Since Covid I have suffered from severe anxiety and depression. I take duloxetine and lorazepam twice a day, but they no longer help. I live alone, I’m 78 and I don’t see the point in continuing. My family tries to help, but I just don’t see a future where I will be happy and content.
Name and address hidden
Dr. Martin Scurr replies: At this time of year many people will be experiencing what you are experiencing and I thank you for your letter. It is brave of you to write and I sympathize deeply with it.
It is clear that you are suffering from a major depressive illness. However, I am optimistic that with better treatment you will make a full recovery.
One intrinsic symptom of depression is that any sense of optimism evaporates. The disease can also cause disturbed sleep, a feeling of worthlessness, loss of appetite and even feeling constantly cold and tired.
The physical symptoms are just as overwhelming and exhausting as the psychological state of fear and sense of doom. This is why doctors view depression as a whole-body problem, not something limited to just the brain.
Worryingly, in your longer letter you say that you have had suicidal thoughts, but your family is the reason you don’t pursue them further. I would encourage you to let them know how you really feel.
Don’t struggle alone, speak to your doctor and family as soon as possible, says Dr. Scurr
Duloxetine can be an effective antidepressant, but the dose you use – 30 mg – is low: the usual maintenance dose is 60-90 mg.
In any case, the fact that the drug helped tells us that it does not contradict you and does not cause unacceptable side effects, such as nausea, dry mouth and insomnia (which affect 5 to 10 percent of patients).
It is important to note that a small number of people may develop suicidal thoughts when they start taking antidepressants or change their dose. Therefore, it is very important that your family and doctor are aware of these feelings.
But if these thoughts predate your medication, it suggests that the medication is not driving them in your case. A reduced response to a drug that previously worked may be a sign that the body has become accustomed to that dose (the liver builds up its enzyme systems to ‘detox’ the blood of the drug, in which case a higher dose will be needed ).
Your doctor may suggest increasing your dose of duloxetine so that the drug becomes effective again.
Lorazepam, a sedative, helps suppress anxiety symptoms. Once your treatment with duloxetine is effective again, you will find that the anxiety will also disappear and you can gradually reduce the dose of lorazepam, under medical supervision.
I urge you to speak to your GP immediately to discuss your dose of duloxetine so that you can get back to your normal self. I also encourage you to talk to your family – and contact the Samaritans by calling 116123 or emailing jo@samaritans.org. Please feel that you can write to me again.
I have a skin problem around my left ankle. It started last Christmas with peeling skin on the sole of the foot, hardening of the skin and swelling. Now it’s spreading down my leg. My doctor prescribed antibiotics and emollients, without success.
Charles Bailey, Manchester.
Dr. Scurr replies: My suspicion is that you have a form of psoriasis – an autoimmune disease that causes the overproduction of skin cells, which build up, resulting in inflamed and often scaly patches known as plaques.
These can occur anywhere on the body, although the scalp, elbows, knees and lower back are most commonly affected. The plaques can be itchy, which invariably causes some discomfort and cracking of the skin.
The usual treatment is topical steroids, although increasingly a drug derived from vitamin D (calcipotriol) and other new medications such as roflumilast are being used.
With treatment, the condition should improve within a few weeks.
IN MY OPINION.. Sugar rules don’t count at Christmas!
After many years of being married to a dietitian, I cured my lifelong sweet tooth through a combination of gentle arm-twisting and irrefutable logic. Because, as I have come to accept, sugar is no better for our health than alcohol.
We don’t have to be puritanical about it, though, as evidenced by a study just published in the journal Frontiers in Public Health (which brings joy to my taste buds).
Analysis of the diets of more than 60,000 middle-aged people showed that regularly consuming sugar significantly increased the risk of cardiovascular disease.
But scientists also found that when sweet foods were consumed as an occasional treat, the risk of heart disease was reduced. Yes, really.
Consuming sugary foods occasionally, surrounded by family and friends, can be helpful.
So enjoy the festivities and don’t worry about breaking the sugar rules every now and then. As I write this, my favorite panettone, florentines and mince pies are waiting on the shelf. Merry christmas!
Write to Dr. Scurr from Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@ dailymail.co.uk – include your contact details. Dr. Scurr cannot enter into personal correspondence. Always consult your own doctor if you have health problems