Q. How to overcome my 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 psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

#

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 psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

# Hello again,

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 having argument with some family member and then emotional reactivity are occurring because of depressive symptoms only. You have to accept that these changes are occurring because of depression and with treatment you will be fine.

For poor sleep and anxiety during sleep after some argument you can think of taking drugs like Clonazepam in dose of 0.25 to 0.5 mg on SOS basis OR alternatively 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 don't loose hope.

Thanks. Take care

# Hello again

- 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 and these results in distress which further worsens the jerks.

- Increasing the dose of Quetiapine to 50 will not cause any big issue. No need 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 dose and increasing the dose to 100 mg will definitely help you. This will reduce your day time 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 future along with loneliness are due to persistent depressive symptoms only. Try to remain calm and remain hopeful. With your treatment you will definitely feel better. Yoga and pranayam will definitely help in improving the fatigue and will supplement the actions of the medicines.

Thanks Take care

# Hello again

Yes increasing the dose to 50 might make you sleepy in mooring hours but this sleepiness will decrease in some days, no need to worry. If you were sleeping well with 50 mg dose then better to continue on the same dose. This will surely help you. Dose of 25 mg is a low dose.

But yes if you reduce the dose to 25 mg even then that would not cause any harm.

To avoid sleepiness caused by increased dose of Quetiapine you can think of taking Modafinil 100 mg in morning hours. This will make you alert and will prevent sleep.

Thanks. Take care

# Hello again

Modafinil doesn't directly help to reduce the symptoms but helps to improve the functioning. The drug helps to maintain daytime alertness and thus supplement the actions of antidepressants.

So you can talk with your doctor again and if possible restart with 100 mg dose.

The sleepiness you are having could be due to 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.

# Hello again

To prevent exacerbation of anxiety symptoms and jerks like symptoms you should practice yoga and progressive muscle relaxation exercises. PMR is a relaxation exercise which helps in reducing anxiety. In this exercise starting from head to toe muscle groups are made to contract and then relaxed slowly. With practice individuals learn to differentiate between anxiety and relaxed situations. You can learn the details with help of youtube. This will surely help you.

PMR prior to 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 decrease definitely.

Thanks and Take care.

# Hello again

Yes you can consult and they will provide you best advise.

If you need to clarify more doubts you can ask again.

Thanks and Take care.

# Hello thanks for asking again


Yes you can take Encorate Chrono with the medicines you are taking. There are no serious drug interactions. No need to worry about that.

The dose of 400 mg is not a high dose and is safe to use. You can even take 200 mg twice a day or together two tablets too.

You are taking Nexito 20 in 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 tablet in morning hours will make your sleep refreshing.

You can take Etizolam on SOS basis for control of anxiety and also for sleep.

Thanks. Take care

# Hello again

I am sorry for late reply. Yes Encorate is safe to use in renal transplant patient. Baseline liver function tests should be done before starting this drug. This drug should be used with caution in hepatic impairment.

The drug will help in stabilisation of mood and will potentiate the actions of antidepressants.

You can take 400 once a day and after a couple of weeks the dose can be increased to twice a day.

Thanks and Take care.

# Hello again

Yes Encorate is totally safe drug. No need to worry. The salt is right and you will start seeing improvement in a couple of weeks.

Please don't remain stressed. The drug is safe to use and have no serious side effects.

The drug will supplement the actions of antidepressants too. So no need to doubt this drug.

Thanks and Take care.

# Hello again

I reviewed the prescriptions and more of less you were given different antidepressants (Escitalopram and Desvenlafaxine) and then low dose antipsychotics were added. On basis of prescription and history of our conversations its clear that your main diagnosis is Depressive disorder. Your depressive symptoms are under control but some symptoms like day time drowsiness are troubling.

For the persistent drowsiness I'd advise you to restart the Modafinil. The drug will not only supplement the actions of antidepressants but will reduce the day time drowsiness and will improve the functioning. Encorate addition is a good step. Though you never showed any symptoms of bipolar disorder but still a lot of psychiatrists 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

I am sorry for late reply as I am out of India right now and due to time difference I replied late.

# Hello again

First of all please don't think that you will become dependent on these medicines. These are safe to use and doesn't cause dependence. Though Etizolam has mild abuse potential but other drugs are totally safe. If you are sleeping good and have refreshing sleep then one option is to quit the Quetiapine. Stopping Quetiapine will not only decrease one drug but will also reduce the day time sedation.

Encorate is already working as supplementation for antidepressants apart from mood stabilisation so this could become a good option for you.

If you haven't get your thyroid status done then get that checked please. Hypothyroidism is an important cause of day time sleepiness and symptoms like reduce energy.

Apart from this as discussed earlier too you can discuss with your doctor to restart Modafinil and maintain its doses at 100 mg per day. This would make the day time functioning better.

Take Vitamin B12 supplements and these will definitely help you in depression.

Please don't remain depressed, with proper medicines you will be alright.

Thanks

# Hello again

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.

# Hello again

Good that you can now stop Quetiapine. Even if he doesn't want you to start Modafinil even then stopping the Quetiapine will reduce your day time drowsiness. Vitamin B12 will also help in supplementing the actions of antidepressants and will also help in reducing fatigue.

Please get a fresh thyroid hormone levels (T3/T4/TSH) done. In the attachment there is no report attached. Give the sample after overnight fasting. Don't taken tea or water in morning.

Regards

# Hello again

Yes your T3 is little low but TSH is normal so there is no harm in getting thyroid checked again. Yes please get thyroid checked again.

You can start taking Neurobion Forte. This will surely help you.

If you are comfortable in taking Nexito in evening then no need to worry for that. Due to anxiety you have fear. With time this will decrease. Just keep one thing in mind that shifting the drug in morning will add to pharmacodynamics only and will have positive effects to anxiety.

Thanks and Take care.

# Hello again

It's acceptable to develop shivering during any anxiety provoking situations. This should not be a matter of worry. Due to autonomic outbursts you are having these symptoms. After any such situations please try to remain calm, sit still and think about the situation and you will realise that you are having anxiety of no reason. You can go to canteen and drink a glass of water slowly over 2 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 if they are aware of the anxiety you have.

Every one has anxiety to some extent and this is a normal thing. But realising this and then losing mind over this result in distress. So just remain relaxed and focus on your work.

Thanks and Take care.

# Hello again

First of all you have to accept this that such type of reactions are seen in most people and not need to get worried for that. The reaction you showed was also acceptable but just you have developed awareness of the symptoms. This awareness is resulting in anticipation that you are anxious and you will get such episodes in future also. Try to suppress the anticipation. But if you couldn't then just accept that this is just an 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 just keep taking medicines and remain relaxed. Green tea can help to make you relaxed and your anxiety will definitely decrease. If you can take green tea now then that would also reduce the anxiety.

Thanks Take care

# Hello again

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


We take the example of the current argument. You've mentioned that you keep on thinking about the incident again and again 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 more happy.

Just try to remain calm in situations and make habit of keeping the things of 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 yourself by listening music, or by exercise or by yoga. All these things will release endorphins in your brain and this will make you happier and more confident. Just learn what to keep in mind and what not.

I hope you are understanding what I mean to say.

Thanks and Take care

# Hello again

Wait for 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 doesn't cause any serious effects. It can be used in renal conditions too in low doses. So please don't remain worried.

Checking of effects of drug on renal system considering you are a transplant patient is normal and acceptable. But once you checked the effects and you are satisfied with the effects then please make a habit to not to check these again and again. I hope you are 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 no need to remain stressed.

Yes Neurobion will work but that will take some time. Avoid taking the drug in evening hours and preferably take it in day time with water.

I don't think restarting the Quetiapine is a good idea. This will add to drowsiness only. Wait for 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 definitely.


Thanks Take care

# Hello thanks for asking again

One option considering your current situation is to divide the dose of Escitalopram in two times that is 5 mg in morning and 5 in evening. Take the tablet immediately after meals. Avoid going to bed immediately and if possible have a walk for around half hour. The around 15-20 minutes before going to the bed take Etizolam. This will make you relaxed and will help in sleep onset. The rumination thoughts coming in your mind during bed time are resulting in difficulty in sleep onset. Control your thoughts, don't try hard to get sleep. Avoid thinking about getting sleep just remain relaxed. Don't think that if you fail to get sleep you will not able to function normally. Sleep is an spontaneous phenomenon and if your body needs sleep it will sleep. Just remain relaxed and everything will be fine.

Other option is to replace the Etizolam with Clonazepam. This drug has longer action and greater efficacy. You can talk with your doctor for that too.

Thanks

# Hello again

In that case you can divide the dose to 10 mg in morning and 10 mg in evening. Taking 20 mg of drug in evening is one of probable reason for late insomnia. In some time if needed drug can be taken in 15 mg doses.

Take Etizolam as advised. In some time you will definitely see improvement. Just remain relaxed, morning walk or evening walk will help in relaxing your mood and you will feel better. Etizolam is safe to use so need to worry.

Neurobion is also safe to use.

Thanks.

# Hello again

Yes you will be completely normal with the drug treatment. Don't remain distressed. You have depression and with treatment the symptoms will definitely remit.

Start taking Escitalopram in morning and evening doses and this will make your sleep better. The day time drowsiness will also reduce. Apart from this don't 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. Don't loose confidence. Just keep one thing in mind that you have depression and this will definitely reduce with treatment. No need to worry. Just don't loose the confidence and remain relaxed. Accept the illness and don't feel bad about the illness.

Thanks and Take care

# Hello again

No need to start taking Etizolam in morning. The drug will reduce anxiety and will aid in sleep in evening. The drug if taken for long without proper supervision of a psychiatrist could result in increased abuse potential. But the drug is safe to use and has very little abuse potential.

Yes Nexito (Escitalopram) 10 mg twice daily is my advise.

Continue to take Encorate as advised.

You have depressive disorder and renal transplantation aggravated the symptoms. 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 normal things and no need to worry about that. Continue to take medicines as advised and avoid overthinking and overanalysis. With time you will be fine.

Don't forget exercise and yoga.

Thanks and Take care

# Hello again

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. Some times 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 kid 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 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

# Hello again

Yes there will be no problem in taking the drug in twice daily dose. 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 totally safe and are free of serious side effects.

Please stop anticipating. You will feel better with medicines.

Thanks and Take care

# Hello thanks for asking

Sertraline is safer relative to Escitalopram but that doesn't mean that Escitalopram is unsafe. As you are doing good in Escitalopram with minor issues so I don't think switching to another drug is a good idea. Sertraline causes relatively more gastric side effects especially diarrhoea and might worsen your symptoms in first few days of starting the drug.

Escitalopram is metabolised by cytochrome enzymes via liver metabolism. Its safe in renal transplant. Remain relaxed for that.

Thanks and Take care

# Hello again

Dear that oil is a local application. Since it consists of Levander so this will have calming effect as written on its bottol too. 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 of breath and feeling that something in temple area when something is said that doesn't suit you are due to anxiety only. This is a normal thing in anxiety and is seen by most individuals. As I have mentioned earlier too, accept that you have anxiety and you are prone to develop such symptoms in anxiety provoking situations. Once you will develop awareness of these symptoms you will be able to control your bodily symptoms effectively. Try to find ways to ignore any thing that is against your ego. You can distract yourself by listening music, or even by taking a cup of coffee alone or a glass of cold water. Learn to remain stress free. This seems difficult but with practice you will be able to control these symptoms in unwanted situations. 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 mind.

Thanks and take care

# Hello again

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 and this will help to supplement the actions of antidepressants. So please don't remain stressed. With time the drug will help in better response.

Yes you can start `Levander oil which will help in reducing anxiety and will give sense of well being.

Thanks and Take car

# Hello again

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 white wash 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

# Hello thanks for asking

This is not a problem but is in your mind only. Why would anyone look or stare on you? Think about this. Did you do something wrong or bad with him/her?

If the answer is "NO" then why are you getting bothered for that. Why are you stressed?

Look into 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 on seeing someone.

Behavioural modification, distraction, suppression of intrusive unwanted thoughts etc are solutions for these problems. So just remain relaxed. Try to exercise daily and this will help to solve the problem.

Thanks and Take care

# Hello again

Encorate chrono will help to stabilise 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 anxiety free. PMR can be learned from youtube and will help in keeping you relaxed in anxiety provoking situations. The exercise works on behaviour therapy principle.

Any exercise you can do. Walking briskly for about half hour will do a lot. This will help in improving your mood.

Thanks and Take care

# Hello again

You have to take initiative and will have to go for 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 definitely.

Just don't loose hope and keep trying. You are on right medicines and you will definitely improve in your mood.

Don't feel that there is no way. You are taking treatment and are doing good in most of aspects so you will come out of illness. Don't loose hope.

Thanks and Take care

# Hello again

I am sorry and I will try to explain in detail. If we consider treatment and prognosis of any psychiatric disorder then that depends a lot upon insight of illness. Insight is awareness of having psychiatric illness. When an individual has insight and he himself seeks treatment then the response to treatment is far better compared to those who have no insight.

You are seeking help of a psychiatrist by yourself and this is a good factor and response will be good. I am mentioning this to explain you about the nature and course of psychiatric disorders. So don't think that there is no way to get out of this serious illness. You have insight and you are doing much better compared to those who fail to seek treatment.

If you don't have activeness in day to day activities especially on weekends and you remain on bed most of times then there is no need to feel bad about this. You are working regularly on weekdays so if you are feeling tiredness on weekends then this is not a very bad thing. A lot of individuals want to spend their weekends by lying down on bed. In your case since you have depression this thing is bothering you. As we discussed earlier inclusion of Omega-3-Fatty Acid supplements or B12 (which you are already taking) would help to improve the day to day activities. This will make 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 don't loose hope. Loss of confidence further worsens then depression and treatment response. This should be prevented. Just remain hopeful and continue to take treatment. If you motivate yourself enough for morning walk and exercise then that would make you more and more energetic and you will feel bad. Green tea can be used to increase the metabolism and to remain energetic. Don't 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.

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