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Ask Dr. David Your Own Question
Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 46681
Experience:  Board Certified Physician
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Customer Question

Hello,
Are you available to answer a question
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.
Dr. David :

This is Dr. David

Dr. David :

what is your question?

Customer:

Is Dr Love available to connect with ,as it would be a follow up with him

Dr. David :

he is not online right now.

Dr. David :

can I help you?

Dr. David :

I see your prior questions were about depression

Dr. David :

and venlafaxine

Customer:

oh okay , in that case I wanted to ask you ,I started citalopram on the 25th of june and then switched to venaflaxine on the 30th of this month ,75 mg slow release and It had worked in the past in a couple weeks but may be because my reserves were not completely depleted as I had sertraline in the system for 3 years prior and that had lost its effect , also coz then I would not exercise. if yuu read all my correspondence above you will find that I was on very low dose of venaflaxine for 3 mnths and then on no mediaction for 6 weeks before the symtoms reappeared in a big big way, so shouldn't the dr be increasing the dose ,given that my reserves would have been completely depleted.

Dr. David :

no, you should stay on your current dose of venaflaxine and give it more time

Dr. David :

and it will start to help your symptoms like it has in the past.

Dr. David :

it is too risky to up and down the dose based on your "reserves"

Dr. David :

it is better to stay at a steady dose and give it more time.

Customer:

I have a long standing condition of endogenous depression and my levels do drop very significantly. I have also started playing squash but don't feel good at all.

Dr. David :

I see.

Dr. David :

I would give the 75mg slow release at least 4 weeks to see if it will start to work

Dr. David :

and if after 4 weeks you are still having depression, then talk to your doctor about increasing the dose.

Dr. David :

exercise would not take away more venaflaxine out of your system.

Dr. David :

you should continue to exercise which is good for your mind and your body and also helps fight against depression.

Customer:

he has said to wait 6 weeks before he can up it, unfortunately I am travelling for a holiday on the 25th till the 10th which is a big effort at this time as the mind does not feel well , but he says to wait.

Customer:

is it risky for those who have just started with anti depressants or even for someone like me who has been on it in the past for long periods of time.

Customer:

oh , for sure exercise does not take venaflaxine out , I guess what I meant was that despite playing squash I am not feeling better, and I would have thought that the effect of the medication should kick in sooner as the body can produce serotonin, epinephrine and the receptors quickly

Dr. David :

I see.

Dr. David :

avoid alcohol which can worsen depression.

Dr. David :

you could be low in vitamin D as well.

Dr. David :

your holiday should do you good.

Dr. David :

I bet you will start to feel better by the time of your holiday.

Customer:

also have you had patients with endogenous depression that you have worked with ? my circumstances are picture perfect.I do not drink alcohol at all.

Dr. David :

I would agree with your GP and stay at your current dose

Dr. David :

I know you want to try to feel better sooner, but there are risks at jumping up and down the dose.

Dr. David :

you have only been on it for less than 2 weeks.

Customer:

that is correct.

Dr. David :

so you have to give it more time.

Dr. David :

best of luck to you

Customer:

but for 6 days prior was citalopram

Dr. David :

hang in there.

Dr. David :

let me know if you have other questions.

Dr. David :

if done, please leave positive feedback below the chat box

Dr. David :

we only get credit for helping clients after positive feedback

Customer:

have you had patients with endogenous depression that you have treated.

Dr. David :

http://www.justanswer.com/medical/expert-dr-david/

Customer:

yes, I will , thank you , just a couple more questions before we end the chat please

Dr. David :

yes I have treated patients with depression.

Customer:

why is endogenous depression not so common , while exogenous depression is , I am unaware of any family history , and I have had a good childhood.

Customer:

and my morning till mid day are the worst. in that case would u suggest I take the medication in the morning or the night?

Dr. David :

we don't know why endogenous depression is not as common.

Dr. David :

if it doesn't cause fatigue, I would take it in the morning

Dr. David :

for some patients long acting venlafaxine can cause fatigue and sleepiness and for those patients, I would recommend taking it at night time.

Customer:

it doesn't , but how do I battle the morning, mid day lows, any suggestions?

Dr. David :

keep exercising during the day but not too close to bed time.

Dr. David :

work on eating healthy and drinking lots of fluid

Dr. David :

and having the same bed time at night time.

Dr. David :

lack of sleep can worsen symptoms of depression.

Dr. David :

if you exercise too close to bed time, this can effect your sleep.

Dr. David :

and avoid alcohol and caffeine which can also effect your depression and sleep.

Customer:

okay, thank you and I will now give the feedback.

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