Question

Hello there,
This is Nasrat, 29 years old, I`m suffering form depression since last four years while I have last my beloved brother. So, I took different kinds of medications such as fluoxetine 20 mg, escitalopram 10 mg, paroxetine 10 mg, mirtazapine USP 15 mg, venlafaxine Hcl 75 mg, Lithium carbonate B.P. 400 mg etc. But still I have the same problem, difficulty in thinking (poor concentration, poor memory), excessive feel of guilt, loss of interest in most activities, sleep disturbances, decreased energy or tiredness, feeling of low self confidence, feeling of hopelessness, decrease in activity, excessive or inappropriate worries, anticipation of the worst, thoughts of suicide. Besides, I have premature ejaculation and no sexual desire.
So, I`m really disappointed. Are there any solution for my problems?
Its mentionable that when I was in Japan, I took Lorazepam (0, 5 mg), Brotizlolam (0, 25 mg), Trazodone (25 mg), Suvorexant (20 mg), Escitalopram (10 mg), Lansoprazole (15 mg) for 8 months, with those medications I felt very well, but unfortunately, when I returned to my country, there were no those medications available, and my depression attacked me again.
So, dear doctors Please please please recommend me what to do?
I`m not interested to live in this world but, I`m the only person to support my big family.
At the same time, I took (Clarithromycin 500 mg, Amoxicillin 1000 mg 14 days), (Lansoprazole 30 mg 3 months) for positive h pylori but did not work.
Again, I took (Clarithromycin 500 mg, metronidazole, Amoxicillin 1000 mg 14 days), (esomeprazole 40 mg 3 months) for positive h pylori but still I have the same issue.
Your cooperation would be highly appreciated.
Thank you so much in advance.

Dr.Saranya Devanathan · Accepted Answer

Dear lybrate-user,
You need a proper diagnosis before going in for treatment. If h pylori is confirmed, it needs active treatment. Premature ejaculation and loss of sexual desire also needs to be diagnosed and treated. At Japan, you were treated with Lorazepam (available in India). Instead of brotizolam, you can try etizolam available in India. Trazodone available in India. Suvorexant is another mild hypnotic. You don't need so many hypnotic and anxiolytic. Lorazepam or etizolam will do. Escitalopram is available in India. Instead of Lansoprazole, esomeprazole has been given to you.
All that you need to know, what is the type of depression that you are suffering. If it is bipolar type, Lithium carbonate type of mood stabiliser will work on you. It depends on the effective blood level dose (0.8 - 1.2) not just 400 mg. If it major depressive disorder, you need antidepressants like" fluoxetine 20 mg, escitalopram 10 mg, paroxetine 10 mg, mirtazapine USP 15 mg, venlafaxine Hcl 75 mg" But all are in starting dose. It needs to be built after 2-3 weeks depending on the improvement and side effects. If it is mixed anxiety depression disorder, you need to add etizolam to the antidepressant.
I would suggest second opinion with all your reports of h pylori and endoscopy, hormonal tests and Japan doctors diagnosis and prescriptions.

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