Suggest Treatment For Extreme Bouts Of Depression And Severe Fatigue

Posted on Wed, 15 Apr 2015

Question: I am suffering from an extreme bout of depression for the last 16 months. It came on one day out of the blue. I am retired from a successful career, have a loving supportive family and friends. This is not my first case of mdd. I have been on medication since 1991 and have been able to function and work for 33 years. My main symptom is severe fatigue. I am bedbound at least 20 hours/ day. I cannot take a shower without 2 hrs of exhaustion. Again this just started one day no gradual decline. I have a wonderful psychiatrist who is at her wits end. She has tried me on every known antidepressant. I was on effexor for 10 years until it totally stopped working. Then the guessgame of one drug after another started. I try them all for at least 8 weeks to no avail. Right now I am on 60 mg of seratraline , 2 Mgs of klonopin and 30 Mgs of buspar. I tried rittalin which made me jump out of my skin. To be truthful the only thing that made me feel better was oxycodone for my 3 ruptured discs in my back. But I know I can't take it on a regular basis. One doctor thought I had chronic fatigue syndrome and wanted to add valtrex. I had gastric bypass 12 yrs ago and worry about stomach problems. I also don't think I absorb meds like normal although had a heck of a time coming off effexor. I even had my gallbladder out as I was told this could cause fatigue. That was a year ago with no change. I have had my thyroid tested several times as thyroid disease is rampant in my family. Again told normal except for nodules that are benign. I know I Ned to exercise but I can hardly walk and tend to pass out. My bd is sometimes low and sometimes normal. Nothing seems to raise it. I've also tried every supplement and meditation. I want to make it to my daughters wedding in August but on a daily basis sometimes I feel like I may commit suicide before then if things get worse. Do yo have anything I could advise my psychiatrist and would it be worth it to spend thousands of dollars on a chronic fatigue clinic? Thanks for any help.

Answered by Dr. Dr. Ashok Kumar Choudhary (18 minutes later)

Brief Answer:
Whould you like to mention medicaations that have been tried

Detailed Answer:
Hello,
Thanks for using healthcaremagic.

I read your query and understand your concern related to recurrent MDD and pain.

Since the pain started following MDD i like you to discuss following molecules with your psychiatrist if not already tried.

I generally prefer Duloxetine, in my patients with chronic fatigue syndrome and in my experience it helps about one half to two third of patients. If this has not been tried till date I request you to talk to your psychiatrist.

My second choice in CFS is Wellbutrin 300 to 450 mg per day and many of my patients who have recurrent depressive episode history respond well with it.

My third choice is SSRI with low dose of atypical antipsychotics. Since you are already taking SSRI it will be wise to increase the dose of sertraline and to add on low dose of atypical antipsychotics like 1mg risperidone or 2.5 mg olanazapine.

If I fail on all these measures I go for ECT which may not be acceptable to many of patients due to stigma attached with it. Since you are feeling suicidal and multiple attempts failed with drugs, considering ECT will not be wrong although there must be thousands of questions on this answer from me. Sorry if it offends you but it is one of the most effective treatment in psychiatry and can be used as a last resort. Till date I have treated two patients of CFS with ECT who failed to respond to anything available in psychiatry.

I hope this helps you.
If you have any more questions feel free to write back to me.
Thanks and regards
Dr Ashok Kumar

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar