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68 YEAR OLD MALE, DX Chronic Depression (Monopolar), Well

I AM A 68 YEAR...
I AM A 68 YEAR OLD MALE, DX Chronic Depression (Monopolar), Well controlled PTSD, Some kind of sleep disorder(?) Major Complaint: EXCESSIVE FATIGUE AND SLEEPINESS, every day all day. First Diagnosed with depression in 1964 - not treated until 1973. Hold BA Degree in psychology, two tours in Vietnam, worked 31 years in the Cardiac Pacemaker Business (spent all my time in surgery and cath lab). Worked 24/7 on emergency call, often worked 80 hours per week "felt driven to service my doctors and their patients". After 15 admissions for acute depressive events I was 100% disabled in 1998.
I have taken nearly all MAOI, Tricyclic,ssri, snri, and ECT Treatments. Have had a past history of stimulant abuse.
I am not severely depressed depressed at present but can not overcome feelings of fatigue and sleepiness.
Current Meds:
1) lamotrigine 150 mg per day
2) clonaxepam 1 mg per day
3) fluoxetine 20 mg per day
4) trazodone 25 mg per day
5) armodafinil (nuvigil) 250 mg per day
Do not smoke, do not use alchol, sleep study neg. for apnea
Any suggestions welcome - I WILL NOT QUOT YOU NOR WILL I ALTER TREATMENT WITHOUT PHYSICIANS APPROVAL
Richard Rendall
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Answered in 11 hours by:
12/22/2012
Camille-Mod
Category: Neurology
Satisfied Customers: 12
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Hi,

My name is ***** ***** I am the moderator for this topic. I've been working hard to find a Professional to assist you, but sometimes finding the right professional can take a little longer than expected, as the Professionals come online at varying times. I wonder whether you would like to continue waiting for an answer…hopefully it won’t take too much longer. Please let me know, and I will continue my search. If you’d prefer not to wait, please tell me, and I will cancel this question for you. Thank you!

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Customer reply replied 5 years ago

Happy to wait for answer Camille. Have a Very Merry Christmas.

Richard Rendall

Hi,

Thank you! Merry Christmas:-)….hopefully it won’t take too much longer for me to find the right Professional for you! Please don't respond to this as it may prevent the Professionals from accessing your question. If you want to cancel, please let me know, and I will do that for you. Thank you for your continued patience.

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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Neurology
Satisfied Customers: 11,667
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
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Hi. I am online and available to assist you today.
How long has this feeling of fatigue and sleepiness been going on?
I look forward to your response.
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Customer reply replied 5 years ago

It has been a problem for most of my life. I have felt driven in goal achievement all during my working years and still tend to be over giving (lack discernment) in assisting those in need. I have been treated as a psyc. patient since 1973, first for recurrent major depressive episodes (15 hospital admissions), 100% disability in 1998. At that time I was sent to another Psychiatrist who awarded me a new DX of Bipolar II. I knew at the time that was incorrect and two weeks ago I was able to prove it to the same doctor as a result of testing for a Mayo clinic study to determine genetic markers for Bipolar Disorder. I am not concerned with changes to the diagnosis since treatment is virtually the same for both. I have tried all drug classes, CBT, ECT, do have history of depression in the family.

TESTS:

1) All physical tests normal

2) DNA test for Narcolepsy negative

3) Sleep Apnea normal

Other than the time spent in college and Vietnam my entire adult life has been in the medical field - I am able to understand medical terms. I don't expect any miracle answers - just any thoughts you may have.

Merry Christmas

Richard

Richard,
Thank for you for that additional information.
As you know there is no specific test or genetic marker that can definitively rule out or rule in a diagnosis of bipolar disease.
What did your Mayo Clinic doctors have to say as far as a possible diagnosis is concerned?
Also, were the 15 hospital admissions you mention in a psychiatric ward or the general hospital? How would you say you improved (or not) following discharge?
This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
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Customer reply replied 5 years ago

Dear RickMD

I was called the following morning with a guarded response indicating I may have Bipolar NOS but they had decided not to use my test information nor my blood sample in their research for genetic markers in Bipolar Disorder. They recommended I return to my treating physician. Since I have never had a manic or hypomanic episode I am inclined to believe I have chronic refractory unipolar depression.

The 15 hospital admissions were all to the psychiatric ward. All admissions were voluntary, only one included suicide watch. After release I would continue medication as directed for a proper length of time but eventually discontinued because they were serotonin drugs. I couldn't be alert when called out at 3:00 in the morning then be ready for the 7:00 AM surgery schedual that often included seven cases often in two different cities forty miles apart. To be more specific in answer to your question, I did regain health and strength for a period of time after release but the stress of an emergency on call 80 hour work week would cause another acute episode.

I would just like to be able to stay awake, alert and enjoy life in the years I have left.

Thank you

Richard

Richard,
I am sorry to hear about all the difficulties you have been having over the decades and commend you on seeking the best care available at institutions such as the Mayo Clinic.
As you know there is a fine diagnostic line between severe unipolar depression and bipolar disease. The issues that you are experiencing with not being alert or staying awake could very well be an aspect of your underlying disease process or somethings entirely different, such as thyroid problems etc. I would think, however, that your current doctors after all this time would have checked for these other issues....
Perhaps, after all that you have been through, it is time to transfer your care over to a "super institution" such as the Mayo clinic. Not just for a very interesting research project, but for all of your daily care. As you know, at an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.
Does this make sense to you?
I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.
Thanks in advance,
Dr. Rick
Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Neurology
Satisfied Customers: 11,667
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
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Satisfied Customers: 11,667
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