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What Causes Constant Fatigue?

Posted on Wed, 2 Nov 2016

Question: Hello
I am feeling tired all the time and sometimes i sleep up to 15 hours straight and still wake up feeling tired.
I did blood test to check my thyroid , hemoglobin, all vitamins and every thing came back normal
I do suffer from depression and I'm using 40 mg of Prozac and 300 mg Wellbutrin daily and Xanax occasionally when I get anxious

Otherwise I'm physically healthy, except for migraines that I have two to three times a month and last up to 3-5 days

I do manage to exercise almost daily for at least an hour, I eat healthy food, low carbs, and no sugar. I have red wine occasionally and I don't smoke

I ran out of options and don't know what can I do to get my energy back .. is there something else I need to check for or do?

Appreciate your help

Answered by Dr. Scott Rebich (3 hours later)

Brief Answer:
A new different anti-depressant or high dose of current medication

Detailed Answer:
Hi there,

The most common causes of fatigue are:
- Depression
- Anxiety
- Substance abuse/medication induced
- Viral illness
- Anemia
- Thyroid dysfunction
- Cancer, tumors, carcinoma
- Infections
- Obstructive sleep apnea

I would recommend taking the Epworth sleepiness scale which you can google and find online. It will help determine if you have sleep apnea. A score of greater then 10 is concerning.

Since your blood work was all normal, a lot of your fatigue is likely related to your depression and anxiety. I would recommend returning to your prescribing doctor for a different anti-depressant or a higher dose of prozac. You can go up to 80 mg daily with Prozac. If the 80 mg does not work for you, I would recommend increase your Wellbutrin. If the combination does not work, I would recommend switching to a different anti-depressant. There are many different anti-depressant - a lot of it is trial and error until you find the right one for you.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Scott Rebich (5 hours later)

Thank you doctor
I took the online test for sleep apnea and my score was 9 which is in the normal range.

My doctor already increased my wellbutrin a week ago and i started feeling more tired
I have tried multiple anti depressants , these are the only ones that put me in a better mental state and doesnt make me feel sick all the time

Is there anything else i can do!

Thanks

Answered by Dr. Scott Rebich (3 hours later)

Brief Answer:
Continue your current medications, make appointment with prescribing doctor

Detailed Answer:
Hi there,

I would continue the Wellbutrin at the current dose. In the meantime, I would schedule an appointment with your prescribing doctor for next week in case you still feel fatigued. Therefore, if you do not feel better at that time, you can go back to a lower dose of Wellbutrin and go up on the Prozac. If this combination does not work, then you will need to try a different anti-depressants. Treatment resistant depression is usually treated with Citalopram (Celexa) and Buproprion (Wellbutrin). If this fails, the next option is a nortriptyline with SSRI (such as zoloft or prozac).

There are many options for you - it is all trial and error. I know you are concerned, but you need to continue to try different combinations until you get the right dosage and medication. Unfortunately, there is nothing you can do in the meantime until your see your prescribing physician. In addition, it is recommended that you always try an anti-depressant for at least a month before trying a new medication or dosage.

Let me know if you have more questions!

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Raju A.T