### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
HI, I HAVE A VERY DEAR FRIEND WHO HAS BEEN EXPERIENCING EXTREME FATIGUE FOR SEVERAL YEARS. TRADITIONAL DOCTORS TELL HIM THERE IS NOTHING WRONG, HE HAS HAD A MENTAL/EMOTIONAL EVALUATION SHOWING ONLY SLIGHT IF ANY DEPRESSION . WHEN SEEING A BIOFEEDBACK (SCIO) PRACTITIONER IT SHOWS DEPRESSION, (ATYPICAL) . THE PRACTITIONER FEELS IT IS A GENETIC DISORDER . HIS ENERGY SEEMS TO BE MUCH IMPROVED WITChatDoctorBALTA, HOWEVER THERE ARE MANY SIDE EFFECTS. HIS IMMUNITY IS VERY LOW AND IS SICK OFTEN EVEN THOUGH HE EATS HEALTHY AND TAKES MANY SUPPLEMENTS . HE HAS BEEN SUFFERING WITH THIS FOR YEARS. ANY IDEAS WHERE TO START?

### output:

Hello and welcome to Chat Doctor. Thanks for your query. Fatigue and decreased energy can often be the predominant complaints in depression. You have mentioned that your friend has been diagnosed to have depression by two different practitioners and that he has shown significant improvement on Cymbal ta. Now, Cymbal ta (Duloxetine) is an antidepressant medication, which has been found to be more effective on the somatic symptoms of depression. Another possibility for your friends problems could be Chronic Fatigue Syn Chat Doctor.  However, you have mentioned that Cymbal ta is causing him many side effects.  I would advise your friend to consult a Psychiatrist for a detailed evaluation and psychological assessment. Depending on the diagnosis, further treatment options can be planned. If he needs anti-depressants, then there are other classes of medication which can be tried. There are also effective psychological and behavioral therapies which can help deal with his problems. Wish you all the best. 