Originally Posted by atrooterisu
I have been on 20 mg of prozac for about a month now. I am extremely tired all the time. I have to take daily naps and sometimes 2! I don't have any motivation or energy to do anything. However my mood is much better. Has anyone experienced this with prozac and has it subsided?? This sucks.
I have had EXACTLY the same experience with prozac, as well as all of the other SSRI meds. I have been taking an SSRI for over 10 years, and my experience with each of them (prozac, paxil, zoloft, luvox, etc.) has been the same regardless of the dose: Each of them improves my mood significantly, but does so at the expense of my wakefullness and motivation. While I feel relieved of my despair, I struggle throughout the day to stay awake, and while awake, even the simplest tasks feel like impossible chores.
I am afraid that I have not experienced relief of this side effect after weeks, months, or even years of continued use. Increasing the dose only intensifies this effect. I have found that if I take anything larger than a small dose of any os the SSRI drugs, then the fatigue is totally disabling (sleeping over 16 hours out of 24). By the way, I had the same experience when taking the supplement 5-HTP instead of an SSRI.
My solution has been to augment SSRI use with a stimulant medication and to take the lowest possible dose of SSRI that I can tolerate without total return of depressive symptoms.
When decreasing the dose of any of the SSRI medications, I experience a brief period of time (usually limited to 1-2 days) wherein my depressive symptoms are managed at the level of the original dose, but my fatigue diminishes markedly. Then after the 1-2 day period, the despair intensifies, and the fatigue is consistent with the new dose. This is to say that it is my experience that when tapering down in dose, the therapeutic effects outlive the side effect of fatigue by one to two days.
Here is a summary of my 10 years of experience with these drugs.
1. The higher the dose of SSRI, the more my mood improves.
2. The higher the dose of SSRI, the more fatigued I am.
3. Taking a stimulant medication (such as Adderall or provigil) helps a lot to offset the fatigue, but once I reach a moderte to high dose of SSRI, then even the stimulants are not enough, and the fatigue is crippling. Over time, I have also noticed that the stimulants are less effective unless I cycle their use regularly (take days off).
4. There is a window of time when down-tapering when I get the antidepressant effects of the 'before' dose and the fatigue effects of the 'after' dose.
5. In ten tears of trial and error with almost every possible dose of almost every different SSRI, I have not been able to find a dose/drug combination of SSRI that did not have this effect.
6. Prozac has been the most tolerable in terms of side effects. I suspect that this is because the long half-life of prozac is less predisposing to swings in the intensity of fatigue. It is more predictable.
If you are set on the psychopharmacology approach, then I would suggest that you continue the dosing regimine and hope that the fatigue side effect goes away (for some it does). If it has not gone away after 4 weeks (if you are willing to wait that long), then I would suggest that you talk to your doctor about adding provigil or adderall.
Another alternative would be to make the same medication change that I am presently trying, and switch to an MAOI. These are effective antidepressants which, as far as I can tell, are not known to cause such dramatic fatigue. This is a more aggressive approach than the augmentation strategy (because of the dietary hazzards) but it seems worth a try to me.
Here is the citation of a good article that addresses this subject.
The title is; An open label study of adjunctive modafinil in patients with sedation related to seroternergic antidepressant therapy.
It can be found in the Sep 2004 issue of the Journal of Clinical Psychiatry
65 (9): 1223-7
I will hope the best for you and let you know if the MAOI drugs cause me any fatigue. Let me know how things go for you.
I really appreciate how difficult this experience can be. Hang in there, something is bound to help.