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Dear Customer, it is a pleasure to attend you today, I am very sorry for the health situation you have been experiencing since the beginning of the diagnosis three years ago, evidently this situation seems to have evolved having a refractory response to treatment with venlafaxine for this reason it is essential through specific actions of psychotherapy can make proper diagnosis as many of the signs and symptoms that you tell me may be related to alterations in cortisol levels, serotonin and also possible hormonal and endocrinological metabolic alterations in the levels of blood sugar and thyroid hormones is for this reason that it is necessary to perform certain tests and specific studies so you could talk to your primary health care physician to consider the possibility of conducting all these studies, all this will help us to know what is happening in order to establish a timely treatment, I would like you to keep me informed of your health situation to know about your evolution in the coming weeks, I will be happy to assist you and guide you in everything I can.