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What Causes Severe Numbness In Head, Headache And Fatigue Caused By Depression?
Question: I am impressed with the answers given by you for questions posed to you.
As a student I used to be very studious,ambitious and hardworking with excellent memory and cheerful disposition.My first Major Major Depressive episode occured 22 years back (i.e in the the year 1993) followed by recurrent depresive (unipolar) episodes(milder than first one) at various points of time. I am on Flunil 40mg for most of this period.
The symptoms are as follows during major depressive episode/attack and later period of time.
severe numbness of brain, unsteady walking ( balance related) problems, anhedonia,complete lack of emotions/feelings(blankness),severe stiffness in neck region(tics),headaches, severe fatigue,loss of erections and severe memory impairment(nothing get registered and retained in brain), slow thinking, reflexes,excessive sleepiness etc.
My mood is always depressive, lot below the base line , I never had any manic episodes. The usage of Lamictal since last two months helped me to some extent in slighly stabiliing the mood and improved fatigue condition, but still lot need to be improved.
The major problems are
1-Lack of normal or elevated mood,(dullness throughout the day)
2-Lack of motivation
3-Laziness
4-Excessive sleepiness
5-Anhedonia(No pleasure in activities I used to enjoy earlier),
6-Severe memory impairment (register, retention and recall)
7-Lack of normal erections and libido
Considering this long duration (22 years)drug resistant kind of depression , kindly advise me the future course of action, even though mild improvement in mood and fatigue leves after introduction of lamictal observed
Regards XXXXXXX XXXXXXX
As a student I used to be very studious,ambitious and hardworking with excellent memory and cheerful disposition.My first Major Major Depressive episode occured 22 years back (i.e in the the year 1993) followed by recurrent depresive (unipolar) episodes(milder than first one) at various points of time. I am on Flunil 40mg for most of this period.
The symptoms are as follows during major depressive episode/attack and later period of time.
severe numbness of brain, unsteady walking ( balance related) problems, anhedonia,complete lack of emotions/feelings(blankness),severe stiffness in neck region(tics),headaches, severe fatigue,loss of erections and severe memory impairment(nothing get registered and retained in brain), slow thinking, reflexes,excessive sleepiness etc.
My mood is always depressive, lot below the base line , I never had any manic episodes. The usage of Lamictal since last two months helped me to some extent in slighly stabiliing the mood and improved fatigue condition, but still lot need to be improved.
The major problems are
1-Lack of normal or elevated mood,(dullness throughout the day)
2-Lack of motivation
3-Laziness
4-Excessive sleepiness
5-Anhedonia(No pleasure in activities I used to enjoy earlier),
6-Severe memory impairment (register, retention and recall)
7-Lack of normal erections and libido
Considering this long duration (22 years)drug resistant kind of depression , kindly advise me the future course of action, even though mild improvement in mood and fatigue leves after introduction of lamictal observed
Regards XXXXXXX XXXXXXX
Brief Answer:
Lamictal can be increased
Detailed Answer:
Hello,
Thanks for choosing health care magic for posting your query.
I have gone through your question in detail and I can understand what you are going through.
You seem to be having a severe depression and looking at the pattern, its definitely a recurrent depressive disorder. Now these recurrent depressive disorder are definitely difficult to treat and antidepressants are not the main choice of treatment. The main choice of treatment are mood stabilizers like divalproex and lamotrigine. Its good that you are already on lamotrigine, but what I feel is that the dose can still be optimized. A good dose of lamotrigine can go upto 200mg and it has to be slowly increased under observation of a psychiatrist to avoid any kind of rashes.
Other options are divalproex which can be initiated at 250mg and can be built upto 1000mg or 1500mg depending on the case.
I suggest you should discuss these optins with your psychiatrist who can include these suggestions in his prescriptions.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy
Wish you good health,
Kind regards
Dr. Srikanth Reddy M.D.
Lamictal can be increased
Detailed Answer:
Hello,
Thanks for choosing health care magic for posting your query.
I have gone through your question in detail and I can understand what you are going through.
You seem to be having a severe depression and looking at the pattern, its definitely a recurrent depressive disorder. Now these recurrent depressive disorder are definitely difficult to treat and antidepressants are not the main choice of treatment. The main choice of treatment are mood stabilizers like divalproex and lamotrigine. Its good that you are already on lamotrigine, but what I feel is that the dose can still be optimized. A good dose of lamotrigine can go upto 200mg and it has to be slowly increased under observation of a psychiatrist to avoid any kind of rashes.
Other options are divalproex which can be initiated at 250mg and can be built upto 1000mg or 1500mg depending on the case.
I suggest you should discuss these optins with your psychiatrist who can include these suggestions in his prescriptions.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy
Wish you good health,
Kind regards
Dr. Srikanth Reddy M.D.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Dear Sir
Thanks a lot for your detailed reply and would like to continue online consultation with you along with my regular medication. I will increase the lamictal upto 200 mg as advised under guidance.
1-I have increased lamictal to 100 mg on 17 th November (approx. 1 month) as per doctors advice, now can I increase to 200mg ?
2-One thing I would like to ask do you think combination of mood stabilizers(with least side effects) or any other add on medication that works well incase of my long and disturbing problem like memory related issues I m facing now, as I used to have very sharp memory before the first depressive episode.
3-Any other add on medication or change in current medication to improve my motivation levels .
Pls advise
Regards XXXXXXX
Thanks a lot for your detailed reply and would like to continue online consultation with you along with my regular medication. I will increase the lamictal upto 200 mg as advised under guidance.
1-I have increased lamictal to 100 mg on 17 th November (approx. 1 month) as per doctors advice, now can I increase to 200mg ?
2-One thing I would like to ask do you think combination of mood stabilizers(with least side effects) or any other add on medication that works well incase of my long and disturbing problem like memory related issues I m facing now, as I used to have very sharp memory before the first depressive episode.
3-Any other add on medication or change in current medication to improve my motivation levels .
Pls advise
Regards XXXXXXX
Brief Answer:
B12 and folate supplementation may help
Detailed Answer:
Hello Mr. XXXXXXX
If its been 1 month, it would generally be wise to increase the lamotrigine to 150mg and then after amonth to 200mg. However as I had mentioned earlier, lamotrigine is notorious in causing rashes and hence the increase should be strictly under the supervision of a treating psychiatrist face to face. Moreover online consulting platforms do not allow us to prescribe the medicines for you. Thats the reason we need to keep your personal psychiatrist in the loop.
Also the memory disturbances and the low level of motivation can be attributed to the presence of depression. Ones depression is off, these symptoms will also settle down. However a trial of B12 and Folate supplementation can be tried. They can be taken daily (Y=Tab Methycobal 500 mic gm and Tab Folate 5mg) as a supplementation.
Hope this helps
Kind regards
Dr. Srikanth Reddy
B12 and folate supplementation may help
Detailed Answer:
Hello Mr. XXXXXXX
If its been 1 month, it would generally be wise to increase the lamotrigine to 150mg and then after amonth to 200mg. However as I had mentioned earlier, lamotrigine is notorious in causing rashes and hence the increase should be strictly under the supervision of a treating psychiatrist face to face. Moreover online consulting platforms do not allow us to prescribe the medicines for you. Thats the reason we need to keep your personal psychiatrist in the loop.
Also the memory disturbances and the low level of motivation can be attributed to the presence of depression. Ones depression is off, these symptoms will also settle down. However a trial of B12 and Folate supplementation can be tried. They can be taken daily (Y=Tab Methycobal 500 mic gm and Tab Folate 5mg) as a supplementation.
Hope this helps
Kind regards
Dr. Srikanth Reddy
Above answer was peer-reviewed by :
Dr. Prasad
Dear Sir
Thanks for the prompt reply
Infact I am using 1000 mcg B12 and Vitamin D 1000 IU daily since last one year without much improvement in memory levels,motivation levels and anhedonia (lack of pleasure in activities ) levels. Do you suggest any other combination that works well in long term Major Depressive cases like me as my current treatment is not improving my condition effectively.Fatigue levels only improved to some extent (by around 15%) rest of the symptoms persisting
Regards XXXXXXX XXXXXXX
Thanks for the prompt reply
Infact I am using 1000 mcg B12 and Vitamin D 1000 IU daily since last one year without much improvement in memory levels,motivation levels and anhedonia (lack of pleasure in activities ) levels. Do you suggest any other combination that works well in long term Major Depressive cases like me as my current treatment is not improving my condition effectively.Fatigue levels only improved to some extent (by around 15%) rest of the symptoms persisting
Regards XXXXXXX XXXXXXX
Brief Answer:
Other options
Detailed Answer:
Hello Mr. XXXXXXX
The only way to improve your anhedonia or fatigue is by treating your depression.
I suggest following other options
1) Combination of lamotrigine and divalproex sodium.
2) Combination of Lamotrifine with oxcarbazepine.
3) Venlafaxine (upto 225mg) and mirtazapine- a combination of antidepressants
4) Lithium can be useful in some cases.
5) Check for the thyroid profile
6) Combination of medical management with cognitive behavioural therapy done for psychologist.
7) Dailty aerobic exercises.
All these options if tried one after other should take you out of this RDD.
Kind regards
Dr. Srikanth Reddy MD
Other options
Detailed Answer:
Hello Mr. XXXXXXX
The only way to improve your anhedonia or fatigue is by treating your depression.
I suggest following other options
1) Combination of lamotrigine and divalproex sodium.
2) Combination of Lamotrifine with oxcarbazepine.
3) Venlafaxine (upto 225mg) and mirtazapine- a combination of antidepressants
4) Lithium can be useful in some cases.
5) Check for the thyroid profile
6) Combination of medical management with cognitive behavioural therapy done for psychologist.
7) Dailty aerobic exercises.
All these options if tried one after other should take you out of this RDD.
Kind regards
Dr. Srikanth Reddy MD
Above answer was peer-reviewed by :
Dr. Prasad
Dear Sir
Can I initiate one of these combinations without much tinkering with my current medication? or with minor modification ? If so which is the combination you advise first and also provide the details in prescription format like medication name/brand , dosage, what time to take (morning/afternoon/evening) and how long to continue in that dosage before next review after one month or so etc
Regards
XXXXXXX
Can I initiate one of these combinations without much tinkering with my current medication? or with minor modification ? If so which is the combination you advise first and also provide the details in prescription format like medication name/brand , dosage, what time to take (morning/afternoon/evening) and how long to continue in that dosage before next review after one month or so etc
Regards
XXXXXXX
Brief Answer:
increasing lamotrigine to 150mg can be tried as first choice
Detailed Answer:
Hello
Thanks for the follow up question.
I would suggest that you should first try to optimize the dosage of lamotrigine to 150mg. It come by the brand name of lamictal 150mg to be taken at night and the mood can be reassessed after 1 month. However as i have mentioned before, we are not allowed to prescribe medicines on online forum, so that i our limitation. Sorry for that.
Kind regards
Dr. Srikanth Reddy MD
increasing lamotrigine to 150mg can be tried as first choice
Detailed Answer:
Hello
Thanks for the follow up question.
I would suggest that you should first try to optimize the dosage of lamotrigine to 150mg. It come by the brand name of lamictal 150mg to be taken at night and the mood can be reassessed after 1 month. However as i have mentioned before, we are not allowed to prescribe medicines on online forum, so that i our limitation. Sorry for that.
Kind regards
Dr. Srikanth Reddy MD
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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