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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 65006
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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Hi, I have been on medication for over 10 years. I am diagnosed

Resolved Question:

Hi, I have been on medication for over 10 years. I am diagnosed with Cyclothymic disorder and OCD. The current combination of medications I take, which I have taken for about 2 years, is:
1000mg Depakote
20mg Escitalopram
100mg Seroquel XL
45mg Mirtazapine
I am comfortable with taking these, as the benefits outweigh the risks. I haven't found talking therapies to be very useful for me and I have also tried unsuccessfully to come off them before. But my questions is: am I risking long-term health problems by taking these? Are there risks I should be thinking about in the long-term? I know there are no guarantees, but I would like an objective view on this. Many thanks.
Submitted: 3 years ago.
Category: Medical
Expert:  DrRussMD replied 3 years ago.
Hello
You stated above that the benefits outweight the risks.
That is what we want.
That is why we use medications...the benefits outweigh the risks....
I am not sure I understand your question
Customer: replied 3 years ago.

Recently my parents asked me if, by taking these medications, I am taking on additional risks i.e .increased risk of heart attack or stroke or something else by having these drugs in my system over the long term.


 


I just wanted to be able to give another opinion. I agree with my own doctors about the benefits vs how I am without the medication. But should I be worried about being on them for potentially the rest of my life?

Expert:  DrRussMD replied 3 years ago.

The risks are as follows:

There are some potentially serious drug interactions. Escitalopram and mirtazapine together can cause seritonin syndrome, which can be life threatening.

Seroquel can interact negatively with both escitalopram and mirtazopine.

 

Seroquel and mirtazopine increasing the qt interval on the EKG and if you have any other heart problem or add another drug this can be a problem.

 

The warning on this is to "monitor closely" for any side effects.... The monitoring is the key. How using these medications long term affects you is not studies adequately.

 

This is why we try to make an assessment of...do the benefits outweight the risks. We also do therapy and try to streamline meds in general, using a single medicating when possible.....for example, only an SSRI.

 

So we step up the therapy only when a single agent fails. Or, when multiple single agents with therapy fail.

 

You mention your 'team'

Where are you, what city and state?

 

Use reply to let me know if you have further questions [click reply to expert]. Please do not forget a positive rating [hopefully you will click an excellent; or come back to ask me more as needed].

Customer: replied 3 years ago.

Thanks for explaining this. In your opinion, does four different medications sound unusually high? I know everyone is different, and we've got to this combination by trial and error, and it works which is great.


 


Or do you think this sounds ok, given that it works and the benefits seem to outweigh the risks?

Expert:  DrRussMD replied 3 years ago.
I think it is OK for the time being.
You mention your team
What city and state?
Customer: replied 3 years ago.

I'm actually over in the UK, in Swindon. We have the NHS, which is great but they are so overstretched that I wanted to get another opinion.


 


To be honest I wasn't even thinking about it until my parents asked about the long term risks. Then I suddenly started worrying I was about to drop dead!


 

Expert:  DrRussMD replied 3 years ago.
OK
So ask your GP for a referral to a psychiatrist if that has not been done.

If so, ask your psychiatrist what the plans are to streamline these meds.

Use reply to let me know if you have further questions [click reply to expert].
Please do not forget a positive rating [hopefully you will click an excellent; or come back to ask me more as needed].
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