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Doctors' Answers to "Frequently Asked Questions" - Psychotherapeutic Drugs

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Schizo-Affective Disorder Medications [posted 8/13/98]
Question: My daughter is diagnosed schizo-affective disorder and has just been placed on Seroquel. What is a recommended dosage. Our MD did not have dosage level and started her at 25mg to increase to 50mg. Research literature shows a range up to 700mg, but indicated 300mg as most successful range. Any experience with this new drug? My daughter is 21 years, moderately compliant on the medications, formerly on xyprexia, but side effects were bad- weight gain, lethargy, hormonal imbalance. Thanks for the help.

Answer: One usually starts low and works up. 25 mg would be low for most patients. But, it is very individual, especially in terms of side effects.

Three Medications For Phobia [posted 8/13/98]
Question: I have a severe panic disorder with agoraphobia. I am taking Klonopin, Xanax and Zoloft. Zoloft is also helping my depression, and actually it made it disappear. I take 100 mg Zoloft every morning, 2 mg Klonopin 1 to 1.5 hours before I go out. Once I'm out, if I'm in trouble I dissolve 0.5 mg Xanax under my tongue. I then take another 1 mg Klonopin 3-5 hours after I took the first 2 mg or I might dissolve another 0.5 mg Xanax an hour or two after I dissolved the first one. Depending on whether I'm having a good or bad day, I will take another 1 mg Klonopin 3-4 hours after the last one. This has been doing quite well for me. My concern is: What about health impact in the long run? What about drug interactions? Can I drink any alcohol?

Answer: There is no data on long term use of Zoloft. Klonopin and Xanax have no obvious problems except for the physical addiction that comes with frequent use. I doubt if you have been on this dose that an occasional drink would be a big deal. However, use caution since the combination of Klonopin and xanax with Etoh can produce quite an effect in some. I wouldn't exceed the one and would not drive or use machinery after ingestion.

Side Effects of Psychotherapeutic Drugs on the Elderly [posted 8/12/98]
Question: A ninety-three year old women who is taking Paxil and Risperdal for depression and anxiety is exhibiting the following symptoms, particularly in the morning - confusion, slurred speech, forgetfulness, instability in walking. She has a severe heart condition (aortic valve replaced 8 years ago) and is on coumadin and nitro patch along with other medications. For the past year her walking has been unsteady, but her cognitive abilities have been sharp, until now. She has been on the psychotropic drugs for about three months. I am wondering if her current symptoms are a natural progression of aging or if the Paxil and Risperdal are affecting her mental status and gait. I know it is difficult to determine her medical condition without a thorough history, but is it possible that these psychotropic drugs are causing these recent symptoms?

Answer: No way to know without stopping one or both. Many geriatric patients wind up with pharmacopia and a drug holiday is always a good idea as long as her medical condition is watched closely. What other drugs is she taking?

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