Suggest Treatment For Severe Fatigue And Dizziness While On Zoloft And Buspar

Posted on Wed, 20 Jul 2016

Question: hello I am a little concerned I just woke up really tired its 2 am and I took my bp and it was 100/47. ive had a calcium ct score normal holter monitor normal. normal bloodwork chest and brain ct brain mri all normal. everymorning I wake up once or twice a nightand when I wake up to start my day I feel really tired and drowsy almost dizzy body feels really light. normal bp can range from 105/60 before I fall asleep at night to 130/80 during the day. is this low bp during sleep normal or should I worry? ive been taking Zoloft 150mg for depression/anxiety along with buspar 5mg once a day

Answered by Dr. Manisha Gopal (1 hour later)

Brief Answer:
bloodpressure is normal; hike zoloft; stop buspirone & add sedative

Detailed Answer:
Hello
Welcome to health care magic.

I have gone through your all questions and can see that you have been on zoloft and buspirone for anxiety disorder.

Firstly, you have a chronic probelm of difficulty of getting up and working as you feel weak and tired.
I would like to tell you that it is a very common thing. This happens mostly due to incomplete sleep at nighttime.

I have many patients who come to me with similar problems.

I try to do the following things-
1. Avoid day time naps or sleep
2 avoid lying down in daytime
3. Add a short term sedative in night.
If possible stop buspirone and hike the dose of zoloft by 25mg.

For sleep I prefer clonazepam 1mg or zolpidem 12.5mg to be taken at night.

4. I also advice and teach relaxation exercise to these patients to bring early relief.

Secondly-you are concerned about the blood pressure. It is common thing that blood pressure falls in night as we take rest and lie down. No need to worry for this.

Get your B 12 vitamin and D vitamin tested for ruling out neurovitamin deficiency.

Please discuss the above things with your treating team.
I hope the reply is useful for you.

Wish you good health.
Dr. Manisha Gopal
MD Neuropsychiatry

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Manisha Gopal (4 hours later)

im really concerned about the 100/47 reading when I woke up at two AM my bp when I get in bed and am drowsy my bp is usually 105-115 over 58-70 im just concerned that the reason I am waking up in the middle of the night is because my bp is getting to low and that my bp could kill me in my sleep when its that low... also I have very low vitamin d 15.6 ml. and mild b12 vitamin deficiency is there any medical conditions that could cause low bp in my sleep. I may have a connective tissue disorder, im being tested for marfan syndrome and ehlers darlos syndrome. as I have symptoms of a connective tissue disorder. when I do wake up in the night I feel very week. and if I look at my phone and check the time I see everything very blurry than my eyes adjust.

Answered by Dr. Manisha Gopal (2 hours later)

Brief Answer:
get your ECHO done & start vit D supplement. and do yoga

Detailed Answer:
Hello
Thanks for writing back.

I can see your concerns now.

Firstly, I feel that as you have so many comorbidities, you can get your ECHO done for the heart. It will rule out any problems there. And it will also tell about its functioning.

Secondly, It is not documented that such conditions lead to death in sleep due to low blood pressure. Your connective tissue disorder thing is still not confirmed.
So, please dont worry about it.

Thirdly, your vit D level is low. For that I usually prescribe -vit D3-60K IU one tablet per week. Taken for 6-8 weeks. And also start daily calcium tablets simultaneously.

Fourthy, try to do deep breathing, like some breathing yoga daily. It helps in overall health recovery

Fifth, the eyes take time to adjust after getting up from sleep and take more time for this in night hours. So,if there is no other issues with your eye sight in daytime, then there is no need to worry.

I wish you good health and long life.
Please ask if there are any more concerns, I will try to help you.

Dr. Manisha Gopal
MD Neuropsychiatry

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

Follow up: Dr. Manisha Gopal (2 hours later)

what do you mean by comorbidities? mentally? or psychically? second off im very concerned about that low bp during sleep? what can be causeing this? and is it normal? 100/47 is very concerning to me please clarify this issue with me, thank you very much :)

Answered by Dr. Manisha Gopal (7 hours later)

Brief Answer:
echo can guide about the reasons of low BP &check fluid intake

Detailed Answer:
Hello
Thanks for writing back!

By comorbidities I mean the illnesses you already suffer from, like symptoms suggestive of eher danlos syndrome , and like marfans possibility and ?connective tissue probelms.

Keeping all these in mind I asked you to get an ECHO for heart done. Only after the ECHO we can comment on the structure and functioning of heart and thereby pointing towards the cause of low blood pressure.

Without an appropriate investigations it will not be wise to make a comemnt on this.
You can also go for blood pressure measurement - in daytime: one in sitting posture and then after lying down. This is also a very good indication of any postural fall of BP one may have . This is also seen in normal individuals.

So, you should meet your doctor and ask for the above said investigations and then we can proceed in the right direction. Fear is a much bigger enemy of health compared to illness. So, please go for the tests.

P.S. -The low blood pressure can be due to less of fluid intake after afternoon hours..so check that.

Wish you good health!
Please feel free to ask any more query for clarification.

Dr. Manisha Gopal
MD Neuropsychiatry

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

Follow up: Dr. Manisha Gopal (51 minutes later)

I had an echocardiogram done back in January and it was completely normal. I have an echocardiogram schedualed for july 18th. but in January everything looked good. normal aortic root and normal pumping of heart 65 percent doc said 60-70 is perfect so is this an indicator that my blood pressure is normal at night? 100/47 is low but might be normal for me since my bp and drop to low 60s high 50s while im awake. also can Zoloft and buspar cause night time drop in blood pressure? can these low numbers at night kill me?ive had my orthstoics checked during the day and they also came back normal

Answered by Dr. Manisha Gopal (2 hours later)

Brief Answer:
your bo is always towards the lower side, its ok as echo is normal.dont wor

Detailed Answer:
Hello

Thanks for replying back!

If your echo was normal in january then it is highly likely that it will still be normal this time too!

And in night time, the fall in blood pressure is fine. It can fall normally in many people at night time and can also be due to zoloft. But it dosent kill anyone in sleep.

The normal orthostatic pressure is also in favour of good and normal working heart muscle. So, you can relax! Its just your anxiety that is making you worry so much. You have lots of fear about your health..but there is no relevant basis ..so, no worries..ok

Please do some breathing exercises or learn yoga-it will help you in long run.

I wish you good health!

Dr. Manisha Gopal
MD Neuropsychiatry

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

Follow up: Dr. Manisha Gopal (19 hours later)

I woke up last night at 4 hours into my sleep and had a headache that only hurt on the back of the head while I took in a breath that lasted until I fell back to sleep than when I woke up and didn't feel it anymore. this happened once before but it concerns me especially since that when I wake up I feel exhausted having a hard time focusing and feel like its hard to talk. however last night when I had the headache I took the bp as soon as I woke up, I took it twice and both reading came up 105-114/60-66 so that's good, but should I be concerned with waking up in the middle of the night with pain in the back of the head only on inhaling and exhaling a breathe?

Answered by Dr. Manisha Gopal (2 hours later)

Brief Answer:
dont worry about neck pain, it could have been coz of posture

Detailed Answer:
Hello and welcome to health care magic!
Thanks for writing back.

I think that there should not be any problem with the pain in neck that happened when you woke up in middle of night. It was most probably due to some postural problem when you were sleeping. As there is no complaint the following morning, I think you should not worry about it.

Its good that the bloopd pressure reading came out to be normal. So, you can see that its not harmful or dangerous at all.

You can try avod taking naps during the daytime to prevent waking up in night in between and also avoid tea or coffee after 4pm.
Decrease screen time -this is very helpful in getting good night sleep.

Hope the reply is useful for you
wish you good health.

Dr. Manisha Gopal
MD Neuropsychiatry

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

Follow up: Dr. Manisha Gopal (2 hours later)

there was no neck pain, just pain over my head when I took in air and exhaled

Answered by Dr. Manisha Gopal (57 minutes later)

Brief Answer:
ypu are right..the reason still is portural problem while sleeping.

Detailed Answer:
Hello

Yes, you are right ..its back of the head...I thought you wanted to say that back of the head down to neck..because its quite common.

Still, the most likely reason can be the postural difference when you were sleeping..

The best part was that you were keeping fine when you woke up..so, I would say that everything there is normal. No worries.

Little symptoms here and there are usual feature of a normal human body! You look just fine..

Wish you luck.
Please ask of there is any more doubts for clarification. I would be glad to help.
Dr. Manisha Gopal
MD Neuropsychiatry

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