Combined effect of Klonopin, Lamictal, Seroqel, Celexa and Xanax

[MarianneW]

1) Is it typical and appropriate to prescribe daily doses of Klonopin, Lactical, Seroquel, AND Celexa (plus Xanax on an as needed basis)?  
2) If so, would it be typical and appropriate for a patient who has never had a seizure, and has not been diagnosed with manic depression, schizophrenia, or any other psychosis?
3) Would the combination of these 4 (or 5) drugs be likely to cause a side effect of interference with thinking, memory, and speech?  

I ask for a family friend, who has been prescribed and is taking these all 4 of these medications daily this year.  During that time he has become increasingly debilitated, so that his thinking is foggy, his speech slowed, his memory impaired, and he cannot work.  His doctor insists that the mental deterioration is a new symptom, but I am concerned it is more likely a drug interaction side effect.  The use of anti-psychotic medications began about January 2008, when the patient (who had been taking Effexor, Paxil, and Xanax for mild depression, anxiety and insomnia) had a first-time ever episode of manic-type symptoms: racing thoughts, extreme insomnia, panic, and distorted thinking.  Neurological problems such as a tumor or brain trauma have been ruled out by an MRI and a CAT scan, and because the episode was a one-time event occurring at age 62, the doctors consider it unlikely that it represents permanent psychosis.  My concern is that our friend seems to be caught in a downward spiral of overmedication, in which new drugs treat side effects of old drugs, but create new side effects.  I am writing instead of him basically because he is so debilitated that he doesn't even have the energy or acumin to be asking probing questions. I am hoping that, by at least letting us know whether the combination of these drugs is typical, and what risks they have, it may help our family friend to look for new solutions.

[ILADVOCATE]

In terms of psychiatry yes. When I was at the psych. hospital in 1991 a good number of the people of the age range of 50+ had tardive dyskinesia. I knew very little about the condition then and I was told it was because of the amount of medication they had been on in the past when I finally got an "honest" answer from a psychiatrist there but even for their knowledge then that was untruthful. In reality it was the statistical probability of it ("5% per person per year with the typical antipsychotics, 2.5% per person per year with the atypical antipsychotics" to quote my psychopharmocologist"). But what I was speaking about was something even newer and stated by clinical psychiatrists themselves, that anti-psychotics should be used with caution in the elderly population. 62 is at the low age range of that population but still would count. As I stated any neurological disability should be ruled out and the potential of it being straight bipolar having been worsened by an anti-depressent. Schizophrenia usually emerges at a much earlier age and if there was psychosis it would be essential to figure the exact cause as many neurological disabilities cause psychosis and are increasingly common as people age.

[dippy1]

not sure I would call 62 elderly!!

[ILADVOCATE]

I am concerned in that because is elderly that he is being medicated for something neurological they were unable to diagnose. I had an elderly friend of the family whom my mother knew. He was in the hospital and he had some blood loss after surgery. He started talking incoherently because of this and they almost gave him Risperdal for "psychosis". Of course my mother stopped them and he did not have any "psychosis" but imagine if she hadn't. They should not give all that medication for one episode. Schizophrenia or another psychotic disorder must be diagnosed first. And even standard psychiatric guidelines are now stating to use anti-psychotics with caution in the elderly given that the rate of emergent tardive dyskinesia as well as other side effects of current anti-psychotics are more severe in an older population. Even for someone who needed the medications Klonopin already is an anti-anxiety drug. Xanax is not needed as well and can be highly addictive. Celexa is a standard SSRI anti-depressent. Lamictal is a mood stabilizer that is relatively safe and effective. I've been on it. But then again there must be a mood disorder diagnosed. If he was diagnosed for depression he could have actually had bipolar and the anti-depressents created a manic episode. Therefore out of all the medications the Lamictal might be the only one he needs.
   The first thing to do is change doctors. They should titrate him off the anti-psychotic to see if he actually develops psychotic symptoms. If he is diagnosed as having any form of bipolar an anti-depressent should not be given as it will worsen mania. The Xanax and Klonopin should not be given together but both should be titrated downwards slowly to prevent withdrawal symptoms. And have a consult that is a second opinion by a neurologist who is a gerentologist to see if there was some neurological disability that was overlooked. They only ruled out the most comon conditions. Those would be starting points.

[dippy1]

Hi, he's lucky to have you as a supportive friend...hang in there! I think I can help a bit with your questions, in the past year I have been taking fur out of those five; no lamictal for me..though currently being considered. At my worst I was extremely debilitated and there was talk of admitting to to a unit, fot months I could barely function, the drugs as they came on board slowly helped me, but were no miracle cure. Side effects come with all of them and may be dose-related, I am on lower doses now- the quetiapine was initially very sedating but that wore off after a few weeks leaving a brain fog and drowsiness through which I could begin to function, I was up to 60mgs with the celexa and probably in retrospect this caused some of my jitteriness and anxiety, despite the chemical kosh my sleep has not been restorative (or seemed to last beyond about 6 hours) I've been on another antidepressant too, which added to everything else caused anorexia and worsened my weight loss...my GI tract packed in altogether , constiation, then bowel obstruction due to gut paralysis! Joy! I'm on more laxatives than psych drugs nowadays. The benzos; the xanax and the clonazepam are both sedative and additive and tend to build up in your system, I certainly had slowed thinking and speech and total brain fog, but hard to know how much was depression (did have simialr problems before treatment stakes were upped) and how much drugs. Technically if an antidepressant triggers a true manic reaction I think the docs would call that first presentation of bipolar, either way it sounds as though they switched the AD and started a mood stabiliser....that much makes sense. Hope this helps, come back to me if I can answer anything more specific for you.