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Old 06-12-2009, 05:37 AM   #1
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Chronic fatigue or depression? Please advise!

Hi everyone--

Ever since I was little, my normally-sunny mood would disintegrate if I got too tired. Growing up, this was "managed" by early bedtimes and daily naps...a luxury in the life of a busy professional.

Last week I had one of my "meltdowns", prompting my internist to put me on an antidepressant. Now, I've tried any number of them in the past to no avail (and gained 70 pounds in the process), and I'm not at all convinced I'm depressed, bipolar, etc...I'm EXHAUSTED.

My internist has done every test and sent me to specialists and the only medical source of possible fatigue they found is anemia. I've been on 325mg iron three times a day for several months and my levels have increased, and yet...still tired.

I also have chronic pain issues (which I believe also cause physical and mental fatigue, personally), and found long ago that taking 1/2 a Percodan boosts my energy level slightly, making me feel almost "normal"...for about 15 minutes, followed by a horrible crash.

I am getting injections in my neck for one of the two pain issues next week and would really like to get off the narcotic pain meds, as the rollercoaster ride only worsens the fatigue.

Getting to my point, have any of you been diagnosed with depression rather than chronic fatigue and treated with psych meds? If so, did they help? I hate the side effects of them, and I don't understand prescribing them for fatigue UNLESS that fatigue is definitely depression-related, and I just don't think mine is.

My internist is sending me to a psychiatrist next week in an effort to determine a "which came first, the chicken or the egg?" sort of thing: do I have depression that is causing fatigue, or do I have chronic fatigue that has gone untreated for over 20 years now and am totally exhausted, which "looks" like depression b/c I'm more easily overwhelmed than someone who is well-rested would be?

I'm also being referred for a sleep study; even with 5mg of Ambien at night, I just don't sleep well and am up several times a night. My son was up studying last night and I went into his room at 1:30am to ask if his younger brother could use his flip flops at the beach today...which tells me I was fretting about that prior to waking up. My younger son said I came downstairs at 2:30 and worked on laundry for half an hour...Ambien amnesia.

I hope I am making sense; I'm sure many of you have wrestled with this issue, and I appreciate your input greatly. After all the hoops I've already jumped through, I had hoped my doctor would at least let me try dextroamphetamine to get through the work day (and maybe even have enough energy to make dinner for my sons), but she won't write for it until a psychiatrist rules out depression. I know she is just being cautious, but all the stress of visits to specialists, spending more money, and missing more work just adds to the exhaustion and makes me more prone to "meltdowns".

Lastly, she mentioned putting me on Provigil once my "moods are regulated", but I've read it causes hair loss and I really don't want to go there! I have read as much as possible and it seems like dextroamphetamine might be the better option.

Your thoughts???

Cheers,
nancyjo

 
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Old 06-15-2009, 05:06 PM   #2
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Re: Chronic fatigue or depression? Please advise!

sometimes it takes 2 types of anti depressants to work right...such as pristiq and abilify.


Hope this message helps a little and finds you doing better

 
Old 06-15-2009, 08:04 PM   #3
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Re: Chronic fatigue or depression? Please advise!

Depression feels close to being possessed by an evil spirit. It takes you so out of your "normal" state of mind. It's like something else is taking control of it. And all you want to do is cry and over dramatize every problem.

What's a meltdown? Are you getting upset and crying over your health problems? I don't think that means your depressed. It's more so probably just having a hard time dealing with the health issues. Which is perfectly normal.

 
Old 06-15-2009, 09:38 PM   #4
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Re: Chronic fatigue or depression? Please advise!

So sorry, but I have had a similar problem. I been on depression meds for years and helped for a while but they have had to change them around several times but I'm not really noticing any difference. I stay tired all the time. Most of the time I sleep all day, then sleep all night too. I feel like I am sleeping my life away, and am still tired. A visit to the doctor wipes me out completely. My doctor also feels I need to have a sleep study done. I have had several of these thru the years and they never show any sleeping disorder. I was watching a program one day and chronic fatigue syndrome came up and it sounded so much like a lot of my problems. I don't know how to get a doctor to understand this and how frustrating it is. My current doctor just kinda laughed it off and said, "well we all have that". From my understanding, I don't think most doctors believe in this and the ones that do say there is no cure. Do what you can on your good days.

 
Old 06-16-2009, 05:39 AM   #5
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Re: Chronic fatigue or depression? Please advise!

Sometimes I wish I could rest when I want/need to, but the reality is that I'm a single mom who drives 60 miles round-trip to work each day and holds down a very busy, responsible position. I'm sure all of this contributes not only to the daily all-consuming fatigue, but also the "meltdowns", which are the times when I just get so overwhelmed by my circumstances that I have a crying spell or panic attack. It passes quickly enough b/c I am optimistic by nature, but not having any REAL answers or plan of treatment really bothers me.

My internist wants to try me on Provigil once any psych issues are ruled out, so perhaps that will help. Maybe the sleep study will give us some clues as well, though I haven't scheduled it yet.

Thanks for your input,
nancyjo

 
Old 06-16-2009, 09:34 AM   #6
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Re: Chronic fatigue or depression? Please advise!

I'm sure if given the chance, any human in this world that went for a psych evaluation, they could find something wrong with them.

20 years of fatigue and your doctor has to have you evaluated for depression before giving you provigil. my god. that's really messed up. they should give it to you anyways. it'll help keep you more alert and awake, and even if depression was a factor, with that kind of fatigue, you should qualify for the pill already.

Fatigue can be a cause behind depression. It does get overwhelming. But your just having random spells that quickly go away. Your still holding down what sounds like a pretty rough job with your condition. Taking care of your kids. I don't think that qualifies as depression. Depression makes you dysfunctional. You socially withdrawal from the world and don't want to do anything. Not because your tired, but because your depressed.

The sleep study sounds like a step in the right direction. Ambien at 5 mg will wake you up during the night, I know this because I have been cutting my dose down by half trying to get off the stuff. At 10mg you'd sleep alot better.

I worry that maybe chronic use of a sleeping pill and not sleeping naturally may play a part in my fatigue so that is why I am trying sleep on my own, some nights I don't even take it, but some nights, I have to. I've never noticed after-effects of fatigue with Ambien, but I have with most other sleeping pills I've tried. So my theory is maybe it's occuring, and I don't know it.

 
Old 06-16-2009, 09:48 AM   #7
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Re: Chronic fatigue or depression? Please advise!

Quote:
Originally Posted by whiteroses54 View Post
So sorry, but I have had a similar problem. I been on depression meds for years and helped for a while but they have had to change them around several times but I'm not really noticing any difference. I stay tired all the time. Most of the time I sleep all day, then sleep all night too. I feel like I am sleeping my life away, and am still tired. A visit to the doctor wipes me out completely. My doctor also feels I need to have a sleep study done. I have had several of these thru the years and they never show any sleeping disorder. I was watching a program one day and chronic fatigue syndrome came up and it sounded so much like a lot of my problems. I don't know how to get a doctor to understand this and how frustrating it is. My current doctor just kinda laughed it off and said, "well we all have that". From my understanding, I don't think most doctors believe in this and the ones that do say there is no cure. Do what you can on your good days.
I think it is normal for all of us to experience a certain amount of fatigue sometime throughout the day but from the time you wake up and until the time your back asleep, that kind of fatigue, is far from normal. If you've already had several normal sleep studies, why torcher yourself with another? If you are interested in determining if your problem is chronic fatigue syndrome, have an ANA blood test done to determine if you have auto-immune dysfunction. And I know you may not necessarily want to here this, but you can't sleep all day like that and expect to feel good. Your feeding the disease.

 
Old 06-18-2009, 01:56 PM   #8
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Re: Chronic fatigue or depression? Please advise!

neveragain444, thanks for your response. I used to take 10mg of Ambien at night and slept much better, but I worried about staying on it so long that I couldn't sleep without it. I took 10mg at night for several years (seriously), and managed to get off it for awhile. However, I always had nightmares and constant wakefulness without it. Like you, I like the fact it doens't leave you "hung over" the next morning.

If the psychiatrist I'm seeing tomorrow tries to put me on depression meds, I won't be going back there. I totally agree that the constant fatigue, coupled with a very demanding life, get me down briefly at times, but I always snap right back to being positive so I really don't think depression is the issue. Honestly, I think I have been so tired for so long and NO ONE in the medical field has really LISTENED to me...it's very discouraging. Someone gave me the name of a doctor in town who readily hands out prescriptions, so if the psychiatrist won't put me on something like Provigil, I'm going to meet with him -- I just can't keep on doing everything I have to do while I'm this tired all the time!

Do you have any side effects from the Provigil? I've read that it causes hair loss...did you experience that? I have LOTS of hair, but I'd like to keep it if at all possible!

Thanks again for the input,
nancyjo

 
Old 06-19-2009, 02:37 PM   #9
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Exclamation Re: URGENT -- Please advise on NEW development re: chronic fatigue vs. depression

Today I went for the "psych evaluation", which is the next hoop my internist wanted me to jump through before she would prescribe Provigil or anything that will combat daytime fatigue.

When I arrived, however, I was told I would have to pay $225, which I simply don't have. I thought it would be their standard office visit fee, so I was prepared to pay $100 (out of pocket) even though I know this has nothing to do with anything psych-related; I'm just trying to do what my internist tells me to so hopefully she will help me.

I left without seeing the psychiatrist and called the internist to tell her what had happened. I told her that I've spent a year doing everything she's asked of me at great expense and I'm only getting worse not better, and told her I'm just not willing to continue seeing all kinds of specialists. At that point she told me she "just isn't comfortable" writing for Provigil, and I told her that if (God forbid) I fall asleep driving and hurt anyone, then she will be partially responsible b/c at this point, standard of care protocol is being completely ignored. She had the nerve to tell me that since I said something like that, I "must be bi-polar" and "definitely" need to be locked up in a psychiatric facility long-term...unbelievable!

Needless to say, that was the end of our conversation AND our doctor/patient relationship. I give up; I am just too damn tired to try to get help anymore. All I know to do is continue to try to function as best as I can and continue to live with disabling fatigue, despite the hideous irony that I HAVE to work; going on disability is just not an option for me.

Sorry to be a downer, but this whole situation is absolutely ridiculous!

Thanks for "listening",
nancyjo

 
Old 06-19-2009, 08:20 PM   #10
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Re: URGENT -- Please advise on NEW development re: chronic fatigue vs. depression

NancyJo, It sounds like maybe you should have been looking for a new doctor a while ago since this one seems to not want to listen to you at all, and is not following the standard protocol of treatment... I'm sure you just wanted to give her the benefit of the doubt and didn't want to go through the hassle of switching doctors. I CAN'T BELIEVE SHE SAID THAT TO YOU!!!! Aside from the fact that it is incredibly unprofessional, it is incredibly rude and hurtful (whether it's true or not, which I don't think it is). I am completely befuddled at how someone who's supposed to be trying to help you could go off and say something like that you. Truly amazing... I would report him/her to the medical board or the certification in your state. That is truly incredible!! I wish you a lot of luck in finding another doctor soon!!!
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Old 06-20-2009, 06:04 AM   #11
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Re: Chronic fatigue or depression? Please advise!

Thanks for your response, New...I appreciate your encouragement and advice!

I emailed one of my closest friends about the situation, knowing she had been involved for years with a man who is bipolar. She is certain that is NOT the situation with me, and like you, advised me to find another internist. I have the name of one near my home (the other one was convenient to my office in the city, which is why I picked her) who has gotten some really good reviews online.

Again, thanks for the advice; I've been worried since I woke up this morning about finding a psych doctor I can afford in case I AM bipolar, but you and my friend have helped put my mind at rest a bit. I just don't think some doctors understand how debilitating and discouraging chronic fatigue is so they mistake our frustration for mental illness, which is unfortunate for us!

Cheers,
nancyjo

 
Old 06-20-2009, 08:27 AM   #12
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Re: Chronic fatigue or depression? Please advise!

Quote:
Originally Posted by nancyjo View Post
Thanks for your response, New...I appreciate your encouragement and advice!

I emailed one of my closest friends about the situation, knowing she had been involved for years with a man who is bipolar. She is certain that is NOT the situation with me, and like you, advised me to find another internist. I have the name of one near my home (the other one was convenient to my office in the city, which is why I picked her) who has gotten some really good reviews online.

Again, thanks for the advice; I've been worried since I woke up this morning about finding a psych doctor I can afford in case I AM bipolar, but you and my friend have helped put my mind at rest a bit. I just don't think some doctors understand how debilitating and discouraging chronic fatigue is so they mistake our frustration for mental illness, which is unfortunate for us!

Cheers,
nancyjo

 
Old 06-20-2009, 09:04 AM   #13
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Re: Chronic fatigue or depression? Please advise!

NancyJo, I've suffered from Bi-Polar disorder for quite some time and what you've described doesn't sound like any sort of mental illness at all just frustrated at your situation and not getting anyone to listen to you, help you, treat you and always sending your out or referring you. If you have a doctor that is always inclinded to think that all of your symptoms are from ONE disorder and doesn't have an opend mind to other things, then you're going to have a problem. My best girlfriend is going through this right now. She went to her doctor wanting to get checked for MS and the doctor said she had depression and wanted to give her AD. None of her symptoms were depression or depression reltated pain. It was all neurological stuff. He should have referred her out to a neuro. It can be so frustrating. One thing to also remember you don't necessarily have to find a special psych to deal with a mental illness if it turns out you do have depression or bi-polar disorder, unless you choose too. If you can find a PCP that will script for it, then you have that option as well.
I used to see a PM doctor (for chronic pain, fibro), psychiatrist (for depression and bipolar), PCP (everything else and female health) and a neurosurgeon (for my herniated disks). I absolutely ADORE my PCP and eventually we phased everyone else out. She manages my psych meds, pain meds, handles my everday stuff, does MRI's if needed when my back flares. The only other reason I would start seeing another doctor for anything again is if my MRI came back with another herniated disk that needed surgery, then I would involve my neurosurgeon again.

So if you can find a situation like that, In my opinion that's the way to go. That way ONE doctor is handling all of your meds and knows any and all interactions. Seems to work much better. I wish you the best of luck in your upcoming search. Let me know how it goes or if there is anything I can do! Have a great weekend!
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Old 06-20-2009, 09:22 AM   #14
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Re: Chronic fatigue or depression? Please advise!

well join my club people. My fatigue started when i took chemo at age 35 and forced me into premenopause. That was 20 years ago. Hormones helped some along with xanax. The drugs have changed constantly this whole time period. I have never been without. The past 3 years have been unbearable. My internist did recommend a physco because he is more in tuned with the mixing of meds than an internist. Have been to a rhermatoid doctor who ran extensive test/sleep clinic/adrinalyn test/thyroid/changing hormones and nothing found to help the chronic fatigue. They have ruled out i am not depressed but i do get the symtoms of depression sometimes because i am so frustrated. Have started on aderol and been on provigil and i got no results, but some people do. I have about 30% of energy to give. Have tried natural supplements, and again, nothing. I use to get a natural high from working out at the gym. But now i am more exhausted after i go work out. I have even had an brain scan.
Right now my dr is taking me off ativan and it was the only drug that put me to sleep. I just got put back on prozac because i was crying alot again---of course from the frustration of no energy. I hate it when family and friends say you got to make yourself get up and go do things and you will feel better. Little do they know that they don't have a clue that it only makes it worse. They only understand depression and not chronic fatigue. I wish i was depressed because then i could get some happy pills that would help depression, they just don't help fatigue now do they??? I think my next step is to find a holistic that may find some nutrient my body may be lacking. Any stretch to find anythng to help is what my goal is. You guys may want to, if you haven't already, read up on hormones. I have tried to stop mine from time to time and i am totally exhausted without them. So they actually do help me. I had to have mine changed several times when i first started on them several years ago after menopause till i felt i was on the right level. I know most women do not want to take them but i would not have made it thru the day without them. Just remember (long ago i thought everything you tried worked overnight) whatever you take by presciption or over the counter, you have to allow it time to work. Some take up to 4-6 weeks to get results. I did not know this 20 years ago. Hope some of this helps and will keep trying to find answers thru your experiences.

 
Old 06-20-2009, 07:30 PM   #15
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Re: Chronic fatigue or depression? Please advise!

I hear what you are saying, New, and I'm thrilled for you that you have one "go to" doctor who manages your health care! That is what I was hoping for in the doctor I've been going to, but I knew when she was out on maternity leave and her colleagues refused to fill my monthly pain medication prescription that there were problems on the horizon.

That situation worked out for the best, however, b/c the pain management practice I went to for SI joint injections last year just hired a female doc who is EXCELLENT. Even though I only take 1/2 a pain pill every 4-6 hours as needed, I truly believe they make the fatigue worse. The fatigue was present LONG before the cervical disc and SI joint issues were diagnosed, however, so the pain meds aren't the root of the problem. Still, I've told the PM I want to get off them ASAP, so I started cervical injections yesterday. Chronic pain and chronic fatigue seem to go hand-in-hand, that's for sure.

All physical sources of fatigue have been ruled out; the only one that turned up was moderate anemia, so I've been on 325mg of iron three times a day (and lots of laxatives, lol) for about six months and my iron levels are much higher now.

I am scheduled to meet with a sleep specialist next Friday (I may have mentioned this already, so forgive me for repeating myself!). One thing my former internist mentioned is might have narcolepsy, which I always thought was falling asleep at any given moment. As I've researched it, however, there is more to it than that; one of the main symptoms is EDS (extreme daytime sleepiness), disrupted sleep at night, and getting up and doing things while sleeping with no recollection...all of which apply to me. Have any of you ever had a sleep study? If so, how did it go? Did it offer any clues to the fatigue?

zekerazz, I have a friend with a story similar to yours, in that she went into forced menopause during treatment for breast cancer at a fairly young age. I know she takes a host of medications, including Effexor. She isn't able to take any hormones, however, b/c her cancer was hormone-related. I can't even imagine the frustration you've had to deal with over all these years.

I do know that I don't exhibit signs of even perimenopause, despite being 49. All of my hormone panels have been perfectly normal, so that was ruled out as a cause of fatigue months ago. Still, hormones and menopause are tricky things, so I suppose they could factor in.

Like all of you, I just want to find some answers and get enough energy to at least get me through the work day and my commute. Oh, and it would be fabulous to be able to sleep soundly at night and wake up refreshed...what a concept! I took a .25mg Benadryl last night and slept better than I ever have on Ambien, but who knows what tonight will bring.

I am going to call the office of that internist who is near my home since it's likely I'll need one at some point. He's known to be very compassionate and a good listener, so maybe he will help me get to the bottom of this. I've even looked into ordering dextroamphetamine online, but despite the websites' claims that it is legal, they also recommend you only order in small amounts in case you get caught. I'm just not comfortable with receiving a baggie of pills from Mexico...no prescription bottle, no real assurance of what one is getting. No, I'd rather go through the normal channels, even though it sure is a long, drawn-out ordeal. I can see how people get desperate enough to do that, however; dealing with debilitating fatigue on a daily basis is extremely challenging.

Sorry this is so long! Have a great weekend,
nancyjo

 
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