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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Racer on May 8, 2006, at 20:21:53
Meh...
Lately, I've felt so fatigued, pretty much all the time. Dexedrine is not helping with it, which is too bad, and I'm basically feeling ready to throw in the towel and stop all the meds. It's not even a lack of energy, really, it's more a sort of ennui -- I can't seem to get motivated, to care, anything. My get up and go just got up and went.
I'm on 300mg Wellbutrin XL and 10mg Dexedrine, with Ambien as needed for sleep. I don't need the Ambien, though, as long as I take stimulants. (Yeah, I know, but it's true: I sleep great when I take stimulants.) I'm going back and forth between wanting to ask my pdoc about upping the Dexedrine, or upping the WB and switching the Dex to Provigil.
Or, of course, just stopping all the meds... Which would not be a good idea, but it's still in my head as an option. Just not as a good option.
Here's my problem: on ALL the anti-depressants I've ever taken, I've gotten this same sort of fatigue. It's like depression, for me, in that I get very self-critical, and I don't get anything done, and I feel easily overwhelmed, and generally feel pretty non-functioning. And it's hard to say that being miserable and non-functional while on meds is better than being miserable, but able to function a bit better off them.
Does anyone know anything that might help with this? I was wondering if maybe the ADs inhibiting the reuptake of neurotransmitters might be reducing the amount of each substance available? Or maybe the receptors get less sensitive, and that brings this on? Anyone know of anything relating to this?
Also, I'm becoming depressed again, so this combo just ain't rocking my world...
Posted by bassman on May 9, 2006, at 8:15:27
In reply to fatigue or ennui? Or just the usual AD effect?, posted by Racer on May 8, 2006, at 20:21:53
I'd work less about the exact mechanism of what is happening in terms of neurotransmitters and use the Easter Egg Hunt approach to medication. You sound depressed to me...so the meds aren't helping enough, IMO. It sounds to me like everything is related to the depression, period...the negative thoughts, the I-don't-care, the "let's forget the meds", the feeling of depression in the presence of the meds,etc.
Maybe a visit to the pdoc and a "this isn't working, dude" conversation. I hope you feel better, Racer.
bm
Posted by SLS on May 9, 2006, at 9:34:13
In reply to fatigue or ennui? Or just the usual AD effect?, posted by Racer on May 8, 2006, at 20:21:53
> Lately, I've felt so fatigued, pretty much all the time. Dexedrine is not helping with it, which is too bad, and I'm basically feeling ready to throw in the towel and stop all the meds. It's not even a lack of energy, really, it's more a sort of ennui -- I can't seem to get motivated, to care, anything. My get up and go just got up and went.
Have you thought about giving Abilify a try? It probably won't bring you into a state of euthymia, but it can reduce depression and anxiety enough to take the edge off and prevent suicidality. It is weight-neutral. I found that Abilify has helped with motivation and mental energy. Just be prepared for the likelihood of it producing some restlessness, anxiety, and insomnia during the first week or so.
I'm currently taking:
nortriptyline 100mg
Wellbutrin 450mg
Lamictal 150mg
Abilify 10mgAdding Wellbutrin helped initially. No more. My doctor will most likely raise the dosage to 600mg. I don't think it will help. I am not in a real good place right now.
- Scott
Posted by Phillipa on May 9, 2006, at 12:35:25
In reply to Re: fatigue or ennui? Or just the usual AD effect, posted by SLS on May 9, 2006, at 9:34:13
Sorry Scott I was hoping the wellbutrin would kick in. And Racer I think a lot of people are depressed now. I have no idea why though. I know you have tried a lot ot meds. Sometimes I think of going into a controlled enviornment and going off everything and starting from scratch. That way a baseline could be established. Love to all Phillipa
Posted by Racer on May 9, 2006, at 13:02:17
In reply to Re: fatigue or ennui? Or just the usual AD effect, posted by SLS on May 9, 2006, at 9:34:13
> >
> Have you thought about giving Abilify a try? It probably won't bring you into a state of euthymia, but it can reduce depression and anxiety enough to take the edge off and prevent suicidality. It is weight-neutral. I found that Abilify has helped with motivation and mental energy. Just be prepared for the likelihood of it producing some restlessness, anxiety, and insomnia during the first week or so.That's not something that's come up, so far. I have an appointment for 19 May, and will ask about it then. It does frighten me, primarily because of the weight gain, but as a 5HT2a antagonist maybe it's not gonna be a problem? The weight thing is a bit problematic for me...
I spoke with my pdoc last night, when she called about me running out of Dexedrine. We decided that, since the Dexedrine was rather underwhelming, we'd try raising the WB back to 450 and switching back to Provigil. I see her again in ten days, so we will talk then about whether anything has been better than anything else.
Of course, my fear of doctors is still so strong that that gets in the way, too. When I think about telling her how I'm feeling, I kinda deflate, and kinda decide that going off all drugs or staying with something that isn't *too* bad is better than taking the risk of bringing it up with her.
Especially since my experience with Dr CattleProd really wasn't very good, either. It wasn't as awful as the [excrement] with Dr EyeCandy, but it still wasn't likely to offer any reassurance.
I'll talk to my T about this, though. I chose this new pdoc at her recommendation, because I know they communicate with one another. Maybe if I think she might have talked to pdoc about it, I will be more confident when I see pdoc.
>
>I am not in a real good place right now.
>
>
> - Scott
>
>And I'm always very sorry to hear that, Scott. I wish I could wave a magic wand and fix that for you. You're good people.
And bassman wrote:
> I'd work less about the exact mechanism of what is happening in terms of neurotransmitters and use the Easter Egg Hunt approach to medication.
Which is very good advice. The problem, as usual around here, is having tried nearly everything out there already. Add in things like my reaction to weight gain, and my already low blood pressure, and that strikes a bunch of meds off the list to try again.
> You sound depressed to me...so the meds aren't helping enough, IMO. It sounds to me like everything is related to the depression, period...the negative thoughts, the I-don't-care, the "let's forget the meds", the feeling of depression in the presence of the meds,etc.
I think you're right about all of that. I know that I go through a circle of rumination -- "I'm depressed, changing drugs might help, but if I change drugs, it might make the fatigue worse or I'll gain weight, and that just isn't worth it." There's a bit more, but it comes down to this: I really cannot remember ever having had the depression treated without this sort of brain fog and fatigue/ennui. And the drugs that worked best, caused the most weight gain.
{sigh} Just thinking about this, I feel like giving up.
>
> Maybe a visit to the pdoc and a "this isn't working, dude" conversation. I hope you feel better, Racer.
> bmThank you.
And, I just noticed that something came in from Phillipa while I was writing this:
Jan, while I agree that sometimes going off meds in a safe place, to get a baseline, is useful, that's not something I need. If I go off meds, I can do it safely at home.
Posted by Phillipa on May 9, 2006, at 13:34:04
In reply to Thanks, to both of you, posted by Racer on May 9, 2006, at 13:02:17
Racer fear is what gets in my way of doing it at home. Okay I'm a wimp. Love Phillipa
Posted by Jost on May 12, 2006, at 3:09:51
In reply to Re: Thanks, to both of you » Racer, posted by Phillipa on May 9, 2006, at 13:34:04
Anyone have experience with abilify in combination with ADs, or by itself (or with benzos)?
I took it very briefly after a discontinuation with another AD, attempt that was very rocky. I had switched to Cymbalta, and with that, at a small dose, used the smallest dose of abilify. I experienced a fairly strong tightening of my neck, shoulder and head muslces, but it went away after a day or two. Somewhat akathesia-like. I didn't continue the abilify at that time..
Now I'm off cymbalta, and may try the emsam patch (or not--I'm not sure I want to try another maoi---) but was thinking of giving abilify a try. I had heard it was supposed to help you think more clearly. That was rumored soon after its introduction, so I wondered if it panned out.
Is it activating? does it cause weight gain? insomnia? My problem is anxiety leading to fatigue and deperession, with a tendency toward ruminating about or becoming intracticably disturbed about some ambiguous situation into which I project whatever aspects of myself I'm feeling least acceptaing of.
I think my mood and energy would improve and and be more stable, if I could at least keep sight of a clear path through the forest.
Anyone have any suggestions or help?
Jost
Posted by Larry Hoover on May 12, 2006, at 7:36:53
In reply to fatigue or ennui? Or just the usual AD effect?, posted by Racer on May 8, 2006, at 20:21:53
> Here's my problem: on ALL the anti-depressants I've ever taken, I've gotten this same sort of fatigue. It's like depression, for me, in that I get very self-critical, and I don't get anything done, and I feel easily overwhelmed, and generally feel pretty non-functioning. And it's hard to say that being miserable and non-functional while on meds is better than being miserable, but able to function a bit better off them.
That sounds awfully familiar to me.
> Does anyone know anything that might help with this?
Forgive me, but although I haven't met a chemical I don't remember, people confound me. I can't remember who has what symptoms and what they've tried, or not. In case we cover old territory....did you try Enada NADH? In conjunction with TMG? Some alphalipoic acid, at relatively high doses? Does coffee clear your head?
It kind of dove-tails off the adrenal fatigue theme. It's like your car over-heated, but you don't top up the coolant before you start it up again. It overheats again, quite quickly.
If I wasn't so absent-minded about my own self-care, I might be able to offer you personal anecdote with greater substance, but, when I am looking after things, I pay particular attention to the adrenals and my mitochondria. Lots of antioxidants. Vitamin C in large doses. And supps directly aimed at enhancing both the integrity and the capacity for energy transfer at the mitochondrial surface. This pain thing I'm dealing with has got me so totally whacked that I can't speak from recent memory, but.....when I did these things, I didn't get those symptoms you list.
BTW, I attribute the symptoms to my PTSD. Although they are depressive-realm symptoms, I link them specifically to the trauma. The severity of symptoms is also correlated to emotional content with respect to the trauma; when I'm working on stuff in therapy, my symptoms are more persistent.
Lar
Posted by Racer on May 12, 2006, at 10:47:04
In reply to Re: fatigue or ennui? Or just the usual AD effect? » Racer, posted by Larry Hoover on May 12, 2006, at 7:36:53
> >
> Forgive me, but although I haven't met a chemical I don't remember, people confound me. I can't remember who has what symptoms and what they've tried, or not. In case we cover old territory....did you try Enada NADH? In conjunction with TMG? Some alphalipoic acid, at relatively high doses? Does coffee clear your head?Uh... Not only haven't tried any of the substances you mention, I don't know anything about them. How about I post on Alt and you can tell me there?
As for coffee, I don't remember if it clears my head or not -- largely because I can't drink caffeinated coffee. If I do, one cup is usually enough to start me being sick. I don't think it matters much if it's on an empty stomach or not, although it's been so very many years since I drank "real" coffee, I can't really remember. I don't think it was the caffeine, per se, because I used to drink multiple diet colas each day. And I don't know what else it was, because I could and did for many years drink a pot of decaf every weekday morning. Have my cup at home, then take the rest to work in my thermos.
THanks for your input. I guess I gots some research to do.
This is the end of the thread.
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