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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for severe fatigue

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3430 Questions

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Posted on Tue, 28 Mar 2017 in Brain and Spine
Question: I am a registered nurse and I am trying to find some relief for my daughter. She is having an increasing difficult time with panic attacks which often interfere with her daily life, I just recently discovered that she has undiagnosed periodic limb movement (jerking) during sleep. She tells me she also has quite a bit of fatigue. Need some ideas on treatment or type of physician to take her to. Neurologist vs. Sleep Clinic etc...?
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Answered by Dr. Olsi Taka 2 hours later
Brief Answer:
Should go directly to sleep clinic.

Detailed Answer:
I read your question carefully and I understand your concern.

That description you provide seems typical for what is called periodic limb movement disorder (PLMD) as you yourself say. It may explain the daytime fatigue she is feeling which could be due to the low quality of sleep. It is a benign condition so shouldn't be alarmed.

As for where to go next I would go to a sleep clinic as you seem to have already done the routine blood tests advised to check for possible causes (like anemia) and now the remaining test to confirm the diagnosis would be a polysomnography test.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Olsi Taka 2 days later
What about the panic attacks? They are most times fairly severe and sometimes limits her choices of what she feels like she is able to do. Do you think her current treatment is appropriate or are there other treatment options available for us to try?
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Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Read below

Detailed Answer:
Zoloft is an SSRI class antidepressant. In terms of suitability yes, SSRIs are among the most used drugs for the treatment of panic disorders, I do not see anything wrong with that, SSRIs are considered first choice. If a 12 week course is seen not to be effective then tricyclic antidepressants like imipramine or clomipramine may be tried instead.
However remember that medication is only one side of management, it is at least as important to undergo psychotherapy as well. Cognitive-behavioral psychotherapy is a vital part of management and it goes without saying that it has no side effects. Usually it is tried first before starting medication.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Prasad
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