Patient's Query
Hello doctor,
I suffered major depression and severe anxiety since the age of 12 years. I was initially put on Citalopram and did well on this medication for seven to eight years at which point it was no longer effective and my GP prescribed Duloxetine 60 mg. This dosage worked for about six months and then I was referred to a psychiatrist who upped my dose to 90 mg. Since then, I have been getting worse in terms of emotional breakdowns and anxiety and have had to periodically increase dosages as well as introduce new medication. I was admitted to a psychiatric institute last year. Currently, I am taking: 50 mg Venlafaxine bi-daily.75 mg Epitec in the morning.50 mg Epitec at night.10 mg Pur-Bloka bi-daily.50 mg Trazodone at night.0.5 mg Rivotril at night.50 mg Quetiapine (started three weeks ago). I feel I am drinking too much medication and would like to scale down. Also, I still suffer from anxiety but currently my main problem is paranoia. I am not psychotic as I do not believe that UFO's are planning to abduct me or that the CIA is tapping my phone. I, however, believe that my spouse is being unfaithful even though I have no reason to think this. I also believe that my colleagues have hidden motives. I believe my family and friends are deceiving me, I perceive malice in innocent statements, I am weary and suspicious of everyone around me. Due to the paranoia, I am a prisoner of my own mind and am truly suffering. My MRI, EEG, and blood investigations were all normal. Bi-polar has been excluded. Aspergers is possible. Traits of paranoid personality disorder as well as borderline personality disorder. I have an appointment to see my psychiatrist to change my script. Could I please have suggestions on what to change?
Hello,
Welcome to icliniq.com.
In my opinion, you can discuss with your treating psychiatrist regarding following changes, I suggest Rivotril (Clonazepam) can be tapered off. The dose of Quetiapine can be increased. Pur-bloka (Propranolol) dosage can be adjusted The dosage of Venlafaxine can be increased. The dose of Trazodone can be decreased if sleep is not a problem. I hope this solves your query. Feel free to ask if you have any further queries.
Patient's Query
Hello doctor,
Thank you very much for your response, much appreciated. Lastly, could you give me your opinion on changing from Venlafaxine to an SSRI? Could the Norepinephrine reuptake exasperate paranoia or anxiety?
Hello,
Welcome back to icliniq.com.
Norepinephrine reuptake inhibitors are not known to exasperate paranoia or anxiety. In fact, they are very much used in the treatment of anxiety disorders. Yes, there are some case reports of Venlafaxine causing paranoia but not due to Norepinephrine. It is due to the effect on Dopamine at higher doses. It is not certain yet though. But, considering your particular case, in my opinion, SSRI (selective serotonin reuptake inhibitor) would be better suited. I hope this helps. Feel free to ask if you have any further queries.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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