Hi!
For years (%26gt;8 yrs) I've been treated for social anxiety and PDD-NOS. I have also tried the SSRI's: paxil, prozac and effexor. In the beginning the effect was amazing and my life was changed: I was starting to talk spontenously to others- it seemed more like a miracle!
Now, after 5 years of medication and looking back I wonder if the meds have done more good than bad. For years and years I have been tired- tired and tired while taking SSRIs: a total and constant lack of energy. What makes things worse is that the doctors I've seen don't consider continuos tiredness to be a serious side effect at all. This can drain the body out much more than the mind can benefit.
Recently I quit seeing my psychiatrist. I asked if I could take a lower prozac dose than 20 mg. -but she refused. The reasons differed from 'it is not clinically shown to be effective" to "not being sure whether 10 mg is available."
What can I do to maintain trust (a good contact) with my next psychiatrist?
Answer:
That's a hard one. I've gone through many psychiatrists. The one I liked the most worked very hard with me but didn't help. Some of them were assholes and wouldn't try anything new. The last one blamed me for being depressed and I ended up with a little vacation in the locked ward.
Now I realize it's luck of the draw and you have to regard the relationship as businesslike. You go somewhere else if you don't like the products and services you receive.
I think your pdoc was right when she said Prozac doesn't come in a 10 mg. dose, but she could have tried Provigil or dexedrine. (I've tried both.)
BTW, do you have other symptoms besides tiredness? You could have an underlying disorder. I walked around with some kind of infection for about four months because I was so depressed I didn't recognize that something else was wrong. I even stopped eating. After about 48 hours of Cipro I perked right up and got hungry.
Doctors see things differently than we do; I just read that one of my most troubling medical problems is "relatively benign". I suppose that's because it won't kill me. I don't think they take quality of life issues seriously enough. What's the point of life if you're not awake enough to experience it?
Maybe you can try asking about his or her treatment philosophy before you have the first appointment. It's worth a try--all s/he can do is say no.
Best of luck.
Sounds like you got a head strong psychiatrist. Remember it's your treatment, you get to have the final say on what you put in your body. I mean if it's has not been shown to be "clinically effective" at a lower dose, oh well. It's not like you're going to go crazy and rape a bunch of animals at the zoo. You'd figure out if it was working for you or if you wanted to go back up.
Explain to your new psychiatrist what you just said here. judge their response and if you don't like it try another one, it's called a second opinion.
GOOD LUCK,
Do you really think that it is a side effect of the med or is it that you are not getting enough B12 in your Diet. I have a friend who suffers with the tired tired and a total lack of enegry she also takes paxil. Well she went and got on some B12 and it took about 2 week to get regulated but she felt alot better. Most of the time your Doc is not going to over medicate, and the pharmacy would not allow that either. Good luck also be advised Vitamin C helps to.
For some reason, psychiatrists do seem to dismiss fatigue/tiredness - I don't know why but it's very frustrating!
I have tried three anti depressants and have been constantly yawning and tired on all of them. Having said that, I did find that when on the Prozac, I didn't get so sleepy in the afternoon, which was good.
I don't know why your psychiatrist was so against you trying Prozac - you need to find a new doctor who will give you a sensible answer regarding this medication.
I've also heard about another anti depressant called WELLBUTRIN which apparently is very energizing.
There's also another medication, I think the name is Provigil or something like that, which is given for chronic fatigue - worth checking it out.
One MAOI anti depressant, tranylcypromine, is meant to be very stimulating - you might ask about that also. MAOIs interact with certain foods and many other drugs, so if you do take one, make sure you get detailed advice on this!
Although you've had blood tests, you might want to repeat them; you might also consider seeing a specialist in thyroid problems - an underactive thyroid can cause both fatigue and depression. Sometimes regular doctors say that thyroid tests results are normal - but specialists have more sensitive criteria, so you might want to try that.
Another source of fatigue can be - sounds strange but it's true - teeth problems. An undiagnosed tooth infection can make you feel very tired and miserable.
Finally, have you considered attending a fatigue clinic at a hospital? If you're in the UK, there's one at the Royal Free Hospital in North London.
I assume you've ruled out ME and glandular fever? If not, ask your doctor about them.
Good luck.
I would agree that a lower dose than 20mg of Prozac is unlikely to show much clinical efficacy, but tiredness is a side effect with the SSRI's as well as a symptom of depression itself that may just not be responding fully to the Prozac. One possible strategy is to raise the Prozac dosage and see whether the lethargy improves or worsens in response. It is frustrating, however I would argue that it isn't as intolerable as the depression symptoms themselves for most people which is why the docs tend to minimize the impact of chronic tiredness.
What has been shown to help is the addition of Provigil (modafanil) to the SSRI's. It's an off-label use of the medication at this point, so you may have difficulty with getting the insurance to cover it, although medicaid certainly will. It is expensive if you have to pay for it out of pocket, but it really works. There have been studies done to show it's efficacy in treating the lethargy associated with depression, however it remains an off-label use at this point as Provigil is only approved for narcolepsy and sleep shift work disorder.
Good Luck!
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