Hello and welcome to Healthcare Magic. Thanks for your query.

From the description of your symptoms, it appears that you are in the midst of a depressive episode. Loss of energy is, in fact, a cardinal symptom of depression. Though you are already on antidepressant medication, it seems that there is only a partial response. This may also be the reason why you are having only lack of energy as the predominant symptom and not the other typical psychological symptoms of depression.

Though many people respond well to anti-depressant medication, there will be a proportion of people who respond only partially or have a poor response to treatment. If there has been poor or inadequate response despite receiving an adequate dosage and duration of different types of antidepressants, then it is likely that you may be suffering from a "resistant depression". Now, don't get alarmed by that word as it does not imply that there is no treatment option available. It just means that these particular proportions of people need a special way of approach and management.

The management approach first involves investigating for any causes for treatment resistance, for example, certain medical causes, like thyroid problems, certain vitamin deficiencies (like B12), etc. can be contributory. If so, they have to be detected and treated appropriately. Further treatment options include trying different combination of anti-depressants, augmenting the antidepressant with other psychiatric medication like an anti-psychotic or a mood-stabilizer, thyroxine supplementation, etc. Combining intensive psychological therapies (such as Cognitive Behavioural Therapy - CBT) with medication often gives good results.

So, please don't get dejected. There are many options available to tackle your 'resistant' depression. I would suggest that you discuss with your doctor regarding a further treatment options, such as a change or modification of your current medication. In addition to your iron supplements, I would also advise you to take a multivitamin supplement (something which contains b-complex vitamins and vitamin c) on a regular basis. Take a healthy, nutritious diet and plenty of fluids. Though I understand that you may be feeling totally down and drained out, you should try to keep yourself physically and mentally active as much as possible.

All the best.

-Dr. Jonas Sundarakumar
Consultant Psychiatrist

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Hello again,

I can undertand that your symptoms are causing you a lot of distress and dysfunction. Though your symptoms of low energy and poor motivation are likely to be due to the effects of your multiple psyhiatric problems (especially the depression) and chronic pain, it is unlikely that they could be an effect of the psychiatric medication. Now, regarding the prescription of a stimulant, it is not usual clinical practice to start a stimulant for symptoms of low energy alone. The reason is because stimulants have a relatively higher risk for side effects as well as addictive potential. Generally, stimulants are prescribed only for specific psychiatric conditions like ADHD, narcolepsy, etc. Only very rarely are they used by some doctors in the treatment of resistant depression, when all other possible treatment strategies have been exhausted. What may be more likely to be prescribed are antidepressants with an 'activating effect', for example, antidepressants which increase the nor-adrenaline or dopamine levels. So, you can discuss about these options with your psychiatrist. Also, in addition to medication, there are certain effective psychological and behavioural therapies like cognitive behavioural therapy, activity scheduling, etc. which can improve motivaton and drive, and improve your functional level.

Best wishes,

Dr. Jonas Sundarakumar
Consultant Psychiatrist

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