I am on Veniz XR for depression. What can help me heal?

Question

Hello doctor,

I am on Veniz XR 300 mg and Mirtaz 7.5. I started these medicines six months back, but now I am facing executive dysfunction, attention issues, and extreme mood swings. I told my doctor, and she told me to bring my mother.

I took her, but my doctor listened to only what my mother said and told me to keep quiet.

But my mom was focusing on things like not doing household chores. So my doctor said I am focusing on the half-empty glass and said mood swings are normal, but no, I know mine are not. She said that the final decision on no change needed is final.

So these issues, plus emotional healing, are on me now. I wanted to lessen my burden, but the doc is not listening, and I know I have something more than depression. I am confused about what I should do.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I can understand that ignoring your needs and not incorporating you in decision-making has created doubts in your mind, and it is a genuine concern.

These symptoms can be due to residual depressive symptoms (psychomotor slowness), side effects of drugs, especially Mirtazapine 7.5 mg, which can cause cognitive slowing and dizziness.

It can also be due to other conditions such as attention deficit hyperactivity disorder (ADHD), hypothyroidism, B12, and vitamin D. Therefore, a thorough evaluation is mandatory.

Your psychiatrist has added 7.5 mg Mirtazapine to induce sleep; this is not a dose to improve depression. At lower doses, it causes severe sedation. Therefore, you can ask your psychiatrist if you want to talk for 10 to 15 minutes alone.

Discuss your symptoms with your doctor, or you can share them with us. First of all, identify residual depressive symptoms such as overall slowness, feeling hopeless, and worthlessness.

If these are present, Venlafaxine should be added with Bupropion, although the dose of Venlafaxine should be reduced. If due to anxiety, ADHD, or any kind of substance abuse. Rule it out.

Talk to your mother and doctor politely, that you want to discuss your symptoms in detail and want to choose the medication that suits you the best. Also, discuss the following conditions:

Co-morbid anxiety.
Residual symptoms.
Treatment-resistant depression.
Hypothyroidism.
Anemia.
Vitamin B12 and D as well.

The levels of iron and hemoglobin can also mimic these symptoms and should be evaluated.

You can also choose behavioral activation. It is a good psychological therapy and part of CBT (cognitive behavioral therapy). It is evidence-based and very effective. Instead of adding to the burden of medicines, add CBT or behavioral activation.

If you have any other questions, please feel free to ask.

I hope you find this helpful.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concern.

I am glad you took a stand. In my opinion, you should not change your doctor as the previous one knows all about you.

Changing a doctor can create problems. Your current doctor knows everything about you, and this is a big advantage. You should communicate more freely with your treating doctor and ask her to include you in her decisions.

This will be a better approach for you.

I hope this helps.

Thank you