Sir/ madam I am sekhar my age is 42 jam suffering from chronic dysthymia, chronic anxiety tension, chronic insomnia, chronic fatigue syndrome, overactive bladder from 20 years. Jam taken all scars, snris, .but no cure. All scars include vortixitine jam stomach upset, loose stool. Do discontinued. Venlafaxine so sleepy, lethargy,libido, desvenlafaxine no working. I am taking duloxetine, divalproex 500, olanzapine2. 5,clonazepam for 1 year so I got a prediabetes, grade 2 fatty liver. So I discontinued .now I am taking tab deveniz100, zolfresh10 mg from 3 months. But not working very well. Jam taken quetiapine (very sleepy, aripiprazole (insomnia). Jam fear to brutan 150 because I am taking 180 ml whisky monthly twice maybe seizures doubt so 10 days I discontinued. My prediabetes ,grade 2 fatty livercause duloxetine, divalproex,clonazepam, antipsychotic sir/ madam? Is it right sir. Now I want to take duloxetine, bupran,zolfresh. Mel at on in is headache. I'm in village doctor available 200 k.m.i consult many psychiatrist.

Dr. Sushil Kumar SompurPsychiatrist19yrs exp

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I'm sorry to hear about the difficulties you're facing with your health. Managing multiple chronic conditions like dysthymia, anxiety, insomnia, chronic fatigue syndrome, and overactive bladder, along with the side effects of various medications, can be extremely challenging. Here are some points to consider based on the information you've shared: medication side effects and interactions: it's clear that you've experienced a range of side effects from different medications. This is not uncommon, especially when dealing with multiple medications for complex conditions. Each person's response to medication can vary greatly. Impact on health conditions: certain medications, especially psychiatric drugs like antipsychotics, mood stabilizers, and some antidepressants, can contribute to metabolic changes. These changes can potentially lead to conditions like prediabetes and fatty liver. It's important to monitor your physical health regularly while on these medications. Consulting healthcare professionals: given the complexity of your situation and the range of medications you've tried, continued consultation with healthcare professionals is crucial. If access to a psychiatrist is limited in your area, consider telemedicine options, which can connect you with specialists remotely. Medication choices: duloxetine: often used for depression, anxiety, and certain types of pain. It can have side effects like nausea, drowsiness, and sexual dysfunction. Bupropion (bupran): an antidepressant that's sometimes preferred for its lower risk of sexual side effects and sleepiness. However, it needs to be used cautiously in individuals with a history of seizures or heavy alcohol use. Zolpidem (zolfresh): a sedative used for short-term management of insomnia. It can be effective for sleep, but it's not typically recommended for long-term use. Melatonin: a supplement used for sleep problems. Headaches can be a side effect for some people. Lifestyle modifications: in addition to medication, lifestyle changes can play a significant role in managing these conditions. Regular exercise, a healthy diet, good sleep hygiene, stress reduction techniques, and avoiding alcohol can all contribute positively to your health. Therapy and support: psychological therapies, such as cognitive-behavioral therapy (cbt), can be very effective for mood and anxiety disorders, and even for insomnia (cbt-i for insomnia). These therapies can be accessed in person or via online platforms. Regular monitoring and follow-up: regular follow-up with your healthcare provider is important, especially if you're considering changes to your medication regimen. This will help manage your conditions safely and monitor for any side effects or complications. Remember, it's crucial to work closely with healthcare professionals who can provide personalized advice and treatment based on your specific health needs. Don't hesitate to reach out for support or a second opinion if you feel your current treatment plan isn't working well for you.  

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