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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18662
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Customer Question

Hello. Are u available
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Yes, I am available.
How can I be of assistance?
Customer: replied 2 years ago.
Could u check my earlier notes from 6 months ago please
Expert:  Dr. D. Love replied 2 years ago.
Yes, about the venlafaxine.
What is the current question?
Customer: replied 2 years ago.
I was on venlafaxine 75 and all of a sudden I have got my symptoms back of depression. The Dr has upped the dose to 150 on Monday the 12th but still feel terrible. Any advice?
Customer: replied 2 years ago.
Any advice
Expert:  Dr. D. Love replied 2 years ago.
There are a couple comments.

In someone that has been doing well on a certain antidepressant and the symptoms gets worse, it is reasonable to first increase the dose of the medicine that previously was helping. You are still not yet on the maximum dose of the venlafaxine, so it may still be necessary to increase the dose further.

When the symptoms are more severe, then the doctor can increase the dose more quickly, but it is recommended that the dose not be increased more quickly than every 4 days. In most cases, the doctor will usually prefer to adjust the dose more gradually, usually every week or two, but if the symptoms are more severe, it can be done more quickly.

If increasing the venlafaxine to the maximum dose is not effective, then the usual next step would be to change to another antidepressant in a different chemical class.

If I can provide any clarification, please let me know.
Customer: replied 2 years ago.
How much time should I give to the 150 dose to know if that is the right dose for me.
Secondly how does one avoid such crippling lows as the medication was working perfectly fine and with no warning at all it stops working
Thirdly if the Dr has to increase to a further higher dose that would allow no room incase I get another relapse to increase it further
Fourthly at this stage is it better to stick to the same medication?
Expert:  Dr. D. Love replied 2 years ago.
As I noted above, the time would depend upon the severity of symptoms. Doctors will usually prefer to give it a week or two, but if the symptoms are more severe, then the dose can be adjusted more quickly, up to as soon as 4 days.

Usually, there is no way to predict when depression symptoms will worsen, so it is usually impossible to avoid such worsening. The only exception would be a major life event that s known ahead of time, such as the impending death of a loved one, in which case there can be consideration of adjustment of the dose in anticipation of such events.

If it is necessary to increase to the maximum dose to get control of the current symptoms, and then symptoms worsen again, it would be necessary to consider changing to a different antidepressant.

Most doctors will stick to the same medicine if it has been previously helpful.
Customer: replied 2 years ago.
I thought it takes 2 to 6 weeks for the medication to work and have its full effect. So since the Dr just upped the dose on the 12th and today is the 21st can I expect quick results
Expert:  Dr. D. Love replied 2 years ago.
That is why doctors will usually prefer to do it more slowly, but with more severe symtoms, the dose can be adjusted more quickly.
Customer: replied 2 years ago.
How can depression be best managed
Expert:  Dr. D. Love replied 2 years ago.
Antidepressants are the intervention that is used the most often and is best for most people. Certain people seem to do better with counselling, but that depends entirely on the individual.
Customer: replied 2 years ago.
Mine is purely endogenous. No complaints about life otherwise. How can one avoid relapses
Expert:  Dr. D. Love replied 2 years ago.
Since it is impossible to predict when relapses will occur, there is nothing that can be done beyond healthy lifestyle habits, such as eating a proper diet and exercising regularly.
Customer: replied 2 years ago.
Sure. Have people had success rate for a long time being on medication and healthy living and able to live a full life with endogenous depression
Expert:  Dr. D. Love replied 2 years ago.
Yes, but virtually all patterns are possible. Some people have intense symptoms for a limited period of time, and then never have a recurrence. Some people have intermittent recurrences at varying intervals. Some people have chronic symptoms that require chronic treatment. When a person first presents, it is impossible to know what pattern will occur, although if there is a positive family history, it is more likely to follow the pattern in the family.
Customer: replied 2 years ago.
Thank u for your help. Can I request u of I need help. Also can I speak to you
Expert:  Dr. D. Love replied 2 years ago.
Absolutely. In the future, you can request me as you did today. Of course, no expert is online 24 hours per day, although I am online daily. If the requested expert is not online, the system will open any question to other exerts after a period of time. If you desire to wait and have a question that does not require an urgent answer, you can request that any expert that offers to help to opt out and wait until I am online.
Customer: replied 2 years ago.
How about the phone
Expert:  Dr. D. Love replied 2 years ago.
It is easier to speak via this forum. It may be possible to do a phone call over the internet, such as through Skype. I know that the US JustAnswer supports that option at an additional charge and the UK JustAnswer seems to as well. I have never personally done an international phone call via Skype, but if it is supported by the UK JustAnswer and you wish to do so, I can learn to do so.
Dr. D. Love and 2 other Medical Specialists are ready to help you
Customer: replied 2 years ago.
Great. Thank u
Expert:  Dr. D. Love replied 2 years ago.
You are most welcome.