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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by PhoenixGirl on March 20, 2001, at 16:01:46
I would like to discuss possible treatments for chronic fatigue. I'm 23, and have experienced chronic fatigue that has impaired my life. Only recently have I tried anyting that helped. It is Wellbutrin, and I had to actually request it -- no doctor ever tried me on any drug to help my fatigue over these past ten years. I am almost out of the wellbutrin, and have had to decrease the dose because it's too expensive and I only just got insurance. Does anyone have thoughts on why the doctors never tried me on anything for it? It has been so bad that I had to take summer classes in college (because I was too tired to take a full load of classes during the year), and thus have a much bigger college debt than would have been necessary if I could have stayed awake more. Wellbutrin doesn't help with my depression, so I am wondering if there are any treatments for fatigue that may also help depression.
Posted by Lorraine on March 20, 2001, at 20:59:20
In reply to Chronic fatigue hell, posted by PhoenixGirl on March 20, 2001, at 16:01:46
What dose are you on? Wellbutrin should help with your depression. (It did mine.) Wellbutrin is a puppy upper anti-depressant. They are giving you an activating drug because of the CFS. Why didn't they do this before? Because they are bozos and didn't think of it and maybe don't believe in CFS and so forth. If this doesn't work try other activating ADs. Although I would try to make the Wellbutrin work because it has a low side effect profitle--doesn't mess with your sexuality or weight and has a pretty good cognitive boost as well. See if you need to increase the dose and maybe give it time. You could also take a regular SSRI with amphetamine. It would take a pretty forward doctor to prescribe that tho.
Posted by LMM on March 20, 2001, at 21:39:53
In reply to Chronic fatigue hell, posted by PhoenixGirl on March 20, 2001, at 16:01:46
> I need to prozac along with Wellbutrin SR. I tried WB alone and it made me very irritable, I added prozac and they work great together for me.
Posted by pat123 on March 21, 2001, at 13:24:11
In reply to Chronic fatigue hell, posted by PhoenixGirl on March 20, 2001, at 16:01:46
> I would like to discuss possible treatments for chronic fatigue.
Have you had a full workup for all fatigue causes ? CFS (amoung thoses docs who feel it exists) is a Dx of exclusion.
Note.... CFS and chronic fatigue are not the same thing.
Pat
Posted by Cece on March 21, 2001, at 14:30:35
In reply to Chronic fatigue hell, posted by PhoenixGirl on March 20, 2001, at 16:01:46
This is actually a pretty complicated question- they still haven't figured out what CFS is (it may be several different things), and as Pat says, being chronically fatigued is not necessarily the same as having CFS, which is usually now designated as CFIDS.
I have fibromalgia- which used to be considered the same as CFIDS, but has been separated as as its own syndrome. Both have intense fatigue, but CFIDS more so, and CFIDS onset is usually associated with a defineable illness (what might seem like a very bad flu). Fibromylagia includes more body pain.Anyway, I'm also Bipolar II, with a long history of depressive problems, and so have been the route of trying many, many meds to find ones that help me. Along the way, I have discovered that some have significantly reduced (not eliminated) my fibromyalgia symptoms. From my research, I'm pretty convinced that Fibromylagia (and maybe CFIDS) is at least partially a sleep disorder. Although you may be tired and sleep a lot, you are not going into the deeper levels of sleep that really restore the body. So the meds that have helped my Fib. sx. are the ones that have helped my sleep, and for me those have been: Trazodone (an atypical anti-depressant, which unfortunately pooped-out for me after about 1 year, but was great while it worked), Nortriptyline (a tricyclic anti-depressant which I take only at night and has helped for several years now), and Neurontin (a calming mood stabilizer which has helped for several years).
These may not be the right meds for you, but I hope it helps you in some way, perhaps just by enlarging the picture. I hope that your health insurance will cover a really good medical work-up for you, to rule out things like mono, hepatitis, anemia, etc., and that you can find a doctor who is open-minded enough to take the issue seriously.
Best of luck,
Cece
> I would like to discuss possible treatments for chronic fatigue. I'm 23, and have experienced chronic fatigue that has impaired my life. Only recently have I tried anyting that helped. It is Wellbutrin, and I had to actually request it -- no doctor ever tried me on any drug to help my fatigue over these past ten years. I am almost out of the wellbutrin, and have had to decrease the dose because it's too expensive and I only just got insurance. Does anyone have thoughts on why the doctors never tried me on anything for it? It has been so bad that I had to take summer classes in college (because I was too tired to take a full load of classes during the year), and thus have a much bigger college debt than would have been necessary if I could have stayed awake more. Wellbutrin doesn't help with my depression, so I am wondering if there are any treatments for fatigue that may also help depression.
Posted by PhoenixGirl on March 21, 2001, at 15:38:58
In reply to Re: Chronic fatigue hell » PhoenixGirl, posted by Cece on March 21, 2001, at 14:30:35
I was taking 400 mgs of Wellbutrin SR -- the highest dose most doctors will prescribe. It had no antidepressant effect on me, truly none. The first med I think I will ask my new doctor about is Provigil. I'd rather try that, and try the regular stimulants only if Provigil doesn't work. I have never been given a diagnosis for my fatigue, so I've just always assumed that it is a feature of my depression. I don't really care about what the diagnosis is, I just want it to go away.
This is actually a pretty complicated question- they still haven't figured out what CFS is (it may be several different things), and as Pat says, being chronically fatigued is not necessarily the same as having CFS, which is usually now designated as CFIDS.
> I have fibromalgia- which used to be considered the same as CFIDS, but has been separated as as its own syndrome. Both have intense fatigue, but CFIDS more so, and CFIDS onset is usually associated with a defineable illness (what might seem like a very bad flu). Fibromylagia includes more body pain.
>
> Anyway, I'm also Bipolar II, with a long history of depressive problems, and so have been the route of trying many, many meds to find ones that help me. Along the way, I have discovered that some have significantly reduced (not eliminated) my fibromyalgia symptoms. From my research, I'm pretty convinced that Fibromylagia (and maybe CFIDS) is at least partially a sleep disorder. Although you may be tired and sleep a lot, you are not going into the deeper levels of sleep that really restore the body. So the meds that have helped my Fib. sx. are the ones that have helped my sleep, and for me those have been: Trazodone (an atypical anti-depressant, which unfortunately pooped-out for me after about 1 year, but was great while it worked), Nortriptyline (a tricyclic anti-depressant which I take only at night and has helped for several years now), and Neurontin (a calming mood stabilizer which has helped for several years).
>
> These may not be the right meds for you, but I hope it helps you in some way, perhaps just by enlarging the picture. I hope that your health insurance will cover a really good medical work-up for you, to rule out things like mono, hepatitis, anemia, etc., and that you can find a doctor who is open-minded enough to take the issue seriously.
>
> Best of luck,
> Cece
>
>
> > I would like to discuss possible treatments for chronic fatigue. I'm 23, and have experienced chronic fatigue that has impaired my life. Only recently have I tried anyting that helped. It is Wellbutrin, and I had to actually request it -- no doctor ever tried me on any drug to help my fatigue over these past ten years. I am almost out of the wellbutrin, and have had to decrease the dose because it's too expensive and I only just got insurance. Does anyone have thoughts on why the doctors never tried me on anything for it? It has been so bad that I had to take summer classes in college (because I was too tired to take a full load of classes during the year), and thus have a much bigger college debt than would have been necessary if I could have stayed awake more. Wellbutrin doesn't help with my depression, so I am wondering if there are any treatments for fatigue that may also help depression.
Posted by Ted on March 21, 2001, at 16:28:18
In reply to Chronic fatigue hell, posted by PhoenixGirl on March 20, 2001, at 16:01:46
FWIW, chronic fatigue & depression are nearly impossible to distinguish, and they can be comorbid, which complicates things further. Add to that CFS may or may not be Epstein-Barr virus, which itself is little understood.
I like the idea of augmenting ADs with a stimulant, but the addiction problems may be an issue. Another help (was for me anyway) is to have some activity away from work & school which you really enjoy to give you something to look forward to. I know this is easier said than done, but the "escape" helps deal with the "reality".
Good luck!
Ted
> I would like to discuss possible treatments for chronic fatigue.
Posted by pat123 on March 21, 2001, at 18:16:29
In reply to Re: Chronic fatigue hell, posted by PhoenixGirl on March 21, 2001, at 15:38:58
I don't really care about what the diagnosis is, I just want it to go away.
>
I think you should care. Given that no psyco meds have helped it (my impression), Chronic fatigue is common in many physical conditions (running the gambit from deadly, treatable, and curable).
Given the number of meds you have tried with little sucess it is reasonable to consider that you may be treating the wrong condition(s).Pat
Posted by Noa on March 22, 2001, at 16:57:33
In reply to Chronic fatigue hell, posted by PhoenixGirl on March 20, 2001, at 16:01:46
Caroline H. posted a message below that you might want to see. here is the url:
Posted by JB on March 23, 2001, at 10:09:23
In reply to Chronic fatigue hell, posted by PhoenixGirl on March 20, 2001, at 16:01:46
Regarding chronic fatigue,excessive daytime sleepiness, lethargy, etc., your pychiatrist ought to help you determine if these are possible side effects fo your anti-depressant. A number of anti-depressants, particuarly SSRI's, can induce lethargy as a side effect. Wellbutriin is less know to do this. Parnate, and irreversible MAOI, is know to be rather stimulating. I believe Prozac (fluoxetine) can also be somewhat stimulating. So, you should discuss the side effects with your psychiatrist. However, I have found not all psychiatrist are equally expert pharmacologists (expert in drug actions, willing to seeking alternative drugs in combination or augmentation therapy).
Drugs known to help with narcolepsy, lethargy, excessive daytime sleepiness, an so on, include Ritalin (methylphenidate) and Provigil (modafinil). Modafinil is relatively new on the US market.
In managing your symptoms, it's important that your psychiatrist understand all of your symptoms. That way, he or she can either prescribe an alternative anti-depressant, prescribe a combination anti-depressant, or prescribe an augmentation agent (such as Ritalin or Provigil).
My psychiatrist, for example, feels comfortable augmenting (means prescribing a different class of drug, such as a non-antidepressant with an anti-depressant)Serzone with Ritalin. Some psychiatrists, as you will find, are much more conservative, and will not do this. So, change psychdocs if you can find one sufficiently agressive and informed about psychopharmacology to meet your needs.
JB
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