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Anxiety

Sam Ashoo, MD and Mizuho Morrison, DO
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Sam Ashoo MD reviews management of anxiety in the UC. He discusses current pharmacologic recommendations and options. And overall approach to anxiety/panic management in the UC.

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Janet W. -

Symptom of activation after starting SSRI could represent unmasking of previously undiagnosed bipolar disease with the symptoms representing hypomania or increased suicidal ideation. I would have liked the speaker to address this even though beyond the scope of the talk about pure anxiety and panic. Might consider discussion of screening using the Mood Disorder Questionnaire and if concerned about hypomania, yes, plan to stop the SSRI , consider use of Seroquel Quetiapine to help with symptoms , especially to improve sleep for the patient. Also and give careful guidelines for support and close follow-up and advise patient how to access help in case of onset of suicidal ideation that can be triggered by recent start of SSRI. thank you.

Mike W., MD -

Good thoughts and fantastic suggestion - it would b fun to cover this in a future episode!

Sam A. -

Thanks Janet- You are correct, of course. It can be complex to discern the difference between activation and underlying bipolar disorder. In addition to screening tools, this kind of differentiation requires a deeper examination of the prior medication history and response. This is really best achieved by referral to psychiatry. If you are comfortable doing so, and you have the time, it can certainly be accomplished in an urgent care setting. However, these subtleties require longterm follow up and close monitoring which is something most of us do not perform in the UC. My practice is to discontinue the SSRI and provide community psychiatric resources. You are also correct that Seroquel for sleep can be effective in temporizing symptoms. All great points ! Thanks for sharing.

Mizuho M., DO -

Such great convo and agreed Janet W, that we have to be careful of missing an underlying bipolar d/o. We'll continue this discussion for sure. And Sam Ashoo...can we talk about how amazing your avitar is?!?! :)

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Hacking Up A Lung Full episode audio for MD edition 176:04 min - 83 MB - M4AHippo Urgent Care RAP - April 2018 Written Summary 365 KB - PDF

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