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Suggest The Ideal Dosage For Duloxetine

Posted on Wed, 22 Jun 2016

Question: Dr Naval Mendiratta, this is to let you know that I have failed to see my psychiatrist yet to see if he will raise my ritalin. If he doesn't think that it would do any good, I will ask him to prescribe duloxetine 20 mg per day. Do you think I might need to go higher than that? What time period needs to elapse before we raise it? After two more injections, I'll stop taking the testosterone. XXXXXXX

Answered by Dr. Naval Mendiratta (16 hours later)

Brief Answer:
Medications adjustment

Detailed Answer:
Good evening XXXXXXX

good to hear from you

When is the appointment scheduled?? Lot of time it takes there to schedule an appointment. Here in XXXXXXX you can meet 3 doctors in the same day.

Well for the duloxetine to take it s course, it takes usually around 3 weeks to 4 weeks. But we normally step up the dose after a week as 20 mg is slightly on the lower side. Maximum dose if 60 mg. But that will depend on your initial response to it and provided there are no side effects.

But if they feel increasing Ritalin will work, you can give it a try..Withint 3-4 weeks you can feel the difference in symptoms if they are working or not...Yeah you can go off the injections...I really dont think they are making much difference...

DO let me know for more queries

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (2 days later)

Dr. Mendiratta, I have felt so bad for so long that it's hard to believe that another pill is going to make me feel better. I have been disappointed so many times with answers like "you'll have to live with it" or "it's all in your head" that it's hard to keep going. NO, IT'S NOT IN MY HEAD AND I CAN'T LIVE LIKE THIS!!! No one can realize how bad this really is. But I think you sort of realize that I am suffering. A person couldn't work if they felt this bad or even perform daily functions. I just needed to tell you how bad I am really feeling. I can't stand to wake up every morning feeling as bad as when I went to bed!

Answered by Dr. Naval Mendiratta (20 hours later)

Brief Answer:
Understandable

Detailed Answer:
Good evening Mr XXXXXXX

Well,this is something which I normally dont tell everyone...But, yes when you tell a patient he is gonna live like that , they lose any hopes of gaining any improvement. So that is something I dont do... There are a very few medications in medical field...But first and foremost is to give someone a hope that they will get better. And I am sure, if I am Able to motivate you to get better, half the job is done.. You will work on whatever is needed to get better...The medication I recommended is to help you get out of the situation, so you can feel better and work towards even more betterment.

But just try to beat the stress around your illness and wake up..as if you are gonna hit it back harder and come out of it. Like today is the day, I am gonna do it...It is still gonna tire you out and stuff, but keep progressing...

I hope it provides some motivation

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Naveen Kumar

Follow up: Dr. Naval Mendiratta (25 hours later)

hi Dr. Mendiratta and thank you for the motivation. I can't, however, just talk my way out of feeling this bad. I do, however, push until I can push no longer and then I have to lay down and rest for a period of time. The person who told me it was all in my head was a therapist who didn't know else to do. She had me believing that for a few hours until I got wise and knew that there was more to it. I've never asked you this quesrion: what's causing the problem? Is it my immune system? my nervous system? some other system in my body? what exactly is messed up? There has to be an answer and hopefully your medication will help. XXXXXXX

Answered by Dr. Naval Mendiratta (21 hours later)

Brief Answer:
Which system is wrong

Detailed Answer:
Good evening

Well, I understand just talking is not the way out, but believe me, it is one of the first steps forward. I do feel you already are motivated enough to get back to your normal life style, but the fatigue is limiting you

Well, it is not your immune system...It is mostly from the central nervous system which is causing this problem. It doesnt affect the nerves or muscle...But more of a center located in the brain. And once triggered it doesnt rest and it becomes a vicious circle of fatigue/tiredness. ( Chronic Fatigue Syndrome)

Difficult problem with difficult solution. But I hope some different medicine works well in your case

Regards
DR Naval

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Naval Mendiratta (20 hours later)

Dr. Mendiratta, I couldn't pay you enough for all of this valuable information. I couldn't make enough visits to the doctor to learn all of this. The hardest part is waiting to see the doctor to get a prescription. I go to group therapy at the hospital 3 days a week and I can see him when it's my turn. It's now my turn next week. I will tell my therapy group that it's not low testosterone but it's chronic fatigue syndrom and it takes the right medication. I can't imagine anyone feeling any worse than I do. I can't describe it. I guess I should be thankful that there's no pain involved.

Answered by Dr. Naval Mendiratta (24 hours later)

Brief Answer:
Chronic Fatigue syndrome

Detailed Answer:
Good evening Mr XXXXXXX

Well, yeah I can understand the long waiting periods there with the appointment. I hope it works out for you next week and you get the desired medications..Something to make you feel better. It definitely aint testosterone deficiency.

Do let me know whatever they prescribe and counsel you further

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Naval Mendiratta (2 days later)

I finally saw the psychiatrist this morning and he increased the ritalin only at my suggestion and only by a small dose so I wouldn't get too nervous. He has always wanted to find the cause of my fatigue and not just say it's chronic fatigue syndrom. He wants to know the REASON for the fatigue. He is going to do gene testing and do another testosterone test on Thursday. I won't mention your medication to him until he's finally done everything else. He tells me not to give up and we'll figure this out. What do you think about gene testing and what could that reveal? XXXXXXX

Dr. Mendiratta, I wrote you a letter a couple of days ago and have not gotten a response. If you did not receive it, I'll be happy to send it again. Just let me know. Thanks, XXXXXXX

Answered by Dr. Naval Mendiratta (3 days later)

Brief Answer:
Late Response

Detailed Answer:
Good evening Mr XXXXXXX

Really sorry for the late response. Was out of town and just got back in today evening

Well, it is good that he is at least into it and not just letting you go off without finding the actual cause. I thought he may just increase the medicines and ask you to follow up after 3 months again.

As for the Gene testing, I am not sure what genes he wants to test..But I doubt they will reveal anything significant here. Gene testing at your age, may have already been altered with all the enviromental changes. Maybe he has something different in mind which he wants to look at. Never the less, if it is something he can figure out we should let him proceed with it.

Repeat testosterone is of not much use i feel. If needed he should measure Sex horomone Binding Globulin as it will give us the correct picture whether free testosterone is low or high or normal. Total testosterone doesnt hold too much value especially since you have already been treated with it.

Do let me know if you come across the genes they are gonna check. I can do some research on it as well and see if it will give us the right direction

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Naval Mendiratta (20 hours later)

hi Dr. Mendiratta, and I apologize for acting impatient. I just didn't want to lose connection with you and I didn't know that you were out of town. Here's all I know about the gene testing so far: the nurse swabbed the inside of my mouth thoroughly and will send it to the lab as it will take two weeks for results. He is doing this to find out what medicines work MOST EFFECTIVELY for my illness since he doesn't know. The medicine that you suggested may be one of them. I will be sure to tell him when he gets the results. Does this make more sense now or are you still not sure what he's doing? I think that he would have raised the ritalin more than 5mg if he thought that it would help. XXXXXXX

Answered by Dr. Naval Mendiratta (24 hours later)

Brief Answer:
Further course

Detailed Answer:
Good evening XXXXXXX

Well, really sorry to say. I still cant interpret what exactly he is planning to do here. I havent heard of such a test or how the medicines you are taking gonna be helpful. We normally do it for allergy but not for the other medicines. Maybe some advanced technology in US which is still not there in XXXXXXX

But never the less, do let me know the results once they are out. Will do some research on it and see how useful they have been or not. But if he s confident, within 2 weeks we should know the result and what exactly should be our next step.

Will wait for your result

REgards
Dr Naval

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Yogesh D