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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 33. Go back in thread:
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.
Posted by Conundrum on May 16, 2010, at 6:48:29
In reply to Re: depression + mental exhaustion » bulldog2, posted by g_g_g_unit on May 16, 2010, at 0:36:55
I guess I'm in the same boat but atleast my pdoc is willing to treat me. I've only been working temp jobs so maybe that is why. I'm glad she seems concerned with me being at my potential. I think it would be worth it for you to do another trial with memantine if it was helping and just stay on 10 mg. Maybe you could get it from you GP if you have found it helpful in the past?
I'm probably gonna go back on low dose prozac whether docs want me to or not since its the only thing that helps with motivation and I can't f*rt around hoping lamictal will work.
Posted by Conundrum on May 16, 2010, at 7:20:02
In reply to Re: depression + mental exhaustion, posted by chujoe on May 16, 2010, at 6:39:44
Just curious where did you live and where are you living now? Don't they have any psychiatrists that think outside of the box? I would think if you were in a big city in the U.S. you could find someone who would be willing to try anything as long as it helped. Not that its much help to you if you don't live in the U.S. but look if you know your pdoc isn't helping you need to fire them, period.
Posted by Conundrum on May 16, 2010, at 7:28:27
In reply to Re: depression + mental exhaustion, posted by chujoe on May 16, 2010, at 6:39:44
> g_unit, if you are spending a month in bed, that is effing depression no matter what your psychologist says.
I was just thinking about this after I made my post. I'm sorry your pdoc disagreed with you nothing is more frustrating than being told you don't have a particular problem when you know something is wrong. The fact that you stayed in bed for a month is a sign that something is amiss. You got your hopes up and were let down and then saw no reason to keep the facade going. I honestly don't understand why a pdoc would dismiss someone like that, its pretty f*ckin stupid if you ask me. The fact that someone goes to a psychiatrist means that someting must be wrong, since most people with only minor mood problems would probably avoid psychiatrists and the stigma of taking psych drugs and their unpredicatable side effects. I mean does your pdoc think he is such a great person to be around that people are making up reasons to see him and play russian roulette with pills? This person's observational skills are way off, I'd find someone new fast if I were you. Is this current psych an OCD specialist?
Posted by g_g_g_unit on May 16, 2010, at 8:28:08
In reply to Re: depression + mental exhaustion, posted by chujoe on May 16, 2010, at 6:39:44
> g_unit, if you are spending a month in bed, that is effing depression no matter what your psychologist says.
>yeah. i guess i don't experience much emotional intensity when depressed, which can be misleading. it's more that i find my reduced capacity (to work, think, socialize) intensely depressing, so just give up on what little i can do already
>
> 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.oh no, i was horrendously anxious during my late teens. in fact, i spent most of my university years tormented by OCD, which i fended off by losing myself in work, studying (and partying, sadly). it was only once i stopped being able to work due to reduced cognitive functioning that things went sour, and i just crashed into depression.
i had tried various meds up until that point to primarily treat the anxiety but didn't find the side-effects worth it. and i still haven't found much relief from my depression with SSRI's alone - they seem to bring me back to a baseline which isn't all that great. i would begrudgingly revisit an SSRI at this point (only because there's not much else) as long as there was some way to effectively deal with the side-effects (brain fog, concentration difficulties etc.), and i guess something like low-dose stimulant might help, as long as it didn't cause an OCD flare-up
Posted by g_g_g_unit on May 16, 2010, at 8:40:42
In reply to Re: depression + mental exhaustion » chujoe, posted by Conundrum on May 16, 2010, at 7:28:27
> I was just thinking about this after I made my post. I'm sorry your pdoc disagreed with you nothing is more frustrating than being told you don't have a particular problem when you know something is wrong. The fact that you stayed in bed for a month is a sign that something is >amiss. You got your hopes up and were let down >and then saw no reason to keep the facade going. I honestly don't understand why a pdoc would dismiss someone like that, its pretty f*ckin stupid if you ask me. The fact that someone goes >to a psychiatrist means that someting must be >wrong, since most people with only minor mood >problems would probably avoid psychiatrists and >the stigma of taking psych drugs and their >unpredicatable side effects. I mean does your >pdoc think he is such a great person to be >around that people are making up reasons to see >him and play russian roulette with pills? This >person's observational skills are way off, I'd >find someone new fast if I were you. Is this >current psych an OCD specialist?i'd rather not say where i live, but it is a big city and it's not the US. i thought my psych would be good because they're a drug researcher and oversee clinical trials, etc. they're not an OCD specialist though. i guess complaining about them on the internet probably isn't of much use either. my mom wants to accompany me to my next meeting, but i donno if that's the best idea. i don't mean to sound melodramatic but i've kind of reached the point where i've stopped caring; i've lived the past two years feeling like i live on another planet
Posted by chujoe on May 16, 2010, at 9:06:00
In reply to Re: depression + mental exhaustion, posted by g_g_g_unit on May 16, 2010, at 8:28:08
Have you tried an SNRI like Cymbalta? When the SSRI didn't work for me this time around, the SNRI pulled me out. And now a low-dose stim is helping me focus. Everyone's different, but this might be an approach to try. Interestingly, the Ritalin has not reactivated my anxiety, just sharpened my thinking and motivation.
Posted by tonyz on May 19, 2010, at 20:15:51
In reply to Re: depression + mental exhaustion » g_g_g_unit, posted by Phillipa on May 12, 2010, at 10:40:58
Phillipa,
I seem to recall that you are taking luvox and the effects of caffeine are really amplified - I'm sure you know this already.
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