Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Worsening Panic Attacks, Abdominal Bloating And Water Retention After Stopping Alcohol Consumption Cold Turkey
Posted on
Fri, 2 Mar 2018
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Thu, 1 Mar 2018
Answered on
Mon, 14 Jan 2019
Last reviewed on
Question : age 28 married weight 120kgs height 5'8 male was alcoholic for 5 years. now stopped when even cant take a sip. puked as soon as i take a sip. had LFTS test ALT AND AST were around 200. GGT was 690 CBC report was almost 99 percent perfect. NO HEPITITUS B OR C Dont know now that the symtoms are due to withdrawl or liver damage. left drinking 14 days ago symotoms are cough with mucus oftently extreme bloating in the abdomen. like some water retention or fluid build up. diarehea little nausea dull pain on upper right side under rib cage. confusion fear depression insomnia or sometimes alot of sleep weakness pain in legs ( like weak legs ) panic attacks NO dark urine. urine is light coloured NO bloody aur blackish stool. its light yellowish had an abdomen ultrasound 4 months back and there was just a little fatty liver. rest was perfect. i have a history of past 12 years of anxiety and depression. the withdrawl has even made it worse. the panic attacks mentioned above are more worsened after the last day i left cold turkey taking 2 anti depressants and 2 benzos. wellbutrin xl 600mg seroxat CR 25mg xanax 1mg thrice a day rivotril 0.5mg thrice a day the symtoms i have mentioned were also there before withdrawl bec of the anxiety problem but the withdrawl has worsen it. on bed for 10 days :(
Brief Answer:
Diagnosis: Alcoholic hepatitis
Detailed Answer:
Hello,
The symptoms you are experiencing and the blood workup is suggestive of alcoholic hepatitis, which is alcohol-induced liver injury.
Ultrasound abdomen can confirm the diagnosis and also rule out any cirrhotic changes. If there is no evidence of cirrhosis, then the good news is that alcoholic hepatitis is completely reversible by abstaining from alcohol. Cirrhotic changes if present will be irreversible.
The anxiety and depression are likely due to withdrawal from alcohol. Benzodiazepines are the medications of choice for treating alcohol withdrawal symptoms. However, both Xanax and Rivotril are metabolized by the liver and in case of liver injury their metabolism can be affected and liver can be stressed further.
The safest benzo in patients with liver injury is Lorazepam. The dosage is 1 to 2mg thrice daily. Start with initial low dose and the dosage can be titrated up to 2 mg thrice daily as needed. Follow up with your treating physician to switch from Xanax and Rivotril to Lorazepam.
Also, Wellbutrin can also affect your liver. It is better to switch to a safer antidepressant like Sertraline.
If you find it very difficult to deal with the withdrawal symptoms, it is best to get admitted and go through a formal detoxification program. Such programs will make the withdrawal period more tolerable by using a combination of medication and psychotherapy.
Once the acute problems have subsided, you will need a structured de-addiction program to prevent relapsing into alcohol abuse.
Please be advised to get in touch with your treating physician to make the necessary medication changes. Also, abstain from alcohol and repeat Liver function test after a week to assess your progress.
Hope this answers your question. Please let me know if you need further clarification.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Diagnosis: Alcoholic hepatitis
Detailed Answer:
Hello,
The symptoms you are experiencing and the blood workup is suggestive of alcoholic hepatitis, which is alcohol-induced liver injury.
Ultrasound abdomen can confirm the diagnosis and also rule out any cirrhotic changes. If there is no evidence of cirrhosis, then the good news is that alcoholic hepatitis is completely reversible by abstaining from alcohol. Cirrhotic changes if present will be irreversible.
The anxiety and depression are likely due to withdrawal from alcohol. Benzodiazepines are the medications of choice for treating alcohol withdrawal symptoms. However, both Xanax and Rivotril are metabolized by the liver and in case of liver injury their metabolism can be affected and liver can be stressed further.
The safest benzo in patients with liver injury is Lorazepam. The dosage is 1 to 2mg thrice daily. Start with initial low dose and the dosage can be titrated up to 2 mg thrice daily as needed. Follow up with your treating physician to switch from Xanax and Rivotril to Lorazepam.
Also, Wellbutrin can also affect your liver. It is better to switch to a safer antidepressant like Sertraline.
If you find it very difficult to deal with the withdrawal symptoms, it is best to get admitted and go through a formal detoxification program. Such programs will make the withdrawal period more tolerable by using a combination of medication and psychotherapy.
Once the acute problems have subsided, you will need a structured de-addiction program to prevent relapsing into alcohol abuse.
Please be advised to get in touch with your treating physician to make the necessary medication changes. Also, abstain from alcohol and repeat Liver function test after a week to assess your progress.
Hope this answers your question. Please let me know if you need further clarification.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Yogesh D
now that was a good reply but... i am too afraid to go for ultrasound . :( does the LFTS report tell what condition is my liver in? secondly do you recommend any blood tests related to my problems. i just want to get rid of this as soon as possible. why is my stomach so bloated or so tightened and swollen up? will the GTT come down by the passage of time? any food you recommemd to eat or not to eat. wellbutrin is an NDRI . seratline is an SSRI. wont it worsen the symtoms switching cold turkey. just left alcohol cold turkey too. can i excercise in this position? need to loose weight. and can you sugggest something to get rid if this puffy face and abdomen because of water retention.
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
The blood work up is strongly suggestive of hepatitis. There is marked inflammation shown in the liver function test as quite raised. The GGT value will come down once the inflammation of the liver subsides (for which abstaining from alcohol is very important). Time required for liver inflammation to come down vary from person to person and the severity of disease. There is no definite time frame.
Wellbutrin dose can be slowly tapered down while introducing Sertraline. That way you do not have to worry about switching cold turkey.
The bloating and facial puffiness is due to edema associated with decreased liver function. Edema will subside once the liver regains its function. If the edema is worsening, you can take Spironolactone once daily, which will get rid of excess water.
You can exercise. Start with mild exercise like walking and gradually work your way up. Limit exercise to what you can do comfortably until the acute phase of your illness have subsided.
Hope this answers your question. Please let me know if you need further clarification.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
The blood work up is strongly suggestive of hepatitis. There is marked inflammation shown in the liver function test as quite raised. The GGT value will come down once the inflammation of the liver subsides (for which abstaining from alcohol is very important). Time required for liver inflammation to come down vary from person to person and the severity of disease. There is no definite time frame.
Wellbutrin dose can be slowly tapered down while introducing Sertraline. That way you do not have to worry about switching cold turkey.
The bloating and facial puffiness is due to edema associated with decreased liver function. Edema will subside once the liver regains its function. If the edema is worsening, you can take Spironolactone once daily, which will get rid of excess water.
You can exercise. Start with mild exercise like walking and gradually work your way up. Limit exercise to what you can do comfortably until the acute phase of your illness have subsided.
Hope this answers your question. Please let me know if you need further clarification.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Kampana
you are the best doctor ever :) I still remember that honeymoon effect of wellbutrin when i started it. years passed and i have build tolerance to it. any alternative you can suggest which gives me that boost. more focused and concentrated. full energetic. An alternate medicine is very important here. dont want to waste my life sittinng depressed anymore. i just want to LIVE again. As i already told you that i am trying to loose weight also so any medication except orlistat which can aid in weight loss or suppress appetite. Lastly all of these medicines are not OTC. will you provide me prescription? Do Pray.
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
Sertraline is a good alternative antidepressant. However, I would like to add that Sertraline can cause weight gain. Therefore, you must be very particular about portion control and healthy diet while taking Sertraline.
Another anti-depressant which is an alternative option and that does not cause weight gain is Venlafaxine. Venlafaxine belongs to the class of antidepressant SNRI (Serotonin-norepinephrine reuptake inhibitor). But Venlafaxine is not as safe as Sertraline for use in patients with reduced liver function. In individuals with decreased liver function, only reduced doses of Venlafaxine should be used.
There are two options you can consider at this point:
- Switch to Sertraline and follow a healthy diet and regular exercise. Monitor weight regularly.
- Switch to low dose of Venlafaxine and closely monitor liver function. Once your liver completely recovers, the dose of Venlafaxine can be increased.
Whichever option you choose (sertraline/venlafaxine), slowly titrate down the dose of Bupropion and introduce increasing dose of medication.
These medications are not available over the counter and unfortunately, prescriptions cannot be provided onoine. Please be advised to follow up with your treating physician to make necessary changes.
I will definitely keep you in prayers. I understand that you are going through a difficult situation. But appropriate treatment and support from your family, friends, and physician will help you in easy recovery.
Please let me know if you have any more questions. Wishing you fast recovery and good health.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
Sertraline is a good alternative antidepressant. However, I would like to add that Sertraline can cause weight gain. Therefore, you must be very particular about portion control and healthy diet while taking Sertraline.
Another anti-depressant which is an alternative option and that does not cause weight gain is Venlafaxine. Venlafaxine belongs to the class of antidepressant SNRI (Serotonin-norepinephrine reuptake inhibitor). But Venlafaxine is not as safe as Sertraline for use in patients with reduced liver function. In individuals with decreased liver function, only reduced doses of Venlafaxine should be used.
There are two options you can consider at this point:
- Switch to Sertraline and follow a healthy diet and regular exercise. Monitor weight regularly.
- Switch to low dose of Venlafaxine and closely monitor liver function. Once your liver completely recovers, the dose of Venlafaxine can be increased.
Whichever option you choose (sertraline/venlafaxine), slowly titrate down the dose of Bupropion and introduce increasing dose of medication.
These medications are not available over the counter and unfortunately, prescriptions cannot be provided onoine. Please be advised to follow up with your treating physician to make necessary changes.
I will definitely keep you in prayers. I understand that you are going through a difficult situation. But appropriate treatment and support from your family, friends, and physician will help you in easy recovery.
Please let me know if you have any more questions. Wishing you fast recovery and good health.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
hello doc weight gain is already an issue. cant take more risk. secondly i took 50mg sertraline in the morning and it is not working for me. because deuratics make you go to the washroom 2 times in an hour atleast. i just went 2 times in the whole day. suggest me a stronger one. kindly have a look at my todays reports and let me know that is there any improvement after 5 days or not. after looking at the reports let me know about the serataline velaxafine issue. what should i do.
Correction: Please note that its not "sertraline". It is "spirinolactone" that I am referring to.
Correction: Please note that its not "sertraline". It is "spirinolactone" that I am referring to.
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
The lab values are indicative of a progressive improvement in your liver function. So, it should be fine to start with a low dose of Venlafaxine. Monitor liver function weekly and once the liver function completely normalize the dose of Venlafaxine can be increased.
Spironolactone will take almost 3-5 days to provide effective diuresis. You can wait for 3 more days and if the edema does not decrease by then, increase the dose of Spirinolactone once daily. However, you should not increase the dose without consulting your physician.
Hope I have answered your query. Please let me know if you have any more questions.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
The lab values are indicative of a progressive improvement in your liver function. So, it should be fine to start with a low dose of Venlafaxine. Monitor liver function weekly and once the liver function completely normalize the dose of Venlafaxine can be increased.
Spironolactone will take almost 3-5 days to provide effective diuresis. You can wait for 3 more days and if the edema does not decrease by then, increase the dose of Spirinolactone once daily. However, you should not increase the dose without consulting your physician.
Hope I have answered your query. Please let me know if you have any more questions.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
thank God improvements are there now :) i think it will take 2 months to recover with the help of my greatest doc, U :) i have planned to quit seroxat cold turkey. if i can quit alcohol cold turkey than this is a piece of cake for me. decrease the dosage of wellbutrin to 150mg from 600mg and start with venlafaxine. how does this plan sound to you. ( let me know the dosage of venlafaxine ) how much mg to start and where to maintain. and i asked you for any appetite supprrsant because starting a new anti deprassant literally keeps you eating all day long. i was searching over the internet and found out that the people with edema also have swollen ankles feet and legs. i only have problem with the abdominal area. does it make sense saying it might be bloating? and i wanted to ask is there still no SNDRI,S in the market? i mean all 3 neurotransmitters in 1 tablet. i told you keep praying i.ll get well soon :)
i am totally insomniac.
yesterday night i took 4mg lorazepam with 3mg melatonin but no luck. the maximum i am sleeping past 14 days is 2-3 hours per day.
and dont know why there is fatigue and sort of pain in the legs. your thoughts on this?
i am totally insomniac.
yesterday night i took 4mg lorazepam with 3mg melatonin but no luck. the maximum i am sleeping past 14 days is 2-3 hours per day.
and dont know why there is fatigue and sort of pain in the legs. your thoughts on this?
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
You are currently on a very high dose of Wellbutrin. So we have to titrate down the dose very slowly. Reduce the dose to 150 mg thrice daily for 4 days, followed by 150 mg twice daily for 4 days, to 150 mg once daily for a week before stopping.
During the last week of Wellbutrin, we can introduce Effexor XR 37.5 mg. You should remember than Effexor can take 4 weeks to give good results and you should not stop Effexor cold turkey. Stay on Effexor 37.5 mg for 2 weeks. Monitor liver function at the end of 2 weeks. If your liver function is improving the dose of Effexor XR can be increased to 75 mg once daily.
Regarding weight loss, I see that you mentioned before about taking Orlistat. Orlistat is not safe for your liver. So avoid it. There is no pill available that can safely help in reducing weight. A healthy diet and regular exercise is the best way to attain a healthy weight.
Insomnia is likely due to your current medical condition, alcohol withdrawal, and anxiety. You can continue Lorazepam (total dose not exceeding 6 mg a day) to help.with insomnia. Once acute hepatitis and alcohol withdrawal phase subsides you will be able to sleep better. Let us also see how Effexor is working on your depression and anxiety. Keep in mind it takes 4 to 6 weeks to show good results. Once Effexor controls your depression and anxiety, your sleep will improve too.
Regarding edema, it is true that there will be swollen feet and ankles too. However, sometimes it can be too little to be appreciated. In your case, I am thinking more of edema rather than just bloating is because you mentioned the presence of facial puffiness too. Clinical examination is required to confirm. You need to follow up with your physician to assess the presence of edema and need a diuretic.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
You are currently on a very high dose of Wellbutrin. So we have to titrate down the dose very slowly. Reduce the dose to 150 mg thrice daily for 4 days, followed by 150 mg twice daily for 4 days, to 150 mg once daily for a week before stopping.
During the last week of Wellbutrin, we can introduce Effexor XR 37.5 mg. You should remember than Effexor can take 4 weeks to give good results and you should not stop Effexor cold turkey. Stay on Effexor 37.5 mg for 2 weeks. Monitor liver function at the end of 2 weeks. If your liver function is improving the dose of Effexor XR can be increased to 75 mg once daily.
Regarding weight loss, I see that you mentioned before about taking Orlistat. Orlistat is not safe for your liver. So avoid it. There is no pill available that can safely help in reducing weight. A healthy diet and regular exercise is the best way to attain a healthy weight.
Insomnia is likely due to your current medical condition, alcohol withdrawal, and anxiety. You can continue Lorazepam (total dose not exceeding 6 mg a day) to help.with insomnia. Once acute hepatitis and alcohol withdrawal phase subsides you will be able to sleep better. Let us also see how Effexor is working on your depression and anxiety. Keep in mind it takes 4 to 6 weeks to show good results. Once Effexor controls your depression and anxiety, your sleep will improve too.
Regarding edema, it is true that there will be swollen feet and ankles too. However, sometimes it can be too little to be appreciated. In your case, I am thinking more of edema rather than just bloating is because you mentioned the presence of facial puffiness too. Clinical examination is required to confirm. You need to follow up with your physician to assess the presence of edema and need a diuretic.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
yeah i.ll taper down wellbutrin.
its the first day i have quitted seroxat but no withdrawl symtoms yet. i pray that this phase never comes. just 1 symtom which is benifecial for me is loss of appetite :)
i think you forgot that i.ve left left a SSRI ( seroxat ) yesterday so i have to take a ssri in its replacement .
yes i know that every ssri takes 4 months to show its effects. as far as liver functions are concerned i will be doing LFT,S every week so we.ll get to know the liver situation. go
from Monday i am going back to work so if you dont have a nice than the day goes too nauseaus , disorientated and non focused.
today i got my last results of free t3 and t4. kindly have a look. attached the picture.
lastly i have these hand tremors all the time like those in parkinsons. its sometimes so embarising shaking hands with people. it cant be parkinsons because i.ve already have had a Brain MRI. The tremors are still there even when the anxiety is fully under control.
one thing i forgot to tell you that i sweat alot. even when people are wearing jackets i.m literally sweating. throid is fine . blood pressure is undee control. even when i am not feeling anxiety even than i sweat alot alot. cant diagnose this yet. its like 2 years its happening. and overall i feel more hotter than normal people.
waiting for your kind reply
its the first day i have quitted seroxat but no withdrawl symtoms yet. i pray that this phase never comes. just 1 symtom which is benifecial for me is loss of appetite :)
i think you forgot that i.ve left left a SSRI ( seroxat ) yesterday so i have to take a ssri in its replacement .
yes i know that every ssri takes 4 months to show its effects. as far as liver functions are concerned i will be doing LFT,S every week so we.ll get to know the liver situation. go
from Monday i am going back to work so if you dont have a nice than the day goes too nauseaus , disorientated and non focused.
today i got my last results of free t3 and t4. kindly have a look. attached the picture.
lastly i have these hand tremors all the time like those in parkinsons. its sometimes so embarising shaking hands with people. it cant be parkinsons because i.ve already have had a Brain MRI. The tremors are still there even when the anxiety is fully under control.
one thing i forgot to tell you that i sweat alot. even when people are wearing jackets i.m literally sweating. throid is fine . blood pressure is undee control. even when i am not feeling anxiety even than i sweat alot alot. cant diagnose this yet. its like 2 years its happening. and overall i feel more hotter than normal people.
waiting for your kind reply
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
You can safely discontinue Seroxat. Since you are planning on starting Effexor, there is no need to add another SSRI. Effexor (Venlafaxine) acts both on serotonin and norepinephrine.
Regarding thyroid levels, your blood results are normal. Your T4 level is only mildly reduced. However, since T3 and TSH levels are in normal range, there is nothing to be worried about.
Hand tremors you are experiencing is due to the effect of alcohol on nervous system and withdrawal from alcohol. Once you abstain from alcohol consumption and recover completely, the tremors will subside.
Excessive sweating in your case is due to effects of alcohol and being overweight. Alcohol increases your heart rate and dilates blood vessels which leads to excessive sweating. The excessive sweating can persist for a few weeks even after you stop drinking. Another important factor for excessive sweating is being overweight. Fat acts as an insulator, retain heat and increases body temperature, therefore, you sweat excessively. To cool down your body, weight loss will also help resolve the issue.
Hope I was able to help you. Let me know if I can assist you further.
Regards
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
You can safely discontinue Seroxat. Since you are planning on starting Effexor, there is no need to add another SSRI. Effexor (Venlafaxine) acts both on serotonin and norepinephrine.
Regarding thyroid levels, your blood results are normal. Your T4 level is only mildly reduced. However, since T3 and TSH levels are in normal range, there is nothing to be worried about.
Hand tremors you are experiencing is due to the effect of alcohol on nervous system and withdrawal from alcohol. Once you abstain from alcohol consumption and recover completely, the tremors will subside.
Excessive sweating in your case is due to effects of alcohol and being overweight. Alcohol increases your heart rate and dilates blood vessels which leads to excessive sweating. The excessive sweating can persist for a few weeks even after you stop drinking. Another important factor for excessive sweating is being overweight. Fat acts as an insulator, retain heat and increases body temperature, therefore, you sweat excessively. To cool down your body, weight loss will also help resolve the issue.
Hope I was able to help you. Let me know if I can assist you further.
Regards
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
finally was able to sleep 5 hours today. its 8am here. Thank God things are settling down. :)
A good sort of morning after 5 years....
took 4mg lorazepam with 3mg melatonin.
As you said before that things will get better with the passage of time. i.ve concluded time heals everything.
i am on a diet and hope results would be great. not doing heavy excercises in fear of any inflammation in the abdominal area. lets see if the FAT was the victim or not. let the ALT and AST levels come down near 100 or so.
i was looking at my 5 years old pictures and thinking what have i done to myself. ah and yes i also was thinking to send you 2 of my pics to let you know atleast how does your patient used to look. i.ll be back soon like this. Its like when you have someone to discuss your problems with than things get much much easier because you know there is someone always there at your back.
As far as effexor and zoloft are concerned which one do you think is better. The weight gain of zoloft is because of hunger and bigger portion controls or is it something to do we the metabolism? if its the matter of eating healthy thats not an issue. Seroxat is on top list on weight gain but somehow i managed to loose 50 kgs on it back in 2010 in 2 years.
now you decide which one do you prefer zoloft or the effoxor.
Another thing which i was thinking that effoxr or zoloft which ever you select will cope with my anxiety and depression than what about that energy, kick and power that wellbutrin used to give me.
i was looking at Ritalin the other day. i think it works like wellbutrin but its a trycylic as far as i remember. your comments on this?
i asked you before that is there any SNDRI available yet in the market but you never answered that question.
except this one of my biggest problem is social anxiety. i dont meet people. i dont go out with friends . infact i dont have friends anymore. dont know why but this feeling of failing in futures has taken over my life.
and is there any use to take a multi vitamin these days because being on a 1000 calorie deflict diet would not fulfil your vitamin and minerals need i think so.
And what about the diet. Am i allowed to eat protein with this kind of liver position? only chicken and mutton not beef. kindly suggest.
Todays edema that swelling feeling is better than yesterday. i took 100mg or it can be a placebo. i.ll confirm you tomorrow exactly let one more day pas.
now your turn. :)
What country are you in these days? so i can judge accordingly what time is there.
waiting for your kind reply.
A good sort of morning after 5 years....
took 4mg lorazepam with 3mg melatonin.
As you said before that things will get better with the passage of time. i.ve concluded time heals everything.
i am on a diet and hope results would be great. not doing heavy excercises in fear of any inflammation in the abdominal area. lets see if the FAT was the victim or not. let the ALT and AST levels come down near 100 or so.
i was looking at my 5 years old pictures and thinking what have i done to myself. ah and yes i also was thinking to send you 2 of my pics to let you know atleast how does your patient used to look. i.ll be back soon like this. Its like when you have someone to discuss your problems with than things get much much easier because you know there is someone always there at your back.
As far as effexor and zoloft are concerned which one do you think is better. The weight gain of zoloft is because of hunger and bigger portion controls or is it something to do we the metabolism? if its the matter of eating healthy thats not an issue. Seroxat is on top list on weight gain but somehow i managed to loose 50 kgs on it back in 2010 in 2 years.
now you decide which one do you prefer zoloft or the effoxor.
Another thing which i was thinking that effoxr or zoloft which ever you select will cope with my anxiety and depression than what about that energy, kick and power that wellbutrin used to give me.
i was looking at Ritalin the other day. i think it works like wellbutrin but its a trycylic as far as i remember. your comments on this?
i asked you before that is there any SNDRI available yet in the market but you never answered that question.
except this one of my biggest problem is social anxiety. i dont meet people. i dont go out with friends . infact i dont have friends anymore. dont know why but this feeling of failing in futures has taken over my life.
and is there any use to take a multi vitamin these days because being on a 1000 calorie deflict diet would not fulfil your vitamin and minerals need i think so.
And what about the diet. Am i allowed to eat protein with this kind of liver position? only chicken and mutton not beef. kindly suggest.
Todays edema that swelling feeling is better than yesterday. i took 100mg or it can be a placebo. i.ll confirm you tomorrow exactly let one more day pas.
now your turn. :)
What country are you in these days? so i can judge accordingly what time is there.
waiting for your kind reply.
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
The mechanism by which SSRIs like Zoloft increase weight is by increasing appetite and eating more. However, Zoloft will not give the energy boost as much as Effexor.
Considering that you need to lose weight, you need energy boost as in Wellbutrin and since your liver function has started to improve, I would recommend Effexor as a better choice. Start with a lower dose of Effexor as we discussed previously.
Ritalin (methylphenidate) is not an SSRI or tricyclic. It is a central nervous system stimulant that is used to improve concentration in ADHD. It can be habit-forming and should be avoided in people with addiction issues.
There is no SNRDI available in the market currently.
Social anxiety and fear of failure can be a part of your depression and generalized anxiety. Once treatment with Effexor is initiated and depression improves, social anxiety is also likely to decrease. Psychotherapy along with medications can also help.
About the diet, you can take proteins safely. There is no need to restrict protein intake. Chicken and turkey breast are good protein sources when compared to mutton or beef. Chicken and turkey breast has less amount of saturated fats which is harmful to health. Other good sources of protein low in saturated fat include soy protein, fish like salmon and soybeans.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
The mechanism by which SSRIs like Zoloft increase weight is by increasing appetite and eating more. However, Zoloft will not give the energy boost as much as Effexor.
Considering that you need to lose weight, you need energy boost as in Wellbutrin and since your liver function has started to improve, I would recommend Effexor as a better choice. Start with a lower dose of Effexor as we discussed previously.
Ritalin (methylphenidate) is not an SSRI or tricyclic. It is a central nervous system stimulant that is used to improve concentration in ADHD. It can be habit-forming and should be avoided in people with addiction issues.
There is no SNRDI available in the market currently.
Social anxiety and fear of failure can be a part of your depression and generalized anxiety. Once treatment with Effexor is initiated and depression improves, social anxiety is also likely to decrease. Psychotherapy along with medications can also help.
About the diet, you can take proteins safely. There is no need to restrict protein intake. Chicken and turkey breast are good protein sources when compared to mutton or beef. Chicken and turkey breast has less amount of saturated fats which is harmful to health. Other good sources of protein low in saturated fat include soy protein, fish like salmon and soybeans.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
The side effects of seroxat have started kicking in. i slept all day long and still sleepy. Alot of mental confusion. i think we should decrease the wellbutrin dosage to 300mg tomorrow morning and 37.5 mg effoxr. its 10.30pm here. Which benzos should i use with it? before i was using Xanax and rivotril. let me know the names, dosages and quantities. i was reading today and came to find a medicine named metadoxine. should we use it to flush out the toxics in the blood and liver as soon as possible? how should i increase me t4 levels to normal? i hope you answer before i wake up in the morning.
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
As we discussed earlier, the safest benzo in patients with liver injury is Lorazepam. The dosage is 1 to 2mg thrice daily. Start with initial low dose and the dosage can be titrated up to 2 mg thrice daily as needed. The dosage should not exceed 6 mg/day. If you are feeling too sleepy, then reduce the dose of Lorazepam. Discontinue Xanax and Rivotril.
Reduce the dose of Welbutrin to 150 mg thrice daily for 4 days, followed by 150 mg twice daily for 4 days, to 150 mg once daily for a week before stopping. During the last week of Wellbutrin, we can introduce Effexor XR 37.5 mg.
Please do not worry about your T4 level. Your T3 and TSH levels are within normal range which is indicative that thyroid is functioning normally.
Metadoxine can help eliminate toxins from the body and protect the liver. However, it can cause an allergic reaction (very rare), abdominal bloating and diarrhea. Most importantly, you should avoid alcohol intake with Metadoxine. Please follow up with your family physician to receive a prescription for Metadoxine.
I would also like to add that it is good to supplement Thiamine (vitamin B1). Since you are already taking vitamin supplements, make sure it contains thiamine too, as thiamine deficiency is common in heavy alcohol use.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
As we discussed earlier, the safest benzo in patients with liver injury is Lorazepam. The dosage is 1 to 2mg thrice daily. Start with initial low dose and the dosage can be titrated up to 2 mg thrice daily as needed. The dosage should not exceed 6 mg/day. If you are feeling too sleepy, then reduce the dose of Lorazepam. Discontinue Xanax and Rivotril.
Reduce the dose of Welbutrin to 150 mg thrice daily for 4 days, followed by 150 mg twice daily for 4 days, to 150 mg once daily for a week before stopping. During the last week of Wellbutrin, we can introduce Effexor XR 37.5 mg.
Please do not worry about your T4 level. Your T3 and TSH levels are within normal range which is indicative that thyroid is functioning normally.
Metadoxine can help eliminate toxins from the body and protect the liver. However, it can cause an allergic reaction (very rare), abdominal bloating and diarrhea. Most importantly, you should avoid alcohol intake with Metadoxine. Please follow up with your family physician to receive a prescription for Metadoxine.
I would also like to add that it is good to supplement Thiamine (vitamin B1). Since you are already taking vitamin supplements, make sure it contains thiamine too, as thiamine deficiency is common in heavy alcohol use.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
i think i have to get back to seroxat today again and taper it down like wellbutrin. seroxat cold turkey withdrawl symtoms are too bad. i can not drive and go to work with this wierd state of confusion feeling, totally unfocused and imbalance of the feet ( wobbly feeling ). the only chance is to take bed rest until we introduce effoxr. kindly guide what should i do. today i.ll check thiamine in my multivitamin tablet. if not present than i.ll buy it. As far as metadoxine is concerned it is not a problem to buy in our city. the only medicine which they dont give without prescription are benzos. i.ll buy 300mg metadoxine today.
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
If you are noticing withdrawal symptoms from stopping Seroxat abruptly, then tapering down the dose can help. Decrease Seroxat at 10 mg decrements weekly until stopping the medication completely.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
If you are noticing withdrawal symptoms from stopping Seroxat abruptly, then tapering down the dose can help. Decrease Seroxat at 10 mg decrements weekly until stopping the medication completely.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
hi doc hope you are doing good. i was reading one of your articles on iclinic on Gynecomastia. in 2012 or so when i lost 50kgs than it was the time to tone up my body. i used a alot of anabolic steriods to build up muscle. with the passage of time i developed these men breasts and which is quite embaressing. than i gained weight and all became a big disaster. people are fat but being fat with these breasts is too difficult to manage. i have to wear tight vests to hide them of course. can you kindly tell me some blood work so that we can know the problem and than move towards treatment. as far as wellbutrin and seroxat is concerned the tapering is still going good. i think i.ll start effoxr in the end of this week after having the LFT,S. The lorazepam is going quiet good. some times i feel sleepy but i have to adjust the dosage my self. i am taking 100mg of caffeine per day because the tapering down of wellbutrin is making me a little non focused and lazy. kindly advice. looking forward for your reply
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
Glad to hear you have been feeling better.
Gynaecomastia or enlarged male breast can be due to deposition of fat (psuedogynaecomastia), the growth of breast glandular tissue (true gynaecomastia) or a combination of both.
You have multiple risk factors for gynecomastia- High BMI (40.2) in the obese category, Reduced liver function and the use of anabolic steroids.
The first step in the evaluation of gynaecomastia is to identify whether the breast enlargement is true or pseudo-gynaecomastia. Physical examination and mammography can differentiate between the two. In your case, it is likely to be a combination of both. Mammography will also help rule out any cancerous changes in the enlarged breast tissue.
Follow healthy diet and exercise regularly. Weight reduction will greatly help reduce the breast size. Excess body fat will cause gynaecomastia by fat deposition in breast and increasing estrogen levels thereby stimulating breast growth. Once your liver also starts functioning normally, the gynecomastia will go down. The liver is important in metabolizing excess estrogen in your body. Reduced liver function also contributes to excess estrogen and breast growth. Another important factor is Anabolic steroids. Please be advised to discontinue anabolic steroids as it can cause gynecomastia, again by increasing estrogen levels and reducing testosterone production.
The important steps to work towards treating gynecomastia in your case at present are:
- Reduce weight
- Do not take anabolic steroids
- Avoid alcohol to improve your liver function
- Consult a doctor for physical examination and to get mammography done.
If the breast size does not decrease after few months, then medications for treatment of gynaecomastia can be considered.
The lack of energy and concentration issues will be resolved once Effexor is introduced into the treatment regime. Please note that you should not take Seroxat and Effexor simultaneously, as both these medications act on Serotonin. When taken together they can dangerously increase serotonin levels in your body leading to serious adverse effects.
Hope this answers your question. Please let me know if you have any more questions or concerns.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
Glad to hear you have been feeling better.
Gynaecomastia or enlarged male breast can be due to deposition of fat (psuedogynaecomastia), the growth of breast glandular tissue (true gynaecomastia) or a combination of both.
You have multiple risk factors for gynecomastia- High BMI (40.2) in the obese category, Reduced liver function and the use of anabolic steroids.
The first step in the evaluation of gynaecomastia is to identify whether the breast enlargement is true or pseudo-gynaecomastia. Physical examination and mammography can differentiate between the two. In your case, it is likely to be a combination of both. Mammography will also help rule out any cancerous changes in the enlarged breast tissue.
Follow healthy diet and exercise regularly. Weight reduction will greatly help reduce the breast size. Excess body fat will cause gynaecomastia by fat deposition in breast and increasing estrogen levels thereby stimulating breast growth. Once your liver also starts functioning normally, the gynecomastia will go down. The liver is important in metabolizing excess estrogen in your body. Reduced liver function also contributes to excess estrogen and breast growth. Another important factor is Anabolic steroids. Please be advised to discontinue anabolic steroids as it can cause gynecomastia, again by increasing estrogen levels and reducing testosterone production.
The important steps to work towards treating gynecomastia in your case at present are:
- Reduce weight
- Do not take anabolic steroids
- Avoid alcohol to improve your liver function
- Consult a doctor for physical examination and to get mammography done.
If the breast size does not decrease after few months, then medications for treatment of gynaecomastia can be considered.
The lack of energy and concentration issues will be resolved once Effexor is introduced into the treatment regime. Please note that you should not take Seroxat and Effexor simultaneously, as both these medications act on Serotonin. When taken together they can dangerously increase serotonin levels in your body leading to serious adverse effects.
Hope this answers your question. Please let me know if you have any more questions or concerns.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Prasad
i think you misunderstood. i used to take anabolics 3-4 years back and i.ve quitted alcohol forever now. good bye to both if these. oh plz dont scare me. my breasts are not so big to be cancerous. i'll tone them up later after losing some weight with chest excercises. i am having a healthy diet and lost 1kg already in 1 week. daily requirements are around 2800 for me. i am on a deflict of 1000-1200 per day. i met one of my friends today. he is a doc too. he suggested me to take mezeron 30mg after the liver imporovement before sleep. its a trycylic. he said it worked wonders for some of his family friends. can we later add mezeron with effoxr? what do you have to say about this? i didnt tell my friend that i.ll be switching to effoxr next week. From tomorrow i am starting CBT also. i hope it.ll help too. The worst part of taking antidepressants is the lack of intrest in sex. Premature ejaculation and poor libido is too depressing. i think all the people taking anti depressants have this complain. any treatment for this? i have this pain and weakness in my legs past 1 month. its a dull sort of pain specially around knees and calves. any clue?
kindly see the attached file
kindly see the attached file
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
If you stopped anabolic steroid 4 years ago, then it shouldn't be an issue. Since you have stopped alcohol rather recently and your liver has still not completely recovered, the effect of these on breast enlargement is relevant in your case. Once your liver recovers completely and you lose weight, breast enlargement will eventually subside.
Please don't worry too much about cancerous changes in breast. It is very rare. I recommended mammography since it is routine investigation in evaluation of male breast. Just to be sure that there is nothing to be worried about.
Could you please let me know what is the active ingredient in Mezeron?
I have looked the new screenshot you attached. The medication Rameron (Mirtazepine) is a good anti depressant and it also increases sleep. However, weight gain is a major issue with Mirtazepine and not ideal for you.
Regarding the leg pain, please follow up with the following details
- Are both legs affected?
- Is the pain worsened by walking?
- Do you have joint pain in knees or ankles? If so, is it worsened by movements?
-Any morning stiffness of joints?
- Do you have back pain?
- Do you have history of smoking?
- How is your cholesterol levels and blood pressure?
Awaiting your reply.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
If you stopped anabolic steroid 4 years ago, then it shouldn't be an issue. Since you have stopped alcohol rather recently and your liver has still not completely recovered, the effect of these on breast enlargement is relevant in your case. Once your liver recovers completely and you lose weight, breast enlargement will eventually subside.
Please don't worry too much about cancerous changes in breast. It is very rare. I recommended mammography since it is routine investigation in evaluation of male breast. Just to be sure that there is nothing to be worried about.
Could you please let me know what is the active ingredient in Mezeron?
I have looked the new screenshot you attached. The medication Rameron (Mirtazepine) is a good anti depressant and it also increases sleep. However, weight gain is a major issue with Mirtazepine and not ideal for you.
Regarding the leg pain, please follow up with the following details
- Are both legs affected?
- Is the pain worsened by walking?
- Do you have joint pain in knees or ankles? If so, is it worsened by movements?
-Any morning stiffness of joints?
- Do you have back pain?
- Do you have history of smoking?
- How is your cholesterol levels and blood pressure?
Awaiting your reply.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Nagamani Ng
i have always wondered what causes the weight gain in anti depressants. some times its the appetite but in case of rameron i think it has something to do with Metabolism. At the current moment we have to focus on the brain health rather than the body fat health. i think the effoxr would cancel out the weight gain effecfs of weight gain. just give it a second thought. in the end i.ll be doing what you.ll say. regarding leg pain , yes both legs are effected. no it is not worrsend by walking. no morning stiffness of joints, it says the same from waking up till i sleep. sometimes its that bad that i have to cross my legs while going to sleep to stop a little blood flow to the legs. no i dont have a back pain. yes i do have joint pain in knees but not in ankles. no i dont smoke. my blood pressure is ok. little on the higher side bec of obesity. 130/90 mostly. i never had my cholestrol levels checked. which tests are recommended for cholestrol? You did not tell anything about the sex thing i wrote in my previous post.
Brief Answer:
Follow up answer
Detailed Answer:
Hello,
Even though we set aside the effects of Remeron on weight gain, the effects of Effexor are most comparable to Wellbutrin. Effexor is better at providing energy boost and improved concentration when compared to Remeron. So I would prefer Effexor when compared to Remeron.
Regarding the sexual side effects, sorry I forgot to get to that point in the previous discussion. All antidepressants have sexual side effects. Sexual side effects resolve once the antidepressants are stopped, but then there is the risk of relapse of depression. The way to avoid sexual side effects of anti-depressants is to use the lowest possible dose. Moreover, in your case alcoholic hepatitis can also contribute to decreased sex drive and problems with ejaculation. Once your liver recovers completely and you manage to reduce weight, the sexual function will greatly improve. This can take a few months. Also, try to stay on the lowest possible dose of antidepressant that provides you symptomatic relief.
Even then if the sexual side effects persist, then medications to enhance sexual function like Sildenafil can be added.
The leg pain you are experiencing is likely due to the effect of obesity on your knee joints. Extra body weight puts extra pressure on knee joints causing pain and increased risk for early arthritic changes. Again, weight reduction is important. However, the leg pain can make it difficult to exercise. The best way to exercise without worsening your pain is by:
- Muscle strengthening exercises especially for legs to improve muscle tone
- Stretching exercise like yoga
- Low impact aerobic exercise like water aerobics, swimming, cycling
Your blood pressure is within normal range. Nothing to be worried. Test for checking cholesterol levels in fasting lipid profile. You have to fast overnight for 8 hours and provide the blood sample in the morning for Lipid profile.
Hope I have answered your query.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Follow up answer
Detailed Answer:
Hello,
Even though we set aside the effects of Remeron on weight gain, the effects of Effexor are most comparable to Wellbutrin. Effexor is better at providing energy boost and improved concentration when compared to Remeron. So I would prefer Effexor when compared to Remeron.
Regarding the sexual side effects, sorry I forgot to get to that point in the previous discussion. All antidepressants have sexual side effects. Sexual side effects resolve once the antidepressants are stopped, but then there is the risk of relapse of depression. The way to avoid sexual side effects of anti-depressants is to use the lowest possible dose. Moreover, in your case alcoholic hepatitis can also contribute to decreased sex drive and problems with ejaculation. Once your liver recovers completely and you manage to reduce weight, the sexual function will greatly improve. This can take a few months. Also, try to stay on the lowest possible dose of antidepressant that provides you symptomatic relief.
Even then if the sexual side effects persist, then medications to enhance sexual function like Sildenafil can be added.
The leg pain you are experiencing is likely due to the effect of obesity on your knee joints. Extra body weight puts extra pressure on knee joints causing pain and increased risk for early arthritic changes. Again, weight reduction is important. However, the leg pain can make it difficult to exercise. The best way to exercise without worsening your pain is by:
- Muscle strengthening exercises especially for legs to improve muscle tone
- Stretching exercise like yoga
- Low impact aerobic exercise like water aerobics, swimming, cycling
Your blood pressure is within normal range. Nothing to be worried. Test for checking cholesterol levels in fasting lipid profile. You have to fast overnight for 8 hours and provide the blood sample in the morning for Lipid profile.
Hope I have answered your query.
Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
