Brief Answer:
I do not think the venlafaxine effect can last this much duration

Detailed Answer:
Dear Dr XXXXXXX
Thanks again for posting to me.

Although there are many symptoms in favour of CFS but I think last one is classical for mood disorder which is "want to do many things". In addition In my experience I have observed functional GI symptoms and repeated sore throat as universal symptom of CFS which you did not mention in regard to your daughter.

With limited available evidence I feel CFS is not a diagnosis for your daughter although I will keep my option open till I have further information.

Now regarding the current management I am of the opinion the prescription of Prozac should be reconsidered as it is associated with excess fatigue and exhaustion provided these symptoms worsened after starting prozac. In case they are prevalent music earlier than use of prozac we can continue it at this dose itself.

In reagard to well burin my request is to increase the dose to 150 mg from today and 300 mg after three days. Considering her current symptom profile and poor response with multiple antidepressants the option should be explored for non antidepressant medications such as atypical antiipsychotics.

I look forward to get more details to reach final diagnosis and chart out appropriate treatment for her.
Thanks and regards.

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Brief Answer:
I think it is Treatment Resistant Depression

Detailed Answer:
Dear Dr XXXXXXX
Thanks for reverting back to me.

The atpical antipsychotics are newer generation antipsychotics which include seroquel, ability, zyprexa, latuda, risperdal and geodone. Among these I think ability will be a better option as it is weight neutral and can be used along with wellbutrin or prozac.

This is because I consider her problem as treatment resistant depression. Since her thyroid is normal thyroxine supplementation is out of option. There are many pain symptoms which can be best done with low dose of atypical antipsychotic.

I hope this clarifies further.
Thanks and regards.

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