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Medication Management

Prescription Medication

Medication management of Anxiety, Depression, Bipolar and PTSD disorders

Anxiety Disorders 

It is normal to experience some level of anxiety. However, when the level of anxiety you are experiencing—extreme worry, fear, and nervousness—interferes with your day-to-day activities, you may have an anxiety disorder. There are many types of anxiety disorders and related illnesses. Anxiety disorders share common symptoms of uneasiness, inability to feel calm or to sleep well, dizziness, and shortness of breath.

To receive a diagnosis and treatment, you will need to schedule an in-person assessment by a trained clinician like Dr. Tilak who has experience of over 30 years treating Anxiety disorders.  

Medications we use for Anxiety disorders:

1) SSRI like Lexapro (escitalopram), Zoloft (Sertaline) , Prozac (fluoxetine), Paxil (paroxetine)

2) Other agents: Buspirone, Duloxetine, Venlafaxine, Mirtazapine

3) Many patients have sexual or other intolerable side effects to the above agents. In such situations, we will use Benzodiazepines like Xanax (alprazolam) or Clonazepam or Valium (diazepam) or Lorazepam. Please note that these are controlled medications, meaning they can be habit forming.

4) Medical Marijuana

5) Ketamine: see under Ketamine Tab

Depression

The most common signs of depression are a discouraged, overly sad, or irritable mood most of the day and nearly every day for at least two weeks. Depression often prevents you from enjoying activities that you used to find enjoyable. Additional symptoms include otherwise unexplained weight loss or gain, changes in sleep, loss of energy, feelings of guilt and worthlessness, difficulty concentrating, and thoughts of self-harm. While the number and severity of symptoms vary by person, depression can affect every part of a person's life, including the ability to work, sleep, eat, and enjoy regular life activities. 

Depression should not be confused with the blues or normal feelings of sadness, grief, or disappointment that often occur following stressful major life events such as bereavement, loss of employment, or relationship problems.

If feelings of depression persist beyond what seems to you to be a reasonable period of time, we encourage you to speak with a trained clinician like Dr. Tilak who has experience of over 30 years treating Depressive  disorders.  

Medications we use for Depressive disorders:

1) SSRI like Lexapro (escitalopram), Zoloft (Sertaline) , Prozac (fluoxetine), Paxil (paroxetine)

2) Other agents: Duloxetine, Venlafaxine, Mirtazapine, Bupropion

3) For refractory depression: we will add a second generation antipsychotic and may need to add Benzodiazepines like Clonazepam or Lorazepam.

4) Ketamine is an excellent option: see under Ketamine Tab

Bipolar Disorder 

Patients with bipolar disorder seesaw unpredictably between two types of mood extremes—mania and depression. The mania phase of the disorder brings increased energy and less need for sleep accompanied by extreme irritability or an unreasonable sense of elation or happiness. The depressive phase is characterized by fatigue and an irritable, down mood, almost the polar opposite of the manic phase. Both moods may feel normal to the patient, but the extreme swings affect the ability to maintain relationships and manage daily activities.

There is no cure for bipolar disorder, but treatments can decrease the number of mood swings and lessens the severity of the changes. Enjoying life, succeeding, and having healthy relationships are all possible with the right care.

Treatment programs for bipolar start with an accurate diagnosis of the disorder. Once we have determined what is going on, we can offer psychotherapy, medication, and the possibility of participation in clinical trials for new treatments. 

Medications we use for Bipolar disorders:

1) Mood stabilizers and/or atypical antipsychotic: Quetiapine, Lamotrigine, Lurasidone, Olanzapine/fluoxetine

2) Add antidepressant to above like Escitalopram or Bupropion

3) Anticonvulsants like Depakote

4) Many patients have underlying anxiety for which Benzodiazepines like xanax (alprazolam) or clonazepam may need to be added

5) Ketamine works in resistant cases: see Ketamine tab

Post-Traumatic Stress Disorder 

Post-traumatic stress disorder (PTSD) can result from a terrifying or life-threatening event such as military combat, a violent attack, a serious accident or illness, or a natural disaster. While military service during war is a common cause of PTSD, it is not the only cause of PTSD.

Fear during such events is a natural response. However, when the level of anxiety that you or a loved one experiences afterward interferes with everyday life, it may be PTSD. This disorder can make it difficult to socialize or work due to symptoms such as flashbacks to the trauma, irritability, an overactive startle response, or being extremely sensitive to your environment in a constant state of anticipating danger (hypervigilance).

Signs of PTSD usually occur within three months of the traumatic event. There can be a delayed onset of PTSD with many months or years passing before symptoms appear.

Medications we use for PTSD:

1) Primary option: Paroxetine, Fluoxetine, Sertaline

2) Secondary option: Above SSRIs or Venlafaxine  AND quetiapine or Risperidone 

3) Tertiary options: Quetiapine, Mirtazapine, Amitriptyline, Phenelzine

4) Many patients have underlying anxiety for which Benzodiazepines like xanax (alprazolam) or clonazepam may need to be added

5) Ketamine is an excellent option: see Ketamine Tab

Please call us today at 904-298-1994 to schedule an appointment.

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