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Suggest Treatment For Fatigue, Weakness, Constipation And Hemorrhoids

Posted on Mon, 19 Dec 2016

Question: Depressive Disorder with psychosomatic symptoms - for the last 10 years
Symptoms include fatigue, weakness, uneasiness and nausea, IBS, constipation, hemorrhoids, headaches, low concentration, brain fog, diplopia, muscle tension, nasal heaviness and post nasal drip, irritability and anger issues
Since I plan to travel and study abroad next year, I need a solution to keep these symptoms at bay and not let them trouble me excessively, as they do now.

Answered by Dr. Chintan Solanki (32 minutes later)

Brief Answer:
can you provide details of medicines

Detailed Answer:
Hello XXXXX,

Thanks for writing to us. I can understand your concern.

There are many patients who do not improve 100% but they remain better with medicines and live functional life.

To guide you further I need more details.

- How did problem start?

- How is your life affected with stress?

- Can you provide details of medicines you have taken with dose and duration so I can guide you about remaining options?

- Is vitamin B12 and thyroid level assessment done?

- Is there any other physical problem apart from mitral valve you mentioned?

- Can you brief me about CBT and psychotherapy you have taken?

I will be happy to help further after your response.
Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (1 hour later)

Hi doctor,
Thanks for your prompt response.
To answer some of your questions,
- Vitamin B12 and thyroid function tests, the latest done about a year ago, show normal results.
- The only other major physical problem is amblyopia, which has led to strabismus and extremely poor vision in the right eye, since I was about 4.
- Currently my stress levels are mainly due to my health issues and frequent issues at home (I live with my parents), also due to lack of financial stability.
- The issue started when I was 17-18 years old, initially with inexplicable physical symptoms such as nasal heaviness, muscle pain and dyspepsia, but later emotional symptoms also started showing up.
- I have a complete case history detailing the various medications/treatments tried, is it possible to send it to you?

Answered by Dr. Chintan Solanki (3 hours later)

Brief Answer:
yes you can send images of case history

Detailed Answer:
Hi young man,

Thanks for follow up.

You are fighting with multiple ailments. It is good that thyroid and vitamin B12 are normal. For somatic symptoms there are lots of medicines. if you can upload your details I may comment about treatment aspect.
You can send old reports, case history, prescription by taking photographs or pdf file with attachment option. You can take help of customer care if you face difficultly. Also send me exact diagnosis made by your psychiatrist.

Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (2 minutes later)

I have attached the case history as a pdf report on this question. Kindly view it.
Thanks.

Answered by Dr. Chintan Solanki (13 hours later)

Brief Answer:
duloextine and etizolam are recommended

Detailed Answer:
Hi,

Thanks for excellent history.

Your major improvement was always with escitalopram. It is a good and safe drug for depression. When somatic symptoms are predominant I prefer duloxetine. It has given superb results in many patients. With that to cover your anxiety I suggest adding etizolam in daytime which is not non sedative anti anxiety drug. IF muscle symptoms are lasting long, flupirtine maleate (Retense)can be added.

With medicines, you must continue healthy lifestyle with yoga and meditation. If your concentration does not improve even after this stimulant drug from amphetamine group can be added later on.

If time permits CBT should be restarted.

For a while I can recommend online CBT programme. These are basically for depression but you may get idea what is CBT and how to do it.

https://moodgym XXXXXXX edu.au/welcome

http://serene.me.uk/

Feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (2 hours later)

Hi doctor,

Thanks for your advice; I have heard about the efficacy of SNRIs like duloxetine but not yet been prescribed it.

Currently, however, I am not under any particular psychiatrist as my previous doctor has shifted out of the city. I am currently in XXXXXXX

I understand that you are in Gujarat; so if you could suggest a way I can be under your guidance or if you have any colleagues in XXXXXXX whom you can recommend me to, that would be great.

I shall look at the online CBT programs, due to time constraints travelling for CBT sessions have generally not been feasible so far. So thanks for this.

Answered by Dr. Chintan Solanki (1 hour later)

Brief Answer:
you can take help of following link

Detailed Answer:
Hi XXXXX,

I would surely like to treat you but limitation is I cannot prescribe medications online.

With help of following link you can search psychiatrist in XXXXXXX

http://doctor.healthcaremagic.com/doctors/Psychiatrists-in-Bangalore/L18862S35

You can search psychiatrist near to you.

NIMHANS is the apex institute of mental health in India; I suggest visiting Dr. XXXXXXX XXXXXXX there for your problem.

However I can guide you in future about treatment aspect anytime

http://bit.ly/drchintansolanki (for future communication this is a link to contact me directly by clicking on 'Ask me a question' on same page with three follow up questions).

Wish you good health.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar