Psycho-Babble Medication Thread 73965

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Fatigue and depression

Posted by MB on August 7, 2001, at 11:58:28

Does anybody know the connection between fatigue and depression...I mean, I understand that the two are often comorbid, but is there a causative link either one way or the other? I've been off of antidepresants for about 8 months and think I could handle the awful mood and anxiety if it wasn't for the *FATIGUE*...I remember that SSRIs made the fatigue go away at first. They were stimulating to the degree that I needed to drink alcohol, smoke pot, or pop Vicodin to combat the insane rages and anxiety. After a few months, the overstimulation got better. Slowly, however, the fatigue came back with compound interest!! Anyway, no amount of coffee would wipe the fatigue out. In fact, coffee made it worse. Getting off the SSRIs gave me my energy and life back, but eight months later, here the fatigue is again. I've been to the doctor and had CBC, electrolyte, kidney, liver, B-12, TSH, and a few other tests done. They all came back normal. Could I be missing some physical problem? Is this just depression? If it's just depression, I don't know what to do given that ADs make the fatigue so much worse in the long run and stimulants make me completely crazy. 18 months ago, during the stage in the cycle when the overstimulation of the SSRI (Paxil, this time) began to wane, I got "clean and sober" (which is really an annoying misnomer because I'm allowed to drink caffeine which is a drug). Could I still be suffering some kind of post-acute withdrawal? I don't know. I feel like I'm going to keel over and die most of the time. Walking up the stairs is almost too much. I've been forcing myself to exercise to lose the 30 lbs I gained on Paxil et al., and the exercise only makes the fatigue worse (I was hoping it might make it better). I'm afraid to see a pdoc, worrying about what horrible drug I'll be put on next...The last guy I saw put me on Remeron because the Paxil was making me tired and fat!!! I just don't trust any of these guys. I'm afraid because soon I *will* have to trust one of these guys because my emotional condition is getting bad...probably because my life consists of: a) drinking one cup of coffee (one is all my tattered system can handle); b) going to gym and excercising to exaustion; c) collapsing at home for the rest of the day with anxiety and panic attacks because I'm not being a "good person," whatever the hell *that* means. I'm so fed up. Without the option of recreational drugs (read: drugs that *work*) to ease the suffering, some kind of self mutilation starts looking better and better. If another person from "The Program" tells me to "just pray" about it, I'll snap for real...I mean, you'll see me on national TV being led into a courthouse with a coat over my head :-) LOL!! OK, so I still have a sense of humor. That's a good sign, right? AHHHHHHHHHHHHH.

 

Re: Fatigue and depression » MB

Posted by SalArmy4me on August 7, 2001, at 12:09:11

In reply to Fatigue and depression, posted by MB on August 7, 2001, at 11:58:28

You could probably use a more stimulating antidepressant like Buproprion, Venlafaxine, Selegiline (http://www.dr-bob.org/tips/split/Selegiline-for-depression.html), or Tranylcypromine.

http://www.preskorn.com/cgi-bin/sp.pl?words=buproprion&wt=be&bl=an&d=/books/omd_s8.html
http://www.dr-bob.org/tips/split/Fatigue-not-responding-to-.html
http://www.dr-bob.org/tips/split/Antidepressants-for-CFS.html

 

Re: Fatigue and depression » SalArmy4me

Posted by MB on August 7, 2001, at 13:36:10

In reply to Re: Fatigue and depression » MB, posted by SalArmy4me on August 7, 2001, at 12:09:11

Hey SalArmy4me,
Thanks for the references! You're like a research guru, I appreciate it. Unfortunately, the only way I can tolorate something stimulating like Effexor or Wellbutrin is with a benzodiazepine (which is contraindicated in someone like me with a history of illicit self-medication). However, I keep forgetting about MAOI ADs, and I will check the links you quoted above. When I go back to see a pdoc, I will mention MAOIs as a possible avenue. I had given up because SSRIs/Effexor didn't work; tricyclics, Remeron and neuroleptics were to antihistaminic; and Wellbutrin was only tolorable with Xanax which I can't take because I'm in alcohol recovery. **I had totally forgoton about MAOIs** They may be the answer!! Thanks.

One question about Selegiline: is it the type of drug shrinks will shy away from? A google search turned up that it is an "alternative" treatment.


> You could probably use a more stimulating antidepressant like Buproprion, Venlafaxine, Selegiline (http://www.dr-bob.org/tips/split/Selegiline-for-depression.html), or Tranylcypromine.
>
> http://www.preskorn.com/cgi-bin/sp.pl?words=buproprion&wt=be&bl=an&d=/books/omd_s8.html
> http://www.dr-bob.org/tips/split/Fatigue-not-responding-to-.html
> http://www.dr-bob.org/tips/split/Antidepressants-for-CFS.html

 

Re: Fatigue and depression » MB

Posted by Cindylou on August 7, 2001, at 13:45:51

In reply to Re: Fatigue and depression » SalArmy4me, posted by MB on August 7, 2001, at 13:36:10

Hi MB --
Wow -- you described me to a T!!!!! I also suffer from horrible fatigue, which seems to get worse on the SSRIs after a time. I've had all those blood tests taken as well, and all come back normal. And I can SO relate to the little things (like climbing stairs or picking up a piece of paper) feeling like huge mountains to climb.

I am coming to the conclusion after many years that the fatigue is in fact caused by my depression. I THINK it gets worse on the meds after awhile because the meds are no longer working -- they "poop out" as people say on this board. I'm not sure that's true, but I'm going to test it out -- I'm back on Prozac + Wellbutrin and the fatigue is better, but I'm just waiting for it to come back with a vengence like it always does ... then I'm going to try and increase the Prozac and see if it works -- before, I would just stop the med altogether.

Let me know if you try the MAOIs and how they work for you. I've been afraid of them! My pdoc mentioned trying Manerix (available in Canada) which doesn't have as many contraindications as the irreversible MAOIs available here in the US. But she did say it could cause fatigue. I'm not sure if all MAOIs cause fatigue or not -- please keep me posted in your quest!

Thanks for your post; it's comforting to know we're not alone ...
-cindy


> Hey SalArmy4me,
> Thanks for the references! You're like a research guru, I appreciate it. Unfortunately, the only way I can tolorate something stimulating like Effexor or Wellbutrin is with a benzodiazepine (which is contraindicated in someone like me with a history of illicit self-medication). However, I keep forgetting about MAOI ADs, and I will check the links you quoted above. When I go back to see a pdoc, I will mention MAOIs as a possible avenue. I had given up because SSRIs/Effexor didn't work; tricyclics, Remeron and neuroleptics were to antihistaminic; and Wellbutrin was only tolorable with Xanax which I can't take because I'm in alcohol recovery. **I had totally forgoton about MAOIs** They may be the answer!! Thanks.
>
> One question about Selegiline: is it the type of drug shrinks will shy away from? A google search turned up that it is an "alternative" treatment.
>
>
> > You could probably use a more stimulating antidepressant like Buproprion, Venlafaxine, Selegiline (http://www.dr-bob.org/tips/split/Selegiline-for-depression.html), or Tranylcypromine.
> >
> > http://www.preskorn.com/cgi-bin/sp.pl?words=buproprion&wt=be&bl=an&d=/books/omd_s8.html
> > http://www.dr-bob.org/tips/split/Fatigue-not-responding-to-.html
> > http://www.dr-bob.org/tips/split/Antidepressants-for-CFS.html

 

Re: Fatigue and depression » Cindylou

Posted by MB on August 7, 2001, at 14:31:20

In reply to Re: Fatigue and depression » MB, posted by Cindylou on August 7, 2001, at 13:45:51


> Thanks for your post; it's comforting to know we're not alone ...
> -cindy

It is indeed comforting to know we're not alone. I feel stuck between "a rock and a hard place" because psychiatric drugs are either sedating and worsen the fatigue, or they are stimulating and make my anxiety/panic/racing-thoughts unbearable. If there is an energizing drug that doesn't make my heart and mind explode out of my body, I sure haven't come accros it yet (MAOIs, maybe?). Chronic fatigue is such an annoying thing to suffer because most docs don't even recognize it as anything other than psychosomatic, and then the drugs they prescribe (SSRIs, tricyclics, remeron, effexor) make it worse!! After a few months, after the panic and anxiety subsided, even *Wellbutrin* made me feel like I weighed 500 lbs: like every step was impossible.

I've called and left a message with a pdoc, but he never called back. This was two weeks ago. In a way I'm glad he didn't call back because I *so* much dread getting back on some medicine that makes me feel worse (it seems like in order for the FDA to approve a psych med, it can't make you feel better--otherwise they see it as having "abuse potential," and they toss the baby out with the bath water in puritanical fervor). BLAHGHAAAGAH!!!!!! Ok, I feel better now. Phew!

 

Re: Fatigue and depression » MB

Posted by chloe on August 7, 2001, at 17:49:24

In reply to Re: Fatigue and depression » Cindylou, posted by MB on August 7, 2001, at 14:31:20

> If there is an energizing drug that doesn't make my heart and mind explode out of my body, I sure haven't come accros it yet (MAOIs, maybe?).

Hi MB
This is a total long shot. But you did mention that you tried neuroleptics and couldn't tolerate them b/c of the histiminic effect. Well, the lastest atypical AP to be released has very little histiminic effect. It's called Geodon. I was only on it for two short weeks. But I have to say, I never emotionally felt better. It has a bit of an antidepressant effect (it hits some serotonin and norepinephorine receptors), while at the same time helping rumination thoughts, obsessions, etc.

It is slightly activating, which I usually hate and can't tolerate. But with my thoughts under control, it was a welcome energetic effect, because I felt SO positive! And I tend to be a negative person, by nature! I got so much done in my two week trial. I really miss the drug, but I developed TD like symptoms b/c I had gotten TD years ago from over use of a typical AP.

You might want to look into this drug...
Just a thought...
Chloe

 

Re: Fatigue and depression » chloe

Posted by MB on August 7, 2001, at 19:38:54

In reply to Re: Fatigue and depression » MB, posted by chloe on August 7, 2001, at 17:49:24

> > If there is an energizing drug that doesn't make my heart and mind explode out of my body, I sure haven't come accros it yet (MAOIs, maybe?).
>
> Hi MB
> This is a total long shot. But you did mention that you tried neuroleptics and couldn't tolerate them b/c of the histiminic effect. Well, the lastest atypical AP to be released has very little histiminic effect. It's called Geodon. I was only on it for two short weeks. But I have to say, I never emotionally felt better. It has a bit of an antidepressant effect (it hits some serotonin and norepinephorine receptors), while at the same time helping rumination thoughts, obsessions, etc.
>
> It is slightly activating, which I usually hate and can't tolerate. But with my thoughts under control, it was a welcome energetic effect, because I felt SO positive! And I tend to be a negative person, by nature! I got so much done in my two week trial. I really miss the drug, but I developed TD like symptoms b/c I had gotten TD years ago from over use of a typical AP.
>
> You might want to look into this drug...
> Just a thought...
> Chloe


That is another great idea to think about. I didn't know that Geodon had little antihistaminic effects. What are your TD symptoms? I used to have tics as a kid that went away as I got older. After a recent trial of Wellbutrin, they came back (eyelid, shoulder and diaphragm tics) and haven't gone away. Someone told me a while back that if you have any kind of movement disorder (like tics, for example) you are at greater risk for TD. Does anyone know if this is true? I know they sometimes use antipsychotics on people with tourette's. I wonder if they have a higher incidence of TD than other patients? Anyway, these are all questions I should be asking a pdoc, I guess.

Thanks everyone for the suggestions. An MAOI or Geodon might really be a good idea.


ps. what do you know about Geodon and weight gain? Also, do your TD symptoms go away when you get off APs?

 

Re: Fatigue and depression » MB

Posted by chloe on August 8, 2001, at 17:36:43

In reply to Re: Fatigue and depression » chloe, posted by MB on August 7, 2001, at 19:38:54

MB,
If you have had problems with tics or TD stuff, I would be reluctant to try an AP. Even an atypical one. The AP's work wonders for me, but always, since my years on Mellaril, give me tongue movements and jaw clenches. And on Geodon, I even had a bit of trouble swallowing.
My pdoc thought it's worth giving Geodon a try...Well, I had the greatest two weeks of my life, but I am left feeling empty and angry because I know there is a great med that works for me available. I just can't take it and there is nothing better to fill the void so far. AND, I do still have lingering tongue movements and teeth clenching.

So I would be very cautious about using AP drugs with your history. Esp. when there are other options out there like the MAOI's.

Good luck with your search. Keep us posted!
Chloe

 

Re: Fatigue and depression » chloe

Posted by MB on August 8, 2001, at 21:10:18

In reply to Re: Fatigue and depression » MB, posted by chloe on August 8, 2001, at 17:36:43

> MB,
> If you have had problems with tics or TD stuff, I would be reluctant to try an AP. Even an atypical one. The AP's work wonders for me, but always, since my years on Mellaril, give me tongue movements and jaw clenches. And on Geodon, I even had a bit of trouble swallowing.
> My pdoc thought it's worth giving Geodon a try...Well, I had the greatest two weeks of my life, but I am left feeling empty and angry because I know there is a great med that works for me available. I just can't take it and there is nothing better to fill the void so far. AND, I do still have lingering tongue movements and teeth clenching.
>
> So I would be very cautious about using AP drugs with your history. Esp. when there are other options out there like the MAOI's.
>
> Good luck with your search. Keep us posted!
> Chloe


I'll let you know what happens...thanks for the info. TD is, indeed, a scary thing.

 

Re: Fatigue and depression

Posted by cjay on August 9, 2001, at 0:19:41

In reply to Fatigue and depression, posted by MB on August 7, 2001, at 11:58:28

> Does anybody know the connection between fatigue and depression...I mean, I understand that the two are often comorbid, but is there a causative link either one way or the other? I've been off of antidepresants for about 8 months and think I could handle the awful mood and anxiety if it wasn't for the *FATIGUE*...I remember that SSRIs made the fatigue go away at first. They were stimulating to the degree that I needed to drink alcohol, smoke pot, or pop Vicodin to combat the insane rages and anxiety. After a few months, the overstimulation got better. Slowly, however, the fatigue came back with compound interest!! Anyway, no amount of coffee would wipe the fatigue out. In fact, coffee made it worse. Getting off the SSRIs gave me my energy and life back, but eight months later, here the fatigue is again. I've been to the doctor and had CBC, electrolyte, kidney, liver, B-12, TSH, and a few other tests done. They all came back normal. Could I be missing some physical problem? Is this just depression? If it's just depression, I don't know what to do given that ADs make the fatigue so much worse in the long run and stimulants make me completely crazy. 18 months ago, during the stage in the cycle when the overstimulation of the SSRI (Paxil, this time) began to wane, I got "clean and sober" (which is really an annoying misnomer because I'm allowed to drink caffeine which is a drug). Could I still be suffering some kind of post-acute withdrawal? I don't know. I feel like I'm going to keel over and die most of the time. Walking up the stairs is almost too much. I've been forcing myself to exercise to lose the 30 lbs I gained on Paxil et al., and the exercise only makes the fatigue worse (I was hoping it might make it better). I'm afraid to see a pdoc, worrying about what horrible drug I'll be put on next...The last guy I saw put me on Remeron because the Paxil was making me tired and fat!!! I just don't trust any of these guys. I'm afraid because soon I *will* have to trust one of these guys because my emotional condition is getting bad...probably because my life consists of: a) drinking one cup of coffee (one is all my tattered system can handle); b) going to gym and excercising to exaustion; c) collapsing at home for the rest of the day with anxiety and panic attacks because I'm not being a "good person," whatever the hell *that* means. I'm so fed up. Without the option of recreational drugs (read: drugs that *work*) to ease the suffering, some kind of self mutilation starts looking better and better. If another person from "The Program" tells me to "just pray" about it, I'll snap for real...I mean, you'll see me on national TV being led into a courthouse with a coat over my head :-) LOL!! OK, so I still have a sense of humor. That's a good sign, right? AHHHHHHHHHHHHH.

My first sign of depression was the fatigue, that is what sent me to the doctor to start with!
It has been 11months and only now is the fatigue starting to lift. I never thought of depression when I first went to the Doctor with my major fatigue but that is what has been the hardest for
me to deal with. Finally the combination of celexa, sleeping pills and a social anxiety medication has made life bearable.

 

Re: Fatigue and depression » cjay

Posted by MB on August 28, 2001, at 16:04:16

In reply to Re: Fatigue and depression, posted by cjay on August 9, 2001, at 0:19:41

> me to deal with. Finally the combination of celexa, sleeping pills and a social anxiety medication has made life bearable.

Have you gained weight on the Celexa?

 

Re: Fatigue and depression

Posted by cjay on August 29, 2001, at 18:54:37

In reply to Re: Fatigue and depression » cjay, posted by MB on August 28, 2001, at 16:04:16

>
>
> > me to deal with. Finally the combination of celexa, sleeping pills and a social anxiety medication has made life bearable.
>
> Have you gained weight on the Celexa?

NO, but I had gained 20lbs on Effexor xr!
I managed to lose 10lbs but the other 10lbs is impossible, my doctor said he doubted that I would lose on the celexa but I should not gain either.
By the way my fatigue is back, the sleeping pills are doing nothing, I have tried three different kinds of perscription pills and all they do is make me feel like I'm on speed...mind racing heart pounding, My doctors just says, some people can not take sleeping pills. I feel like I am on a roller coaster good for a couple of days then way way down again. I have not worked for 11mths and although my company has been great they are now starting to hound me and this just makes matters worse.
cjay

 

Re: Fatigue and depression » cjay

Posted by SalArmy4me on August 29, 2001, at 18:59:16

In reply to Re: Fatigue and depression, posted by cjay on August 29, 2001, at 18:54:37

Have you ever tried any stimulants? I would suggest modafinil, adrafinil, or pemoline.
http://www.dr-bob.org/tips/split/Stimulants-for-depression.html

 

Re: Fatigue and depression

Posted by afatchic on August 29, 2001, at 20:49:22

In reply to Re: Fatigue and depression, posted by cjay on August 29, 2001, at 18:54:37

cjay,

I'm curious, you say that Effexor made you gain weight, did it also make you tired? For me, Effexor is very stimulating and it's causing me to lose weight.

> >
> >
> > > me to deal with. Finally the combination of celexa, sleeping pills and a social anxiety medication has made life bearable.
> >
> > Have you gained weight on the Celexa?
>
> NO, but I had gained 20lbs on Effexor xr!
> I managed to lose 10lbs but the other 10lbs is impossible, my doctor said he doubted that I would lose on the celexa but I should not gain either.
> By the way my fatigue is back, the sleeping pills are doing nothing, I have tried three different kinds of perscription pills and all they do is make me feel like I'm on speed...mind racing heart pounding, My doctors just says, some people can not take sleeping pills. I feel like I am on a roller coaster good for a couple of days then way way down again. I have not worked for 11mths and although my company has been great they are now starting to hound me and this just makes matters worse.
> cjay

 

Re: Fatigue and depression

Posted by cjay on September 2, 2001, at 12:47:53

In reply to Re: Fatigue and depression, posted by afatchic on August 29, 2001, at 20:49:22

> cjay,
>
> I'm curious, you say that Effexor made you gain weight, did it also make you tired? For me, Effexor is very stimulating and it's causing me to lose weight.
> My first sign of major depression was EXTREME FATIGUE,the effexor did not help my depression or fatigue but it certainly made me gain weight!
Cjay
> > >
> > >
> > > > me to deal with. Finally the combination of celexa, sleeping pills and a social anxiety medication has made life bearable.
> > >
> > > Have you gained weight on the Celexa?
> >
> > NO, but I had gained 20lbs on Effexor xr!
> > I managed to lose 10lbs but the other 10lbs is impossible, my doctor said he doubted that I would lose on the celexa but I should not gain either.
> > By the way my fatigue is back, the sleeping pills are doing nothing, I have tried three different kinds of perscription pills and all they do is make me feel like I'm on speed...mind racing heart pounding, My doctors just says, some people can not take sleeping pills. I feel like I am on a roller coaster good for a couple of days then way way down again. I have not worked for 11mths and although my company has been great they are now starting to hound me and this just makes matters worse.
> > cjay

 

Re: Fatigue and depression » SalArmy4me

Posted by Zo on September 3, 2001, at 16:49:31

In reply to Re: Fatigue and depression » cjay, posted by SalArmy4me on August 29, 2001, at 18:59:16

> Have you ever tried any stimulants? I would suggest modafinil, adrafinil, or pemoline.

Why would you suggest Cylert (pemoline) when it requires regular liver enzyme testing. . .as opposed to Dexedrine and Adderall, which do not. . .?

Zo

 

Re: Fatigue and depression » Zo

Posted by SalArmy4me on September 4, 2001, at 10:45:05

In reply to Re: Fatigue and depression » SalArmy4me, posted by Zo on September 3, 2001, at 16:49:31

Cylert doesn't require a visit to the doctor every month and triplicate forms. Liver enzyme testing? I thought that was for Depakote and Clozapine.

> > Have you ever tried any stimulants? I would suggest modafinil, adrafinil, or pemoline.
>
> Why would you suggest Cylert (pemoline) when it requires regular liver enzyme testing. . .as opposed to Dexedrine and Adderall, which do not. . .?
>
> Zo

 

Re: Fatigue and depression » SalArmy4me

Posted by Zo on September 4, 2001, at 14:55:07

In reply to Re: Fatigue and depression » Zo, posted by SalArmy4me on September 4, 2001, at 10:45:05

> Cylert doesn't require a visit to the doctor every month and triplicate forms.

Cylert requires regular blood tests.

I don't know about other pdocs, but mine does not require a monthly visit for Dex or Adderall. He just mails me the triplicate.

Zo


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