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Tim Brown
Tim Brown, GP
Category: Medical
Satisfied Customers: 4077
Experience:  GP in Sussex
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L have had depression on and off throughout my adult life,

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l have had depression on and off throughout my adult life, sometimes seasonal; usually lasts about 6 months with anti depressants which l continue for about another year then l'm back to 'normal'. This time it's been nearly 3 years - it's NOT covid. Now saying I should take lithium as I've tried two anti depressants, duloxetine and venlafaxine. I really don't want to, but I feel so awful l might get pushed into it. Any ideas?
JA: How long have you had depression? Do you have a cough, fever, or shortness of breath?
Customer: This time, nearly 3 years. Sometimes a bit short of breath, but l think that's anxiety/panic,bot something i've had before.
JA: The Psychologist will be able to answer that. Where are you located? How widespread is COVID-19 in your area?
Customer: Liverpool. Covid very low here. I;ve had two jabs.
JA: Thank you so much for your time. Finally, is there anything else in your medical history you think the Psychologist should know?
Customer: Can't think.

Good morning, I am Dr Ruff, thank you for contacting us today

I am sorry to hear of this. Lithium is useful in mood instability, so rarely used in depression. You should try two of the same drug class to see if there is any benefit. So another SSRI would be reasonable to try. Lithium is a difficult drug due to regular blood monitoring of it as it becomes toxic easily due to its low therapeutic range.

I would consider trying another SSRI such as Vortioxetine which is one of the newer ones.

If this fails, you should arrange a psychiatric medication review for support with this. Only they can start Lithium if it was to be indicated.

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Customer: replied 20 days ago.
I keep saying there must be other antidepressants l haven't tried / found to suit me. I've not heard of vortioxetine; that's a SSRI not an SNRI ? How doe is it differ? Side effects?