Views on Effexor/venlafaxine?

[Mister Fixit]

My wife has just been prescribed Effexor 37.5 mgs at her menopause clinic today.  I asked why and she sort of described whirling thoughts and 'thinking about everything'.  I think she probably means anxiety.

 

I am very concerned.  It's an SNRI and I am not too happy about them.  I was on venlafaxine about 18 to 20 years ago and it was horrible stuff.  I walked round like a zombie most of the time, and it was almost impossible to come off it.  When I decreased the dosage, I felt awful - fatigued, unwell, etc.

I had a useless GP in the UK who had prescribed it for my ADHD because he refused to prescribe Ritalin.  Ritalin would have been 20 times better as it's gone in 4 hours, but the venlafaxine hung around for days.  You cannot cold turkey with it.

 

Had I known he was going to prescribe it today, I would have protested.  He has only prescribed 28 days supply, so that they can decide to continue or move to something else.  Her next appointment is in 3 weeks anyway, so I shall make sure I am there and there'll be some close questioning. 

 

Has anyone else been on it for any length of time, and did they have any problems with being on it, or coming off it?   Or know of a perhaps better alternative?

 

Edited July 13, 2021 by Mister Fixit

[Sheryl]

There is no point in asking people's experiences as everyone's reason for being on this medication will be different and few if any readers here will have been on it for menopause related issues. In addition, people vary enormously in how they respond to this medication.

 

The main advantage to venlafaxine is that, unlike many other antidepressents, it has an anti-anxiety effect as well. Whether or not your wife needs to be on an antidepressent/anti-anxiety med  is another matter and obviously I have no way of knowing.

 

I do know that Thai doctors are not very up to date in management of menopause and that few places understand and use bioidentical HRT and the tendanecy here is to use synthetics.  Synthetic HRT can sometimes cause depression, anxiety and other mental problems -- especially synthetic  progestins. What has she been given in terms of hormones?

[Mister Fixit]

On 7/15/2021 at 10:04 PM, Sheryl said:

There is no point in asking people's experiences as everyone's reason for being on this medication will be different and few if any readers here will have been on it for menopause related issues. In addition, people vary enormously in how they respond to this medication.

 

The main advantage to venlafaxine is that, unlike many other antidepressents, it has an anti-anxiety effect as well. Whether or not your wife needs to be on an antidepressent/anti-anxiety med  is another matter and obviously I have no way of knowing.

 

I do know that Thai doctors are not very up to date in management of menopause and that few places understand and use bioidentical HRT and the tendanecy here is to use synthetics.  Synthetic HRT can sometimes cause depression, anxiety and other mental problems -- especially synthetic  progestins. What has she been given in terms of hormones?

Nothing yet.  Nor does she want to take any, more fool her IMHO.  

[IvorBiggun2]

On 7/15/2021 at 10:04 PM, Sheryl said:

In addition, people vary enormously in how they respond to this medication.

 

Absolutely. I was on and off antidepressants for 20 years. Been on a few over those years. Last one was Sertraline. In all those years I took the medication because I wanted it to work but in reality it hasn't/didn't. Looking back I see them as placebos and not worth the hassle. I stopped taking Sertraline 5th April and I'm determined never to go back on them.

What I do now when I get kind of depressed is to sit down and talk to the wife on how I'm feeling. I find talking about my moods to be far better than taking medication. Seems to be working so far.

[Sheryl]

8 hours ago, Mister Fixit said:

Nothing yet.  Nor does she want to take any, more fool her IMHO.  

Well if she won't go on HRT then psychotropic meds may be necessary. As shame as the right HRT will often resolve these problems.

 

(Why bother going to a menopause clinic in this case?)

[NancyL]

When I went into menopause my general doctor, an internist, recommended trying to wait out the undesirable side effects for six months before prescribing HRT because once you start on HRT, it can be difficult to stop.  

 

Fortunately, my major side effect was hot flashes and since it was winter in Michigan and we kept our house cold, heating just the main living area with a wood stove, all I had to do was go into a colder part of the house or step outside during a hot flash.  Eventually, everything settled out and I no longer had problems.

 

This was after decades of menstrual cramps, monthly moodiness, endometriosis, infertility, miscarriages.  Finally peace.  I overheard my husband telling a male friend at a party "menopause was much easier than I thought it would be."  As if he was the one going through it!

 

I agree with my doctor on the subject of HRT.  Don't rush into it.  Give yourself six months or so to see if your body is going to settle down on its own first.

[IvorBiggun2]

12 minutes ago, NancyL said:

"menopause was much easier than I thought it would be."  As if he was the one going through it!

Menopause just doesn't affect females. It affects the whole family.

[Mister Fixit]

On 7/18/2021 at 8:59 AM, IvorBiggun2 said:

Menopause just doesn't affect females. It affects the whole family.

So does andropause.

[Mister Fixit]

On 7/17/2021 at 11:24 PM, Sheryl said:

Well if she won't go on HRT then psychotropic meds may be necessary. As shame as the right HRT will often resolve these problems.

 

(Why bother going to a menopause clinic in this case?)

Why bother going?  Because she asked to go when I started the andropause clinic.  She has started the venlafaxine, but has only taken 3 tablets so far, so no time at all to see how or if they will help.  She did say she felt a bit dizzy when she took them (she forgot yesterday) but I suspect that's just because she's new to them.  I think that effect will wear off after a week or 10 days.   We see the doc again on 3 August so I will be having a chat with him about the venlafaxine too.  To my mind, it's a bit of a cosh and I remember having real problems myself when coming off it about 20 years ago.  It took a few months, but I had a rubbish GP in the UK.

 

I know about VF being an anti-anxiety med and with the help of Google Translate, she agreed that that's what she experiences as well as being generally 'down' and worrying about many disparate things some time after her menopause started.  That's been going a good 3-4 years now and still she has periods at 52.  

 

She's a very traditional and old-fashioned middle-aged Thais woman and prefers Thai alternative medicine, which she studied for 6 years.  She goes off to the department at the MOPH every so often for whatever it is she gets for her menopause symptoms.  I am not much of a believer in alternative stuff, but it's ingrained in many older Thais.

 

And I have been talking about HRT with her quite a lot recently and I have suggested she tries a short course of whatever the doc suggests for 3 months and see how she goes.  

 

I am sure she'll come round eventually because she has seen how good TRT has been for me.  That's what piqued her interest initially, when I went to a different hospital and she saw how sympathetic and pleasant the doctors are there.

 

 

 

 

Edited July 19, 2021 by Mister Fixit

[Mister Fixit]

On 7/18/2021 at 8:45 AM, NancyL said:

When I went into menopause my general doctor, an internist, recommended trying to wait out the undesirable side effects for six months before prescribing HRT because once you start on HRT, it can be difficult to stop.  

 

Fortunately, my major side effect was hot flashes and since it was winter in Michigan and we kept our house cold, heating just the main living area with a wood stove, all I had to do was go into a colder part of the house or step outside during a hot flash.  Eventually, everything settled out and I no longer had problems.

 

This was after decades of menstrual cramps, monthly moodiness, endometriosis, infertility, miscarriages.  Finally peace.  I overheard my husband telling a male friend at a party "menopause was much easier than I thought it would be."  As if he was the one going through it!

 

I agree with my doctor on the subject of HRT.  Don't rush into it.  Give yourself six months or so to see if your body is going to settle down on its own first.

Nice helpful post.  My wife started her menopause about 3 to 4 years ago and still has periods aged 52.  

I think that's long enough to start considering a short course of HRT and be monitored regularly.

 

I have never experienced any female partners undergoing the menopause before so I am somewhat at a loss about modern HRT.

I have known women say it was a Godsend, but that was many years ago and medicine has moved on.  The big thing then was injectable pellets but I have no idea at all how it is treated nowadays.  Daily tablets, weekly/monthly injections?  

 

What are the usual methods of treating it nowadays?

[Mister Fixit]

On 7/17/2021 at 4:47 PM, IvorBiggun2 said:

Absolutely. I was on and off antidepressants for 20 years. Been on a few over those years. Last one was Sertraline. In all those years I took the medication because I wanted it to work but in reality it hasn't/didn't. Looking back I see them as placebos and not worth the hassle. I stopped taking Sertraline 5th April and I'm determined never to go back on them.

What I do now when I get kind of depressed is to sit down and talk to the wife on how I'm feeling. I find talking about my moods to be far better than taking medication. Seems to be working so far.

Interesting to hear.  In 1992, 30 years ago next January I discovered I had ADHD, but my useless British GP knew nothing about it and refused to refer me anywhere.  I took matters into my own hands and I went to the US with my eldest son and we were diagnosed at the Massachusetts clinic of the world expert, Prof Russell Barkley.  I got a supply of Ritalin in the States, but sadly, I was one of the 30% who don't respond to it. 

 

Came back to the UK, took the report in to the doc and he still refused to believe it because 'it was American' (!) or to prescribe Ritalin.  I knew Prof Eric Taylor of the Institute of Psychiatry in London so he wrote another report which convinced the GP, but still no Ritalin as he said I might sell it on the streets because I was unemployed at the time!  Berk.

 

I ended up with so many different tricyclics, SSRIs and SNRIs note of which did me any good at all.  I has so many different ones that I have forgotten the names of most of them.

 

Certainly, the two worst to come off were venlafaxine and sertraline, I do remember that.  None of them were especially effective so I stopped the lot eventually, no need to keep banging your head against a brick wall.  

 

Then I came to Thailand and threw myself into teaching and found I had a flair for it.  I became extremely organised and was juggling sometimes 4 or more different classes a day (not every day) all over Bangkok between 8 am and 8 pm most days, so I had no choice but to be on time, find new places I hadn't been to and keep track of where students were in their book etc.   

 

Hard work was the best thing to keep me on track.  Still is.

 

[IvorBiggun2]

1 hour ago, Mister Fixit said:

Hard work was the best thing to keep me on track.  Still is.

Same goes for me I have a large garden, too big in fact, and that along with walking my and cycling 20km every other day works for me. 

I have now come off antidepressants, cold turkey, three times since coming to Thailand 16 years ago. Never a problem with side effects. Why did I come off of them cold turkey the first time? I was on Fluoxetine and I went to Bangkok Hospital in Korat as that was the only place I could find that stocked them. The doctor decided to use me as the butt of his joking. He just started sniggering and asked my wife why she just didn't take me to the temple. I was none the wiser but my wife told me why he said that once we left his office. Thais firmly believe that if you have beliefs/depression etc then you are being controlled by spirits. At that time it was, probably still is now, normal for people to be taken to a temple and have the monks beat the bad spirits out of them. That's what the doctor thought was funny.

[NancyL]

8 hours ago, Mister Fixit said:

Nice helpful post.  My wife started her menopause about 3 to 4 years ago and still has periods aged 52.  

I think that's long enough to start considering a short course of HRT and be monitored regularly.

 

I have never experienced any female partners undergoing the menopause before so I am somewhat at a loss about modern HRT.

I have known women say it was a Godsend, but that was many years ago and medicine has moved on.  The big thing then was injectable pellets but I have no idea at all how it is treated nowadays.  Daily tablets, weekly/monthly injections?  

 

What are the usual methods of treating it nowadays?

I'm not going to be much help.  I went into menopause over 20 years ago and followed my doctor's recommendation of waiting it out for six months and the "difficulties" resolved themselves.  I had some hot flashes, but nothing a Michigan winter couldn't treat.  Menopause isn't a medical condition that needs treatment, it's just a phase in a woman's life for most women.  

 

I think the same is true of most men.  

8 hours ago, Mister Fixit said:

andropause

I had to look that one up.  Hmm.  Couldn't that just be nature's way of telling you it's not a good idea to father children when you're getting up there in years?  

 

Hubby and I have a very good life together, but admittedly we don't worry about our hormone levels or how often we "do it".  There's more to a good, long lasting relationship.  

[Sheryl]

10 hours ago, Mister Fixit said:

 I have no idea at all how it is treated nowadays.  Daily tablets, weekly/monthly injections?  

 

What are the usual methods of treating it nowadays?

Thai doctors tend to use synthetic hormones by mouth which is nto the best approach but all that most of them know

 

The best approach is bioidentical hormones via creams or gels. There is a bioidentical estrogen gel readily available OTC in Thailand (oestrogel) but sourcing bioidentical progesterone is problematic unless you order ti from iherb.

 

the various antiaging clinics ioffer bioidentical HRT and supposedly so does  http://www.maximumclinic.com/womens-hormone-replacement-therapy/

 

You might point out to your wife than vebnlafaxine is hardly "natural" whereas bioidenticial HRT is.

[Mister Fixit]

16 hours ago, NancyL said:

I had to look that one up.  Hmm.  Couldn't that just be nature's way of telling you it's not a good idea to father children when you're getting up there in years?  

 

And isn't menopause exactly the same when telling women not to bear children after 'getting up there in years'?

 

It's an unstoppable natural process but andropause normally comes much later in life for men.  In my case, it was 'caused' (if that's the correct word) by me developing a cyst in my pituitary gland (a pituitary adenoma) when I was in my mid-50s and reduced my ability to produce testosterone naturally.  I have to have regular injections to keep the levels up.

 

It's important for normal functioning - testosterone is not just a 'sex hormone'.  It regulates mood, memory, bone and muscle mass, fat distribution and storage, production of red blood cells, semen, and of course, libido.  

Edited July 20, 2021 by Mister Fixit

[Mister Fixit]

15 hours ago, Sheryl said:

Thai doctors tend to use synthetic hormones by mouth which is nto the best approach but all that most of them know

 

The best approach is bioidentical hormones via creams or gels. There is a bioidentical estrogen gel readily available OTC in Thailand (oestrogel) but sourcing bioidentical progesterone is problematic unless you order ti from iherb.

 

the various antiaging clinics ioffer bioidentical HRT and supposedly so does  http://www.maximumclinic.com/womens-hormone-replacement-therapy/

 

You might point out to your wife than vebnlafaxine is hardly "natural" whereas bioidenticial HRT is.

I wouldn't DARE 'point out' anything to my wife!  <grin - smileys still don't seem to work!>

Seriously, that's an interesting post and thanks for the tip on oestrogel.  I will ask the doc about it in our next visit on 3rd August.

In female HRT, do both hormones need replacing?  I thought progesterone was only produced in pregnancy, but I am a bit out of date because my last child is now 26!  

 

In terms of hormone gels, my utterly useless British GP prescribed Androgel for me but it did nothing. 

 

As soon as I was properly diagnosed at Bumrungrad with hypogonadism due to pituitary adenoma and given testosterone enanthate every 3 weeks, things became much better.  I lost weight, my memory improved, my general health also improved, my whole sense of well-being and, of course, my libido!  

 

I believe that it has really helped my weight too.  In 2004 I was 107 kgs, and now I am 71 kgs (but that was after 2 years of keto starting 2017, and 2 more years maintaining that weight.

I have actually lost 50 kgs or about 110 lbs overall, because 3 month long trips to the UK piled it all back on <about 6-8 kgs a time> and that had to be lost again).  
 

 

 

[Sheryl]

6 hours ago, Mister Fixit said:

In female HRT, do both hormones need replacing?  I thought progesterone was only produced in pregnancy, but I am a bit out of date because my last child is now 26!  

 

In terms of hormone gels, my utterly useless British GP prescribed Androgel for me but it did nothing.

BOTH estrogen and progesterone need to be replaced. Indeed, replacing estrogen alone puts a woman at risk of uterine cancer. But that is nto the only reason, progesterone itself is very important. It is not produced only in pregancy (though levels in pregnancy are much higher). It is produced continuously and plays a very important role, especially in terms of mood stabilization. Indeed, while estrogen is what helps the hot flashes of menopause, progesterone is what often best helps the mood swings. Levels normally rise mid cycle and keep rising until menstruation, then drop.

 

Dermal creams and gels work very well for female HRT. Oral is not advisable as passes through the liver.

 

HOWEVER I note an earlier post from you states : "My wife started her menopause about 3 to 4 years ago and still has periods aged 52.  ". This makes no sense. Menopause is defined as the cessation of menstruation. If your wife still menstruates, she is not yet menopausal.

 

Rather she is in the period known as "peri-menopause" and may nto need estrogen at all, though a blood test (FSH) will shed light on that.

 

During the peri-menopause many women develop PMDD (previously known as PMS) or, if they already had it, it worsens. It is very important to get the distinction between PMDD and menopause clear as the treatments differ and, in fact, estrogen would make PMDD much, much worse. PMDD responds to natural progesterone and, in severe cases, soemtimes needs the addition of low dose sertraline.

 

the hallmark of PMDD is that the symptoms occur somnewhere in the 2 weeks prior to menstruation (may start mid-cycle and last a full 2 weeks, or may start a little later in the cycle, but also continuing to menstruation) and then there is dramatic improvement when the period arrives - it feels like a curtain has suddenly lifted. Have your wife keep a diary of the timing of her symptoms. If they resolve once her period starts and she then has at least 10-14 days symptom free before it tarts again, this is PMDD.

 

Thai doctors are not well informed about PMDD.

 

 

[Mister Fixit]

On 7/20/2021 at 10:28 PM, Sheryl said:

BOTH estrogen and progesterone need to be replaced. Indeed, replacing estrogen alone puts a woman at risk of uterine cancer. But that is nto the only reason, progesterone itself is very important. It is not produced only in pregancy (though levels in pregnancy are much higher). It is produced continuously and plays a very important role, especially in terms of mood stabilization. Indeed, while estrogen is what helps the hot flashes of menopause, progesterone is what often best helps the mood swings. Levels normally rise mid cycle and keep rising until menstruation, then drop.

 

Dermal creams and gels work very well for female HRT. Oral is not advisable as passes through the liver.

 

HOWEVER I note an earlier post from you states : "My wife started her menopause about 3 to 4 years ago and still has periods aged 52.  ". This makes no sense. Menopause is defined as the cessation of menstruation. If your wife still menstruates, she is not yet menopausal.

 

Rather she is in the period known as "peri-menopause" and may nto need estrogen at all, though a blood test (FSH) will shed light on that.

 

During the peri-menopause many women develop PMDD (previously known as PMS) or, if they already had it, it worsens. It is very important to get the distinction between PMDD and menopause clear as the treatments differ and, in fact, estrogen would make PMDD much, much worse. PMDD responds to natural progesterone and, in severe cases, soemtimes needs the addition of low dose sertraline.

 

the hallmark of PMDD is that the symptoms occur somnewhere in the 2 weeks prior to menstruation (may start mid-cycle and last a full 2 weeks, or may start a little later in the cycle, but also continuing to menstruation) and then there is dramatic improvement when the period arrives - it feels like a curtain has suddenly lifted. Have your wife keep a diary of the timing of her symptoms. If they resolve once her period starts and she then has at least 10-14 days symptom free before it tarts again, this is PMDD.

 

Thai doctors are not well informed about PMDD.

 

 

@Sheryl

 

Thank you for your long reply and improving my medical knowledge and vocabulary.  PMS was just starting to be used as a term instead of ‘period pains’ when I first married in the 70’s and now it’s changed again!  I had to Google the term PMDD because you didn’t explain it, but I get the idea. 

 

I delayed replying because I wanted to see how we got on at the andropause clinic at our joint appointment last Tuesday so please allow me to report on events.

 

First, my wife – she chatted to the doc at some length, then I stuck my oar in to see what was being said or she’d not have told me. 

Basically, the doc told me that she feels a lot better on the venlafaxine but is sleepier.  Her anxiety and constant worrying over numerous small things (which she had never mentioned to me before in 14 years) has abated considerably and the pain and tension in her neck, shoulders and back has all but gone.  I said I was disquieted by the use of venlafaxine because of considerable negative experiences I had had, especially coming off it, 18-20 years ago.  I asked if she could go on something more innocuous, eg. fluoxetine or something similar but he said, and I understand this, that he wanted her to try at least one more month, possibly two, because it can take 4 – 6 weeks for the effects to kick in properly. 

 

Fair enough by me but at the end of that period, I will want to be discussing continuance of the medication or changing it and the management of her cessation period.  That can take a while.  She may prefer to stay on it, and that’s her choice as long as when she decides to stop, it’s well managed.

Then we spoke about Oestrogel and he’s all for it but said she isn’t ready for it as she is still having periods regularly.  Again, fair enough. 

 

I asked for a copy of her 29 June test results (attached below) which were printed as we left so we couldn’t discuss anything at the time. I will next month though! 

I attach a copy because although I understand some of the items, I am lost on others.  I wonder if you could help with answering some questions?

 

In terms of the biochemistry, all looks OK apart from somewhat elevated cholesterol level at 235.4 (it would be 5.88 in the UK, where 5 is the number to aim for) so not massive.

Triglycerides are in the normal range so that’s OK.  The HDL is a little low but within range.  However, the LDL is way high – what can cause that and how can it be lowered? 

 

LH (which I assume is luteinising hormone) just says <0.3 but I understand it depends on the phase of her menstrual cycle and I have no idea what that would have been at the time.  Google tells me is seems low whatever phase she is in.  Is this figure significant?

 

Her haematology figures all look within range except her MPV which I had to Google, but it’s not way above the top of the range.  Any thoughts?

 

FSH just shows <0.3 with no range, but Google says for 41 years plus females ‘Any day of the menstrual cycle’ is = 0.5 ng/mL.  Day 3 of the cycle for that age group would be < 8.5 mIU/mL.

Is there any significance to her figure in this report?

 

The figure for oestradiol (E2) doesn’t have a range, but Mr Google tells me that its  30 to 400 pg/mL for premenopausal women and  0 to 30 pg/mL for postmenopausal women so as my wife still has periods this figure seems low. Any ideas why this could be?

 

Urine test seems OK unless you can see anything in there that I don’t know about.

 

Most of this means nothing to me now, but I used to be very familiar with some of it 45 years ago when my first wife and I were having problems having children. 

 

I will post again with my version of my own appointment and test results.

Edited August 8, 2021 by Mister Fixit

[Sheryl]

Elevated LDH can be due to diet/lifestyle or genetic. Hers is high enough to warrant attention. Avoiding processed carbs (or at least minimizing them - note that this includes white rice) and more exercise might do the trick if she is willing. 

 

The FSH result does nto suggest menopause but a single FSH reading is not too reliable at her age.

 

Very slight MPV elevation with a normal platlet count is of no significance

 

LH, estradial etc, cannot tell anything when unknown where she was in her cycle. Anyhow I question the need for those tests (and in fact most of what was done).  As it is now clear she is not menopausal there is no reason for her to attend an andropause clinic.

 

I think with your wife the issue is: is this PMDD (which as nothing to do with "period pain" AKA menstrual cramps) or is it generalized anxiety/depression? And that answer can only be determined by charting her moods relative to her cycle over time. If it is PMDD, natural progesterone may help. As I said before, the hallmark of PMDD s tat the mood issues occur in the 2 weeks prior to menstruation and improve dramatically when the period arrives.

 

Do not expect an andropause clinic to know anything about PMDD.

[Mister Fixit]

On 8/8/2021 at 10:18 PM, Sheryl said:

Elevated LDH can be due to diet/lifestyle or genetic. Hers is high enough to warrant attention. Avoiding processed carbs (or at least minimizing them - note that this includes white rice) and more exercise might do the trick if she is willing. 

 

The FSH result does nto suggest menopause but a single FSH reading is not too reliable at her age.

 

Very slight MPV elevation with a normal platlet count is of no significance

 

LH, estradial etc, cannot tell anything when unknown where she was in her cycle. Anyhow I question the need for those tests (and in fact most of what was done).  As it is now clear she is not menopausal there is no reason for her to attend an andropause clinic.

 

I think with your wife the issue is: is this PMDD (which as nothing to do with "period pain" AKA menstrual cramps) or is it generalized anxiety/depression? And that answer can only be determined by charting her moods relative to her cycle over time. If it is PMDD, natural progesterone may help. As I said before, the hallmark of PMDD s tat the mood issues occur in the 2 weeks prior to menstruation and improve dramatically when the period arrives.

 

Do not expect an andropause clinic to know anything about PMDD.

Yes, I think you are right in your penultimate paragraph.  I initially took my wife because the doc had  suggested it, so that she could discuss MY ED problems with the doc and her perception of how things were, and perhaps by speaking in Thai together she could tell him better what had been going on.  Also, to speak to him about the problems she had been having with her periods, whether or not she has started the menopausal process. 

 

Instead, she seems to have discussed her, what do seem to me the anxiety/depression problems that you hit on, with him and that's why she ended up with venlafaxine.  I had no idea of any of this - she had never said a word, although I could see she was moody and quiet at times.  Whenever I asked her why, she just fobbed me off.  Last week she told me she didn't want to worry me with her problems due to the 'greng jai' concept (which I disagree with).  How can I help if I am not told what's going on?  And like a typical middle-aged traditional Thai woman, she was reluctant to voice her feelings anyway.  

 

She now tells me that since taking the meds, all the pain and  tension in  her neck, shoulders and upper back has gone and she no longer has whirling thoughts in a whizzing brain, so that's all good.   I am happy for her to continue, now that I know what was going on.

 

She takes them about 6 pm and is usually asleep between 9 and 10 pm as they make her drowsy.  It's hard to say how she is during the day at the moment as she can't open her traditional Thai massage shop so just mooches about cooking or watching TV.  I work part time and tend to sit at my computer in another room for the rest of the time.

 

Generally though, after a bit of zombie-like behaviour for the first week, she seems to have settled down with the meds.  

 

We just need to be sure that the meds are managed well and when she decides to come off, that the withdrawal is well managed.   

 

As to the lipids, yes, I know that eating a lot of white rice is a problem for many Thais, and why so many have high cholesterol and are often diabetic, as well as adding all that unnecessary sugar to their food.  She tends to mix white rice and that 'rice berry' black rice but not always.  She never adds sugar to food, but she does eat a few sugary things, mainly fruit, rarely chocolate or biscuits.

 

About 3 months ago, before we went to the hospital, she started exercising for about 30 minutes every evening, mainly hula-hoop and stretching and bending exercises using the hula-hoop as a prop.

 

We're due another appointment at the end of the month so I think it's best to leave things to develop and see what the doc has to say then.