Brief Answer: You can try duloxetine Detailed Answer: Hello and welcome to HCM! I have read your question carefully and it says that you want an antidepressant which dosent cause trouble with your enlarged prostate. You have tried three others previously but have not mentioned their names. From my clinical experince I can say that duloxetine is good in such patients, not only it helps in depression, but also helps in neurological pain symptoms ( which you have also mentioned in your medical history) as well. It doesn't trouble patients with enlarged prostate, and controls depression. One may try it after discussing with their treating team. I usually start with low doses, like 20 mg and then gradually increase it after seeing the response. It is also safe and dosent carry many side effects. ## should check your diet and include adequate water and salad to prevent constipation ( however, almost all antidepressants do cause some amount of constipation). So, you may start this medicine ( your doctor would know how to go about it) if you have not tried it before. # do check your sugar levels- as diabetes may also be one of the factors witch increases frequency of urination.. Hope the reply is useful for you Please feel free to ask more questions for clarification If you are satisfied, kindly rate the answer and close the query Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Explained below Detailed Answer: Hello, So, there is another issue ( small Pitutary) which had come up in your case which might be interlinked and may be related to depression as well. A) You have small pituitary gland ( so, that's why you have low testosterone levels), this can also lead to hypothyroidism. I would sincerely advice you to get your thyroid levels done, along with sugar levels (as mentioned previously) , because they may be affected. Treating these will help you a lot in all symptoms. ## Pitutary is a major gland which secrets lots on important hormones in our body, so in case of small Pitutary syndrome, many of them may be affected. They can be screened and if found low, should be treated. B) I have seen cases like your responding to duloxetine nicely, so you may try that ( and you have not even tried it before ). I am hopeful that it will help you. You should also take care of following things apart from drug managment to reduce night trips - 1. reduce intake of tea/ coffee in late evening hours, may be after 5 pm 2. reduce water intake 2-3 hours before going to bed C) For your low testosterone levels, I would say that in clinical practice I have seen that usually hormonal creams and gels are used, or sometimes injectables can be tried. Both the methods have their own pros and cons, but you may talk with your doctor and discuss about injectable hormone. Sometimes, pellets can be inserted under the skin, but that again is not fool proof method. I would suggest that you should discuss the issue of hormonal replacement with a specialist, he can guide you in best possible way, better than what I can do. D) for your nerve related pains and aches, I feel that you may try taking either pregabalin or gabapentin ( after discussing it with your neurologist). These two molecules have a very good response along with Vit B12 supplement in managing pains related to nerves. I have had very satisfactory results with them in such patients. These drugs even helps in sleep ( if there is mild insomnia). Hope the reply is useful for you please feel free to ask more questions for clarifications If you are satisfied, please rate the answer and close the query Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Please read below Detailed Answer: hello, According to your response I do not think that duloxetine will help you (as you said it gave same effect on the bladder). May be you can try : amitryptalline, in dose of 25-50 mg, it may also give some sleep to few people initially, but it should be a welcome as you can rest at night...( talk to your doctor if you feel it is helping). Secondly, I am sorry but I do to think that the question can be transferred to any other doctor, however, you may mail the XXXXXXX team at YYYY@YYYY anytime, and get information about someone who has done special course in hormonal replacement therapy ( I think he would be a better guide in your case compared to an endocrinologist, as already you are seeing one ). Another option can be consulting a hormone clinic directly (if you are aware of any good one near your home) , because they must be managing several similar cases and have a better understanding of the issue you are facing. Thirdly, you have been on vicodyn and fentanyl for several years but this problem has not been associated with their use. According to the query- you are fine when you are off drugs which irritate the bladder, (even though you must be taking vicodyn and fentanyl in that phase ). So, I do to think that these two medicines are causing this issue. ## This new drug , amitryptalline - is also good for nerve related aches and pains, along with managing depression. Hope the reply is helpful for you wish you good health! Please feel free to ask more questions for any clarification, I will be glad to answer them Dr. Manisha Gopal MD Pscyhaitry

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Brief Answer: Please read below Detailed Answer: hello, You have correctly got the message reagrding the two drugs: Vicodin. and fentanyl, that I do not think that they can be the culprit. Secondly, I want you to contact the XXXXXXX team to inquire about any hormone replacement specialist, so that you can get an expert advice reagading testosterone supplement. Thirdly, I think amitryptalline might help -- as the problem is related to either nerves ( which repeatedly irritate the bladder causing frequent bathroom trips. This drug has additional effect on nervous system , that it calms the nerves/ aches and pains also apart from tackling depression. I know that we have not found " the drug" for you but still we have to try what may suit your profile from the options we have in our drug basket. And everyone dose not get the side effects mentioned, even the commonest ones. Fourthly, do you think if by somehow you are able to have a very sound sleep, will this bladder be able to irritate you/ wake you up? What is your opinion in this? May be you can think about this point and discuss it with your doctor. Like, what'd about a drug ( may be an antidepressant ) which has additional property of being a good sedative too? or a sedative itself? Please feel free to ask more questions for clarifictaion, I will be pleased to answer them Dr. Manisha Gopal MD Psychiatry

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