My friend is 74 years old. She had a financial shock and slid into depression. She has little family support. Doctor has prescribed d venizep 100 0-0-1, mirtaz 7.5,o-0-1, lonazep .25, 0-0-1 sizodon ls 0-0-1, citadep 10 1-01. Her anxiety has increased, her face is puffy. She is unable to speak clearly. Her hands are shaking. She's been taking these for 1 week only. I am afraid of serotonin syndrome. This seems like too many meds.

Dr. Saranya DevanathanPsychiatrist48yrs exp

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Dear Nina, Thank you Nina for taking care of your friend. Serotonin syndrome is a rare side effect. However at the age of 74 years, it is better to go slowly to higher doses. Stop venizep and citadep. Let her continue with mirtaz, lonazep and sizodon ls for 2 more weeks before other antidepressants are added. But let her get her medical check ups done for puffiness of face and slurring of speech. It might not be serotonin syndrome, it may hormonal like hypothyroid or a neurological condition or renal condition. Let us find out and treat. 

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