Question: 19 year old caucasian male college student | weight: 155 lbs | blood pressure: 140/80 | resting heart rate: 95 bpm | respirations: 18 | O2 saturation: 96% | My s/s are: depression, anxiety, fatigue, intermittent insomnia, chronic low fever, migrating myalgia, excessive sweating, daytime drowsiness, inability to concentrate, impaired memory, general cognitive decline. | Diagnostic tests: CBC, CMP, thyroid function tests, HIV test, ANA, and diabetes test were all negative/normal as of one year ago. | Prior drug therapies: (1) fluoxetine 40 mg po qd, (2) fluoxetine 40 mg po qd + trazodone 100 mg po qhs, (3) sertraline 100 mg po qd + trazodone 100 mg po qhs, (4) sertraline 100 mg po qd + bupropion XL 150 mg po qd + trazodone 100 mg po qhs, (4) escitalopram 20 mg po qd + bupropion 300 mg XL po qd + trazodone 100 mg po qhs, (5) venlafaxine ER 150 mg po qd + 150 bupropion XL po qd + trazodone 100 mg po qd; CURRENT regimen: venlafaxine ER 225 mg po qd + modafinil 200 mg po qd + trazodone 50 mg po qhs + mirtazapine 15 mg po qhs. | Four months ago, I had an XXXXXXX osteotomy for flatfoot reconstruction on left foot after which my depression worsened. During recovery I had two separate occurrences of severe cellulitis in my left foot. MRI was performed to rule out osteomyelitis. Three years ago, over the course of about a year, I had FOUR spontaneous pneumothoraces, one on left side and three on the right. About 4 years ago, I had a kidney stone that remained stationary for nine months, shockwave lithotripsy was eventually performed. IN CONCLUSION: Other than sleep, my symptoms have not improved despite the aforementioned drug therapies. Any suggestions of different medications I could try? Or maybe retry, just at a higher dose? What other medical conditions could explain the symptoms that have not yet been tested for?

Hello, Dr. Solanki. Thank you for your reply. It was very detailed. What is your opinion on milnacipran with regards to my condition?