please help.

Hello,

Welcome back to icliniq.com.

Thanks for asking. Sertraline is safer relative to Escitalopram, but that does not mean that Escitalopram is unsafe. As you are doing good in Escitalopram with minor issues, I do not think switching to another drug is a good idea. Sertraline causes more gastric side effects, especially diarrhea, and might worsen your symptoms in the first few days of starting the medication. Cytochrome enzymes metabolize Escitalopram via liver metabolism. It is safe for renal transplants. Remain relaxed for that. Thanks and take care.

Patient's Query

Thank you, doctor,

Thank you so much for again giving valuable suggestions for Nexito. My psychiatrist has also analyzed that I am getting a good response from Nexito. Thanks again. One problem is that if the views of somebody do not suit me, my head pains, and I feel losing breath. Something goes upward from the temple area. Would you please suggest good advice? Secondly, I get a sensation of motion very strongly on minimal tension, and then I have to go for it.

Medicines continuing are as follows:-

1. Nexito (escitalopram) 10 mg - 9 AM and 9 PM (Total 20 MG)

2. Encorate Chrono 400mg - 9 AM and 9 PM (Total 800 mg)

3. Etizolam 0.5 mg in the morning and night at 10 PM.

4. Neurobion Forte once daily in the morning.

My doctor prescribed Khadi lavender oil. She told me to take three to four drops mixed with water during a bath in the morning, which is beneficial in this disorder and told me to do it regularly. The picture of the oil is uploaded for your understanding. Would you please suggest whether it has to be done regularly?

I have purchased this oil. I want your advice. Regards and thanks.

Hello again,

Welcome back to icliniq.com.

This oil is a local application. Since it consists of Lavander, this will have a calming effect as written on its bottom. This should help in reducing the anxiety to some extent. But keep one thing in mind that this is not a substitute for medicines.

Feeling of loosening breath and feeling that something in the temple area when something is said that does not suit you is anxiety only. This is a normal thing in anxiety and is seen by most individuals. As I have mentioned earlier, accept that you have anxiety and are prone to develop such symptoms in anxiety-provoking situations. Once you create an awareness of these symptoms, you will control your bodily symptoms effectively. Try to find ways to ignore anything that is against your ego.

You can distract yourself by listening to music or even taking a coffee cup alone or a glass of cold water. Learn to remain stress-free. This seems complicated, but you will be able to control these symptoms in unwanted situations with practice. I hope this helps you. Continue to take medicines and also exercise or walk daily to stay stress-free. Have good healthy balanced food. Take foods rich in proteins and complex carbs. Avoid fatty food as this increases depression. Eat at least one chocolate in a week. Chocolates also stimulate the mind. Thanks and take care.

Patient's Query

Thank you doctor,

Sleepy problem in the day is still there. Shall I start that lavender oil side by side? There is no benefit seen after taking Neurobian forte for 11 days? Regards.

Hello again

Welcome back to icliniq.com.

Wait for some more time. I hope reducing the night dose to 10 from 20 has resulted in refreshing sleep. Neurobion forte will improve the vitamin B12 levels, which will help supplement the actions of antidepressants. So please do not remain stressed. With time the drug will help in better response. Yes, you can start Levander oil, which will help reduce anxiety and give a sense of well-being. Thanks and take care.

Patient's Query

Thank you doctor,

Yes, my sleep is quite fine. Doing 20 from 10. Yesterday I forgot to take Nexito 10 mg in the morning. We have started whitewashing in our home. I am a little bus scary.

Hello again,

Welcome back to icliniq.com.

Try not to forget your doses. This could precipitate anxiety though the chances are less. Your sleep is good, and that is a welcome thing. With time your symptoms will improve. Why are you feeling scared due to whitewash at home? This is a normal thing. Try to suppress any unwanted thoughts. Just acknowledge that this is anxiety, and you have to suppress this. Thanks and take care.

Patient's Query

Thank you doctor,

One botheration is that I am scared of a particular person I know beforehand. If that person comes in front of me, I get scared of what that person might speak or look at me with big eyes. I want this problem to be solved as soon as possible. I have a tiny bit of confidence that has set in. Regards.

Hello,

Welcome back to icliniq.com.

Thanks for asking. This is not a problem but is in your mind only. Why would anyone look or stare at you? Think about this. Did you do something wrong or bad with them? If the answer is no, then why are you getting bothered by that. Why are you stressed? Look into the mirror and think about the good qualities in yourself. Think about your job and your achievements. All these will help to boost your confidence. Avoid thinking bad about yourself. Improvement in confidence will decrease the scary feeling of seeing someone. Behavioral modification, distraction, suppression of intrusive, unwanted thoughts are solutions for these problems. So remain relaxed. Try to exercise daily, and this will help to solve the problem. Thanks and take care.

Patient's Query

Thank you doctor,

I am still not able to get up at 5.30 AM because the symptoms are persisting. There is no effect of Encorate Chrono and Neurobian forte. I am not able to explain things adequately to anyone. This results in frustration. Still, the sleep problem is disturbing on weekends. What exercise or yoga can I do? Regards.

Hello again,

Welcome back to icliniq.com.

Encorate Chrono will help to stabilize the mood and will supplement the actions of antidepressants. Wait, and you will see improvement. Similarly, the Neurobion will take time to act. The drug will improve vitamin B12 levels and thus will reduce anxiety and depression. You can try progressive muscle relaxation exercise to stay fit and tension-free. PMR can be learned online and will help in keeping you relaxed in anxiety-provoking situations. The exercise works on the behavior therapy principle. You can do any exercise. Walking briskly for about half-hour will do a lot. This will help in improving your mood. Thanks and take care.

Patient's Query

Thank you, doctor,

I am a little bit confident but still many more hurdles in the way. On weekends l sleep all day. No job gets completed. I want to go for a morning walk, but the issue is still lingering. On Sat and Sunday, I feel very, very frustrating. No way to get out of this severe illness. Regards.

Hello,

Welcome back to icliniq.com.

You have to take the initiative and will have to go for a morning walk. For some days, you will feel drowsy and will have fatigue. But with time, the body will start secreting endorphins which will make your mood better. This will have positive effects on your health. Just do not lose hope and keep trying. You are on the right medicines, and you will improve your mood. Do not feel that there is no way. You are taking treatment and are doing good in most aspects to come out of illness. Do not lose hope. Thanks and take care.

Patient's Query

Thank you doctor,

I am not satisfied this time.

Hello,

Welcome back to icliniq.com.

I am sorry, and I will try to explain in detail. If we consider the treatment and prognosis of any psychiatric disorder, it depends a lot upon the insight of illness. Insight is awareness of having a psychiatric illness. When an individual has insight and seeks treatment, the response to treatment is far better than those who have no insight. You are seeking a psychiatrist's help by yourself, which is a good factor, and your response will be good. I am mentioning this to explain to you about the nature and course of psychiatric disorders. So do not think that there is no way to get out of this severe illness. You have insight, and you are doing much better compared to those who fail to seek treatment.

If you do not have activeness in day-to-day activities, especially on weekends, and you remain in bed most of time then there is no need to feel wrong about this. You are regularly working on weekdays, so if you feel tired on weekends, this is not a very bad thing. A lot of individuals want to spend their weekends lying down in bed. In your case, since you have depression, this thing is bothering you. As we discussed earlier, the inclusion of Omega-3-Fatty acid supplements or B12 (which you are already taking) would help improve the day-to-day activities.

This will make the response of drugs faster. You can take Omega Fatty Acid rich foods like Salmon or Sardine fish, walnuts, hazel nuts etc. This will improve the activity level. Apart from this, please do not lose hope. Loss of confidence further worsens depression and treatment response. This should be prevented. Just remain hopeful and continue to take treatment. If you motivate yourself enough for morning walks and exercise, that would make you more energetic and feel bad. Green tea can be used to increase metabolism and to remain energetic. Do not use sugar in green tea, and this will surely help you. So please wait for more days, and you will surely come out of this illness. Thanks and take care. I hope this helps you in making your mood better.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Seikhoo Bishnui
Dr. Seikhoo Bishnui

Psychiatry

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