Hi doctor, This is about my brother. Earlier he used to get very angry over small matters. He was not able to concentrate on anything and was not able to sleep. He was confused and used to think that everybody was watching him. He used to harm the family members sometimes. He started his medications three months back. He was on Fluoxetine 40, Aripiprazole 10, Quetiapine 50 and Divalproex 750. He is now calm but has tremors in his hands and legs and feeling numbness in head and is very confused. He is feeling as if he is mad. He is mostly confined in home and hardly goes out. Need your advice on what to do and when he will feel better? Is antidepressant Fluoxetine not working?
Hello. I read your query and understand your concerns. First of all, I would like to inform you that three months are generally enough for the antidepressants to show effects. Secondly, 60 mg of Fluoxetine is generally a sufficient dose for antidepressant purposes. Considering the fact, that there is some response despite the presence of adequate dose for sufficient time indicates the possibility of partial response. Thirdly, the above observation is not unique as problems are often encountered in patients with long duration of untreated illness. Now regarding the tremors, I think Divalproex is likely to cause tremors as a common side effect. In my opinion, 250 mg of Divalproex has a little role on this day as his aggressive behavior already reduced. Regarding the next course of action, I feel adding another antidepressant is the first option. In case there are reasons for not doing the same adding low dose antipsychotics can be used provided there is aggressive behavior still present. I often prefer low doses of Olanzapine 5 mg to boost up the effect of Fluoxetine. I must assure you that over a period of time he will improve further. I hope this helps.