How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Kaushik Your Own Question

Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4068
Experience:  MD Psychiatry
9385906
Type Your Mental Health Question Here...
Dr. Kaushik is online now
A new question is answered every 9 seconds

Thank you for your advice Dr Kaushik. I am going to see how

Resolved Question:

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.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 5 years ago.

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.

 

Regards....

 

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4068
Experience: MD Psychiatry
Dr. Kaushik and other Mental Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education
 
 
 
Chat Now With A Mental Health Professional
Dr. Kaushik
Dr. Kaushik
Mental Health Professional
4068 Satisfied Customers
MD Psychiatry