A relative of mine diagnosed with psychotic depression with auditory illusions, have been plenty of medications for t he last 3 years. Many previous gen medicines were tried along with ECT of 10 to 15 sessions in 3 time intervals. The person has gained a lot of weight and currently on 375 mg of clozapine 40 mg of zypsidon and Aripropole 10 mg on a daily basis. The problem looked OK for a while but it has returned back now. Request advise.

Dr. Saranya DevanathanPsychiatrist46yrs exp

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Dear Kannan, Thank you very much for taking interest in knowing what your relative is going through. This is a serious mental illness with frequent relapses. So it needs long term treatment to keep the illness under control. For some persons it is life long. ECT is a temporary treatment to prevent suicidal thoughts and disturbing hallucinations (not illusions). If it is effective it needs to be adminstered at regular intervals as maintenance ECT. Of usually maintenance is done by Clozapine. The choice is yours. Clozapine increases the person's hunger and induces sleep as side effect. Thereby he gains weight. Probably your doctor recognised this weight gain and introduced Ziprasidone and Aripiprazole in his treatment. Both are weight neutral drugs. Slowly he/she may reduce and stop Clozapine. But it depends on the benefit that Clozapine gave. If it is good, then ask your relative to diet and exercise to control weight. May be his family members want him just to take rest and don't recommend exercise. They may be feeding him too much fearing his anger. It is good that in certain combination of drugs, he is OK. 

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