Q. Dear Dr. Markovitz,

Thank you so much for providing a wonderful service of free Q&A.; I understand you are busy so I will try to be brief.

For a person with the below symptoms, what be your best estimate as to a recommendation for medication and other forms of treatment? I fully realize the typical disclaimer information such as seeking a local doctor for an interview, medical interactions, etc. Much thanks!

I am making an attempt to list these in order or importance also

- major depression (not suicidal)
- a score of 78 on the Sheenan Test for Anxiety (30 being abnormal and 80 being severe)
- extreme difficulty getting school work, occupational work, recreational interest related work, etc done
- frequent anger/rage at entirely insignificant details
- relationship problems
- lack of feeling alive or real; disassociated from reality
- distancing oneself from others (i.e. rarely answering/screening calls)
- _NOT_ self mutilating
- TMJ
- paranoia - can handle being in any size group of people but quickly separate from the crowd
- irregular sleep patterns (sleeping mostly during the day and not being able to sleep at night) (while having a full recognition of this problem and having considerable problems correcting it)
- emphasis on loosing myself emotionally in music
- frequent deja-vu

Thank you, any help would be appreciated greatly,

A. If you have no obsessive compulsive symptoms, Serzone would be a great medication to start out with. It should get rid of all your symptoms at a dose of 500 to 750 mg at bedtime. It is cheap, effective, and has few side effects. You may get some side effects, and need to change medications or it may not work. Make sure you take a minimum of 500 mg at bedtime for two to three weeks before you even think about giving up on it.

If you have obsessionality or the Serzone does not work, you need to be on Effexor XR at 300-450 mg per day or one of the SRIs (Prozac, Zoloft, Celexa, Luvox or Paxil). Zoloft, may worsen your TMJ.