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What Causes Chest Tightness While Exercising In A Patient Suffering From Severe Anxiety?
Question: So our last conversation closed 4 hours ago. I let time slip away. I've been pushing forward using the information from our last talk. my anxiety levels are still up and I'm not sure of the time it will take to come down.
In the meantime, I've been adding some exercise to my daily regimen. Tell me if you know the answer to the following. I've been doing a few weight lifts but I felt a tightness/pressure on chest when inhaling. Would it be safe to assume that the excess anxiety hormones that are still in my body are causing this.
In the meantime, I've been adding some exercise to my daily regimen. Tell me if you know the answer to the following. I've been doing a few weight lifts but I felt a tightness/pressure on chest when inhaling. Would it be safe to assume that the excess anxiety hormones that are still in my body are causing this.
Brief Answer:
Private Consultation
Detailed Answer:
Hi again XXXXXXX Let's get right back to it.
First, let me congratulate you on exercising. This is THE BEST thing you can do for your physical and mental health. Exercising works as an antidepressant and will make anyone feel better. Stick with it!
You're right that anxiety can stick around for some time, and you're also right in thinking that anxiety is the cause of your chest tightness here. Or more accurately, anxiety is leading you to be worried about your chest tightness more than the average person. The average person would simply say, "Oh, I'm exercising now, so my chest is a little more tight. That's normal, doesn't mean anything bad," and move on with their day. Because of your brain chemistry and personal experiences, this isn't so easy for you. Maybe you could elaborate on your concerns about your chest tightness during exercise? What is it that you worry is wrong with you or bad? What are you afraid will happen?
Let's talk more about medication. The treatment for anxiety is a combination of CBT (which we are doing together), an antidepressant long-term, and a benzodiazepine such as Klonopin or Ativan in the short term. Remind me, you're taking Lexapro if I recall? What is your dose, and when was the last adjustment made? It may be that you need a tweak to your regimen.
Dr. Sheppe
Private Consultation
Detailed Answer:
Hi again XXXXXXX Let's get right back to it.
First, let me congratulate you on exercising. This is THE BEST thing you can do for your physical and mental health. Exercising works as an antidepressant and will make anyone feel better. Stick with it!
You're right that anxiety can stick around for some time, and you're also right in thinking that anxiety is the cause of your chest tightness here. Or more accurately, anxiety is leading you to be worried about your chest tightness more than the average person. The average person would simply say, "Oh, I'm exercising now, so my chest is a little more tight. That's normal, doesn't mean anything bad," and move on with their day. Because of your brain chemistry and personal experiences, this isn't so easy for you. Maybe you could elaborate on your concerns about your chest tightness during exercise? What is it that you worry is wrong with you or bad? What are you afraid will happen?
Let's talk more about medication. The treatment for anxiety is a combination of CBT (which we are doing together), an antidepressant long-term, and a benzodiazepine such as Klonopin or Ativan in the short term. Remind me, you're taking Lexapro if I recall? What is your dose, and when was the last adjustment made? It may be that you need a tweak to your regimen.
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Prasad
woke up at 3 am monday morning, thoughts developed into a panic attack regarding breathing. never fully shed the thoughts as the day went on.
Woke up at 3:30 on tuesday morning. thoughts developed into another panic attack. This time was knowing that I have a pft that have pulmonary defect listed Obstructive in nature and that of those I dont have Bronchitis, My retired Pulmonologist had Asthma listed, but I do not have basic symptoms of that unless you look at exercise related. So the thoughts of emphysema can be scary when you think that that would be the worst way to die.
I am in the middle of the midwest blizzard and have 12 inches of snow down
got up out of bed at 7:30, unsure of breathing issues, I took my lexapro and followed it with a xanax kicker to relax. I also took a shot of qval inhaler.
I took a long hot shower, i used a scented body wash formulated for stress relaxation.
Before I continue with this story, i will expect you have picked up on that I am highly anxious and panicky.
Had to open a path to let the dog out far enough to go to the bathroom. The depth of the snow is about 12 inches in depth and semi wet. I shoveled a 8 foot half moon from the house to give room for the dog.
Step back to shower, while taking it, as I began in noticed that my inspiriation through open mouth is 3 seconds before i hit a stopping point, inspirations via nasal breathing was 5 seconds. as I was shaving in the shower as i always do, I noticed a slight improvement in breathing.
The level of anxious and panic caused me to do a energized snow removal instead of calm controlled movements. This caused a increase in oxygen usage and pressure to the chest only notice able when i ceased and the shoveling and chose to wait out till the storm ended before i go out.
First, the uncomfortable feeling from the post shoveling has a fright to having it return when I know I have to go shovel a lot more afterward.
Second is the volume available to get air when i am relaxing or working.
Now for the Education I hope i have accurately gleened from You. And two Pulmonologists and my Internal MD and lastly my Daughter-the respiratory therapist. Excluding you, the others have all agreed that there really isnt any change from my first PFT 15 years ago so i have only aging causing the expected decrease in breathing for all people as they age.
Your comments from prior conversations have been numerous and I am trying to focus on them to help me through this. Your explanations of physical and mental cause and reactions to the elevated levels that i have and let hang around.
You found humor in my pun on the statement that My first real girlfriend took my breath away when I had a panic attack when trying to kiss her for the first time. Knowing that breathing could be challenging because of that event has given me a more open consideration to the causes of my issue.
So, I am highly strung today, more so than usual because I was already elevated before the two panic attacks set in and add them and boy oh boy, I bet i have the anxiousness and the hypersensitivity to my breathing.
I will figure that my chest pressure is caused similar to that first kiss event and more hormone release to elevate.
Lastly, a phone call yesterday came in that was ironic in nature. My local pulmonologist office called and wanted to set follow up visit for tomorrow.
Knowing what you know and your best suggestions in mind. What would be questions relating to my overall condition and issues would you find most valuable to ask, those that the answers would help in cleaning up the inability to drop the gad and panic
Your last question on prior was about meds. Lexapro 20 mg a day with a buspar kicker. nothing more
Not sure of your location. Being in the blizzard in Nebraska, I have a bit of free time to put to use. The following is a list of stress/panic/anxious moments over the past few years. With the time between each and with some extending over long periods and the imprint of each, you might get a better understanding
1994 I lost my job in a corporate shakedown. I had a family to take care of and only a hs education
1994-1995. My father has a stroke, then into coma, then passes away
1999 my oldest brother passes away. Not certain but believe it was a heart attack
2000 I think I had a heart attack. Panic begins with thoughts of death because of heart. Hyperventilate till I schedule a pulminologist visit and pft
2001 pft at beginning and at end numbers are in ok range pulminologist records comment on defect and very mild copd. Words copd trigger a bad thought
2001 lose my younger brother to a semi vs suv accident on freeway.
2003-2004 mom is diagnosed with copd. This lasts until 2012
2005 I shake my anxiety panic on my heart.
Things go good for a short time
2007. My sister commits suicide.
2008 I buy an apartment building no issues until little things start to go wrong. I sell in 2015
2009 my wife decides to divorce me. Not a good thing. Too much pressure
2010 meet a young lady, date until 2013. She was demanding with a short temper.
2014 marry an old girlfriend from 30!years before its stressful. I must move away from my home, leave my loved ones behind
Now looking to correct that
Those were events or triggers I failed to includ that tha loss of the 5 family members over 17 years was all on my shoulders to plan and deal with. The others could not handle it. That's a stress load too
You asked me about mom
While taking care of her I read a lot of info on COPD. What to expect and such. Those things locked into my head. Along with the visuals it created a lasting memory that is not one to enjoy. Along with the comments on the first pft, I am uncertain to my future and if it develops or s
Is developing I am not calm to it.
Now tomorrow I am gonna have the pulminologist go more in detail for my future to the best he can give. Push to clarify my anxiety and what may not be. Etc
Woke up at 3:30 on tuesday morning. thoughts developed into another panic attack. This time was knowing that I have a pft that have pulmonary defect listed Obstructive in nature and that of those I dont have Bronchitis, My retired Pulmonologist had Asthma listed, but I do not have basic symptoms of that unless you look at exercise related. So the thoughts of emphysema can be scary when you think that that would be the worst way to die.
I am in the middle of the midwest blizzard and have 12 inches of snow down
got up out of bed at 7:30, unsure of breathing issues, I took my lexapro and followed it with a xanax kicker to relax. I also took a shot of qval inhaler.
I took a long hot shower, i used a scented body wash formulated for stress relaxation.
Before I continue with this story, i will expect you have picked up on that I am highly anxious and panicky.
Had to open a path to let the dog out far enough to go to the bathroom. The depth of the snow is about 12 inches in depth and semi wet. I shoveled a 8 foot half moon from the house to give room for the dog.
Step back to shower, while taking it, as I began in noticed that my inspiriation through open mouth is 3 seconds before i hit a stopping point, inspirations via nasal breathing was 5 seconds. as I was shaving in the shower as i always do, I noticed a slight improvement in breathing.
The level of anxious and panic caused me to do a energized snow removal instead of calm controlled movements. This caused a increase in oxygen usage and pressure to the chest only notice able when i ceased and the shoveling and chose to wait out till the storm ended before i go out.
First, the uncomfortable feeling from the post shoveling has a fright to having it return when I know I have to go shovel a lot more afterward.
Second is the volume available to get air when i am relaxing or working.
Now for the Education I hope i have accurately gleened from You. And two Pulmonologists and my Internal MD and lastly my Daughter-the respiratory therapist. Excluding you, the others have all agreed that there really isnt any change from my first PFT 15 years ago so i have only aging causing the expected decrease in breathing for all people as they age.
Your comments from prior conversations have been numerous and I am trying to focus on them to help me through this. Your explanations of physical and mental cause and reactions to the elevated levels that i have and let hang around.
You found humor in my pun on the statement that My first real girlfriend took my breath away when I had a panic attack when trying to kiss her for the first time. Knowing that breathing could be challenging because of that event has given me a more open consideration to the causes of my issue.
So, I am highly strung today, more so than usual because I was already elevated before the two panic attacks set in and add them and boy oh boy, I bet i have the anxiousness and the hypersensitivity to my breathing.
I will figure that my chest pressure is caused similar to that first kiss event and more hormone release to elevate.
Lastly, a phone call yesterday came in that was ironic in nature. My local pulmonologist office called and wanted to set follow up visit for tomorrow.
Knowing what you know and your best suggestions in mind. What would be questions relating to my overall condition and issues would you find most valuable to ask, those that the answers would help in cleaning up the inability to drop the gad and panic
Your last question on prior was about meds. Lexapro 20 mg a day with a buspar kicker. nothing more
Not sure of your location. Being in the blizzard in Nebraska, I have a bit of free time to put to use. The following is a list of stress/panic/anxious moments over the past few years. With the time between each and with some extending over long periods and the imprint of each, you might get a better understanding
1994 I lost my job in a corporate shakedown. I had a family to take care of and only a hs education
1994-1995. My father has a stroke, then into coma, then passes away
1999 my oldest brother passes away. Not certain but believe it was a heart attack
2000 I think I had a heart attack. Panic begins with thoughts of death because of heart. Hyperventilate till I schedule a pulminologist visit and pft
2001 pft at beginning and at end numbers are in ok range pulminologist records comment on defect and very mild copd. Words copd trigger a bad thought
2001 lose my younger brother to a semi vs suv accident on freeway.
2003-2004 mom is diagnosed with copd. This lasts until 2012
2005 I shake my anxiety panic on my heart.
Things go good for a short time
2007. My sister commits suicide.
2008 I buy an apartment building no issues until little things start to go wrong. I sell in 2015
2009 my wife decides to divorce me. Not a good thing. Too much pressure
2010 meet a young lady, date until 2013. She was demanding with a short temper.
2014 marry an old girlfriend from 30!years before its stressful. I must move away from my home, leave my loved ones behind
Now looking to correct that
Those were events or triggers I failed to includ that tha loss of the 5 family members over 17 years was all on my shoulders to plan and deal with. The others could not handle it. That's a stress load too
You asked me about mom
While taking care of her I read a lot of info on COPD. What to expect and such. Those things locked into my head. Along with the visuals it created a lasting memory that is not one to enjoy. Along with the comments on the first pft, I am uncertain to my future and if it develops or s
Is developing I am not calm to it.
Now tomorrow I am gonna have the pulminologist go more in detail for my future to the best he can give. Push to clarify my anxiety and what may not be. Etc
Brief Answer:
Private Followup
Detailed Answer:
Hi XXXXXXX Thanks so much for this information. It really paints a more complete picture for me.
First, regarding the snowstorm -- I really have to commend your ability to face down panic when it hits you. You try your best to keep your mind and body busy. You took a hot shower to calm yourself down, which was a fantastic idea. You have wonderful insight into when you are panicking, and are taking active steps to calm yourself down. This will all help you very much as we go forward.
I'm in NYC, so we got blasted with snow about 10 days ago, almost 2 feet. It was not a pretty picture. But then again, I didn't have to dig out a path. You really had your work cut out for you!
How long have you been on the Lexapro 20mg? If it has been more than 6 weeks, I would seriously consider switching to a different antidepressant, as Lexapro clearly is not doing the job for you. I would try Zoloft or Prozac. If it has been less than 6 weeks, we can still give it time to kick in. Medicine can cure panic attacks -- I cannot stress this enough. So we really need to keep a close eye on the medications.
When you describe to me how your attention becomes totally focused on every minute detail about your breathing, this to me is classic anxiety somatization. Your brain says to you, I'm working hard and I'm having trouble breathing, I better focus 100% on my breath, could it be COPD, could it be a heart attack, oh no! It's your brain hijacking your senses and your attention. Lots of people all over the country were shoveling snow and getting short of breath, but they did not have fears about COPD. When you begin to recognize this as irrational, that will help you fight it when it hits.
Your chronology was very helpful to read. I had no idea the extent of stressors you have experienced in your life. So many deaths in your family -- it is truly staggering to think about. I can't imagine how difficult that must be for you. It's no wonder your brain has become wired to fear the worst -- you have experienced many terrible things. The good news is you are resilient, intelligent, and have a good sense of humor. These qualities will help you when panic hits.
I would tell your doctor what we have been discussing together. Bring him your PFTs and ask him for reassurance that you do not have COPD. I'm sure he will tell you that this is anxiety, and that there is no evidence of serious pulmonary illness. Sometimes reassurance from an expert is really incredibly helpful. Don't be afraid to ask him any and all questions. I'm sure he will be happy to answer everything on your mind, no matter how small or embarrassing you may perceive it to be.
Definitely update me on what your doctor has to say tomorrow. We can talk about your meeting with him in more detail.
Dr. Sheppe
Private Followup
Detailed Answer:
Hi XXXXXXX Thanks so much for this information. It really paints a more complete picture for me.
First, regarding the snowstorm -- I really have to commend your ability to face down panic when it hits you. You try your best to keep your mind and body busy. You took a hot shower to calm yourself down, which was a fantastic idea. You have wonderful insight into when you are panicking, and are taking active steps to calm yourself down. This will all help you very much as we go forward.
I'm in NYC, so we got blasted with snow about 10 days ago, almost 2 feet. It was not a pretty picture. But then again, I didn't have to dig out a path. You really had your work cut out for you!
How long have you been on the Lexapro 20mg? If it has been more than 6 weeks, I would seriously consider switching to a different antidepressant, as Lexapro clearly is not doing the job for you. I would try Zoloft or Prozac. If it has been less than 6 weeks, we can still give it time to kick in. Medicine can cure panic attacks -- I cannot stress this enough. So we really need to keep a close eye on the medications.
When you describe to me how your attention becomes totally focused on every minute detail about your breathing, this to me is classic anxiety somatization. Your brain says to you, I'm working hard and I'm having trouble breathing, I better focus 100% on my breath, could it be COPD, could it be a heart attack, oh no! It's your brain hijacking your senses and your attention. Lots of people all over the country were shoveling snow and getting short of breath, but they did not have fears about COPD. When you begin to recognize this as irrational, that will help you fight it when it hits.
Your chronology was very helpful to read. I had no idea the extent of stressors you have experienced in your life. So many deaths in your family -- it is truly staggering to think about. I can't imagine how difficult that must be for you. It's no wonder your brain has become wired to fear the worst -- you have experienced many terrible things. The good news is you are resilient, intelligent, and have a good sense of humor. These qualities will help you when panic hits.
I would tell your doctor what we have been discussing together. Bring him your PFTs and ask him for reassurance that you do not have COPD. I'm sure he will tell you that this is anxiety, and that there is no evidence of serious pulmonary illness. Sometimes reassurance from an expert is really incredibly helpful. Don't be afraid to ask him any and all questions. I'm sure he will be happy to answer everything on your mind, no matter how small or embarrassing you may perceive it to be.
Definitely update me on what your doctor has to say tomorrow. We can talk about your meeting with him in more detail.
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thanks I neededa response today.
Lexapro was prescribed at least 4 years ago.
Today's snow removal left me drained. Drained from work and from the physical symptoms I felt like I had punch balls for lungs but they were trying to inflate while trapped in a 20 oz pop bottle. It made me wonder if the comments on the last pft were right about continuing treatment for asthma or if it was the panic.
The dr I will see has the full copies of the 6 PFTs I gave them to him 6 months ago he has once commented that I should live a long time
Tomorrow I intend to ask number of questions including his thoughts on comments on the PFTs and the asthma comment., anxiety and anything else I can think of. I will also discuss today
Lexapro was prescribed at least 4 years ago.
Today's snow removal left me drained. Drained from work and from the physical symptoms I felt like I had punch balls for lungs but they were trying to inflate while trapped in a 20 oz pop bottle. It made me wonder if the comments on the last pft were right about continuing treatment for asthma or if it was the panic.
The dr I will see has the full copies of the 6 PFTs I gave them to him 6 months ago he has once commented that I should live a long time
Tomorrow I intend to ask number of questions including his thoughts on comments on the PFTs and the asthma comment., anxiety and anything else I can think of. I will also discuss today
Brief Answer:
Private Followup
Detailed Answer:
Given the length of time you've been on Lexapro, I think you very much need to try a different antidepressant. Often, when people do not get better on one antidepressant, switching to a different one can have totally different and very beneficial results. I'd recommend Zoloft or Prozac. I think this should be your highest priority in terms of treatment for panic disorder, in addition to continuing therapy with me.
The doctor tomorrow will give you peace of mind, I'm sure of it. Make sure to ask all your questions about COPD. I can guarantee you do not have it, but hearing it from a lung specialist will ease your mind.
Let me know how it goes tomorrow!
Dr. Sheppe
Private Followup
Detailed Answer:
Given the length of time you've been on Lexapro, I think you very much need to try a different antidepressant. Often, when people do not get better on one antidepressant, switching to a different one can have totally different and very beneficial results. I'd recommend Zoloft or Prozac. I think this should be your highest priority in terms of treatment for panic disorder, in addition to continuing therapy with me.
The doctor tomorrow will give you peace of mind, I'm sure of it. Make sure to ask all your questions about COPD. I can guarantee you do not have it, but hearing it from a lung specialist will ease your mind.
Let me know how it goes tomorrow!
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
I will fully disclose outcome of dr visit on next text but for now it occurred as you said. I don't want this discussion to close before I can fully text the events. So for now it was good
Brief Answer:
Private Followup
Detailed Answer:
It sounds like generally things went well. In our next discussion on a new thread, I look forward to hearing about it in detail. We can discuss your thoughts and reactions in depth.
Dr. Sheppe
tinyurl.com/DrSheppeAnswers
Private Followup
Detailed Answer:
It sounds like generally things went well. In our next discussion on a new thread, I look forward to hearing about it in detail. We can discuss your thoughts and reactions in depth.
Dr. Sheppe
tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Deepak
So the appointment went according to my plan. I went in, had the nurses check my vitals, hurt my feelings (told me my weight-gained to much), gave my updates to meds, then saw the doc. We did brief pleasantries, chatted about what's new, ran the tests of listening to breathing/lungs, heart, and sounds in chest as I talked. I asked all the questions I needed answers to. I voiced my need to get his opinion to what he read in my medical records, how he perceived what I should expect in my life such as lung problems, etc.
His answers were, you are very anxious( this we know), you have no apparent lung disease, your mother smoked for 70 years and died at 91. Even though she died from copd, she had good, tough genes to last that long. That can pass on to children from maternal side so I think you should live long life. If I were to say you have anything to watch, it would be a very mild case of asthma.
Now that the news is in front of me, I have relaxed quite a bit. New way of thinking. I wonder how long the body can take to come down so the sensitivity is completely absent.
Monday I will make a med change request. Do you have a long term anti depressant that you like My friend suggested Zoloft or its generic.
He said to refuse cymbalta. He said it was bad news and he'll to get off of.
His answers were, you are very anxious( this we know), you have no apparent lung disease, your mother smoked for 70 years and died at 91. Even though she died from copd, she had good, tough genes to last that long. That can pass on to children from maternal side so I think you should live long life. If I were to say you have anything to watch, it would be a very mild case of asthma.
Now that the news is in front of me, I have relaxed quite a bit. New way of thinking. I wonder how long the body can take to come down so the sensitivity is completely absent.
Monday I will make a med change request. Do you have a long term anti depressant that you like My friend suggested Zoloft or its generic.
He said to refuse cymbalta. He said it was bad news and he'll to get off of.
Brief Answer:
Private Followup
Detailed Answer:
Hello Matt!
I'm so glad the appointment was reassuring for you. I hope this gives you continued confidence that you do not have COPD or any serious lung disease, which will cognitively help you combat feelings of anxiety and panic as they arise.
Anxiety and panic may continue, as your brain has developed this pattern. Cognitive behavioral therapy will help use the rational parts of your brain to help combat these feelings. I can't say for sure how long they will last, but you are developing all the tools you need to combat it.
I do recommend tapering off the Lexapro and simultaneously starting and uptitrating a new antidepressant. Zoloft, an SSRI antidepressant, is a good choice. I usually start at 25mg, and increase by 25mg every couple of weeks up to a maximum of 200mg as tolerated. An adequate trial would be 4 months at the maximum dosage. This will often cure anxiety and panic completely. If it does not, do not worry -- there are many antidepressants to try, and many augmentation strategies that we can use. We will in time get this under control.
I agree that Cymbalta would not be my first choice. Even among the SNRI antidepressants, I would prefer Effexor or Pristiq to Cymbalta, as Cymbalta can indeed have some of the worst withdrawal side effects.
Open up a new thread, and we'll continue. I think we should focus on other aspects of your life (take a break from discussing your mother), and how anxiety affects them. But we can talk about anything you'd like!
Dr. Sheppe
tinyurl.com/DrSheppeAnswers
Private Followup
Detailed Answer:
Hello Matt!
I'm so glad the appointment was reassuring for you. I hope this gives you continued confidence that you do not have COPD or any serious lung disease, which will cognitively help you combat feelings of anxiety and panic as they arise.
Anxiety and panic may continue, as your brain has developed this pattern. Cognitive behavioral therapy will help use the rational parts of your brain to help combat these feelings. I can't say for sure how long they will last, but you are developing all the tools you need to combat it.
I do recommend tapering off the Lexapro and simultaneously starting and uptitrating a new antidepressant. Zoloft, an SSRI antidepressant, is a good choice. I usually start at 25mg, and increase by 25mg every couple of weeks up to a maximum of 200mg as tolerated. An adequate trial would be 4 months at the maximum dosage. This will often cure anxiety and panic completely. If it does not, do not worry -- there are many antidepressants to try, and many augmentation strategies that we can use. We will in time get this under control.
I agree that Cymbalta would not be my first choice. Even among the SNRI antidepressants, I would prefer Effexor or Pristiq to Cymbalta, as Cymbalta can indeed have some of the worst withdrawal side effects.
Open up a new thread, and we'll continue. I think we should focus on other aspects of your life (take a break from discussing your mother), and how anxiety affects them. But we can talk about anything you'd like!
Dr. Sheppe
tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks, I will keep all the anti depressants options open. Except one. I had taken Effexor XR 10 or so years ago. I had a weird reaction to it, I yawned continually every 40 seconds to three minutes. very annoying so I stopped.
Brief Answer:
Private Followup
Detailed Answer:
Yes, there are so many options. We can consider any or all in detail. No need to pursue Effexor or Cymbalta, there are many others!
Dr. Sheppe
tinyurl.com/DrSheppeAnswers
Private Followup
Detailed Answer:
Yes, there are so many options. We can consider any or all in detail. No need to pursue Effexor or Cymbalta, there are many others!
Dr. Sheppe
tinyurl.com/DrSheppeAnswers
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Above answer was peer-reviewed by :
Dr. Raju A.T
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