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    Suggest treatment for tiredness and depression

Posted on Fri, 5 Sep 2014 in Brain and Spine
Question: I don't know if this is the right place to be asking about things like procrastination and difficulty with school work, but I feel as though in the past 10-12 years, a terrible, drastic change has come over me. I used to be a model student studying on a scholarship at a good school. But around the age of 11-12 just after I entered secondary school I started to become incredibly forlorn. It was just after Christmas that it seemed I stopped handing in work promptly, and then I stopped handing it in altogether. At the time it I was aware that I was simply very tired, and the idea of completing all this homework which I wanted to achieve top grades in seemed to completely paralyse me motivationally speaking. Instead I would go to sleep early at 7pm, and wake up in the morning yet feeling completely unrested. And this exhaustion continued day after day, week after week, and I found each school night I would push things to the back because of the tiredness and the dread which only continued to mount. 12 years down the line and I've only gotten worse. Though I managed to get into university, I'm now facing the possibility of being kicked out because I can't pass my exams. I had never considered that there might be something medically that could help me. But this is something I'm now curious to approach, and I feel very much that I'm completely at the end of my rope. I don't feel I have very many options open to me now. I would like to know what you think might be wrong with me and what I can do about it. After taking online tests, I receive a lot of high positive results for things like anxiety and depression, but I think my GP doesn't take my issues seriously. I believe she thinks I'm simply trying to find a scapegoat for bad behaviour, but I don't know if the simply solution is just to try harder. If that's all it is, then I think I may have reached the end of the line as far as possible solutions go.
Answered by Dr. Manisha Gopal 13 hours later
Brief Answer:
Yes, it can be depression, medicines will help

Detailed Answer:

On reading your query the symptoms are suggestive of - depressive or anxiety related (though the details about the mood complaints are not properly mentioned). You have said that even the online questionnaire has come out with the similar results.

in depression :initially the patient is simply not feeling good about anything in life, dosent want to completely tasks at a hand
-feels great difficulty in performing the tasks which earlier he would easily do --> leading to procrastination ( as you started to do 10yrs back)
-the lethargy takes over, taking precedence on other important areas of life and even going out and meeting people is no more appealing
-studies and other works demanding concentration deteriorate and finally due to poor output the fear takes over in these areas and person starts completely avoiding these tasks
-sleep is mostly disturbed ranging from excessive sleepiness--> but still not feeling refreshed in morning ; to just no sleep at all

These all symptoms are suggestive of depression and can also be seen in anxiety issues ( along with the main complaint of sadness or anxiety).

These all symptoms are easily resolved with anti-depressants /anti-anxiety medications.
As your GP dosent show any interest in your condition, you must ask your parents to look in to the matter and take you to a psychiatrist in order to get a detailed assessment.

I usually prefer sertraline (25-150mg) or escitalopram (5-20mg) in simple depressive disorder. The drugs are good and safe. Usually, the dosage is started low but increased gradually till there is complete response.

You have said that all this started after Christmas, but was there any stressor associated? had anything significantly upsetting happened in your life at that time? the depressive disorder can follow a traumatic life incident or can start denovo or if any of your parents or grand parents have had similar complaints ? This can be genetically related in many patients.

Along with medicines, getting TSH levels also help. If TSH is disturbed, treating the same will help in treating depression to great extent.

Wish you good health and speedy recovery!
Hope the reply is helpful
Please feel free to ask more questions for clarification.

Dr. Manisha Gopal
MD Neuropsychiatry

Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Manisha Gopal 25 hours later

Thank you kindly for your response. I find that much of what you describe in your second paragraph is very accurate of my daily and past experiences. Around the time that I began noticing this change in behaviour and habit, I went through a very sudden period of intense self-doubt and self-dislike that has never really gone away. My mood is often very low, and more days than not I can even verge on feeling quite suicidal.

Strangely, this occurred after receiving very good results at school which put me at the top of my class. So no, I can't say that this happened because of a trauma. I always felt that it happened because of some kind of transition between my pre-teen mentality and my adolescent one when you start to become much more aware of yourself. I felt this self-awareness is what led me to feel very inadequate, almost as an onset of harsh but genuine clarity.

I know that my parents are not happy people, either in their marriage or just with life in general. Whether this is genetic I can't say, but I've seen them go through very difficult times and respond to things with a lot of pain and nihilism, never able to find comfort or support in anyone or anything.

Indeed, it seems that visiting a psychiatrist may be my best option. As per your recommendation, this is something I will promptly pursue. I'm concerned that Sertraline had no beneficial effects for me when I was put on it by my doctor for 4-6 weeks. What could be the reasons for this, and would I likely have similar experiences with other drugs such as the one you mentioned, Escitalopram?

Thank you very much for your help!

Kind regards,
Answered by Dr. Manisha Gopal 46 minutes later
Brief Answer:
Change the drug, read good books & stay fit!

Detailed Answer:

Good to see a detailed response, I will try to answer your new queries one by one:

First about medicines- it can happen sometimes that one molecule or drug dosent bring any response in a patients but when it is changed or dose is increased, there is very good result in almost all symptoms. Also, generally antidepressants take 2-3 weeks to start showing some response, so, one should wait for that time.
Otherwise, if there is no effect, changing to another molecule is generally best. Your body didn't give any effect with sertraline, so, I think it will be best that you are put on a different drug. Something like- escitalopram or paroxetine can be good choices in your case (espically when there are significant anxiety issues along with depressive).

secondly, it's very. right of you to say that the episode started after a major victory or achievement several years back. The term trauma in psychiatry means anything which is an emotional stressor- this can be any very good or bad news or event. Many times, such depressive disorders follow big and happy events like -marriages or getting a big profile job. So, you had it after that big educational achievement of yours: this was an emotional stressor in your case (most probably).
Alongwith this, I would say you were genetically predisposed somewhere (as you feel that your parents are also not very happy people and have had significant struggle in their life. Even though they were never treated ( which is usually the case due to ignorance in general public and old fear of attached stigma or due to limited finances) still this can be taken as a risk factor.

Thirdly, every individual faces some change dusting the pubertal years, both males and females. The time which has passed is gone, so please donot blame yourself or just waste time in pitying yourself--> you are still very young and have along life ahead to look after. ..you can still begin a new life and blossom. You can still achieve all what you were before this happened and increase it more!

Fourthly, along with medicines, try to inculcate reading habit, read motivational books; preffrably on success, positive thinking...remember, we become what we know or what we read! so, fill your mind with positivity and this habit will help you lifelong..this will help you in coping day to day stresses and help in depression..
Attain a healthy life style, getting up in time, taking adequate night sleep, staying away from all kinds of addictive substances.

Wish you good luck!
please feel free to ask more queries for clarification.

Dr. Manisha Gopal
MD neuropsychiatry

Above answer was peer-reviewed by : Dr. Shanthi.E
Answered by
Dr. Manisha Gopal


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