For an adult male with generalized anxiety disorder, ADHD, hypertension, and hyperhidrosis who is on Vyvanse (lisdexamfetamine) and starting Trintellix (vortioxetine), what specific medical questions should be asked about his age, occupation, hyperhidrosis severity and functional impact, non‑pharmacologic measures for sweating, current medications and supplements, recent blood pressure readings, vitamin B12, vitamin D, and folate levels with MTHFR status, potential Trintellix side effects, weight changes, suicidal thoughts, functional impairment, access to psychotherapy, substance use, family psychiatric history, and treatment goals?

Essential Medical Questions for Comprehensive Assessment

Demographics and Baseline Information

Obtain exact age, occupation, and work environment details to assess functional impact and treatment feasibility, as hyperhidrosis significantly affects work productivity in over 60% of patients 1.

• Age: Precise age is critical for medication dosing and risk stratification, particularly given FDA warnings about increased suicidal ideation in patients under 25 years on antidepressants 2.
• Occupation and work demands: Specific job duties, manual dexterity requirements, and social interaction frequency, as hyperhidrosis causes occupational impairment in 63% of patients 1.
• Performance anxiety triggers: Detailed inventory of situations causing anxiety (public speaking, client meetings, physical contact requirements), as these directly relate to both generalized anxiety disorder and hyperhidrosis severity 3.

Hyperhidrosis Characterization

Quantify the severity and functional impact of sweating using validated measures, as this guides treatment intensity and monitors response 4.

• Hyperhidrosis Disease Severity Scale score: Use this validated tool to grade tolerability and guide treatment decisions 4.
• Anatomical distribution: Document all affected areas (palms, soles, axillae, craniofacial, generalized), as 96.4% report palmar involvement but sweating often extends to multiple regions 5.
• Temporal pattern: Onset timing relative to medication initiation (Celexa, then venlafaxine), persistence after discontinuation, and daily variation 6.
• Functional impairment specifics: Quantify impact on handshakes, keyboard use, clothing changes per day, social avoidance behaviors, and intimate relationships, as over 50% report moderate to extreme impairment in personal relationships 1.
• Non-pharmacologic measures tried: Document use of antiperspirants (aluminum chloride concentration), clothing modifications, iontophoresis, or behavioral strategies 4.

Current Medication and Supplement Inventory

Obtain complete list of all substances to identify drug interactions and contributors to hyperhidrosis, as antidepressants are a known cause of secondary hyperhidrosis 6.

• All prescription medications with exact doses: Vyvanse 40 mg timing, lisinopril 10 mg timing, and any other medications not mentioned in chart 2.
• Over-the-counter medications: NSAIDs, antihistamines, decongestants that may interact with Vyvanse or Trintellix 2.
• Supplements and vitamins: Current use of any B-complex, folate, vitamin D, fish oil, St. John's Wort (contraindicated with Trintellix), or other supplements 2.
• Caffeine and energy drink consumption: Quantity and timing relative to Vyvanse, as this affects stimulant efficacy and anxiety levels 2.
• Herbal products: Any use of kava, valerian, or other anxiety-targeted supplements that may interact with Trintellix 2.

Cardiovascular Monitoring

Establish baseline blood pressure patterns and monitor for stimulant-related hypertension, as Vyvanse can elevate blood pressure and the patient has essential hypertension 2.

• Recent home blood pressure readings: Specific values with dates, times, and circumstances (resting vs. active) over the past 2-4 weeks.
• Blood pressure response to venlafaxine discontinuation: Document any changes in readings since stopping SNRI approximately 8 weeks ago.
• Cardiovascular symptoms: Palpitations (noted in 52.3% of hyperhidrosis patients), chest discomfort, or exercise intolerance 5.
• Compliance with home monitoring: Frequency of checks and technique used.

Laboratory Values and Genetic Testing

Review specific vitamin levels and MTHFR status to guide supplementation, as moderately reduced MTHFR activity suggests potential benefit from L-methylfolate 2.

• Vitamin B12 level: Exact value and date, as deficiency can worsen anxiety and cognitive symptoms.
• Vitamin D level: Specific value and date, as deficiency is associated with mood disorders.
• Folate level: Critical given MTHFR results showing moderately reduced activity, which may impair folate metabolism and antidepressant response 2.
• MTHFR genotype details: Specific variant (C677T, A1298C, compound heterozygous) to determine L-methylfolate dosing if supplementation is initiated.
• Thyroid function: TSH and free T4 to rule out thyroid disease as cause of anxiety or hyperhidrosis, as thyroid disease is a common comorbidity 6.
• Fasting glucose or HbA1c: To assess for diabetes mellitus, which is a common comorbidity in hyperhidrosis patients 6.

Trintellix-Specific Safety Monitoring

Screen for contraindications and risk factors for serious adverse effects before initiating vortioxetine, as the FDA label specifies multiple warnings 2.

• Bleeding history: Personal or family history of bleeding disorders, easy bruising, or prolonged bleeding, as Trintellix increases bleeding risk 2.
• Current anticoagulant or antiplatelet use: Aspirin, NSAIDs, warfarin, or other agents that increase bleeding risk when combined with Trintellix 2.
• Glaucoma screening: History of angle-closure glaucoma or family history, as Trintellix can cause pupillary dilation leading to acute angle closure 2.
• Sodium levels: Recent serum sodium, as Trintellix can cause hyponatremia, particularly in elderly or volume-depleted patients 2.
• Sexual function baseline: Current sexual desire, arousal, and orgasm function, as Trintellix may cause sexual dysfunction in both males and females 2.
• Weight baseline: Current weight and recent trends, as weight changes should be monitored on Trintellix 2.

Psychiatric Safety Assessment

Conduct thorough suicide risk assessment given FDA black box warning for antidepressants, particularly important when initiating new medication 2.

• Current suicidal ideation: Frequency, intensity, duration, and specific plans or intent.
• Passive death wishes: Thoughts that life is not worth living or wishes to not wake up.
• Access to lethal means: Firearms, medications, or other methods in the home.
• Protective factors: Reasons for living, social support, future-oriented thinking.
• History of self-harm: Past suicide attempts, non-suicidal self-injury, or psychiatric hospitalizations.
• Recent stressors: Beyond those mentioned (traffic stop, band practice), assess financial, relationship, or health stressors.

Bipolar Disorder Screening

Rule out bipolar disorder before initiating Trintellix, as antidepressants can trigger manic episodes in undiagnosed bipolar disorder 7.

• Personal history of manic or hypomanic episodes: Periods of elevated mood, decreased need for sleep, increased energy, impulsivity, excessive spending, hypersexuality, or grandiosity.
• Family history of bipolar disorder: First-degree relatives with diagnosed bipolar disorder, as approximately one-third of anxiety patients have comorbid mood disorders 7.
• Response to previous antidepressants: Any history of activation, agitation, or mood destabilization on Celexa or venlafaxine.
• Mood cycling patterns: Seasonal variations, rapid mood shifts, or periods of depression alternating with normal or elevated mood.

Functional Impairment and Treatment Goals

Quantify specific functional deficits to establish measurable treatment targets, as hyperhidrosis and anxiety both significantly impair quality of life 1, 8.

• Social functioning: Frequency of social avoidance, canceled plans, or declined invitations due to anxiety or sweating.
• Occupational functioning: Days of work missed, reduced productivity, or avoided tasks due to symptoms.
• Relationship impact: Specific effects on romantic relationships, friendships, and family interactions, as over 50% report moderate to extreme impairment 1.
• Daily activities: Interference with exercise, hobbies, errands, or self-care activities.
• Patient's primary treatment goals: Rank order of priorities (reduce anxiety, eliminate sweating, improve work performance, enhance relationships).

Psychotherapy Access and History

Assess availability and willingness to engage in cognitive behavioral therapy, as CBT is first-line treatment for anxiety disorders with large effect sizes 9, 7.

• Previous therapy experience: Type of therapy (CBT, psychodynamic, supportive), duration, and perceived helpfulness.
• Current barriers to therapy: Insurance coverage, time constraints, transportation, or preference for medication-only approach.
• Willingness to restart therapy: Specific interest in CBT for anxiety and social skills training, as individual CBT is preferred over group therapy 9.
• Availability of qualified CBT providers: Local therapists with expertise in anxiety disorders and exposure therapy.

Substance Use Assessment

Screen for alcohol and substance use that may interact with medications or worsen anxiety, as these are common comorbidities in anxiety disorders.

• Alcohol consumption: Frequency, quantity, and timing relative to anxiety symptoms or medication use.
• Cannabis use: Frequency and perceived effect on anxiety or sweating.
• Nicotine use: Smoking or vaping that may interact with medications or exacerbate anxiety.
• Recreational drug use: Stimulants, sedatives, or other substances.
• Caffeine intake: Total daily consumption from all sources (coffee, tea, energy drinks, supplements).

Family Psychiatric History

Document family history of psychiatric disorders and treatment responses, as this informs genetic risk and medication selection.

• First-degree relatives with anxiety disorders: Parents, siblings, or children with diagnosed anxiety, panic disorder, or social anxiety.
• Family history of depression: Relatives with major depressive disorder and their treatment responses.
• Family history of bipolar disorder: Critical for risk assessment before starting antidepressants 7.
• Family history of substance use disorders: Genetic risk for addiction relevant to benzodiazepine avoidance.
• Family medication responses: Relatives' experiences with SSRIs, SNRIs, or other psychiatric medications, as genetic factors influence drug metabolism.

Dermatological Complications

Assess for skin complications from chronic moisture, as hyperhidrosis increases infection risk by nearly 30% 8.

• Current skin conditions: Athlete's foot, bacterial infections, pitted keratolysis, or skin maceration in affected areas 8.
• History of recurrent skin infections: Frequency and treatment required.
• Skin care routine: Current use of antifungal powders, moisture-wicking fabrics, or barrier creams.