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Ask Dr Ted Manos Your Own Question
Dr Ted Manos
Dr Ted Manos, Doctor (MD)
Category: Mental Health
Satisfied Customers: 726
Experience:  Self employed 40 years experience Ob-Gyn
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From New Zealand I am a 55 yr old male and have been

Customer Question

Hi from New ZealandI am a 55 yr old male and have been struggling with Depression and anxiety for around 17 years now and have never really found a sustainable medication regime that i have felt satisfied with.My latest issue is high levels of anxiety and severe fatigue in the mornings which tends to pass around the middle of the day or early afternoons with energy levels picking up and anxiety decreasing considerably. The pattern repeats each day with my ability to handle stress very much decreased in the mornings.I was originally diagnosed years ago with PTSD after a long and extremely painful battle with a rare CNS disorder which develops schwannoma's inside my spinal cord. For a couple of years I was in excruciating pain over a major portion of my body as a tumor completely blocked my spinal cord and was intertwined with all the nerves feeding my lower body ( waist down). Before being finally diagnosed after the introduction of MRI's, I nearly died as a result of things eventually shutting down and the onset of severe pneumonia. Luckily I received successful neurosurgery and eventually recovered.
My mental health issues started around 5 years later with the return of the physical symptoms and an unexpected battle with doctors to be re-diagnosed as supposedly my prior condition was never meant to return. I completely freaked out and developed severe insomnia and depression and this stuck with me even after my fears were proven correct and I had my second round of neurosurgery.
My major symptom (apart from insomnia) at that time was a high level of rumination of intrusive thoughts mainly the fear of going crazy. I just couldn't stop asking myself the "what if" questions and had incredible feelings of guilt and withdrew from most social activities. I was put on Epilim and spent the next 10 years in a state of emotionless existence until I finally broke free of this mind freezing drug with the help of a G.P.
I went onto Fluoxetine for a few years but again with limited success. In the next few years I was tried on a variety of ssri's etc but nothing seemed to lift the depression until I hit on
a combination of Venlafaxine and Zyban (wellbutrin) and apart from morning zonkiness and brain fog I was relatively ok.
Not being happy with this and in an attempt to prove the cause of the morning brain fog I decided to withdraw from the Zyban first and when that didn't work I took myself off the venlafaxine over a couple of weeks but unfortunately developed severe withdrawal anxiety within a week of stopping, which was a new and scary experience for me.
Severe morning anxiety and a return of OCD style intrusive thought patterns which I had not had for many years. I was put back on venlafaxine but it didn't help much and Moclobemide was added and unfortunately I developed serotonin syndrome and this had to be stopped. It was at this stage the morning fatigue became severe and I have had to force myself out of bed and into work. The anxiety has been severe in the mornings and definitely seems to be linked to the feelings of being unwell which have hung with me for the last few months. When I feel unwell my anxiety wreaks havoc. When I feel good - No anxiety!!!
I have been on venlafaxine (150) by itself for the last 3 months and am slowly getting worse. My psych finally greed to a new regime today of Lepraxo and nortriptyline and I was seeking your recommendation for this combination.
Also what could be causing the severe morning fatigue. I have a number of other conditions which coincide with this but find no one wants to consider their potential contribution to the fatigue once they know I have depressive ilness.
I have secondary hypogonadism which has been treated with Reandron however I have also developed polycythemia and am about to move to Testosterone patches. I also have blood and protein in my urine with no known cause.
Any advice appreciated.
Thankyou.
Submitted: 27 days ago.
Category: Mental Health
Customer: replied 26 days ago.
just for good measure - I also have an Occluded right vertebral artery, an undefined pancreatic cyst and a 13mm splenic artery aneurysm so overall pretty damn healthy!!!!
Customer: replied 26 days ago.
not to mention my latest claim to fame - Sleep apnea. I had hoped this could be my issue but 6 weeks on an apap machine hasn't helped the morning fatigue as hoped.
Customer: replied 26 days ago.
Was i meant to get an answer in 24hours as its way past that????
Expert:  Dr Ted Manos replied 25 days ago.
Hello,and thank you for choosing Justanswer about your concern. I'm Dr Ted Manos M.D. and I can respond shortly.
Expert:  Dr Ted Manos replied 25 days ago.
After years of addressing the health needs of patients, I have seen the difficulties you describe, and only recently have found valuable information that helps. Depression exists for us when the past has been marked by regret we know we live with, and some regrets we don't know can influence the present. Anxiety is a fear of the future that can be exacerbated by choices from the past. It's hard to look at the future while carrying the baggage from the past. The only thing we can transform for our life rests in the present. When you sleep, if the regrets are running in our minds and waking up drains us from anxiety the we are fatigued. Fortunately, you find energy after the morning as you focus on today. I suggest you clean up any incomplete relationships from the past and trust you can make your future more powerful than you fear you can. Different medications don't help the mechanics of what I'm referring to, it just helps numb our minds.
Customer: replied 22 days ago.
I'm sorry I was hoping for an opinion on the medical regime and program I have been placed on.
While I agree with the basis of your answer I have read similar comments on many public forums and it is all a little too holistic for my liking and extremely over simplified.