
Suggest Treatment For Extreme Bouts Of Depression And Severe Fatigue

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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