Q: My 62 years old mother was suffering from acute depression after the death of my father four years back. She was under treatment for the same for almost four years. She is taking Oleanz plus, which has reduced from 10 mg to 2.5 mg and it was stopped. For the last two months, she is feeling giddiness, loss of appetite, headache and extreme weakness. On consulting a doctor, she was prescribed Stalopam (20mg) once a day in the morning for 15 days. She also suffers from frequent bouts of loose motions very often. She is suffering from diabetes and hypertension for, which she is taking medicines. Will Stalopam treat depression?

A:You have mentioned that your mother received treatment with medication under the guidance of a psychiatrist. One needs to carefully understand the symptoms and their course over the period mentioned. Depression can be of different types and therefore needs to be addressed in accordance, based on the symptom profile. Emotional states can be associated with lethargy, generalized weakness, body aches and pains, decreased appetite, sleep disturbances and lack of interest in activities. There is a close connection between the body (soma) and the mind (psyche).

You have mentioned certain gastrointestinal symptoms as well. They could be a part of the psychosomatic syndrome (mind influencing the body and vice versa) or could also be the side effects of medication as SSRIs (Serotonin specific reuptake inhibitors including Escitalopram though effective antidepressant drugs, can be associated with gastrointestinal side effects). Escitalopram is considered to have less drug interactions with other medications that she might be on for her physical problems. One need to keep in mind that antidepressants take approx 2 to 4 weeks to show an effect and good response is expected in 4 to 8 weeks of initiation of the medication. There are a range of antidepressant medications to choose from. May I suggest the following for your mother:

• Detailed evaluation
• Blood investigations if not done in the recent time incl. CBC, Thyroid profile, Blood electrolytes, Blood homocystine level, Blood sugar, lipids, LFT
• Blood pressure check
• To discuss the gastrointestinal symptoms with the treating psychiatrist and possibly consider a change in medication as per the psychiatrist's guidance, keeping in mind the current symptom profile and monitoring for response and tolerability
• Maintaining a positive and healthy home atmosphere
• Redefining meaning and purpose to her life.
• Regular reviews as advised by the psychiatrist and internal medicine experts.