Since Covid, I have suffered from severe anxiety and depression. I take duloxetine and lorazepam twice a day but they don’t help me anymore. I live alone, I’m 78 years old and I don’t see the point in moving forward. My family tries to help, but I don’t see a future in which I will be happy and content.
Name and address withheld
Dr Martin Scurr responds: At this time of year there will be many people going through what you are experiencing and I thank you for your letter. It is very brave of you to write and I deeply understand that.
It is clear that he suffers from a major depressive illness. However, I am optimistic and believe that with better treatment he will make a full recovery.
An intrinsic symptom of depression is that any sense of optimism evaporates. The disease can also cause sleep disturbances, feelings of worthlessness, loss of appetite, and even feeling cold and tired all the time.
The physical symptoms are as overwhelming and exhausting as the psychological state of anxiety and feelings of doom. This is why doctors view depression as a whole-body problem, not something limited to just the brain.
It is worrying that in your longest letter you say that you have had suicidal thoughts; however, his family is the reason he doesn’t take them further. I encourage you to let them know how you really feel.
Don’t keep fighting alone, talk to your GP and family as soon as possible, says Dr Scurr
Duloxetine may be an effective antidepressant, but the dose you are taking (30 mg) is low: the usual maintenance dose is 60 to 90 mg.
The fact that the medication used at least tells us that it does not make you sick or cause unacceptable side effects such as nausea, dry mouth and insomnia (which affects between 5 and 10 percent of patients).
It is important to note that a small number of people may develop suicidal thoughts when starting antidepressants or changing their dosage, so it is very important that your family and doctor are aware of these feelings.
But if these thoughts predate your medication, that suggests the medication isn’t driving them for you. A reduced response to a medication that previously worked may be a sign that the body has become accustomed to that dose (the liver develops its enzyme systems to “detoxify” the blood of the medication, in which case a higher dose will be necessary). ).
Your GP may suggest increasing the dose of duloxetine to make the medicine effective again.
Lorazepam, a tranquilizer, helps suppress anxiety symptoms, so once duloxetine treatment becomes effective again, the anxiety will also disappear and you can reduce the dose of lorazepam slowly, under medical supervision.
I urge you to speak to your GP immediately to discuss your duloxetine dosage and help you get back to your old self. I also urge you to talk to your family and contact the Samaritans by calling 116123 or emailing jo@samaritans.org. Please feel that you can write to me again.
I have a skin problem around my left ankle. It started last Christmas with peeling skin on the bottom of my foot, hardening of the skin and swelling. Now it’s spreading down my leg. My GP has prescribed antibiotics and emollients, without success.
Charles Bailey, Manchester.
Dr. Scurr responds: My suspicion is that you have a form of psoriasis, an autoimmune condition that triggers the overproduction of skin cells, which build up and result in inflamed and often scaly patches known as plaques.
These can occur anywhere on the body, although the scalp, elbows, knees, and lower back are generally affected. The plaques can itch, invariably causing some discomfort and cracking of the skin.
The usual treatment is topical steroids, although a drug derived from vitamin D (calcipotriol) and other new medications such as roflumilast are increasingly used.
With treatment, the condition should improve within a few weeks.
IN MY OPINION.. Sugar rules don’t count at Christmas!
After being married to a dietitian for many years, a combination of gentle pressure and irrefutable logic has taken away my lifelong sweet tooth. Because, as I have come to accept, sugar is no better for our health than alcohol.
However, we don’t have to be puritans about it, as demonstrated by a study just published in the journal Frontiers in Public Health (bringing joy to my taste buds).
An analysis of the diet of more than 60,000 middle-aged people found that regular sugar consumption significantly increased the risk of cardiovascular disease.
But scientists also found that when sweet foods were consumed as occasional treats, the risk of heart disease was reduced. Yes, really.
Eating sugary foods from time to time, surrounded by family and friends, can be beneficial.
So enjoy the festivities and don’t worry about breaking the sugar rules every once in a while. As I write, my favorite panettone, Florentines, and meat pies are waiting for me on the shelf. Merry christmas!
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk; include your contact information. Dr. Scurr cannot correspond personally. Always consult your primary doctor with any health problem.