Discussions that mention emsam

Depression board


I'm hoping some of you can give me some info, advice, or opinions. For about the past 5 years (I am a 27 year old male), I have been trying to figure out what is wrong with me and find a solution to the problem.

I have been told by at least a few people that I'm depressed, but I am not really sure if I am, but I'm pretty certain I have a generalized anxiety disorder of some type at least. My main problem is that no matter how much sleep I get, be it 6 hours or 14 hours, I do not feel refreshed when I wake up. I also have fatigue most of the time and often wake up with morning headaches. When I do wake up I feel "drunk" and I remain this way for hours. I always feel very tense for no particular reason, as though I feel something bad is about to happen. My mind is not clear, my cognitive abilities are slow, mental reflexes are very slow, have trouble with decisionmaking, and have no motivation to do anything. I have to force myself to do everything, including things I enjoy practically all the time, and I feel like all of these problems are very gradually getting worse as the years go by. :(

I have been seeing my family doctor now for a long time and she has done a physical exam, blood work, prescribed various medications including zoloft, wellbutrin, adderall, and none of them give me any results. She referred me to a pulmonologist to check whether I had sleep apnea or some other sleep disorder. I did a sleep study and was found to have what they deem "moderate" obstructive sleep apnea.

Their severity scale was something like:

1-5 = normal number of apneic episodes for the average person
6-19 = mild sleep apnea
20-39 = moderate sleep apnea
40 and up = severe sleep apnea

My score was 23. My blood oxygen levels during the study were completely normal and steady throughout the duration of their testing.

Ok, so the pulmonologist prescribes a CPAP unit for me to use, it took awhile to adjust to it, but after 3 months of use, I found it to be no benefit. I still had the problem where I am sleeping too much and not feeling refreshed when I wake up. The company that leased the unit to me downloaded the data from the CPAP and it said that it was correcting 100% of the apneic episodes. So I decided to stop the CPAP. It was apparently correcting the apnea, but still I was getting no relief.

I was then referred to an endocrinologist to have my thyroid checked. They did a thyroid ultrasound and found 3 small nodules on my thyroid and also found that I had a mild goiter. The endocrinologist concluded that these are problems that could become something to worry about later but that they aren't the source of my sleeping too much and all that. He has me on a small amount of thyroid medication which he says should keep my thyroid from enlarging further and to possibly shrink it back down some.

After checking all that all that remains is psychiatric stuff.

Many years ago I saw a psychiatrist who prescribed zoloft as my family doctor did recently, along with Prozac, Paxil, Effexor, Luvox, and Neurontin, at max dosages over a period of many months, all with no side effect improvements.

I've been seeing a psychologist now for a few months, and he thinks that I have ADHD based on the symptoms I described to him, but I am not so sure about that. He ran some tests on me to test for ADHD and he said that on one of his tests I performed as poorly as someone who had suffered a head injury. There were a couple of other tests he administered as well, one of which was a computerized program that tested my impulsivity and attentiveness (I assume), which I also performed very poorly on. I was already on Adderall as prescribed by my family doctor, but the dose was increased in light of the new developments. Two weeks later I saw the psychologist again and he had me take two of the tests he gave me previously, and I scored extremely well compared to the first run. He seemed convinced that my score improvement was due to the Adderall, but the Adderall didn't give me any noticeable benefits during the time I took it. I believe the reason for my improved score was simply that I knew what to expect the second time around, and was less apprehensive about it. I also employed a more relaxed approach to the computerized test than I did the first time. So the results from the second test in my opinion don't seem valid. I believe that I may just have depression and the symptoms are overlapping which mimic ADHD.

Right now I have just started seeing a new psychiatrist. He has me on Clonazepam right now at 1 mg twice daily as well as Provigil 200mg once daily. I take the clonazepam when I wake up and again when I go to sleep. I take the provigil as soon as my alarm goes off (have water next to my bed along with the pills). I pop the pill but am soon back asleep again. I've heard this drug is used by the military to keep soldiers awake for 40 hours straight while still being fully alert and functional as though fully rested, but for me I have noticed no change at all so far. I've taken it for 3 days now and so far have not experienced any increased "wakefulness". My understanding is that this drug is supposed to take effect quickly, unlike antidepressants which take days to weeks to build up in your system.

I have a weird problem I think. I am immune to practically all psychiatric drugs it seems. I am also unaffected by caffeine (in fact if I have caffeine before I go to sleep, it makes me more relaxed) and alcoholic beverages. I'm sure I could drink enough alcohol to make SOMETHING happen but I actually do not drink at all. However what I have drank in the past didn't change my mood in any way. They say alcoholic beverages are supposed to make you more sociable and relaxed, I get nothing from it. I don't even get tipsy. But anyway, my point is that I've tried all kinds of medications. Stimulants such as caffeine have no effect on me, alcohol doesn't affect me, is there a label for people with this kind of problem? Or is it a problem at all? Maybe I am perfectly normal but just lazy like people say. Since I seemed to be treatment resistant to depression, assuming that's what I have, I suggested to my psychologist the new MAOI Emsam as another route of treatment since I hadn't tried any MAOIs yet and they are supposed to be good for treatment resistant depression, so I tried that for 6 weeks. Well guess what? It didn't do a durn thing for me either :(

Here's what I would like to know from you guys please. My psychiatrist told me something I found hard to swallow but I will give him the benefit of the doubt, but would like your opinions as well. I told him about my immunity to drugs problem and he told me that I could well be immune to some extent, BUT then he said that I have to help make the drugs work. Apparently he thinks that my sleep problem is just me being undisciplined in keeping my hours, and my father is of the same mind, but I do not think so. The psychiatrist says the drugs will not work if I do not help them to work, in other words, make my sleeping/waking times regular. The sleeping problem though, is the centerpiece of my problems! If I could knock that out somehow I could put up with anxiety and mental dullness and I can live with being the butt of people's jokes because I'm so out of it and can't think quickly enough to respond to their insults with any degree of wit.

Is it true these psychiatric drugs won't work if my sleep hours are irregular? I was hoping the drugs would be able to take care of that symptom. I find it hard to believe that that is all it comes down to after all these years of trying to find help. I realize that I need to put forth efforts to get well along with medications but I thought medications had a purpose?? I thought that I would be getting symptom relief from them.

I had a job for 3 years that I loved, but I couldn't make it to work on time and while the boss who hired me was sympathetic toward my situation while I was seeking treatment, he retired, and the new boss didn't tolerate me coming in 6 hours late practically every day for very long, so I was given the choice to resign or be fired, so I resigned. Believe me I tried soooo hard to be able to get up and get to work on time, I didn't want to lose my job, but it was so difficult to get up on time, and eventually it cost me my job. I'd go to bed at a reasonable time and sleep 6-8 hours and would still be dead tired every day.

Here is the big question though. My psychiatrist told me that it is unrealistic for me to expect to feel refreshed when I wake up in the morning. Is this true? I find it hard to believe because there are times, very rarely, when I do wake up and feel what I would call "refreshed". That is, I wake up and have no more desire to remain in the bed and want to start moving about. I don't understand why it is unrealistic to expect to feel refreshed upon waking after 8 hours of sleep. I don't like waking up feeling like I haven't slept at all. I want to go back to work but I will lose my job again eventually because of this problem. On average I sleep about 10-12 hours per night and don't feel rested when I wake up. I would like to sleep 6-8 hours and feel okay, is that asking too much?? I started having these problems around age 14 and I'm now 27. It didn't always used to be this way.....

So anyway my psychiatrist wants me to force myself to normalize my sleep schedule somehow. So I will try my hardest to do what he suggests and see what happens.

I just don't see how this will ever result in a permanent fix for me. Forcing myself to get out of bed every morning when I feel awful and sometimes have a headache for the rest of my life is a miserable existence.

I also definitely think that the sleep problem is only one part of a bigger problem, probably depression, but maybe something else.

Thanks in advance for any input and I apologize for this really long post. :P