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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by g_g_g_unit on May 11, 2010, at 22:09:11
this may sound like a naive question, but is mental exhaustion a primary symptom of depression that should be as equally responsive to AD's as other symptoms?
my psychiatrist has told me i am only moderately depressed (as opposed to severely, which my psychologist indicated several months ago), and would prefer not to prescribe medication, though ultimately it is up to me.
but i find the sheer mental exhaustion really difficult to live with. what further confuses is that i have had all those (two year-spanning) symptoms of cognitive sluggishness disappear within hours upon administration of certain (pseudo-)stimulants (nicotine, ritalin, memantine). i am not trying to treat this as some justification for stimulant use, but does that mean anything?
Posted by chujoe on May 12, 2010, at 5:27:11
In reply to depression + mental exhaustion, posted by g_g_g_unit on May 11, 2010, at 22:09:11
Have you been tested for ADHD? I know we usually think of ADHD as a kind of over-excitement, but mine also presented as sheer exhaustion and inability to think. A low dose stim (Ritalin) has really helped. And it can make you depressed w/o depression being the major symptom.
Posted by g_g_g_unit on May 12, 2010, at 6:20:16
In reply to Re: depression + mental exhaustion, posted by chujoe on May 12, 2010, at 5:27:11
> Have you been tested for ADHD? I know we usually think of ADHD as a kind of over-excitement, but mine also presented as sheer exhaustion and inability to think. A low dose stim (Ritalin) has really helped. And it can make you depressed w/o depression being the major symptom.
ADHD only recently cropped up on my radar as a possible affliction, so it was never taken into consideration (on my part) when i first began seeking treatment. however, after doing a little research, the inattentive subtype made a lot of sense to me, and just before i immigrated, i saw a GP who performed a TOVA test, according to which i do have ADD.
however, the psychiatrist i've being seeing in my new home place doesn't believe in the TOVA, and after performing a battery of neurocognitive tests, claims that my scores were too high for me to have ADHD. so, i'm kinda confused, and pushing for an ADHD diagnosis can sometimes be misread as drug-seeking behaviour (especially where i live). what further complicates things is the fact that i have diagnosed OCD.
Posted by chujoe on May 12, 2010, at 7:08:57
In reply to Re: depression + mental exhaustion » chujoe, posted by g_g_g_unit on May 12, 2010, at 6:20:16
Some of the same drugs that work against OCD can also be of help in ADHD, I think. I have no doubt that ADHD is over-dx'd, but it is a real syndrome and needs to be taken seriously when it is present, but I can understand why some pdocs are skeptical. I've just begun treating my ADHD with Ritalin, so I'm no authority, but it seems to me that much of my depression was caused by untreated ADHD over the course of a lifetime.
Posted by g_g_g_unit on May 12, 2010, at 9:20:29
In reply to Re: depression + mental exhaustion, posted by chujoe on May 12, 2010, at 7:08:57
> Some of the same drugs that work against OCD can also be of help in ADHD, I think.
did you mean that the other way round, i.e. some of the drugs that help ADHD can be of help in OCD? as far as i know, only SSRI's are recommended for OCD, which tend to exacerbate focus problems in me. stimulants on the other hand, on the odd occasions i have used them, can help steer my attention away from OCD thoughts.
>I have no doubt that ADHD is over-dx'd, but it is >a real syndrome and needs to be taken seriously >when it is present, but I can understand why some >pdocs are skeptical.
i agree, which is why i am curious whether mental exhaustion is often a primary symptom of depression that should technically be resolved with anti-depressants alone, or whether it might even require a contextual use of stimulants, regardless of the underlying pathology.
Posted by Phillipa on May 12, 2010, at 10:40:58
In reply to Re: depression + mental exhaustion, posted by g_g_g_unit on May 12, 2010, at 9:20:29
Seems like the adhd and opiod useage is becoming a problem with lots of drug seeking people hence the pdocs hesitation. Could you try nicotine gum or coffee? Coffee stimulates me so can't drink it or what about providgil? Just random thoughts. Wouldn't be living in the South? Phillipa
Posted by conundrum on May 12, 2010, at 13:03:41
In reply to Re: depression + mental exhaustion, posted by g_g_g_unit on May 12, 2010, at 9:20:29
Can't you just tell him that ritalin has helped or memantine? I don't think asking for ritalin would be that bad, its not really as abused as adderall and doesn't cause euphoria in most people. It doesn't matter if those drug aren't indicated for OCD, it matters what works for you. If you have tried SSRIs and they make things worse you need to try something different.
Posted by chujoe on May 12, 2010, at 13:13:10
In reply to Re: depression + mental exhaustion, posted by g_g_g_unit on May 12, 2010, at 9:20:29
Yes, I was going too fast and reversed what I intended to say. In any case, I am more and more convinced that discrete "diseases" don't really exist in the mental world -- at least not as the neat diagnostic boxes they are often presented as. What actually happens is that person X has this particular cluster of symptoms while person Y has this other, partly overlapping cluster. Nor are the causes simple: any particular cluster is the result of genetics, upbringing, experience, other medical problems, etc. I'm not sure what that means in your case except that you need to convince your pdoc that you have a particular assortment of symptoms and it doesn't really matter (to you) what he calls them as long as he is willing to help you deal with them.
Posted by linkadge on May 12, 2010, at 19:50:25
In reply to depression + mental exhaustion, posted by g_g_g_unit on May 11, 2010, at 22:09:11
Has the doctor check b12, thyroid etc?
Linkadge
Posted by g_g_g_unit on May 12, 2010, at 20:05:25
In reply to Re: depression + mental exhaustion, posted by linkadge on May 12, 2010, at 19:50:25
> Has the doctor check b12, thyroid etc?
>
> Linkadgemy b12 was checked a year ago, and found to be low, but that's since been reversed with supplementation. i haven't had my thyroid checked, no ...
Posted by Phillipa on May 12, 2010, at 20:33:13
In reply to Re: depression + mental exhaustion » linkadge, posted by g_g_g_unit on May 12, 2010, at 20:05:25
Get it checked I did find a pattern when working in psych that so many had thyroid problems. This trend stood out. Phillipa
Posted by g_g_g_unit on May 13, 2010, at 1:31:52
In reply to Re: depression + mental exhaustion » g_g_g_unit, posted by conundrum on May 12, 2010, at 13:03:41
> Can't you just tell him that ritalin has helped or memantine?
> Can't you just tell him that ritalin has helped or memantine?
i brought up memantine during our first appointment, and he said he'd be willing to prescribe it, though i only trialled it short-term, so can't be certain whether it's a real solution. as far as ritalin goes, i'm still a little traumatized after my last psych blew up at me for requesting it.
part of the problem is that psychs don't really understand that symptoms are constantly evolving within anyone patient, in my opinion - subject to lingering effects from other meds, sleep patterns, environmental factors, etc. my psych is convinced that all my problems can be traced back to an anxiety disorder, which simply isn't true. he asked me if i want to be on meds for the rest of my life, and my answer frankly is yes - if they help my function within the moment, then i have no qualms with that fact, because at present i'm almost completely dysfunctional. im probably not classically depressed, but my processing speed and concentration are so bad that i'd rather just lie in bed than face the day
Posted by SLS on May 13, 2010, at 5:52:46
In reply to depression + mental exhaustion, posted by g_g_g_unit on May 11, 2010, at 22:09:11
> this may sound like a naive question, but is mental exhaustion a primary symptom of depression that should be as equally responsive to AD's as other symptoms?
It is difficult to truly know how someone else experiences consciousness. I really don't know what you mean by "mental exhaustion". I experience feelings of exhaustion without always feeling fatigued or tired. I don't have any mental energy. This feeling of low mental energy and slowed thoughts resolves completely when I respond favorably to antidepressant treatment. Still, I don't know how my experience compares with yours.
- Scott
Posted by g_g_g_unit on May 13, 2010, at 6:37:54
In reply to Re: depression + mental exhaustion » g_g_g_unit, posted by SLS on May 13, 2010, at 5:52:46
> It is difficult to truly know how someone else experiences consciousness. I really don't know what you mean by "mental exhaustion". I experience feelings of exhaustion without always feeling fatigued or tired. I don't have any mental energy. This feeling of low mental energy and slowed thoughts resolves completely when I respond favorably to antidepressant treatment. Still, I don't know how my experience compares with yours.
>
>
> - Scotthmm, i made a list of examples from day-to-day life which i gave my psychiatrist, though he just kinda shrugged it off. again, if this is only an example of 'moderate depression' then im really at a loss..
basically, things like:
- if i try to read long articles, books, etc. it's almost like my mind shuts down and goes into hiding. i literally have to drag my brain through the material, and even then, i can end up re-reading basic sentences over and over again because the material just won't register- there can be seconds at a time, like when watching movies, where i will almost space out. if i rewind for example, i find that there's a lot of dialogue i end up missing
-i can't elaborate on my own thoughts. if i try to think in the abstract, it's almost like the pieces crumble before i can really attend to them. strangely, and somewhat pleasantly, this also means a reduction in OCD thoughts
- i can't socialize very well because i experience difficulty responding to comments directed at me. i often just rely on stereotyped responses and behaviour
Posted by SLS on May 13, 2010, at 7:08:33
In reply to Re: depression + mental exhaustion, posted by g_g_g_unit on May 13, 2010, at 6:37:54
Your descriptions sound very much like what I experience. Sounds like depression.
- Scott
> > It is difficult to truly know how someone else experiences consciousness. I really don't know what you mean by "mental exhaustion". I experience feelings of exhaustion without always feeling fatigued or tired. I don't have any mental energy. This feeling of low mental energy and slowed thoughts resolves completely when I respond favorably to antidepressant treatment. Still, I don't know how my experience compares with yours.
> >
> >
> > - Scott
>
> hmm, i made a list of examples from day-to-day life which i gave my psychiatrist, though he just kinda shrugged it off. again, if this is only an example of 'moderate depression' then im really at a loss..
>
> basically, things like:
> - if i try to read long articles, books, etc. it's almost like my mind shuts down and goes into hiding. i literally have to drag my brain through the material, and even then, i can end up re-reading basic sentences over and over again because the material just won't register
>
> - there can be seconds at a time, like when watching movies, where i will almost space out. if i rewind for example, i find that there's a lot of dialogue i end up missing
>
> -i can't elaborate on my own thoughts. if i try to think in the abstract, it's almost like the pieces crumble before i can really attend to them. strangely, and somewhat pleasantly, this also means a reduction in OCD thoughts
>
> - i can't socialize very well because i experience difficulty responding to comments directed at me. i often just rely on stereotyped responses and behaviour
>
>
>
Posted by chujoe on May 14, 2010, at 8:54:54
In reply to Re: depression + mental exhaustion » g_g_g_unit, posted by SLS on May 13, 2010, at 7:08:33
g_unit, some of your symptoms overlap with mine as well. I'm increasingly convinced that the whole diagnostic process for "mental illness" is screwed up. I've mentioned this before in other threads, but the idea that a person can be sliced and diced and put into a particular diagnostic box or boxes seems wrong-headed to me. It seems better to me to think in terms of different people presenting different sets of concerns / symptoms that occur in clusters & while some clusters will be more common that others, it's a mistake to give a particular cluster a name like "depression" or "anxiety" and then begin to believe that it is a thing, i.e., a diagnosis.
The implications of this view for prescribing medication is profound. First, most of the clusters of concerns / symptoms a pdoc sees will have multiple causes: genetic & biological, social & psychological, environmental & cultural, etc. Second, not all of these will respond to medication, though they might respond to other sorts of treatment. (Speaking only for myself, I found that meditation tends to allow my medications to work more effectively -- if I don't meditate on a particular day, it's like missing my medication that day, I really feel it.) Third, this view suggests that a good pdoc wouldn't necessarily hand the psychosocial parts of a person off to a social worker or psychologist, but would do that work with his patient him or her self. Unfortunately, in the US at least, the health care system makes this almost impossibly difficult. It may be better in civilized countries.
As clusters go, the research I've looked at suggests very strongly that anxiety / ADHD / depression are often associated with each other, so, to respond directly to g_g_g_, I think you need to convince your pdoc that you have such & such a cluster of concerns & that you want to treat them. You might also discover that you need to take some action on your own, since meds are probably only part of the solution. It's boring, but vigorous exercise, fish oil & a multi-vit with some extra D, a therapist you trust (since it's unlikely to be your pdoc), and maybe meditation / relaxation exercises (take a look at Jon Kabbat-Zinn's materials), might need to be added to your treatment.
Posted by conundrum on May 14, 2010, at 11:59:47
In reply to Re: depression + mental exhaustion » conundrum, posted by g_g_g_unit on May 13, 2010, at 1:31:52
Why did you cut your memantine trial short? It sounds like you were on to something.
Are you seeing a new doc now? I don't think ritalin is a concern of most pdocs. Its abusable but I think most people would request adderall or dexedrine if they wanted to get high.
Posted by bulldog2 on May 15, 2010, at 18:17:33
In reply to depression + mental exhaustion, posted by g_g_g_unit on May 11, 2010, at 22:09:11
> this may sound like a naive question, but is mental exhaustion a primary symptom of depression that should be as equally responsive to AD's as other symptoms?
>
> my psychiatrist has told me i am only moderately depressed (as opposed to severely, which my psychologist indicated several months ago), and would prefer not to prescribe medication, though ultimately it is up to me.
>
> but i find the sheer mental exhaustion really difficult to live with. what further confuses is that i have had all those (two year-spanning) symptoms of cognitive sluggishness disappear within hours upon administration of certain (pseudo-)stimulants (nicotine, ritalin, memantine). i am not trying to treat this as some justification for stimulant use, but does that mean anything?Wow is the ship tilting in the other direction? After the discovery of the ssris even the mildly depressed were getting ads. Some suicides have been blamed on ssris and the ship is tilting the other way.
These p-docs have to learn how to prescribe meds correctly and not go by the current fad! I think prescribing ads is not just a function of how severe the depression is. You need to determine how long the depression is. Several weeks may just need some talk therapy. Several months or years may require some meds initially along with talk therapy. Chronic moderate depression can still take a toll on the body and mind. The difference between mod and severe depression can just be several points on a test.
A person who has been moderately depressed for years has paid a terrible price in terms of quality of life . You would think a good p-doc would factor this into their decision about wether to prescribe meds. Perhaps this shows that the person does not have good skills.
Posted by amparo on May 15, 2010, at 21:32:50
In reply to depression + mental exhaustion, posted by g_g_g_unit on May 11, 2010, at 22:09:11
i'm also "moderately depressed" (as opposed to severely, a year ago) but my mental exhaustion makes the term "moderate" seem completely wrong. so i'm on prozac and after about a month on a low dose (10mg/day) my mental exhaustion is just...lifting. i feel better. i would recommend a low dose for the mental exhaustion, and then talk about increasing it after awhile for the depression part... or whatever your choice/situation.
Posted by Conundrum on May 15, 2010, at 23:21:06
In reply to Re: depression + mental exhaustion, posted by amparo on May 15, 2010, at 21:32:50
I'm thinking of adding 5 mg every other day of prozac to my lamictal since I can't take the risk of the lamictal not working and me not accomplishing anything for a couple months. I think low doses of prozac can be helpful for moderate depression.
Posted by g_g_g_unit on May 16, 2010, at 0:31:32
In reply to Re: depression + mental exhaustion » g_g_g_unit, posted by conundrum on May 14, 2010, at 11:59:47
> Why did you cut your memantine trial short? It sounds like you were on to something.
well, my pdoc was following prescrition guidelines from OCD studies and quickly titrated me to 20mg, which induced mood problems and dementia-like symptoms. it was only looking back that i realised that 10mg was helpful for the week i was on it
>
> Are you seeing a new doc now?yeah i am, i've actually moved countries since then
Posted by g_g_g_unit on May 16, 2010, at 0:36:55
In reply to Re: depression + mental exhaustion » g_g_g_unit, posted by bulldog2 on May 15, 2010, at 18:17:33
>
> These p-docs have to learn how to prescribe meds >correctly and not go by the current fad! I think >prescribing ads is not just a function of how >severe the depression is. You need to determine >how long the depression is. Several weeks may >just need some talk therapy. Several months or >years may require some meds initially along with >talk therapy. Chronic moderate depression can >still take a toll on the body and mind. The >difference between mod and severe depression can >just be several points on a test.you're totally right. moderate depression is like a limbo. my OCD and anxiety are dampened down just enough that i can function in a zombie-like fashion - i.e. go to my part-time job, see friends, etc. - but not actually do much more than that. and from a psychiatric perspective that almost seems to be enough, i.e. oh well, at least you're working, nevermind what you were previously capable of.
and yeah, i've moved from being "severely depressed" to "moderately" on grading system, but overall my quality of life is no different whatsoever
>
> A person who has been moderately depressed for years has paid a terrible price in terms of quality of life . You would think a good p-doc would factor this into their decision about wether to prescribe meds. Perhaps this shows that the person does not have good skills.i'd like to think it's more a naivety on their part, but i don't know
Posted by g_g_g_unit on May 16, 2010, at 0:41:50
In reply to Re: depression + mental exhaustion, posted by chujoe on May 14, 2010, at 8:54:54
>
> You might also discover that you need to take some action on your own, since meds are probably only part of the solution. It's boring, but vigorous exercise, fish oil & a multi-vit with some extra D, a therapist you trust (since it's unlikely to be your pdoc), and maybe meditation / relaxation exercises (take a look at Jon Kabbat-Zinn's materials), might need to be added to your treatment.unfortunately, i've been taking such measures over the past two years and don't have a tonne to show for it. i exercise everyday, eat impeccably (almost obsessively) well, talk to a therapist who i love once a week. that's why when i was told i'm not very depressed, or not even given some kind of explanation for my symptoms, i kind of just gave up and have spent the past month - on and off - in bed. i mean if i'm not depressed enough to warrant medication, and i've reached the ceiling of my functionality, then i'm at a loss.
Posted by g_g_g_unit on May 16, 2010, at 0:43:29
In reply to Re: depression + mental exhaustion, posted by amparo on May 15, 2010, at 21:32:50
> i'm also "moderately depressed" (as opposed to severely, a year ago) but my mental exhaustion makes the term "moderate" seem completely wrong.
yeah, those definitions seem kinda meaningless
>so i'm on prozac and after about a month on a low >dose (10mg/day) my mental exhaustion is >just...lifting. i feel better. i would recommend >a low dose for the mental exhaustion, and then >talk about increasing it after awhile for the >depression part... or whatever your >choice/situation.
thanks for the suggestion, but i tried prozac just before i immigrated and found that it disrupted my sleep too much to justify continuing.
Posted by chujoe on May 16, 2010, at 6:39:44
In reply to Re: depression + mental exhaustion » chujoe, posted by g_g_g_unit on May 16, 2010, at 0:41:50
g_unit, if you are spending a month in bed, that is effing depression no matter what your psychologist says.
Last summer, I hardly left the house because of my anxiety & agoraphobia & fear of driving. Fortunately for me once I began taking meds I started to get better. Sounds to me like you still need to find the right medication -- then, added to all those things you're already doing, you can start to climb out of the hole.
Also, thinking about what you've said here, I still wonder whether you might respond to stims. Our symptoms are not the same since my problems begin, I think, on the anxiety side of the spectrum and move toward depression, while yours seem to go the other way. Still anxiety / depression can both be the result of ADHD or other learning difficulties.
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