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Doctor Rao
Doctor Rao, Doctor
Category: Mental Health
Satisfied Customers: 641
Experience:  MBBS,MD,DPM,MRCPsych
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Hi I am 55 years old and have a few symptoms of depression

Customer Question

Hi I am 55 years old and have a few symptoms of depression - tired ind the morning and more sad than else. I have difficulties in taking decisions. I know I have som stress but is afraid that it will turn into a depression. I have earlier (2001) had a major depression and got Efexor but since november 2010 I have been out of medicin - in agreement of my doctor. Is it a good idea to take Efexor again to prevent a depression ? I have som trouble with my girl friend (divorced 2010) so that is also stressing med. I go to a psychologist and don´t know if it is a better idea to avoid Efexor (Venlafaxin) as my doctors says that I should take medicin at least one year, If I begin.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Doctor Rao replied 2 years ago.

Doctor Rao :

Hi are you online?

Customer:
Customer:

yes online now


 

Customer:
Doctor Rao :

hello

Doctor Rao :

thank you for waiting

Customer:
Customer:

okay


 

Customer:

chat now ?


 

Doctor Rao :

you mentioned you have few depressive symptoms.In those do you have low mood,low energy levels.not able to enjoy pleasurable activities,low self esteem,loss of appetite and weight?

Customer:

only low mood,low energy levels and some negative thougts and guilt-feelings


 

Doctor Rao :

ok

Doctor Rao :

we can approach the issue in two ways

Customer:

yes ?

Doctor Rao :

First and safe way is, To restart venlafaxine low dose 37.5 mg per day and to increase slowly to 75 mg per day+continue at that dose for about 3 to 6 months. The rationale for this is, you have past history of depression,this responded well to venlafaxine,currently you are having some symptoms that might be suggestive of relapse,you also have ongoing stressors int he form of problems with your girl friend

Customer:

I also feel confused when I shall take even small decisions (more than else)


 

Doctor Rao :

The second approach is to closely monitor your mood and if you show further deterioration then to consider start of antidepressant.But if you want to choose method you need close observation of your mood

Doctor Rao :

you do take one tablet of venlafaxine 37.5 mg per day and increase to 75 mg gradually

Doctor Rao :

It is not uncommon that in people experiencing depressive episode they do have ambiguity to take trivial decisions

Customer:

my doctor recommand -if starting - 75 mg because I got 150 mg from 2006-2010. When I was most ill I got 225 mg


 

Doctor Rao :

once you start feeling better mood, your self esteem gets better and you might be slightly more comfortable in making decisions

Doctor Rao :

tHATS RIGHT DOSE

Customer:

and then going up to 150 mg after a week

Doctor Rao :

I suggested 37.5 mg only as a safety because some people prefer low doses as they can't tolerate any side effects

Customer:

in fact I don´t really know why I hesitate to start....I have bought the medicine :-)


 

Customer:

I was very ill i 2001 and got medicil and cognitive therapy, so I was very lucky for the Efexor !


 

Doctor Rao :

ok. Yu don't need to worry to restart the medication. We do know that earlier the treatment the better would be the prognosis

Doctor Rao :

yes.i can see

Customer:

but is it right that I must take it for at least 12 months ??(my doctor was a little irritated on me when I asked for medicine, I think :-)


 

Customer:

I think also that it is a good "insurance" against getting real ill, that I start taking the medicin, and I will probably get more clear in my decision taking. I worry also a lot of not hurting people...


 

Doctor Rao :

The duration can be about 6 months.to be honest the duration depends on how you respond to treatment,ongoing psychosocial stressors at that time,social support and how you are managing your daily living activities

Customer:

my girl friend found that I got a littel "speeded" when I got the medicine, but I myself just felt a good energy !


 

Doctor Rao :

yes.Thats right.Ambiguity is a known issue in depression

Customer:

Efexor shoul not give an artificial or unrealistic mood ???


 

Customer:

can you explain ambiguity ?


 

Doctor Rao :

no.it improves endogeous mood

Doctor Rao :

Ambiguity is when a person struggles to make a decision,dent matter how trivial it is

Doctor Rao :

I hope you find this helpful

Customer:

yes and I really have a good energy ! have run 5 marathons from 2005-2009 :-)


 

Customer:
Doctor Rao :

That was an impressive act

Customer:

yes, I think you have given me a good help.


 

Doctor Rao :

you must be proud of yourself.That should give more motivation to start medication,get better an drove on in life

Customer:

I use to say that my first maraton was going up from the hell of depression in 2001.....


 

Doctor Rao :

So true.It is not easy

Customer:

you think Mindfulless also will do me good ??


 

Doctor Rao :

yes.Mindfullnes sis nothing but be positive and open to suggestions especially psychological intervention

Customer:

thank you very much Mr. Rao. Have a good day


 

Customer:

greetings from Viborg, Denmark www.viborg.dk


 

Doctor Rao :

Sure.Thank you.If you find it useful,please provide positive feedback.have a good day.

Customer:

You get highest rate :-)


 

Doctor Rao :

i shall check the website

Doctor Rao :

thank you

Customer:
Doctor Rao :

OK.Bye for now.Take care

Customer:
Doctor Rao, Doctor
Category: Mental Health
Satisfied Customers: 641
Experience: MBBS,MD,DPM,MRCPsych
Doctor Rao and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
I already started with 75 mg Venlafaxin this afternoon and I feel already a positive effect. I have also in 2010 felt an effect after just 1 og 2 pills. Kan that be true ? Perhaps I am just especially sensitive of this medicine ?
Customer: replied 2 years ago.
Relist: Other.
I was very satisfied but I just have a follow-up question
Expert:  Camille-Mod replied 2 years ago.
Hi, I am a Moderator for this topic. I sent your requested Professional a message to follow up with you here, when they are back online. If I can help further, please let me know. Thank you for your continued patience.

Expert:  Doctor Rao replied 2 years ago.
Hi,
Thank you for the follow up question and I am answering as soon as I saw this question.

To be honest, we do feel better and respond to intervention in many ways. Effect of the medication is one part but talking to a professional,makings decision of reconsidering the medication,willingness to engage with the professionals , these all play a vital role in the response. All these work in different phases.

The response you have seen so far might be a cumulative effect of the above I mentioned. I don't think the response is completely down to the antidepressant effect of Effexor as it would need some time But may be due to its other effects like effect on sleep and anxiety etc.

I hope you would pursue with medication and continue to feel better.

Please do not hesitate to ask me for more information if required. I will answer as soon as I can.

I wish you all the best.

Thank you
Customer: replied 2 years ago.

I am very unsatisfied by reading that if I one more time gives a rate, I have to pay again. That is not written very clearly on the website.


It says that one can ask follw-up questions without paying more.


I require that you have only taken the paying one time ?

Expert:  Doctor Rao replied 2 years ago.
Hi,
I think if it is the same question you wouldn't pay twice. If you think you would be charged twice if you rate the answer, then as long as you are happy with the answer you don't need to rate again.

If you think you have been charged twice please contact the site moderator/administrator but i don't think you would be charged twice for the same question.

I am not very expert in how the site operated.I am sorry about that.
i wish you all the best.
Customer: replied 2 years ago.

Thank you for your answer. It is right that I am not unsatisfied with your work but the information I got when I would respond :-)


What is the address for moderator/ administator ?

Expert:  Doctor Rao replied 2 years ago.
Hi, No problem. Please look in to the website. I have not browsed myself but I am sure it is not difficult to contact customer care services. Thank you

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Doctor Rao
Doctor Rao
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MBBS,MD,DPM,MRCPsych