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Dr. Vikas only: Dear Dr. Vikas, I really need some help and feel so stuck and hopeless. I am 45 years old. Please excuse the way I write with thoughts all over the place. I feel very disorganized. I am able to get a physiological lift and change when I overeat sweets and carbohydrate food. It interferes with my insulin resistance. I am forced to do this on an ongoing basis since my feelings are to overwhelming and frustrating and painful to deal with. I misuse food to control or medicate my moods. My depression exhausted me and my fatigue depresses me. I have no energy and no stamina. I am looking for a way to not have to go to the food for a mental lift. My concerns are that that I cannot figure out if my feelings are due to my hypothyroidism which does cause depression or hormonal fluctuations or mental illness. Sometimes I do wonder if the intensity of my thoughts moods and feelings do cycle around my monthly menstruation. They do seem to be so much worse before the monthly menstrual cycle. I have not been able to tolerate the low thyroid meds since they cause me to feel even more fatigued and foggy minded. My free T3 is 1.9 TSH 2.3 Reverse T3 is 38 Vitamin D 23 Testosterone 11 Dhea 60 My symptoms are: I cannot physically cope w/ stress at all anymore. Have social anxiety I just do not have the motivation to get out of bed and do stuff other than errands. I usually do not experience elation useless something just fantastic happens. It is usually short-lived. I cry alot and sink into a heavier depression 5 days to 1 week before my menstrual cycle It feels like I do not have emotional skin I am overly sensitive to how people respond to me and life events. I have ongoing catastrophic predictions on an ongoing basis and they are very real to me. I always believe the worst case scenario will turn out for me. I do have alot of failures and let downs. I am not paranoid just hopeless I have no friends. I am extremely lonely I have major social anxiety fearing the disapproval and judgement of others I don't seem to be able to accept my problems or stay stuck in the past problems. I have been in psycotherapy for ages and they only have been able to temporarily comfort me or support me but not take away these thoughts and feelings. I dwell on the past alot due to disturbing and traumatic experiences. I have Borderline Personality symptoms and issues. I have moods that fluctuate between low to extremely low based on events and others behaviors towards me I have extremely low self esteem No tolerence to pain Overly sensitive to everything I am hopeless about my life I spend most of my times in bed where I am comfortable and safe. I have so much trouble with mental fogginess and trouble remembering things I am unfocused I am a very negative person always worried It is hard to not have a constantly wandering mind My menstruation cycle happens between 25 and 31 days monthly 50 pounds overweight that I just can not lose. lack of energy Always craving sugar and starch Major food reactive hypoglycemia when ever I eat any kinds of carbohydrates low blood pressure dry brittle thin nails thinning hair no stamina no libido get cold easily wake up in the middle of the night frequent night urination I have been going around in circles getting nowhere. No antidepressants have either agreed or worked in me. I am always very very sensitive to even the lowest doses. I am just an overly sensitive person. Here is a list of some of the ones I can remember taking: Celexa - much more fatigued and robotic non feeling personality. helped socially Wellbutrin - incredible irritable Cymbolta - anti social, sick feeling and agitated Tofernal - sea sick feeling and dizzy constantly Neurontin - lethargic and sleep 16 hours a day Depokote - major eye stain as if I was cross eyed Ritalin - more focused but heavy depression as it was winding down Xanax - calmer but sleepy Lithium - bad headaches and did not notice much mood lift. i was on for 3 years and that was 12 years ago. I have severe stress/anxiety because everything gets to me. I notice that I no do not have the ability to handle and deal with stress. My adrenaline shoots out regularly and I get butterflys and just cannot cope with issues and problems anymore on a physiological level as well. I have taken slow release cytomel T3 and felt so much more tired. I took Amour anywhere from 1/4 to 1.5 dose and felt much more tires. Same with Natures Throid 1/4 to 1 grain and was more tired. Cannot figure out why I would be much more lethargic and tired on the hypothyroid helpers. One person put me on Isocort natural glandular adrenal support alone and I still felt more tired on it. I need something WEIGHT NEUTRAL. By body size is bothering me so much. I feel better as a thinner woman. I was thinking of maybe Prozac but it was hard to fall asleep on it. I may begin Victoza or Phentermine for weightloss. Help!
Hello ! Thank you for your question, I’m Dr. Vikas (M.D Psychiatry) and I’ll try to help you today.
On the basis of all the symptoms you have mentioned, I totally agree with you that Prozac (Fluoxetine) could be a very useful medicine in your case. It is an activating antidepressant so it can control the feeling of tiredness, lethargy, fatigue. It does not cause weight gain and in fact can cause weight loss initially in some patient because it has a side effect of causing lack of appetite.
Being an activating antidepressant, it should be taken in morning or afternoon to avoid insomnia at night. If taken during the day, it should not cause sleeping difficulty at night, but you can request your doctor to also prescribe either Ativan or Klonopin in combination with Prozac. Klonopin when taken at night will help in sleeping. It appears to me that you are also having significant anxiety symptoms and Klonopin can also help in this when taken additionally during the day time.
You can also discuss with your doctor about adding a low dose of Abilify like 5 or 7.5 mg to augment the effect of Prozac.
So to summarize, just discuss with your doctor about this treatment regime mentioned below.
Fluoxetine (Prozac) 20 mg in morning after breakfast, it can be increased to 40 mg after a week if needed by your doctor.
Clonazepam (Klonopin) .25 or .5 mg once or twice day and an extra dose if needed to control the anxiety symptoms.
Aripiprazole (Abilify) 5 or 7.5 mg in the morning.
None of these medicines mentioned above. cause weight gain
I personally don't prefer to prescribe any medicine for loosing weight. If your doctor want to prescribe you phentermine or Victoza you can discuss with him or her about them.
I hope this helps, please feel free to discuss further if you have any other query.
Were you able to read my entire message post? How do you suspect that my issues are caused by psychological reasons and not hormonal or thyroid?
What do you specifically like about the Prozac for me?
I wonder if that could help with the fact that I can barely get myself motivated to get out of bed. I feel why bother? I have to friends, no energy and am so uncomfortable when i speak to people. I am good for the first couple of minutes but then do not know what to say after light chatter so I get really uncomfortable. I feel so inferior to other people that it stresses me out when I try and connect.
Why did the Celexa help me be more social but made me so darn tired on top on my already being tired?
Did you see anything that stood out with the thyroid lab numbers that caused you to think it could all be related to that? I am more tired on the hypothyroid meds for some reason.
I was put on bioidentical Progesterone for 2 weeks due to estrogence dominance and it helped my mind and anxiety alot and made me feel I had a tougher skin but made me start gaining a lot of weight so I came off of it.
I have been in CBT/DBT therapy for years and personal coaching but what happens is all there recommendations seem great such as go do this and that and make it happen but I do not have the energy, confidence or clarity to follow through. Nobody understands this. I have the desire to improve buy I lack the mental strength or motivation and fear gets in the way.
I have been on Xanex as needed for a long time. All that does is slightly sedate me. I have not become addicted to it but it does not help me improve my situation other than turns the volume down a bit.
I have so many fears when I talk to people. I am really friendly for the first minute but cannot carry my weight after that. I just got out of a 15 year emotionally abusive relationship.
I am really struggling with rumination of all the things that I should not be dwelling on. Going over and over in my head about the episodes that occur over the years and his new partner. My mind just goings there. I even put a rubber band on my wrist to stop thought and replace need thought. Never got anywhere with that.
I remember trying Prozac out and feeling bombastic when things really angered me. Did not feel much improvement. Stayed on it for maybe a few weeks to a month. Celexa made me all of a sudden want to socialize but the sleepiness got in the way. It did numb my emotions to flat affect.
I am ashamed to say I stay home day after day in my bed and am missing out on the world and human realtions but just do not know how to properly make things happen. I am scared and feel uncomfortable alone.
Will you please not use the chat format. It is too hard to work with on my smart phone.
Thanks for your reply. Depression and anxiety symptoms are very commonly reported by patients suffering from various medical illness including any hormonal / thyroid illness. In such cases, antidepressants and anti anxiety medicines are frequently used to control these symptoms. Treatment part remains the same whether the symptoms are due to psychological reason or any other reason.
Prozac being an activating antidepressant will not aggravate symptoms like tiredness, fatigue etc. Usually these symptoms are aggravated by sedating antidepressants. Celexa can cause sedation as a side effect in some patients and may be that is why your felt tired after taking it.
In your case, another activating antidepressant Bupropion (Wellbutrin) can also help in controlling your current symptoms. It is also not sedative and does not cause weight gain too.
Xanax is Alprazolam which is a short acting benzodiazepine while Klonopin is a long acting benzodiazepine which can effectively control your anxiety symptoms for much longer duration.
I had a very bad reaction to Wellbutrin. Extreme agitation occured on even the lowest dose. It was awful.
Could antidepressants actually make me feel like getting out of bed?
Could they help me be unfraid to speak to people?
I have bad social anxiety!
I feel hopeless and that my life is not going to be able to get better. Is this depression or am I just useless and doomed?
I do not see how life could ever get better for me since I am defective it seems.
I am concerned because I saw that others on the internet had reported great weight gain on Prozac and a slowed metabolism ans increased appetite. Is this really likely for me?
How long until Prozac kicks in?
How can you tell if it is just situational or if the depression is just brain imbalance and no matter the situation one is still miserable?
I am known as a person who worries about everything, stresses out and has a negative spin on everything. I had a very traumtic past and have never been able to move on.
Could I get improvement from the Prozac for this stuff?
Since I am extra sensitive to meds, do you recommend beginning Prozac alone or can I use the Xanax that I currently have on my shelve along with it?
Does Prozac curb any anxiety?
Why would i need the extra anti anxiety med alongside Prozac?
Do you disagreed with the pharmacist I spoke to who said all ssri's tend to cause fatique/sedation? She said Prozac is just as sedating as Celexa.
Would it help duplicate the sense of comfort, ease and satisfaction I feel when I eat high carbohydrate foods where I get a mood lift?
Do you think there are any mood lifting and fatique fighting benefits to Provigal? Do you like it all all.
Bless you doctor.
HelloXXXXXXXX, XXXXXXXX :) How can you tell if it is just situational or if the depression is just brain imbalance and no matter the situation one is still miserable? - - It does not matter much because the treatment part is going to be the same in both the above mentioned condition. I am known as a person who worries about everything, stresses out and has a negative spin on everything. I had a very traumtic past and have never been able to move on. Could I get improvement from the Prozac for this stuff? Does Prozac curb any anxiety?- - Answer is YES, PROZAC is a very effective antidepressant and antianxiety medicine. It is also the preferred medicine for ruminations. Why would i need the extra anti anxiety med alongside Prozac?-- All SSRI antidepressants including Prozac can initially worsen the anxiety symptoms as a side effect which is usually transient. We usually add an benzodiazepine like Xanax or Klonopin to control these anxiety symptoms. Klonopoin has a longer duration of action in comparison to Xanax and therefore can control your symptoms for much longer duration. Do you disagreed with the pharmacist I spoke to who said all ssri's tend to cause fatique/sedation? She said Prozac is just as sedating as Celexa.--- Yes, I disagree with your pharmacist here. I don't think that Prozac is a sedating antidepressant. Would it help duplicate the sense of comfort, ease and satisfaction I feel when I eat high carbohydrate foods where I get a mood lift?-- In my view, it should help in this. Do you think there are any mood lifting and fatique fighting benefits to Provigal? Do you like it all all.-- Provigil can be a useful medicine in patients complaining of fatigue, excessive sleepiness, tiredness. It can be used in combination with PROZAC for best results.
I need to know what you think of Lexapro?
My doctor today had mentioned in the past that I was irritable on Prozac. That was several years ago.
Does low dose Lexapro cause weight gain or fatique?
What does it help with in regards XXXXX XXXXX symptoms?
My gut still says retry the Prozac since several years have past. I have a new script.
Is it hard to get off Prozac if need be?
How do you get off of it properly?
You are the best!!!