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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4486
Experience:  MD Psychiatry
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Thank you for your advice Dr Kaushik. I am going to see how

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Thank you for your advice Dr Kaushik. I am going to see how i go for the next few weeks, but i agree that duloxetine may be a good option if it is my depression coming back. As to the suggestion re switching to valproate or lithium; I was on depakote for 3 years and put on 6 stone which is why i asked the doctor to change my mood stabiiser. I am also wary about the lithium for the very same reason. It terrifies me to make med changes. If my depression does not lift, I shall definitely try the duloxetine. However, one of the side effects is liver injury. I hardly ever drink these days, but occasionally will have a couple of small glasses of wine if out with friends. I know that i seem to perhaps dwell on the side effects of meds (i am an ex nurse). I just want to take the safest combination without these distressing side effects. I have had TERRIBLE time coming off seroxat in the past and although effexor was brilliant, it caused an increase in blood pressure and was probrably quite activating. It is such a pity because i was so well for three years on depakote and effexor but stupidly cut back (myself) to half dose of depakote due to excessive weight gain. I am getting myself into such a wretched state. Any other possible suggestions as to alternative combos. I do certainly respect your answer. Would it be worth staying on lamictal to see if these aches improve? Its just that this drug has the most benign side effect otherwise.

Hi there,


Welcome back !


Well, your concerns are justified in every sense . Yes , lithium and valproate may cause weight gain, and your apprehension is well conceded, but since you had mentioned that the muscle aches are having a toll on you and depression has again come back , so the only logical reason behind this all , was to change the precipitator that is Lamictal .


However, if you are so apprehensive about using Lithium or valproate , then do not worry we have other options as well , such as Carbamazepine , or the newest mood stabilizer , with the least side effects called as Oxcarbazepine , these two do not cause weight gain, so i propose you may opt for any of these 2 drugs , but i would suggest that you do this change in the presence of your doctor , and not when you are on a holiday , as although we do not expect any untoward side effects of these drugs , but , protocol says that any change in psychiatry drugs need to be done afer discussion with your doctor and in his/ her presence.


As far as duloxetine causing liver injury , well you are quite right in pointing out that , but , for this to happen one should be taking this drug for several years , which was never and will never be a case in your scenario , as we tend to keep you on this drug for 6-8 months and then taper it off , and finally stopping it . So, there is no need to be apprehensive about it's use, although being knowledgeable and cautious is always good. Also, the withdrawl symptoms of duloxetine , you are talking about , happen with all the SSRIs , BUT ,there is a way to prevent it , and that is never to stop an SSRI SUCH AS DULOXETINE, FLUOXETINE, PAROXETINE , SERTRALINE , ETC abruptly , out of sudden , these drugs need to be tapered slowly over a period of few weeks , before finally stopping it, and in this case there will no withdrawl symptoms. Also, having a drink occasionally would not do any harm , so do not take tension about it .Being a care giver yourself , i presume you would appreciate this point all the more.


However, i like to give patients options , so that they go home satisfied and without apprehension , so again , if you are apprehensive about taking duloxetine , then you may opt for an SNRI , called as Milnacipran , although it belongs to the same class to which effexor ( venlafaxine) belongs to , but it is a newer drug with least side effects and equal efficacy as effexor. So, you ,may start taking it , instead.


So, the new options for are ---


1)Carbamazepine or Oxcarazepine --- as a mood stabilizer , for replacing lamictal , these do not cause weight gain.


2)Milnacipran , anti depressant -- in place of duloxetine , if at all you still decide against the use of it.


So, i suggest you discuss the above mentioned drugs with your doctor first and do not start them on your own , as waiting for some more time would not cause any harm , but infact , it will only provide you with the best possible treatment option.


I wish you best of health and enjoy your trip , it definitely will act as a destressor.


I hope my answer serves your query according to your satisfaction.




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