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What Causes Chronic Fatigue, Depression, Hypersomnia And OCD In A Teenager?

Posted on Tue, 5 Jul 2016

Question: My son is very depressed and has anxiety issues. His doctor has tried zoloff, Prozac and is now on Effexor. Each one makes him feel worse or angry. He was diagnosised with acute social anxiety and highly functioning OCD. None of the antidepressions work. I took him to my plastic surgeon recently for a skin peel on acne and he said it was not acne but XXXXXXX producing to much cortisol. That leads to depression he said. My son is so unhappy because he feels like he is different. He is 17 and doesn't even want to drive. He told me two years ago he was XXXXXXX but I am the only one who knows (I told his dr's privately). I don't have any medical records on him because I adopted him from Russia 16 1/2 years ago and they didn't have any medical records. I have tried many doctors in the last 3 years but nothing helps. He has chronic fatigue and sleeps every hour he is not in school. He may get up a couple of hours on Sat and Sun. I love him so much and I wish he could be as proud of himself as I am of him. Can you help? New info, I have taken him to the hospital for a cortisol test of blood an urine. I won't find out for a week. What do they do, if he is body is making to much and doesn't have a growth on his paturitary gland. He is so unhappy, please tell me there is something that can help him.

IN YOUR EMAIL TO ME YOU SAID MY EMAIL WAS ON YOUR PUBLIC FORUM. I DO NOT WANT TO BE ON ANYTHING PUBLIC. WHEN I SEE MY DOCTOR NOTHING IS PUBLIC. PLEASE RESPOND IMMEDIATELY ADDRESSING THIS CONCERN!

Answered by Dr. Binu Parameswaran Pillai (21 minutes later)

Brief Answer:
Cushing's syndrome to be ruled out

Detailed Answer:
Good day .
Sorry to hear about your son's symptoms. From the history you provided, it seems that your son may have cushing's syndrome where body is producing too much cortisol. In this condition, body produces too much cortisol and that can lead to pumple, mood changes, altered thinking and behaviour, weight gain etc. It is important to do a 24 hour urine cortisol test to evaluate further. Till you get reports, please stay calm . Major depressive disorders sometimes can mimic Cushing's syndrome and it is important to rule out this.

You may also consider taking him to a psychologist for counselling. Once you get the blood and urine test results, please write back with reports. In the interim, please ask him gently if he ever used any over the counter drugs or steroids ?
regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (36 hours later)

Good morning Dr. Pillai! Thank you for answering my question so quickly. We returned the 24 hour urine test today, so we should hear something soon. I have taken him to many psychologists for counciling but nothing seems to help. Last night he had a terrible headache, could that be a symptom. He is currently taking Effexor, Busbar, Ambian and advil. He exhibits all of the signs. If it is Cushing, how is it treated?

Answered by Dr. Binu Parameswaran Pillai (11 hours later)

Brief Answer:
Cushnigs's treatment.

Detailed Answer:
Thank you for the reply. It may take few days for the report of Urine tests to come back. Depression and Cushings syndrome can mimic each other. Besides, people with cushing's syndrome can have depression as a main feature.

Headache may be a symptom of cushing's syndrome occasionally. The treatment depends on the cause of cushings syndrome. Most often this is due to a small swelling in pituitary gland which has to be surgically removed. Occasionally cushimgs can be due to a swelling elsewhere in the body including from adrenal gland. If surgery fails or if the cause can not be detected, then medicines can be used.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (36 hours later)

His doctor wants him to see a special psychologist and I will make appointment tomorrow. We should hear any day about the blood and urine test. I will let you know as soon as I know. thanks XXXXXXX

Answered by Dr. Binu Parameswaran Pillai (36 hours later)

Brief Answer:
OKAY.

Detailed Answer:
sure. once the results are ready please let me know.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (5 days later)

Hi Doctor. Good news for me but my son doesn't think so. His blood and urine came back normal. He is upset because he is still so tired all of the time, has the acne cysts on his back, feels mean and unhappy all of the time, wants to stay in bad and not talk to anyone. He has tried to hard to lose weight and is very thin in arms and legs but retains the fat on belly and hips(hip bone). He can not concentrate because he is tired and not interested in anything or anybody. He is so unhappy. When I try to talk to him he snaps or tries to find fault with what I said so he can get mad. What else could it be?

Answered by Dr. Binu Parameswaran Pillai (29 hours later)

Brief Answer:
CUSHINGS + DEPRESSION

Detailed Answer:
sorry for the delay. We can't rule out Cushings with a single test. sometimes we may have to run the tests again
there is an entity called as Cyclical Cushings and another one called as Subclinical Cushings. Both are difficult to diagnose. discuss with your doc.If Cushings is ruled out, we have to consider depression as a strong possibility. have you ever taken him for counseling?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (48 hours later)

YES I HAVE TAKEN HIM FOR COUNSELING FOR MONTHS TO 5 DIFFERENT COUNSELORS. I AM TAKING HIM TUESDAY TO A PSYCHARIST TEAM FOR EVALUATION. I WILL LET YOU KNOW. THANKS, XXXXXXX

Answered by Dr. Binu Parameswaran Pillai (2 days later)

Brief Answer:
Best wishes

Detailed Answer:
I hope he will be okay soon.Constant encouragement and counsellig will help him

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (8 days later)

I HAD TO CANCEL HIS APPOINTMENT TUES AND NOW I HAVE TO MAKE ANOTHER ONE. I HAD TO TRAVEL 5 HOURS AWAY AND MOVE MY DAUGHTER HERE. SHE IS VERY SICK AND WE CANNOT FIND THE PROBLEM. SHE HAS HAD NUMEROUS TESTS BUT THE PAIN IS IN HER STOMACH. HER EPSTEIN BAR IS 6,000 AND HAS BEEN 8,500. WHAT COULD BE WRONG WITH HER...

Answered by Dr. Binu Parameswaran Pillai (27 hours later)

Brief Answer:
Abdominal pain

Detailed Answer:
Oh that is very sad to hear. I hope the doctors did tests to rule out an urinary infection and a kidney stone which are comoom causes of abdominal pain. Has she had a scan?
Any fever/vomiting/change in bowel habits?

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar