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Sarah
Sarah, Psychologist
Category: Mental Health
Satisfied Customers: 143
Experience:  Chart'd Psych, 12 yrs exp. English prisons, Clinical Hypnotherapist, EMDR Therapist, BPS, HPC reg'd.
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Perfer an answer from someone with a deep understanding psychopharmacology.

Resolved Question:

Perfer an answer from someone with a deep understanding psychopharmacology. Ill start with the problem then bullet the history.
Problem: FATUIGUE resitant depression
#1: Current meds: 150 zoloft 1-3 clonazapam for anxiety/assitance in getting to sleep #3ModAlert(I buy from india cause i cant afford american prices) I think it is provigil...this med has done the most for me.
#4: D3/calcium/b12 subq injections (post bariatric)/meta..oh hell...some kinda beta blocker/occasional trazadone, but usually once alseep i stay asleep. Sleep habits always erratic..currently more normalized hours, but hypersomnic.

Getting pretty desparate here. I HAVE A FABULOUS NURSEPRACTICIONER/PSYCHOLOGIST i have seen for >20years. Just looking for more answers. Signed up at a site to see if I might qualify for DBS study in the future.

There are no words in the English language that could describe how desparate I am for energy. I write here to just see if any one else has new ideas

Hx: Live long functional depression (retired-paramedic..worked allmy life) - Married 32 years - 2 great kids and 2 fab grandchildren...(rule out bi polar would ya :PP )
9 years ago my mother chose to shoot herself in the head...very effective
8 years ago i tried to die twice on the table 2ndary to the bariataric surgery..(dying of blood loss if you KNOW what is going on is not a smooth exit, btw)
7 years ago huge insult to my ego and how i view myself (long story)
Before these events I lead a BLESSED live ... no one ever died..and nothing ever bad happened.
Childhood: Only child - Parents remained married until my mother's suicide. Abused? Perhaps verbally, but i know how memories can twist around on themselves so i dont trust every thing i remember. Over all was included in all familiy activities and never "neglected". IQ = 130 ...dont know what else would help you..
ANY IDEAS?? any cutting edge...oooh predilection to Vicodin (i stay away unless omeone has ONE or TWO to give me..i don't "drug seek", and also HATE alcohol..so not an issue there :PP....Smoke, quit for 15 years..picked it back up...dumb...It will go someday too..just not enough energy to fight that now...hmm again need CUTTING EDGE, NEW IDEA AND GOD DAMN I NEED SOME ENERGY I have great ideas/plans/but no follow through or energy to act.
Submitted: 4 years ago.
Category: Mental Health
Expert:  Fabio Goderecci replied 4 years ago.
Hello and thank you for your question to JA. Could you please give more info about this: when you say "lack of energy" do you refer to a situation where you really feel that you lack totally of strength doing things or is this connected also with a painful sense of depressed mood, anxiety, being agitated. Do you have negative thought patterns connected with the lack of energy like thinking all the time negative things, death and so on? I need to get a better understanding of your symptoms first. Also could you please tell has your physical condition checked by extensive medical and laboratory evaluation and if so what was checked (for example blood tests analysis prescribed and results) Thanks.
Customer: replied 4 years ago.
Usually my lack of energy is just that. Usually framed around a decent mind set. Sometimes, however, the feeling of uselessness, hopelessness and all that crap creeps in. Yes anxiety has been a factor in the past. I have not had a "huge" anxiety attack in probably 3 years or so, but do often get generalilzed anxieety that i call the "creepy crawlers". The huge ones were so indescribable, that all I could do was lay on the couch, take a clonazapam, and wait for it to pas...i was frozen...then afterwards sleep was very much like a post ictal state (spelling!) that i have seen in seizure patients, however, i have never had siezure problems and these Huge attacks began aftermy motheres suicide. Asi reread your question, i would have to say Yes, that the lack of energy is usually associated with a depressed mood, not always anxiety, my anxiety usually hits me when ive beenn away from the house for more than 3 or 4 hours , agitated...humm i find the word aagitated almost synonomus with my anxiety. Negataive thought patterns yes, but i externalize the voice...like if i hear "you are always useless" i counter the though (or try to when i have the strength) with now are you "always" useless..etc..I have used my intellect and logic to try and think my way out of those type of though patterns, but yes they do exisit. If I were to select the most promenent one is that I want to feel USEFUL and in a depressed, exhausted state I'm little use to anyone, an not just in the internal voice way, but in a real jworld way. I am a "helper". I do have suicidal thoughts, my mother and grandmother commited suicide. I have never made a "plan"...oh my plan is..if you want to die bad enough you can lay your ass on the couch and starve yourself to death..if you cant do that you dont want to die bad enough :-)...the pain that my mothers suicide has inflicted upon me makes it an impossible choice as my children are more important to me than i can express and my son would be extremely damaged should i make such a foolish choice. I have a good doc. My nmother had graves disease so my thyroid is checked often..my b12 becuse of the bariatric is check and general blood work (im over due :PP)...Personally i have had my testosterone checked and im at the bottom of normal but i can get NO ONE to let me use it or prescribe it though i would like to try it. 2 years ago i was in "moderate kidney failure"..i followed the low oxilate diet like a religion..then POOF teh incurrable condition went away...now im eating more normally, but hagve not had the needed blood work done..yes im over due..i have the orders, just need the energy and motivation :-). Other than that I am addictive personality, current addictions are computer games and cigarettes...vicodin is dangerorus for me but I only take one or two a month when i can sneek one from someone :PP. I have looked into the price from Mexico but was not attracted to the drug enough to pay those kinda price !!! LOL....I have been anemic in the past and im not perfect at taking meds..used to be perfect...but lately not so much..top goal right now...so anemia is an outside possibility, but usally when anemic im not THIS LETHARGIC. My official diagnosis is Major Depressive/PTSD I think....um what else...two c-sections and tonsil out at age 7 (joking)...thats about it...oooh mersa carrier (spelled that wrong too.you know the infection that is hard to get rid of). I read everything i can get my hands on. Im always looking for answers. I always try to think that the answer is just around the corner. Winters are worse for me than summers (exceept this one ... ) i have a full spectrum light but notusing itnow..wasnt sure it did much good anyway. thinking....your statment "lack totally of strength doingthings" is vewry accurate. Im more awake from about 9pm to 3am, but those are useless hours for the rest of the world. I just typed..i can write decently so please excuse all the errors both gramatical and spelling, but just dont have the energy to proof it :PP...Thanks for writing sir. ... Pam
Expert:  Fabio Goderecci replied 4 years ago.
Hello and thank you for your further info. Let´s go step by step discussing one thing at once. Let´s start with anxiety. One of the nastiest symptoms of PTSD is exactly severe anxiety. Could you please tell first how old were you when your mother committed suicide and were you seeing the suicide happening or if not which are your memories of what was told to you. Also please tell did you receive any treatment (psychotherapy, clinical treatment) after mother´s suicide. Also could you please tell the dose of clonazepam you are using and do you use it "at need" or do you use it every day and with a dose which is always the same for example 0,5mg x 3 a day. Thanks
Customer: replied 4 years ago.
Mothers suicide. Very wierd...no warning. Was at the shop. My husband answered theh phone (and i do not believe in esp and crap, but sometimes...). When he hung up I immediately asked him did my mother kill herself..have no idea why that came to me. Went to house. My father found her. I declined to see the body. It was about 9 years ago..so i was about waht 45ish. I have seen Susan (she is a nursepracticioner/psychologist...so she can prescribe and for me she walks on water) for about 20 years for mild depression and then there was a gap where she went to New Zealand for about a year. As best I remember I had her support after my mother's suicide. Susan would like me to take the clonazapam twice a day. I have resisted. I use it when I want to. I want to when #1: I get the creepys (mild agitated anxiety) or when I want to get to sleep at a time that is conisdered sane by normal standards. I am dosed at (2) 1 mg tabs a day and usuallly have left overs each month, this month is going to be an exception....a rare exception. Even writing about the suicide is disturbing, you would think that after almost a decade it would be easier. Also i just thought of something...like 2 -3 times a year I have something OUT OF THE BLUE hit me (like seeing her bedspread) (but NOT opening her china and putting it in the cupboard) that completely wastes me into a molten blob of hysteria. Also, forgot this, but husband of 32 years left for about 1 1/2 years...way way to comcplicated to explain, but most recently had a circumstance that had the flavor of why he left and I came completely apart. We have been back together for about 4 years now :-). So I guess it is germain for you to know that there are still "triggers" that throw me back into some mess that I had experienced. They are not forseeable...they are horrid...and they are thankfully rare. I can live with them. The fatigue is my most life-limiting issue. Thank you again for taking your time. Also if you want we can postpone this discussion further and I can actually go and get the damned blood work done :-)....My mother was cremated within 24 hours of her death (we are practical people) it avoids costs of imbalming. Why the hell i knew she killed her self when there were no threats or other overt signs ill never know. She was in desparate pain and a very ill woman. Another long story, but as a paramedic and life-long depressive you can be assured that I did everything in my power to assist her. Her suicide note to me began "PAM I AM NOT DEPRESSED" and then went on to complain about my father. (who is a great guy) The note for my father wa so hideous that my husband had the coronor take it and neither he nor I have ever read it..nor do i care to. ... anything else :-) All lthe best to you and yours Pam
Expert:  Fabio Goderecci replied 4 years ago.
Hello thank you for your further info. Yes there are all the signs of a post traumatic stress disorder which became chronic. The clonazepam as a medicine is better for panic attacks. Usually the anxiety connected with PTSD is more of the generalized anxiety type. I would say in your case better we go forward step by step. One thing you can try (if not tried, yet) is to switch the clonazepam to lorazepam The dose should be at least 1mg x 3 x day and can be raised at need. I would suggest you should be treated with a dose of lorazepam effective enough to take ALL the symptoms of anxiety away for longer time instead of using the medicine on at need basis. I would also suggest to switch to paroxetine from zoloft. Paroxetine is quite good in PTSD. The dose could be raised from 20mg x day slowly at 40mg day and even 60mg which is the maximum. I would suggest you to be treated with not more than one antidepressant and one medicine for anxiety so that it is easier to detect to which you respond and which not. It seems to me that you did not recover from the emotional traumatic effect of the events and that you would need a psychotherapy with a therapist specialized in treating PTSD. Almost probably the traumatic situation keeps the depression on by making the process of grief impossible to you. When with therapy will be possible to start the process of grief in the proper way the depression will go away, too.

Edited by Fabio Goderecci on 8/14/2010 at 2:20 PM EST
Customer: replied 4 years ago.
I certainlyappreciate all of the due care you have taken. The idea of psycotherapy is not all that attractive to me, but if i get engery id jump through a flaming hoop. Just writing about it is draining so i cant imagine waht it would be to talk about it...UGH. Susan did mention, when i had the melt down about the bedspread that I had not yet "grieved". Please know that I will take your advice to heart and discuss them with Susan. So no miricle DBS - or other "wake up" therabpy huh? How sad :-) Just waiting for a reply about any new treatments for fattigue and i shall accept all of your great work. And again, thank you for your time, and energy.
Expert:  Sarah replied 4 years ago.
Hi Pam,

You could try finding out more about EMDR, eye movement desensitisation and reprocessing, a trauma therapy here you don't have to talk about your trauma, you let the thoughts run through your head whilst your therapist encourages bilateral stimulation of the brain by tapping or eye movements. Have a look at www.emdria.com for more info and a therapist local to you. Best Wishes, Sarah. Don't pay me, pay Fabio for his hard work.

Edited by Sarah on 8/14/2010 at 10:01 PM EST
Sarah, Psychologist
Category: Mental Health
Satisfied Customers: 143
Experience: Chart'd Psych, 12 yrs exp. English prisons, Clinical Hypnotherapist, EMDR Therapist, BPS, HPC reg'd.
Sarah and 3 other Mental Health Specialists are ready to help you
Expert:  Fabio Goderecci replied 4 years ago.
Thanks Sara, EMDR is a very good technique for his problem. See treatment with psycho drugs is not in conflict with psychotherapy. There is increasingly evidence that psychotherapy affects the brain as well. Several studies ( for more info google Glen Gabbard, M.D. for example) increasingly show that psychotherapy when well done affects the brain just like drugs do. This difference between "psychological" and "biological" actually basing on what neuroscience increasingly demonstrates NEVER existed in reality. So basically what happens to your brain which causes this unbearable pain of yours is that it goes back again and again to "solve" the trauma in the past. The pain can be treated with drugs and the trauma with therapy and both support each other. So I would say try first to switch from clonazepam to lorazepam and at the same time try EMDR and then come with more questions at need. Thanks

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