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Family Physician
Family Physician, Doctor
Category: Medical
Satisfied Customers: 2418
Experience:  GP with over 27 years experience including emergency medicine
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hello I am 54 years old. Ive suffered from anxiety and

Customer Question

hello

I am 54 years old. I've suffered from anxiety and depressive symptoms all my life ( from 17 years age ) but no ( DSM Ranked ) schizophrenia symptoms nor symptoms of Bipolar Disorder …
I have never hallucinated anything but I have had depressive episodes ( take Citalopram) and severe anxiety/ panic attacks. I have lived that way 37 years …
until 2 years ago ...

However, over the last 14 months I have started to have occasional experiences wherein I cannot remember what I did yesterday or what day of the week it is …
So, I told a Consultant Psychiatrist and they suggested insipid (weak) schizophrenia asked me to try Quetiapine 50mg at night -but it knocked me out for 18 hours - even a 12mg dose knocked me out and I couldn't think at all in the way I do usually

As a result … I've now been given 20 mg diazepam /day for 12 months but nothing is improving. My recall fluctuates. I also go through stages where I feel disinclined to do things … to complete things.

I used to be known as smart : I graduated from Oxford University ( having read Medicine for a year then I changed to Philosophy and Psychology 1st class hons ) I used to have a cognitive ability - now I sometimes find I feel slightly stupid / cant figure ordinary things and - I eat far too much . A kind of inanition sometimes overwhelms me ..

Thus, I am now feeling very depressed and worried : no-one can give me an accurate diagnosis
Also - I feel that my doctors are a bit stuck … indeed , one of them, has said as
much to me …

I am terrified that I have some sort of creeping dementia … but I can gain neither
re-assurance that I don't nor knowledge that I do from my highly qualified friendsand professionals ..

Anyone any diagnostic ideas / suggest any courses of action please ? obviously not a reprise of what I have stated.
( I am used to high-level discourse in Psychiatry : I read most of the peer -rated journals now and again and , unless I am feeling ill - I understand them, no problem - so, to politely avoid any doubt - I do not seek a child-like explanation or conversation.

Many thanks &

Respectfully

James
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.

Dr. David :

This is Dr. David

Dr. David :

what dose of citalopram are you taking?

JACUSTOMER-18xi5x0z- :

20 mg

Dr. David :

that is a relative low dose.

Dr. David :

I think your anxiety is not being well controlled

Dr. David :

and uncontrolled anxiety can cause you to have lapses in memory.

Dr. David :

20mg is a starting dose of citalopram.

Dr. David :

you have options to talk to your doctor about increasing your dose of citalopram to 40mg or to add on other anti-anxiety agents such as klonopin

Dr. David :

or something else.

Dr. David :

have you taken clonazepam (klonopin) before?

JACUSTOMER-18xi5x0z- :

No - please ad vise me, what is Kloponin and is it available UK

Dr. David :

it is a long acting benzodiazepine which can be used to decrease anxiety.

Dr. David :

so it is in the same class as lorazepam or alprazolam, but longer acting.

Dr. David :

like diazepam.

Dr. David :

I would talk to your doctor about increasing your dose of citalopram

Dr. David :

since you have tried diazepam without much benefit.

JACUSTOMER-18xi5x0z- :

… do you think if 20mg Diazepam doesn't work this will ?

Dr. David :

so klonopin most likely won't help that much more.

Dr. David :

I think if you get your medication of citalopram dose higher and you can continue the diazepam hopefully your anxiety will get better in control and your cognition and memory should get better.

JACUSTOMER-18xi5x0z- :

you believe this is a a (high) anxiety problem - are there an other Anti Anxiety drugs you'd recommend which wll work with Citalopram

JACUSTOMER-18xi5x0z- :

… hello ?

JACUSTOMER-18xi5x0z- :

hello ?

Dr. David :

Augmentation of existing antianxiety treatments with atypical antipsychotics having mixed effects at dopaminergic and serotonin receptors appears to be an effective strategy for refractory anxiety disorders

Dr. David :

medications like olanzapine.

JACUSTOMER-18xi5x0z- :

hello ?

Dr. David :

also adding a beta blocker can also help decrease anxiety.

Dr. David :

such as Pindolol can be used with citalopram.

Dr. David :

this is a good article for you to read over.

JACUSTOMER-18xi5x0z- :

hello ?

Dr. David :

http://journals.psychiatryonline.org/article.aspx?Volume=6&page=486&journalID=21

Dr. David :

does this help?

Dr. David :

do you have other questions?

Dr. David :

let me know if you have other questions.

Dr. David :

if done for now, please leave +++ positive feedback below the chat box

Dr. David :

you can always reach me as Dr. David if you have other questions.

Dr. David :

thanks for using JustAnswer.com

JACUSTOMER-18xi5x0z- :

hhhello ?

Dr. David :

did you see my replies above?

Dr. David :

Augmentation of existing antianxiety treatments with atypical antipsychotics having mixed effects at dopaminergic and serotonin receptors appears to be an effective strategy for refractory anxiety disorders

9:36 PM

medications like olanzapine.

Dr. David :

why are you rating poor service?

Dr. David :

also adding a beta blocker can also help decrease anxiety.

9:36 PM

such as Pindolol can be used with citalopram.

9:37 PM

this is a good article for you to read over.

9:37 PM

http://journals.psychiatryonline.org/article.aspx?Volume=6&page=486&journalID=21

JACUSTOMER-18xi5x0z- :

hello … I have already been told that I should not increase Citalopram - by a Special Consultant Psychiatrist

Dr. David :

then we need to talk to your doctors about adding additional medications to help decrease your anxiety

Dr. David :

to help your cognition.

Dr. David :

talk to your doctors about beta blockers such as pindolol

Dr. David :

and medications like olanzapine.

Dr. David :

you can print out this article to bring to your doctors

Dr. David :

http://journals.psychiatryonline.org/article.aspx?Volume=6&page=486&journalID=21

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