Posted by Tony P on September 28, 2008, at 4:25:37
In reply to thanks, posted by sam K on September 28, 2008, at 1:46:46
Sam,
Tiredness and lethargy are a normal response to exercise, as your body gets rid of waste products such as lactic acid. Some conditions, such as liver disease or poor circulation, can prolong this process. And others such as low thyroid can lead to constant tiredness. Have you had the bloodwork done to test for liver problems, hypothyroid & other common hormone deficiencies? That's an essential first step. Many physical/hormonal problems can lead to abnormal fatigue and heart rate. The fact that B6 helps suggests that you may have a physical or dietary problem. My MD regularly recommends B6 and a number of other supplements, both vitamins & herbals, for lack of energy. A full discussion of those really belongs on the Alternative board.
Please don't take it amiss if I'm covering what is old familiar territory for you or telling you stuff you already know by heart -- I don't know your history, or what you may already have tried.
A low heart rate after exercise is usually a _good_ thing in the absence of other symptoms such as dizziness or almost passing out when you stand up, or cold fingers and toes. It can also be paradoxically caused by _too much_ adrenaline/noradrenaline. See the articles on Norepinephrine (same as noradrenaline) & Reflex Bradycardia at wikipedia.org if you want some technical background.
Noradrenaline/norepinephrine is also one of the Big Three brain transmitter chemicals that are involved in depression. It's been the most popular one for development of new medical treatments for depression in the last few years: e.g. Effexor and Cymbalta, or any med. that is called an SNRI. Personally, I think the most important thing is to find the right _balance_ between the various brain transmitters for _you_.
Anxiety from any cause, often associated with excess NE & other "fight-or-flight" hormones, can cause palpitations. And caffeine is well-known for causing palpitations, although usually the heart beats faster too. Depression can often come mixed with anxiety; I have that type myself, and probably fit somewhere on the bipolar spectrum, as it's coming to be called.
So, not being a doctor, and not being there with you, all I can say is 1) if you haven't already done so, make sure you get a really thorough physical with bloodwork from your regular GP, and discuss your symptoms with him; 2) if the tests don't turn up any physiological causes for your lethargy and abnormal heart rhythms, then maybe you have mixed or treatment-resistant depression/bipolar spectrum, and Lamictal by itself, at the dose you're taking, is not enough to treat it.
As I said in my earlier post, Lamictal can sometimes _cause_ anxiety & palpitations. I had to take 2-4 mg/day of clonazepam to get me through that adjustment period. Lamictal can also cause a subtle kind of lethargy, a case of the "blahs", sometimes called anhedonia, although it's less likely to do that than other mood-stabilizers. Did your heart and fatigue problems start with the Lamictal, or did you already have them?
Are you seeing a psychiatrist? Lamictal at 125 mg/day is an OK mood stabilizer but a pretty mild antidepressant for some people, while others find 25 mg is as much as they need; Lamictal seems to have a very wide range of effective dose for different people. Although the manufacturer recommends 200 mg/day maximum, my former pdoc, who prescribed Lamictal a lot, said he found some patients benefitted from as much as 600 mg/day. Or maybe you need an SNRI along with it, or some other adjuvant or helper med such as Buspar. Is your pdoc open to discussing alternatives? Sometimes it takes a lot of trial-and-error to find the right treatment combination; one size definitely does NOT fit all.
Of course, I may be preaching to the converted; you may already have been through this whole process more than once. But there are so many different medications that can help one person and not another. See my post from earlier today on "Exotic Meds for Treatment Resistant Depression" for just a partial list of the non-standard or less common medications I have tried.
Have you been diagnosed as bipolar? If so, which subtype? (I, II, III or ???) My same former pdoc was convinced that bipolar comes in a variety of forms, degrees and disguises, not always recognized, including ultra-rapid-cycling (daily or worse), sometimes called cyclothymia. That's now becoming a much more widely accepted view of depression & bipolar. Here's an informative web page that I just discovered by Googling "racing thoughts and depression": http://www.psycheducation.org/depression/02_diagnosis.html#Anchor-What-41424
I have to say again, I'm not a doctor; I can only offer my own experience and limited knowledge. But it does sound like you and I have much in common. I'm definitely Bipolar III (some AD meds make me hypomanic), and I probably fit somewhere on the bipolar spectrum or graph. Going back & rereading your first post, I suspect that provigil is triggering _something_ in you; whether it's a bipolar III hypomanic episode or whatever, it sounds like it's not helping you any. The SNRIs are supposed to energize you while reducing anxiety (including "racing thoughts"), but everybody reacts differently. The search goes on; good luck, and keep posting.
Feel free to Babblemail me any time, too.
Tony P
poster:Tony P
thread:854050
URL: http://www.dr-bob.org/babble/20080926/msgs/854568.html