Hello and welcome to Healthcare Magic. Thanks for your query.

Upon review of your current medication, I find that you have are on two different antidepressant medication - Fluvoxine (Fluvoxamine) and Duzella (Duloxetine). Both of them are effective in the treatment of anxiety and depression. Your previous medication has also mostly been with different classes of anti-depressants. Your initial symptoms of low mood, fearfulness, headache, palpitations, etc. also seem to indicate that you are suffering from a mixed anxiety / depressive disorder.

Now, regarding your habit of frequently engaging in call girls, it's a good sign that you have realized that this has become an addiction. The treatment for this will predominantly involve counselling and psychological therapies - to help you control these excessive sexual thoughts and help you overcome this habit. There are many forms effective counselling / psychotherapy techniques like Motivational Enhancement Therapy, Aversion therapy, Hypnotherapy, etc., which can be targetted for this problem. Medication / tablets do not have a major role in the treatment of this problem, since this is predominantly a psychological habituation. So, I would advise you to see a psychiatrist in person for counselling / psychotherapy.

I would suggest the following general measures to help you overcome this problem:

- Firstly, keep your mind active and occupied at all times. Stop being idle. Idle time is not good and your mind will eventually wander away to sexual thoughts. So, find a new hobby or learn something new (like a new sport or a musical instrument); this will keep your mind form being idle and prevent developing these frequent sexual thoughts.

- Regular physical exercise is very important. You can join a gym or have your own exercise schedule. This will not only keep your body healthy but also keep your mind fresh.

- Make plans and goals for your future. You have to make short-term and long-term goals for your life and start working to achieve them. This will keep your mind foccussed and prevent your thoughts from getting scattered.

- Improve your social life. XXXXXXX friends and relatives, go for outings or group activities and keep yourself busy. If you keep staying alone, you are more prone to engage such sexual behaviour.

- Set limits and restrictions for yourself - for example, you can ensure that you don't keep cash in hand and can compulsorily invest your money in some form which is not immediately retrivable. Or you can confide about this problem to a close friend - so that he will be able to monitor your activities and restrict you whenever you have a urge to engage in call girls.

- You can try yoga and meditation. This can help you develop a discipline of your mind and body and help you get a mastery over your thoughts.

Regarding the side effects of the medication, unfortunately most of the antidepressants will have some side effect or the other, and the most common side effect is sexual dysfunction. However, there are certain antidepressants like Bupropion or Mirtazapine, which have relatively minimal sexual side effects. If your side effects are very troubling with the current medication, you can consider changing Fluvoxine to Mirtazapine (Mirtaz) 15mg - to be taken at night. But Fluvoxine has to be gradually reduced before stopping completely. For the constipation problem, I would suggest that you drink plenty of water and take more of fruits and vegetables. You can also try a natural fibre supplement like Naturolax every night (2 spoons of powder mixed in 1 glass of water).

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

---