Dr. Harvinder Singh
Forum Replies Created
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Dr. Harvinder Singh
AdministratorMay 6, 2021 at 9:46 am in reply to: Psychotropics & Risk of Tinnitus?Answer: Lamotrigine.
Watch our chapter for 20 min video discussion and PDF download for summary:
https://psychiatryeducationforum.com/lesson/tinnitus-psychotropics-risk/
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Dr. Harvinder Singh
AdministratorMay 5, 2021 at 2:49 pm in reply to: Psychotropics & Risk of Tinnitus?I just saw my patient for follow up. She was on combination of sertraline 150 mg + Lamotrigine 100 mg. I stopped one of them and today she is no longer having tinnitus. I will disclose the answer with details tomorrow 🙂
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Dr. Harvinder Singh
AdministratorMay 4, 2021 at 3:14 pm in reply to: Psychotropics & Risk of Tinnitus?Bumping the post to top. 😎
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Dr. Harvinder Singh
AdministratorApril 30, 2021 at 10:18 am in reply to: Naltrexone XR: When to Initiate?Answer: A
Please read our recent blog post and watch the video for details: Read Blog Post
Also read our academy chapter for more details on this topic: Read Academy Chapter
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In that case keeping him on lithium makes more sense.
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Educate patient to limit to 1-2 drinks and maintain the hydration status. Educate them that no specific guidelines exist for the lowest safe alcohol dose with lithium, educate about signs of lithium toxicity and document this in your notes.
Which symptom(s) are you treating with lithium for this patient?
The other options you can consider for bipolar 2 disorder depression management are:
- Quetiapine
- Lamotrigine
- Sertraline
- Venlafaxine
These are first and second line recommendations per recent CANMAT guidelines for bipolar 2 disorder.
REFERENCES:
- Bipolar Disord. 2018 Mar; 20(2): 97–170. (pdf)
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Here is what I will recommend but let’s hear others’ recommendations as well.
I will motivate the patient to not drink with lithium as the risk is high. If the patient is still drinking: aim for low alcohol (no specific amount is listed in literature) and maintain their hydration. If the patient has a history of alcohol use disorder or other addiction behaviors: I will not recommend even a low amount as the risk of them drinking more is high.
Here is the summary of lithium & alcohol interaction:
- Acute alcohol does not affect lithium absorption, elimination, distribution, or clearance, but alcohol can increase serum lithium concentrations when taken with alcohol. (1)
- Another concern is increased alcohol use induced diuresis by antagonizing ADH, which can indirectly place a patient at risk of high lithium levels.
Reference:
- Clin Pharmacol Ther. 1985 Jul;38(1):52-5.
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Dr. Harvinder Singh
AdministratorApril 12, 2021 at 11:26 pm in reply to: Serotonergic Medication of Choice for GAD?Read our academy chapter for detailed answer:
https://psychiatryeducationforum.com/lesson/gad-initial-medication-of-choice/
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Dr. Harvinder Singh
AdministratorMay 13, 2021 at 12:47 pm in reply to: Difficult Case with Anxiety, Depression & Antidepressant Withdrawal.Hi Elizabeth. Buspirone is my next option depending on how she responds to the recent addition of escitalopram.
Ashwgandha is not tired yet but she tried l-theanine 200 mg with no benefits. What is your preferred dose for Ashwgandha?
I like the EPA augmentation option. Thanks.