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The more experienced psychiatrists in the cancer centers might ask you about any other symptoms that you have (eg. fatigue, pain, sleep difficulties, gastroparesis) and will try to choose a medication that may help those symptoms as well.
For example, Cymbalta and Effexor can also help pain. Effexor is also felt to be a little 'activating' so shouldn't contribute to fatigue. Mirtazpine can help nausea, increase appetite, and improve sleep for some people, and is very well tolerated when you are older. These are all available as cheap generics.
Sometimes the first dose wont work as well, and it needs to be increased.
Sometimes the first medicine doesn't work as well and a second needs to be
tried. Sometimes a medicine will work for a year or two, and then you have a
worse period and need to make a change. A good psychiatrist understands all
of this, and can help the most.
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