Since Covid, I have suffered severe anxiety and depression. I take duloxetine and lorazepam twice a day but they no longer help. I live alone, I’m 78 and can’t see the point of carrying on. My family try to help, but I just cannot see a future of me being happy and content.
Name and address withheld
Dr Martin Scurr replies: At this time of year there will be many people going through what you are experiencing and I thank you for your letter. It’s brave of you to write and I am deeply sympathetic.
It is clear you have a significant depressive illness. However, I am optimistic that with improved treatment, you will recover fully.
One intrinsic symptom of depression is that any sense of optimism evaporates. The illness can also cause disturbed sleep, a sense of worthlessness, loss of appetite, even feeling cold and tired all the time.
The physical symptoms are just as overwhelming and depleting as the psychological state of anxiety and sense of doom. This is why doctors see depression as a whole-body problem, not something confined only to the brain.
Worryingly, you say in your longer letter that you have had suicidal thoughts, however your family is the reason you don’t take these any further. I would encourage you to let them know how you are truly feeling.
Don’t struggle on alone, speak to your GP and family as soon as possible, says Dr Scurr
Duloxetine can be an effective antidepressant but the dose you are taking – 30mg – is low: the usual maintenance dose is 60-90mg.
The fact that the drug used to help at least tells us that it does not disagree with you or cause unacceptable side-effects such as nausea, dry mouth and insomnia (which affects 5 to 10 per cent of patients).
It is important to note that a small number of people can develop suidical thoughts when starting antidepressants or changing their dose, which is why it is very important that your family and doctor know about these feelings.
But if these thoughts predated your medication, that suggests the drug is not driving them in your case. A reduced response to a drug that previously worked can be a sign that the body has become used to that dose (the liver builds up its enzyme systems to ‘detox’ the blood of the drug, in which case a higher dose will then be needed).
Your GP may suggest increasing your duloxetine dose so that the drug is effective once again.
The lorazepam, a tranquilliser, helps suppress anxiety symptoms, so once your treatment with duloxetine is effective again, you should find the anxiety will also fade and you’ll be able to reduce the lorazepam dose slowly, under medical supervision.
I urge you to speak to your GP promptly to discuss your duloxetine dose to help get you back to your old self. I’d also urge you to speak to your family – and to contact the Samaritans by calling 116123 or emailing jo@samaritans.org. Do please feel you can write to me again.
I have a skin problem around my left ankle. It began last Christmas with skin peeling on the sole of my foot, hardening of the skin and swelling. Now it’s spreading up my leg. My GP has prescribed antibiotics and emollients, without success.
Charles Bailey, Manchester.
Dr Scurr replies: My suspicion is that you have a form of psoriasis – an autoimmune condition which triggers 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 typically the scalp, elbows, knees and lower back are affected. The plaques may itch, invariably causing some discomfort and skin cracking.
The usual treatment is topical steroids, although a drug derived from vitamin D (calcipotriol) and other new medications such as roflumilast are increasingly used.
With treatment, the condition should improve within weeks.
IN MY VIEW.. Sugar rules don’t count at Christmas!
After being married to a dietitian for many years, I’ve been weaned off a lifelong sweet tooth by a combination of gentle arm-twisting and irrefutable logic. For, as I’ve come to accept, sugar is no better for our health than alcohol.
However, we don’t have to be puritanical about it, as a study just published in the journal Frontiers in Public Health demonstrates (bringing joy to my taste buds).
Analysis of the diets of more than 60,000 middle-aged people found that regularly consuming sugar increased the risk of cardiovascular disease considerably.
But scientists also found that when sweet foods were consumed as occasional treats, then the risk of heart disease was reduced. Yes, truly.
Consuming sugary foods on occasion, surrounded by family and friends, can be beneficial.
So enjoy the festivities and don’t worry about breaking sugar rules once in a while. As I write, my favourite panettone, florentines and mince pies are waiting on the shelf. Merry Christmas!
Write to Dr Scurr at 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 GP with any health concerns
