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FamilyPhysician, Doctor
Category: Mental Health
Satisfied Customers: 12816
Experience:  Family Physician with over 23 years clinical experience treating patients with mental health issues
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I have suffered from a lifetime of chronic fatigue and depression.

Customer Question

I have suffered from a lifetime of chronic fatigue and depression. I have tried a half dozen depression medications. Only Cymbalta provided relief but it cost me my marriage as the side effects caused me to lose control of my inhibitions which resulted in adultery, gambling and heavy drinking. I know there is a link between depression and fatigue but I have also read recently that fatigue may be related to underactive thyroid, adrenal fatigue, poor diet and more. I can't go on living this way. Are there any treatments for severe depression that also deal with overwhelming fatigue?
Submitted: 7 years ago.
Category: Mental Health
Customer: replied 7 years ago.

Age: 46; Male, Nevada

Already Tried:
Cymbalta, paxil, prozac, zoloft, wellbutrin, effexor.
Expert:  Susan Ivy replied 7 years ago.



Thank you for writing Justanswer with your concern.


Are you seeing a psychiatrist? The reason I am asking is that this type of reaction to an antidepressant sometimes happens in individuals that have bipolar disorder. There are many other things to look at before a diagnosis should be made, but it would indicate a different type of treatment for the depression.


The treatments for severe depression that also deal with fatigue, you have already tried (cymbalta, effexor, wellbutrin).


Of course, if you have not had your thyroid and other endocrine problems looked into, this is very important to have done.


Definately adrenal fatigue can be related to prolonged stress as well. Does this seems to have been true for you at sometime in your life? Severe stress, even as long ago as childhood can result in an over-reactive stress response, that can lead to things such as adrenal fatigue. Stress relief techniques, visualization exercises can be helpful in turning this around, if you actively practice them.


Poor nutrition, inability to absorb nutrients can definately contribute to fatigue.


If you haven't tried a multiple "B stress" vitamin, you may find that helpful to a certain degree. One B vitamin, Thiamine or B1, has been shown to help mental acuity, but in higher doses than the RDA of 1.25, such as 25 to 50 mg. Another B1 derivative, called sulbutiamine, is prescribed in some countries for asthenia (lack of strength, or fatigue) and can be bought over the counter in the US. See:


Likely one or two supplements won't cure your complete condition, but these I mentioned are safe, and likely will help you to a certain degree.


If you have questions, or comments, please reply so that I can address them.



Customer: replied 7 years ago.
Dear Ms. Ivy,

Thank you for your reply. I have seen two physchiatrists in my lifetime. Both about four years ago. I had reached a point where I could no longer leave my bed and I my ex-wife arranged a few meetings. My experiences were not favorable with the physchiatrists which was at much my fault as theirs. It even seems backwards to me, but the lower I sink with depression the less I want to interact with health care professionals (or anyone for that matter). The physchiatrists did prescribe a variety of medications. I must say I felt good on Cymbalta. My mind was clear for the first time in memory. However, as I mentioned, the Cymbalta made me euphoric at times and unable to control some base urges. I have been off all meds for the past two years.

By prescription, I have also tried uppers to increase my energy levels without dealing with the depression issue. The uppers made me anxious and I would walk laps around the kitchen with no application for the energy.

I think to some degree that there is medication(s) that could help me if the dosing were different. I weigh only 150 pounds and it seems I get the same dose as a man twice my weight. I haven't a clue if that makes a difference.

I forgot to mention that my memory is failing. That sentence would be funny to me if it weren't terrifying. It is intermittent but at times I cannot remember my home phone number or where I live. I have read that depression can wreak havoc with memory too.

You asked about the stress levels in my life. For 25 years I was under incredible stress. I worked too hard in my professional career and even chose a stressful hobby of remodeling homes on weekends. As a result of the self imposed pressure, I am now retired at an early age. Retirement would be great, I often think, if I had the energy to get out of bed or leave the house.

More background... both of my parents (now deceased) were ragin , abusive alcoholics. I was obese as a child, turning to food for comfort. I believe that much of my physical problem today and potential chemical imbalance, may be the result of a high fat, junk food diet as a teen. My diet today is lousy too. Although I eat better quality foods, my metabolic rate has slowed to a crawl due to inactivity. I often just don't feel like preparing a meal and can sometimes go a day or two without eating.

I have felt for a long time that my condition has been spiraling down but in the past year I feel the spiral has gotten tighter and tighter. The lows are lower and the highs have taken a vacation.

I get advice like eat better, but it's tough when you don't leave the house and haven't the ambition to make a meal. Experts tell me to exercise more... that's good for brain chemistry. I think people who tell you to exercise more when you haven't left your bed for a week don't understand depression at all.

I have never had my endocrine system examined. Is there a chance that a strong link exists between low adrenal activity or thyroid issues and my lack of energy? Could my low energy levels be causing my depression or is that a "chicken or the egg" question?


Expert:  FamilyPhysician replied 7 years ago.
Thank you for the additional information provided. While I understand your reluctance to interact with health professionals - I would strongly recommend that you make an appointment with a psychologist or a psychiatrist. In most states psychologist do not have prescriptive power (they can not prescribe medications). For this reason, I find that they are much better at talking to patients than psychiatrists who often have a tendency to pull out the prescription pad too quickly.

I do NOT want to suggest that medication may not be appropriate, however a psychologist can work with your primary care physician or a psychiatrist who would then prescribe any necessary medications.

I would also urge you to see your primary care physician to have a comprehensive physical examination and some testing. Typically this would include a blood count (CBC), thyroid studies (TSH, Free T4, Free T3) and chemistry panel at a minimum. Having this evaluation is important to exclude (or confirm) some medical cause for your symptoms.

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