DR ELLIE CANNON: Why do I always feel such nausea when I wake up?

A few months ago I started to wake up feeling sick, and this lasted about an hour before passing. More recently, I’ve been suffering the same nausea intermittently during the day.

I can’t emphasise enough that any new and persistent symptom, particularly if you’re over 50, should always be explored thoroughly by a doctor. For most people, nausea is a transient symptom lasting only a few days.

Blood tests give us a general overview of health and can sometimes point to serious causes, but they do not provide a complete picture.

Regular nausea could be caused by acid reflux, gastritis, migraine, anxiety or, much more rarely, pancreatic cancer.None of these would necessarily be flagged up in a routine blood test.

DR ELLIE CANNON: I can’t emphasise enough that any new and persistent symptom, particularly if you’re over 50, should always be explored thoroughly by a doctor. For Top Site Info most people, nausea is a transient symptom lasting only a few days (file photo)

Nausea is a common side effect of medication, and this should always be considered as a possible cause.

With any new symptom, especially when persistent and significant, further investigation may be necessary.For ongoing nausea, this may involve stool tests or an ultrasound, as well as tests such as an endoscopy. This involves a tube with a camera attached being passed down the throat and into the stomach, which is uncomfortable.

For 25 years I have been on a daily pill called venlafaxine for anxiety. It works, but at times I feel I’m in a bubble, and my marriage has suffered due to my total lack of libido. Is there an alternative without this effect?

Venlafaxine is an antidepressant prescribed in the UK for generalised anxiety disorder — the name we give the mental health condition that means people feel anxious constantly, rather than in response to specific events.

It’s a type of medication known as a serotonin-norepinephrine reuptake inhibitor, or SNRI.These work by boosting levels of chemicals called serotonin and noradrenalin in the brain, which are linked to mood and energy.

They were developed to be more effective than selective serotonin reuptake inhibitors, or SSRIs, and while there’s been mixed evidence that they are in terms of treating depression, they have been shown to be effective for anxiety.

As with all medications, they have side effects. For many people, the benefits outweigh the downsides. But when the side effects are so significant that they impact on quality of life and relationships, it is right to explore other options.

The most common side effects from venlafaxine are nausea, sleepiness, constipation and a lack of energy.It is also known to increase blood pressure and affect blood sugar levels in people with diabetes.

Sexual difficulty is a recognised side effect of antidepressants and many drugs used for mental illness.

Other medications are available to treat anxiety, including those from the SSRI group such as escitalopram. It may also be that side effects are lessened with a lower dose.

After 25 years, any change to medication needs to be taken incredibly slowly. Withdrawing from medication in a case like this would take months, before a slow introduction of a new tablet.

Any trial of new medication needs to be supervised carefully by a GP or psychiatrist.

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