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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19453
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have been taking 20mg Fluoxetine years, but felt

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I have been taking 20mg Fluoxetine for many years, but felt it wasn't working and my doctor changed my medication 6 weeks ago to Sertraline 50mg per day. However, if there is any change I feel slightly worse.
The symptoms are as follows: My emotions are usually just bland, neither up or down. I feel tired most of the time and sleep easily during the day, especially after a meal. At night I sometimes sleep well and other times have difficulty sleeping. These symptoms are inconvenient and frustrating. The main problem is that I have no interest in anything, I don't want to do anything and I don't want to have to deal with other people or go out. I cannot focus on the present and usually spend my time going over the past with different 'what if' scenarios. I work from home in the family business and when faced with company work I can't get started on anything. My 97 year old mother lives with us in an annexe but I am finding it increasingly difficult to care for and spend time with her. If faced with tasks that must be done either for my mother or the company, sometimes I just dismiss them and sometimes I go into mild panic. I feel overwhelmed with everything all of the time. Is there any therapy you can suggest that could help me?
Hello from JustAnswer.

There are several other medicines that may be able to help in this situation.

The first consideration would be an antidepressant that works by a different mechanism. Both the fluoxetine and the sertraline are SSRIs, so will only affect serotonin. When SSRIs are not effective, then it would be appropriate to use an SNRI, such as venlafaxine or duloxetine, or a medicine that works by a unique mechanism, such as bupropion or mirtazapine.

In addition, it would also be a consideration to use a medicine to augment the antidepressants. There are several medicines that can be used to augment the antidepressants, including lithium, certain anticonvulsants, such as valproic acid, and several medicines that can work as mood stabilizers, such as quetiapine or aripiprazole. However, in someone that is having difficulty getting started, another option is the use of a low dose of a thyroid hormone, triiodothyronine, which may help augment an antidepressant in addition to the direct effect of the thyroid hormone.

It is also reasonable to resume the CBT, as several studies have suggested that the combination of medicines and counselling is more effective than either alone.

If I can provide any further information, please let me know.
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