Q: My 32 years old wife had a history of anxiety and depression. She was taking Prodep and Prothiaden 2 years back before pregnancy; then she stopped the medicines during pregnancy. Post pregnancy, she did not have any anxiety or depression. Only when the child used to get ill, she start getting anxious and sometimes used to blank out with a vacant expression for few minutes only. She couldn't take any medicines since she was feeding the baby. This happened three times in a period of 2 months. After she stopped feeding the baby, she never had this. Now 2 months back, she again has the anxiety problem every morning. She takes Alprazolam (Restyl 0.25 mg) when she wakes up early morning between 3:00 to 4:00 am for the past 2 months. She sleeps well later on and is absolutely fine for the rest of the day. Please suggest.

A:Her course of illness looks more episodic in nature since intermittently we can see periods of recovery also. However, the fact that the problem reappears suggests a lack of holistic treatment. Very often it is seen that there are some disturbing underlying psychological factors, which manifest itself as anxiety, depression during critical situations. This needs to be worked upon through psychotherapy/counseling in addition to pharmacotherapy. Some relaxation exercises along with deep breathing would also help her. She should learn some techniques to calm herself down in various anxiety provoking situations. Another treatment modality is that your wife must consider is Repetitive Transcranial Magnetic Stimulation (rTMS). This is a relatively new technology in India but has proved to be highly effective and therapeutic. A combination of rTMS along with medication is seen to provide excellent results in patients’ recovery with no adverse effects.