Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Stiffness In Body, Fatigue And Lack Of Motivation
Question: Sir
I am a very bright and topper student with excellent memory and confident attitude throughout my academics till the age of 18.After that I started developing headaches(may be because of study stress to become topper or tension) but I never bother to take any medication and used to tolerate those constant headaches and stiffness in neck (mostly tic sounds in moving neck), slowly developed the habit of pulling hair etc out of stress.Suddently
One fine morning I experienced severe Major Depressive episode in 1994 while I was doing my PG in engineering.With complete numbness in brain,mental fog,loss of steadiness in walking,complete loss of short term memory and lack of emotions,motivation,empty mindness,,severe day and night sleepiness .I contacted a Psychiatrist at XXXXXXX and I was prescribed Flunil 20 mg and then increased to 4o mg for almost one year.Eventhough there is slight improvement in my day to day functioning ut I never come back to normalcy wrt motivation, short term memory issues,severe body fatigue and constant feeling of dull mood.I continued Flunil medication for 1 year and tapered and I again got mild depressive feelings in between though not as severe as initial one and I continued to take Flunil 40 and Evion 400 for almost 15 years.3 months back I visited a doctor and he advised VenizXR 150 mg along with existing medication.What I noticed is experiencing worse symptoms than earlier when I was on Flunil 40 mg alone.
Currently I am taking
40 mg Flunil after breakfast
150 Veniz XR after lunch
40 mg Agomelatin(Noveltin) and Lonazep 0.5 mg at Night
Agomelatin is fine except few digestive issues , where as I never got any positive mood lift because of Veniz XR 150,infact I got more depressive feeling.
My current and long standing problems are
1- Lack of freshness , lot of stifness in the body and lack of energyand positive mood in the morning after waking up
2-Dull and low mood,fatigue and lack of motivation
(Never had any manic or bipolar symptoms)
3-Very poor short term memory , where as I used to have very sharp memory before depressive episode.
4-Night sleeps are still disturbed with sleep talking /shouting /dreams and legs,arm and body jerks (my partner observes mostly) etc,recently added risperidone 0.25mg at Night but I did niot start so far.Considering my Fatiogue,memory related and constant dull mood issues over a peroid od 20 plus years kndly suggest proper medication and dosage.
I am a very bright and topper student with excellent memory and confident attitude throughout my academics till the age of 18.After that I started developing headaches(may be because of study stress to become topper or tension) but I never bother to take any medication and used to tolerate those constant headaches and stiffness in neck (mostly tic sounds in moving neck), slowly developed the habit of pulling hair etc out of stress.Suddently
One fine morning I experienced severe Major Depressive episode in 1994 while I was doing my PG in engineering.With complete numbness in brain,mental fog,loss of steadiness in walking,complete loss of short term memory and lack of emotions,motivation,empty mindness,,severe day and night sleepiness .I contacted a Psychiatrist at XXXXXXX and I was prescribed Flunil 20 mg and then increased to 4o mg for almost one year.Eventhough there is slight improvement in my day to day functioning ut I never come back to normalcy wrt motivation, short term memory issues,severe body fatigue and constant feeling of dull mood.I continued Flunil medication for 1 year and tapered and I again got mild depressive feelings in between though not as severe as initial one and I continued to take Flunil 40 and Evion 400 for almost 15 years.3 months back I visited a doctor and he advised VenizXR 150 mg along with existing medication.What I noticed is experiencing worse symptoms than earlier when I was on Flunil 40 mg alone.
Currently I am taking
40 mg Flunil after breakfast
150 Veniz XR after lunch
40 mg Agomelatin(Noveltin) and Lonazep 0.5 mg at Night
Agomelatin is fine except few digestive issues , where as I never got any positive mood lift because of Veniz XR 150,infact I got more depressive feeling.
My current and long standing problems are
1- Lack of freshness , lot of stifness in the body and lack of energyand positive mood in the morning after waking up
2-Dull and low mood,fatigue and lack of motivation
(Never had any manic or bipolar symptoms)
3-Very poor short term memory , where as I used to have very sharp memory before depressive episode.
4-Night sleeps are still disturbed with sleep talking /shouting /dreams and legs,arm and body jerks (my partner observes mostly) etc,recently added risperidone 0.25mg at Night but I did niot start so far.Considering my Fatiogue,memory related and constant dull mood issues over a peroid od 20 plus years kndly suggest proper medication and dosage.
Brief Answer:
Dose adjustments with supplements will help in early recovery.
Detailed Answer:
Hello thanks for asking from HCM for your health related queries
I have read the query and I can understand your concern. As evident from the history also that you have psychiatric disorder of Depressive spectrum. A lot of individuals with depression have associated anxiety also. This is the reason under influence of stress you used to pluck hair. Your current medicines are-
-Veniz XR 150 which is Venlafaxine a SNRI drug
-Flunil 40 or Fluoxetine a SSRI drug
-Agomelatin 40 which is a melatonin agonist drug and Clonazeapm a Benzodiazepine drug.
If we consider the prescription then you are taking three different anti-depressants. Your symptoms are chronic and this is the probable reason the doctor has prescribed two different serotonergic antidepressants. In my opinion increasing the dose of Flunil should have worked because addition of Veniz is not resulting in improvement. Increasing the dose to 60 mg and if needed to add some augmentation agent like Bupropion or Buspirone can help. Continue to take Agomelatin and Clonazepam as your prescription.
Your main issues are negative symptoms of depression like lack of freshness, chronic fatigue like stage, low mood, lack of motivation, aching body, forgetfulness, disturbed sleep. Forgetfulness occurs in depression because of lack of concentration and focus.
For these symptoms SNRIs are drugs of choice but as addition of Veniz is not working so we have to rely on SSRIs like Fluoxetine only. For persisting negative symptoms low dose anti psychotics can help like Amisulpiride or even Risperidone also. Amisulpiride can help in reducing the negative symptoms and also result in increased anti depressant effects. You can think of this drug along with Fluoxetine. The drug has high efficacy in patients of poor response. The symptoms like aching body, fatigue, lack of freshness, lack of positive mood, lack of motivation will show best response to this medicine.
Apart from this I'd also advise you to augment your therapy by taking supplements containing Vitamin B12 (Methylcobalamine 1500-3000 mcg per day), Folic acid (about 5 mg per day) and Omega Fatty Acids. These supplements will increase the efficacy of anti depressants and will also improve the symptoms like poor focus, tiredness, chronic fatigue.
So just to sum up- Don't remain distressed due to your symptoms. Most of individuals with depression show improvement with medicine. Increasing the dose of Fluoxetine to about 60 mg per day, tapering the dose of Venlafaxine, addition of low dose anti psychotics like Amisulpiride and addition of nutritional supplements will help in quick improvement. Please talk to your psychiatrist for change in prescription.
Thanks, Hope this helps you. Take care.
Please don't hesitate to ask again for more doubts.
Dose adjustments with supplements will help in early recovery.
Detailed Answer:
Hello thanks for asking from HCM for your health related queries
I have read the query and I can understand your concern. As evident from the history also that you have psychiatric disorder of Depressive spectrum. A lot of individuals with depression have associated anxiety also. This is the reason under influence of stress you used to pluck hair. Your current medicines are-
-Veniz XR 150 which is Venlafaxine a SNRI drug
-Flunil 40 or Fluoxetine a SSRI drug
-Agomelatin 40 which is a melatonin agonist drug and Clonazeapm a Benzodiazepine drug.
If we consider the prescription then you are taking three different anti-depressants. Your symptoms are chronic and this is the probable reason the doctor has prescribed two different serotonergic antidepressants. In my opinion increasing the dose of Flunil should have worked because addition of Veniz is not resulting in improvement. Increasing the dose to 60 mg and if needed to add some augmentation agent like Bupropion or Buspirone can help. Continue to take Agomelatin and Clonazepam as your prescription.
Your main issues are negative symptoms of depression like lack of freshness, chronic fatigue like stage, low mood, lack of motivation, aching body, forgetfulness, disturbed sleep. Forgetfulness occurs in depression because of lack of concentration and focus.
For these symptoms SNRIs are drugs of choice but as addition of Veniz is not working so we have to rely on SSRIs like Fluoxetine only. For persisting negative symptoms low dose anti psychotics can help like Amisulpiride or even Risperidone also. Amisulpiride can help in reducing the negative symptoms and also result in increased anti depressant effects. You can think of this drug along with Fluoxetine. The drug has high efficacy in patients of poor response. The symptoms like aching body, fatigue, lack of freshness, lack of positive mood, lack of motivation will show best response to this medicine.
Apart from this I'd also advise you to augment your therapy by taking supplements containing Vitamin B12 (Methylcobalamine 1500-3000 mcg per day), Folic acid (about 5 mg per day) and Omega Fatty Acids. These supplements will increase the efficacy of anti depressants and will also improve the symptoms like poor focus, tiredness, chronic fatigue.
So just to sum up- Don't remain distressed due to your symptoms. Most of individuals with depression show improvement with medicine. Increasing the dose of Fluoxetine to about 60 mg per day, tapering the dose of Venlafaxine, addition of low dose anti psychotics like Amisulpiride and addition of nutritional supplements will help in quick improvement. Please talk to your psychiatrist for change in prescription.
Thanks, Hope this helps you. Take care.
Please don't hesitate to ask again for more doubts.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Sir
Thanks a lot for your detailed reply. Why I consulted you is mainly to continue regular consultancy support with you as my doctor is based at XXXXXXX and Currently I am transferred to XXXXXXX and it is not possible to visit often there.
I will increase Flunil to 60 mg from current 40 mg and slowly taper Veniz as I really did nt like it made me feel very dull and hopeless even after I persisted for 3 months.
Kindly advise me change schedule of medications to be taken
1- Flunil currently 40 mg after breakfast, can I take extra 20 mg along with same dose
2-40 mg Agomelatin(Noveltin) and Lonazep 0.5 mg at Night(but lonazep is causing continued morning sleepiness after waking up in the morning which I feel dis comfortable in office.Can I reduce the dosage or any similar medication with less sedation may be suggested
3-Buspirone - Kindly suggest dosage, brand name of capsule and time to take this augmenting agent
4-Bupropion - 150 mg I have used earlier along with Flunil 40 mg and discontinued because of anxiety issues.
5-B12 , Omega fatty acids and folic acid, pls advise the brand name of caps , dosage and right time to take these supplements
6-anti psychotics can help like Amisulpiride or even Risperidone which is better in the sense with least side effects , kindly suggest dosage, brand name and time to take
7- Do you think instead of veniz XR another SNRI like duloxetine will help as I experience fatigue ,dull in mood and forgetfulness mostly . I never had any mania symptoms .If it can be used kindly suggest dosage and time to take the same.
Why I am asking in so much in detail is I read most of the public and private questions you have answered very rationally , including my question. Since my problem is lingering on for more than 20 years I am expecting constant online consultation with you for regular monitoring of my case.I have attached my Brain MRI and EEG report also. Kindly go through once for any suggestion.
Thanks and Regards XXXXXXX New XXXXXXX
0000
Brief Answer:
Increasing the doses of Fluoxetine should work.
Detailed Answer:
Hello thanks for asking a follow up question
1) You can start with 60 mg capsules and this should do the work. Take the medicines after breakfast.
2) Continue to take Agomelatin as your prescribed doses. Try to reduce the dose of Lonazap to 0.25 mg per day for few weeks and then if possible use the drug on SOS basis only for anxiety or sleep. The drug is known to cause dependence.
3) 4) If Bupropion causes the increased anxiety then no need to take the drug. Buspirone is available as Buspar 10 mg doses. Though in some individuals higher doses are required. The drug takes time to show its effect but the drug is not addicting and is a good alternative for symptomatic control of anxiety.
5) Methylcobalamine is available as "Neurokind 500 mcg" "Psyneuron 500 mcg" "Cobaday 500" etc brands in XXXXXXX For Folate brands like Folvite 5 mg, Globin 5 mg etc are available. Omega 3 Fatty Acids are available even in supermarkets or chemist shops without prescription. You can choose any good brand but it can have some side effects.
6) I usually prefer to use Amisulpiride in doses of 50-100 mg for depressive patients. But that depends upon clinical condition. Amisulpiride is available as Sulpitac, Goldpride etc brands.
7) Duloxetine might help but as the drug is also a SNRI so it might cause some restlessness and tolerance issues are there. You have no good experience with Venlafaxine so I doubt if Duloxetine would help. Start taking the medicines as I have mentioned and this should helps you.
Thanks for your appreciation. If possible talk to your psychiatrist before making change in prescription because he has seen you since long time.
I am not finding the attached MRI report. If possible please upload it again.
Thanks. Hope this helps you. Please don't hesitate to ask again for more doubts or if you need more clarifications.
Take care
Increasing the doses of Fluoxetine should work.
Detailed Answer:
Hello thanks for asking a follow up question
1) You can start with 60 mg capsules and this should do the work. Take the medicines after breakfast.
2) Continue to take Agomelatin as your prescribed doses. Try to reduce the dose of Lonazap to 0.25 mg per day for few weeks and then if possible use the drug on SOS basis only for anxiety or sleep. The drug is known to cause dependence.
3) 4) If Bupropion causes the increased anxiety then no need to take the drug. Buspirone is available as Buspar 10 mg doses. Though in some individuals higher doses are required. The drug takes time to show its effect but the drug is not addicting and is a good alternative for symptomatic control of anxiety.
5) Methylcobalamine is available as "Neurokind 500 mcg" "Psyneuron 500 mcg" "Cobaday 500" etc brands in XXXXXXX For Folate brands like Folvite 5 mg, Globin 5 mg etc are available. Omega 3 Fatty Acids are available even in supermarkets or chemist shops without prescription. You can choose any good brand but it can have some side effects.
6) I usually prefer to use Amisulpiride in doses of 50-100 mg for depressive patients. But that depends upon clinical condition. Amisulpiride is available as Sulpitac, Goldpride etc brands.
7) Duloxetine might help but as the drug is also a SNRI so it might cause some restlessness and tolerance issues are there. You have no good experience with Venlafaxine so I doubt if Duloxetine would help. Start taking the medicines as I have mentioned and this should helps you.
Thanks for your appreciation. If possible talk to your psychiatrist before making change in prescription because he has seen you since long time.
I am not finding the attached MRI report. If possible please upload it again.
Thanks. Hope this helps you. Please don't hesitate to ask again for more doubts or if you need more clarifications.
Take care
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Sir
Thanks for prompt reply. Sir Now I have attached my Brain MRI and EEG report
Kindly go through and advise .
1-What is the best time to take B12, Folvite and Omega 3 fatty acids supplements.
2-Buspar 10 mg when it is to be taken (day or night)and how many times in a day please suggest.I may like to discontinue lonazep
3-when is the right time to take Amisulpiride (day or night)in doses of 50-100 mg pls advise.
For me good night sleep medicine without morning sedation and disturbances like sleep talking and shouting , involuntary leg , body and arm movements in sleep is essential to wake up fresh without stiffness in the morning.Accordingly advise.
Regards XXXXXXX K
New XXXXXXX
0000
Thanks for prompt reply. Sir Now I have attached my Brain MRI and EEG report
Kindly go through and advise .
1-What is the best time to take B12, Folvite and Omega 3 fatty acids supplements.
2-Buspar 10 mg when it is to be taken (day or night)and how many times in a day please suggest.I may like to discontinue lonazep
3-when is the right time to take Amisulpiride (day or night)in doses of 50-100 mg pls advise.
For me good night sleep medicine without morning sedation and disturbances like sleep talking and shouting , involuntary leg , body and arm movements in sleep is essential to wake up fresh without stiffness in the morning.Accordingly advise.
Regards XXXXXXX K
New XXXXXXX
0000
Brief Answer:
The MR report suggest lacunar infarcts
Detailed Answer:
Hello thanks for asking again
I have read the MRI report and it is clearly written that few lacunar infarcts were there in brain. This occurs due to obstruction of blood supply to some areas of brain. Lacunar infarcts occur due to obstruction of very small blood vessels. Though detailed clinical examination is needed but they usually pose no serious danger.
1) Best time to take Vitamin B12 and Folic acid is in day time preferable after 2 hours of breakfast with plenty of water. Omega 3 Fatty Acids can be taken in morning hours with water.
2) Start taking Buspar in morning hours after breakfast. This will help to control anxiety in day time and will help in better functioning.
3) Amisulpiride causes very less sedation so it can be taken at any time either in morning after breakfast or after dinner.
Please try to avoid using a sleep medicine. Try to sleep on reduced doses of Clonazepam and this would not cause much day time drowsiness. This will help in improved functioning in day time.
Thanks. Still have more doubts please ask again. Take care
The MR report suggest lacunar infarcts
Detailed Answer:
Hello thanks for asking again
I have read the MRI report and it is clearly written that few lacunar infarcts were there in brain. This occurs due to obstruction of blood supply to some areas of brain. Lacunar infarcts occur due to obstruction of very small blood vessels. Though detailed clinical examination is needed but they usually pose no serious danger.
1) Best time to take Vitamin B12 and Folic acid is in day time preferable after 2 hours of breakfast with plenty of water. Omega 3 Fatty Acids can be taken in morning hours with water.
2) Start taking Buspar in morning hours after breakfast. This will help to control anxiety in day time and will help in better functioning.
3) Amisulpiride causes very less sedation so it can be taken at any time either in morning after breakfast or after dinner.
Please try to avoid using a sleep medicine. Try to sleep on reduced doses of Clonazepam and this would not cause much day time drowsiness. This will help in improved functioning in day time.
Thanks. Still have more doubts please ask again. Take care
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Dear Sir
Thanks a lot for your detailed reply. What I could make out from literature is mine is a case of dysthemic/chronic depression(almost 20 plus years). Hope Amisulpiride and Buspar do not cause any unwanted side effects as I became very apprehensive about new drugs after using Veniz XR which actually deteriorated my condition very much. Pls advise me about any warning signals to look for to stop using medication and also addictive potential of these medicines..
Regards XXXXXXX New XXXXXXX
Brief Answer:
Start with low doses and then proceed gradually
Detailed Answer:
Hello again and thanks for asking a follow up question
Yes you can say its chronic depression but that can be controlled with medicines. Amisulpiride and Buspar both are relatively safe drugs and no need to worry. Don't remain apprehensive about the side effects. Slight drowsiness might occur when you start the drug but that will be tolerable. No worries.
Try to start with low dose and then progressively increase the doses. This will prevent any first dose worsening of symptoms. Amisulpiride is generally well tolerable. Slight weight gain might occur with chronic use but over all the drug is safe.
Thanks. Still have more doubts please ask again. Take care
Start with low doses and then proceed gradually
Detailed Answer:
Hello again and thanks for asking a follow up question
Yes you can say its chronic depression but that can be controlled with medicines. Amisulpiride and Buspar both are relatively safe drugs and no need to worry. Don't remain apprehensive about the side effects. Slight drowsiness might occur when you start the drug but that will be tolerable. No worries.
Try to start with low dose and then progressively increase the doses. This will prevent any first dose worsening of symptoms. Amisulpiride is generally well tolerable. Slight weight gain might occur with chronic use but over all the drug is safe.
Thanks. Still have more doubts please ask again. Take care
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
