My father is chronic depressive patient. The symptoms started in 2001 like lethargy, insomnia, thought problems. He was treated with psychiatrist was okay till dec 2016 on- 1) escitalopram 20 mg 2) amixide-h again in dec 2016 he started headache around forehead and eyeballs, lethargic condition, palpitation, restlessness. For this he was treated but still the patient is as such. Once I was with him in nimhans bangalore & diagnosed as tension type headache and was given amitriptyline 75 mg list of drugs since last 2 years r follows. 1) escitalopram 20 mg 2) paroxetine 25 mg 3) clonazepam 0.5 mg 4) amixide-h 5) fluoxetine 20 mg a day 6) mirtazapine 75 mg blurred vision 7) nortriptyline 25 mg 8) aripiprazole 5 mg 9) amitriptyline 75 mg 8 months 10) d-veniz 200 mg 18 days 11) fluranizine 20 mg/d 4months recently patient was on amitriptyline 75 mg & fluranizine & had relief for 4 months then symptoms exaggerated then I consulted a doctor, he prescribed d-veniz & clonazepam since last 18 days but still the headache & lethargic condition is as such. Best suggestion plzz. Thanks.

Dr. Saranya DevanathanPsychiatrist49yrs exp

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Dear lybrate-user, you can do telemedicine with nimhans - with your card number an appointment can be booked. Your father can audio or video with doctor. Now that your father is on d-veniz and clonazepam, let him take for 3 more days and consult the same doctor for increase of dose. At your father's age, doctors will start with low dose only and slowly they will increase to get the best benefit. He can try with amitriptyline and flunarizine again since he has taken it for longer duration in effective dose. I don't know the dose and duration of intake of escitalopram, paroxetine and mirtazapine, to lebel them as ineffective.  

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Dr. Rashmi NavelkarPsychiatrist9yrs exp

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First of all he is on a cocktail of multiple medications. I don't think he requires so many antidepressants. He should be kept on min medications. Whatever has not worked in the past should be taken off slowly. Besides these medications can cause severe acidity which can also trigger headache. He also may have symptoms like constipation which can be bothersome. Mirtazepine maximum dose is 30 mg, how can he be taking 75 mg? I think there is some mistake.  

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Dr. Sujay N MPsychiatrist20yrs exp

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I am hoping physical causes (e.g blood pressure, tooth aches, eye problems, cervical spondylitis etc) of headache are ruled out before being given diagnosis of chronic tension type headache. Medicines for chronic tension headaches that can also help with depression are duloxetine and amitryptaline. Duloxetine can help with lethargy. Flunarizine can worsen depression. Along with medicines I advise psychological counselling, doing meditation, pranayam, reduced tv and mobile use, and good sleep routine. Drink plenty water.  

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Dr. Soumen KarmakarPsychiatristyrs exp

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Assuming he doesn't have hypertension, and a neurologist has been consulted - the best treatment would be to go upto maximum permissible dose of the medicine (s) he had most relief with. If not, kindly refer to a neurologist for further evaluation.  

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