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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by allisonm on January 22, 2001, at 11:10:42
I've been taking Celexa (10mg/day to start) since Friday and have felt waves of exhaustion and lethargy ever since. Friday night I had to go to bed early. Saturday I woke early (5:30), got up fairly early (8-ish) but then went back to bed until almost noon. Sunday I was able to get and stay up all morning, but had to lie down for awhile at 3 -- and couldn't sleep. I woke up at 5:30 again this morning (no alarm) and got to work early, but I feel extremely tired. I almost feel as socked as I did when I first started Remeron, but I don't remember that tiredness lasting this long. I am trying to figure out whether this is the Celexa or whether I am coming down with something. Ugh! Any ideas?
I take the Celexa in the morning, and I'm also taking Wellbutrin (200mg/b.i.d) and Neurontin (200mg in am and 800mg at bedtime).
Posted by allisonm on January 22, 2001, at 17:41:07
In reply to Did Celexa sap your energy?, posted by allisonm on January 22, 2001, at 11:10:42
OK, so I'm not coming down with something. I've been trudging through the 2400+ archived posts from last year alone and find fatigue is fairly common. Folks with this problem take Celexa at night. This worries me because I have a history of insomnia with my depression, and insomnia seems to be the other side effect other than the sexual side effects. Will this never end?
That's a rhetorical question. People say "keep trying, there are so many drugs out there, you're bound to finally hit the right one(s)." Heck, I've said the same thing to people on this board. I'm just so sick (and tired) of this (again).
Posted by Joy on January 22, 2001, at 18:18:11
In reply to Did Celexa sap your energy?, posted by allisonm on January 22, 2001, at 11:10:42
Hi. You're only a few days on this med. You have to give it a little more time. Just don't dose higher for a little while. Everybody is different. 20 mg of Celexa gave me no side effects, it just did not work for me and 30 mg gave me agitation; no lethargy on this med for me. Hang in there a little while. Don't give up too quickly.
Joy
> I've been taking Celexa (10mg/day to start) since Friday and have felt waves of exhaustion and lethargy ever since. Friday night I had to go to bed early. Saturday I woke early (5:30), got up fairly early (8-ish) but then went back to bed until almost noon. Sunday I was able to get and stay up all morning, but had to lie down for awhile at 3 -- and couldn't sleep. I woke up at 5:30 again this morning (no alarm) and got to work early, but I feel extremely tired. I almost feel as socked as I did when I first started Remeron, but I don't remember that tiredness lasting this long. I am trying to figure out whether this is the Celexa or whether I am coming down with something. Ugh! Any ideas?
>
> I take the Celexa in the morning, and I'm also taking Wellbutrin (200mg/b.i.d) and Neurontin (200mg in am and 800mg at bedtime).
Posted by sundog on January 22, 2001, at 19:45:19
In reply to nevermind, posted by allisonm on January 22, 2001, at 17:41:07
allisonm, I've been lurking for a while but had to reply to this one. I also started 10 mg Celexa last Friday, and have been taking Wellbutrin SR (300mg as of Friday, reduced from 400). I also take 50 mcg Cytomel -- not clinically hypothyroid, but it's been an attempt at augmentation of the WB. I take the Celexa in the morning, with 100 of the WB and the Cytomel.
I haven't noticed any difference in my energy level since Friday, nor any insomnia, just the same general level of fatigue and foggy-mindedness that worsens around the tasks I'm procrastinating on.
I've been on Wellbutrin since last June, with a very long slow ramp-up and no side effects at all except a welcome 10-lb weight loss. The lift I started to feel in late summer/early fall has been ebbing away, though, and I'm not sure I ever really got full effectiveness. I gather that the WB was working for you and has now pooped out?
It would be nice to compare notes on the Celexa occasionally, if you like. I'm female, 39 y.o., long history of undertreated dysthymia.
best wishes,
sundog
Posted by Ron Hill on January 22, 2001, at 19:52:43
In reply to nevermind, posted by allisonm on January 22, 2001, at 17:41:07
Best wishes Allison. I'm believing it will get easier for you soon. :)
-- Ron
------------------------------------------> OK, so I'm not coming down with something. I've been trudging through the 2400+ archived posts from last year alone and find fatigue is fairly common. Folks with this problem take Celexa at night. This worries me because I have a history of insomnia with my depression, and insomnia seems to be the other side effect other than the sexual side effects. Will this never end?
>
> That's a rhetorical question. People say "keep trying, there are so many drugs out there, you're bound to finally hit the right one(s)." Heck, I've said the same thing to people on this board. I'm just so sick (and tired) of this (again).
Posted by quilter on January 22, 2001, at 21:57:17
In reply to Did Celexa sap your energy?, posted by allisonm on January 22, 2001, at 11:10:42
Taking the Celexa at night helped me with both insomnia and low energy during the day. Dosing times can make a surprising amount of difference.
Quilter
Posted by allisonm on January 23, 2001, at 7:32:15
In reply to Re: nevermind, posted by sundog on January 22, 2001, at 19:45:19
Sundog,
Thanks for writing and welcome.
I think the Wellbutrin is working. It just doesn't seem to be enough. I was on Remeron and Wellbutrin before this, and Remeron and lithium before that. This combo of Wellbutrin and Neurontin is the best so far, but also didn't seem to be enough. My doctor and I had a discussion on what was "enough" last week (I don't think I know), and he suggested the 10mg of Celexa. I'm supposed to be working up to 20.I left him a message last night, and he called back this morning telling me to take the 10mg at night instead, at least until my body gets used to it. So we'll see how it goes. I went to bed early last night (8 pm), but couldn't get to sleep till after 10. I woke up at 5 and laid in bed till 6, when I finally decided there was nothing to be done but to go to work.
Re: your mention of the energy level of Wellbutrin wearing off. FWIW, I think this is common. I was full of energy when I first started on Wellbutrin, but that wore off. Cam W., a pharmacist who has taken Wellbutrin, says when the extra energy dissipates, the drug is really beginning to work. I have been on WB since June of '99. I have been at 400mg since last April. Started Neurontin in October.
I would be interested in keeping in touch. I am also 39, female, with what apparently is a long history of depression that went untreated until about 3 years ago and now is being called chronic and treatment resistant by my psychiatrist.
Take care,
Allison
Posted by allisonm on January 23, 2001, at 7:34:02
In reply to Re: Did Celexa sap your energy?, posted by quilter on January 22, 2001, at 21:57:17
Quilter,
How early do you take it before bedtime?
Thanks.
Allison
Posted by danf on January 23, 2001, at 8:08:27
In reply to Re: Did Celexa sap your energy? » quilter, posted by allisonm on January 23, 2001, at 7:34:02
Celexa can ( did for me ) dysrupt sleep patterns & in general mess with all sorts of things... bowel habits.. sinuses... energy... etc
This usually goes on for about the first 3 weeks. between weeks 4 to 6 there can also be a time of increased emotional lability.
This is pretty common with celexa & zoloft..
Posted by quilter on January 23, 2001, at 23:36:44
In reply to Re: Did Celexa sap your energy? » quilter, posted by allisonm on January 23, 2001, at 7:34:02
> Quilter,
> How early do you take it before bedtime?
> Thanks.
> AllisonAllison- I try to take my bedtime pile of pills at 9:00 or so. Then I'm sleepy enough to go to bed about 1:30 a.m. Probably not a reasonable option for most people, and certainly complicated by the number of different meds I take. Sorry I can't be more helpful..........
Quilter
Posted by PatJ. on January 25, 2001, at 12:29:48
In reply to Did Celexa sap your energy?, posted by allisonm on January 22, 2001, at 11:10:42
No. In fact, it gave me more energy than I've had in many years. Funny, huh, how two people differ so. I quit taking it for other reasons, though.
Posted by sundog on January 25, 2001, at 20:46:35
In reply to Re: nevermind » sundog, posted by allisonm on January 23, 2001, at 7:32:15
Allison,
I meant to write back sooner, but I've been feeling pretty overwhelmed by work. Is the nighttime dosing helping your fatigue? If it's been wiping you out during the day, hopefully it will wipe you out at night, despite the presence of Insomnia in the side effect profile. But then, simple logic doesn't rule, does it? I am usually wiped out by anything that has even a remote chance of exerting a sedative effect, like any and all over-the-counter antihistamines ("non-drowsy" or not). For the last week with Celexa I've been trying to monitor my energy level without becoming obsessive (I can be suggestible about side effects) but can't say that I perceive any difference. It seems to be variable within about the same range.
I guess I must not be all that suggestible, though, since I haven't had any insomnia/anxiety effect from Wellbutrin, despite having read many posts from people who said it drove them up the wall. I can take my evening dose at 10 pm if I forget in the afternoon, and still sleep like a log. But then my depression is the logy-slow-somnolent type. The only time I've consistently had trouble sleeping was when I was on Prozac (3 to 6-month stints in '88 and '92?, almost a year around '95 or so).
I really relate to your question about how much improvement is enough. I am worrying that bone all the time. I think I've been the way I am for so long that I truly don't understand what it is I should be aiming for. I sometimes wonder if the Wellbutrin has had any effect on me at all after the initial energy burst (the complete lack of side effects makes it easier for me to wonder this). Then I look back at some objective signs like the state of my apartment, my financial recordkeeping, my ability to deal with small crises, and I see that those things are clearly better. But other major aspects of my life are not, or only in very small ways. My psychiatrist always seems more optimistic about small changes than I am, so then I wonder if it's just depressive habit, or depression itself, that keeps me from sharing his viewpoint. (And which came first? . . . ) But last week I was pretty adamant that I felt I was losing ground, or at least not gaining any, and the thyroid augmentation (first T4, then 50/50 T4/T3, then T3) wasn't doing anything noticeable -- hence the Celexa.
Well, I've got to stop typing, but keep me posted. I guess my current Celexa summary is: I don't feel anything yet, one way or the other.
Best,
Lynn
Posted by sundog on January 25, 2001, at 20:51:11
In reply to Re: Did Celexa sap your energy?, posted by PatJ. on January 25, 2001, at 12:29:48
This is good to hear. Do you mind saying if your reasons for quitting were side effect-related? (weight, libido?)
> No. In fact, it gave me more energy than I've had in many years. Funny, huh, how two people differ so. I quit taking it for other reasons, though.
Posted by allisonm on January 26, 2001, at 11:32:07
In reply to Re: nevermind » allisonm, posted by sundog on January 25, 2001, at 20:46:35
Lynn,
My doctor called me right back and told me to start taking the Celexa at night instead starting Tuesday.. Tuesday and Wednesday nights were bad and I only got about 4 hours of sleep in each because I kept waking up and was not able to fall back asleep. I also was having trouble getting up in the morning -- either because of the Celexa or the lack of sleep. When I got up in the night I felt dizzy. So yesterday he suggested I try it again in the daytime. I took 10mg at 7 am today and by 10:30, my legs felt like wet noodles and all I want to do is curl up. I wish I had a davenport at work. I'm going to try to get some reading done this afternoon. I hope this fatigue doesn't worsen throughout the day as it did before, else I'll just go home. But I slept through the night last night (yay!).
I've also been experiencing intestinal problems that danf mentioned, but I have had the opposite problem with the WB, so am thinking that maybe one will cancel the other out.
I agreed to stick this out longer to see if it helps. The fatigue, while annoying, is more tolerable than the "climbing the walls" feeling I got with drugs such as Effexor and Zoloft. My depression is the anxious kind with suicidal thoughts, no focus or concentration, running tape loops in my head. One of my primary symptoms has been insomnia. I've not experienced the slow somnolent type, so this fatigue is novel and unsettling. Too bad it doesn't include somnolence.
You hit the nail on the head re what is enough, is it depressive thinking or depression. I think if you felt you were losing ground, that is the best barometer. I'm glad your doctor listened.
Take care,
Allison
Posted by sundog on January 26, 2001, at 20:48:16
In reply to Re: nevermind » sundog, posted by allisonm on January 26, 2001, at 11:32:07
Allison,
Fatigue in the daytime, insomnia at night . . . I wonder what that stuff is doing in there! It's good that you slept last night, though. That must be a positive sign that you are starting to adapt.
Tomorrow morning I'll start taking the whole 20 mg pills, per my doctor who I saw today. I am really glad to be stepping up the dose, because I've had a pretty difficult week emotionally and am REALLY ready for more pharmaceutical help.
I mentioned your situation to him, and after saying, of course, that he's seen a range of responses and some people do have problems with both fatigue and insomnia, he also mentioned that some people do take Celexa in two doses to even things out a bit. Now that I think about it, though, splitting that already-halved pill might be tricky.
Yes, a davenport, or a fainting couch(!) in the office would be nice. I have once or twice managed to fall asleep sitting in my desk chair, but not for long.
Best wishes for a somnolent *night* for you tonight!
Lynn
Posted by PatJ. on January 27, 2001, at 14:16:12
In reply to Re: Did Celexa sap your energy? » PatJ., posted by sundog on January 25, 2001, at 20:51:11
> This is good to hear. Do you mind saying if your reasons for quitting were side effect-related? (weight, libido?)
I have another illness and it seemed its symptoms were amplified with celexa (unless I was just having a bout of my anxieties) but I wish they hadn't been because it made me feel pretty good. It did not effect my eating. I was on about 20mg. I've thought of trying to go back to it but I don't know yet.
Posted by sundog on January 29, 2001, at 8:17:44
In reply to Re: Did Celexa sap your energy? » sundog, posted by PatJ. on January 27, 2001, at 14:16:12
Thanks for the followup. It's encouraging to hear some (basically) positive things about Celexa.
> I have another illness and it seemed its symptoms were amplified with celexa (unless I was just having a bout of my anxieties) but I wish they hadn't been because it made me feel pretty good. It did not effect my eating. I was on about 20mg. I've thought of trying to go back to it but I don't know yet.
Posted by sundog on February 3, 2001, at 9:23:54
In reply to Did Celexa sap your energy?, posted by allisonm on January 22, 2001, at 11:10:42
Hello Allison (or anyone else),
Celexa update:
I've just finished the first week at 20 mg (after one week at 10), and will go at least another week at that level. I had a pretty rough four days or so after the dose increase: really sluggish and tired, couldn't concentrate or think clearly, major procrastination on serious things. (These were problems before Celexa, so that wasn't a change, just exacerbation.) I called in sick Monday and Tuesday and just laid around and dozed most of the time (though I did manage to get myself to yoga class on Sunday). No problems sleeping, day or night. Wednesday I went back in to work, mostly because staying away another day would have created more problems than I felt like dealing with, and I felt better that day and Thursday. Of course I wonder whether that was due to the med or the fact that I got out of the house and did something I'd been avoiding, and interacted with other human beings. Friday was kind of up and down, and today so far I feel OK, by which I mean what feels like about base level before Celexa. I'm not sure I perceive any AD effect yet, but at least I seem to be tolerating it now, so I'm mildly optimistic.
How is it going for you? Have the tiredness and insomnia changed at all?
Best,
Lynn
Posted by allisonm on February 3, 2001, at 19:18:32
In reply to Re: Did Celexa sap your energy? » allisonm, posted by sundog on February 3, 2001, at 9:23:54
Hi Lynn,
When I went back to taking the 10mg during the day a week ago last Friday, I still was tired but didn't feel as bone-tired and lethargic as I had before, although I still feel it.
Taking it in the day did help my sleep, although I'm still waking up around 4, sometimes 3, and sometimes 5, but usually 4. Some nights when I think I'll catch up on sleep and go to bed early, I wake up at 2 (like this morning), toss and turn for an hour or two, wake up at 5 and then dose lightly till about 9 (on a weekend; 6-7 on a weekday). So no, the sleep hasn't been terrific. I average 5-6 hours, sometimes 4 and sometimes 8.
I was complaining to my pdoc this week about scattered thoughts, but then he asked me if this was a problem at home, and it wasn't, so I think it has more to do with work. I do have annoying hand tremors.
I'm in week 3 and still taking 10mg. this is the first SRI I've been able to even marginally tolerate, but I am afraid the alternative is a two-week washout and the start of an MAOI (he mentioned this as an alternative when he suggested adding Neurontin. I kind of freaked when it wasn't working enough and he said that we could add Celexa to it to see how that would work.)
I have enough experience with side effects (Wellbutrin taught me a few things) that I'm trying to ride this out and see if the side effects wear off because I'm afraid of the washout and what it could do to me at work. Also, I'm a vegetarian and the restricted MAOI diet would eliminate a lot of what I eat (cheese, yogurt, soy).
I think I am feeling better. I have been waking up feeling pretty good -- upbeat and cheerful. I don't get irritable as often; things don't seem to bother me as much, which I guess is what's supposed to happen. I sure hope these side effects will dissipate. This fatigue can't last or I'll have to stop it.
I'm glad you wrote. I'm sorry you've been having a tough time. I hope things get better. Take care and keep in touch.
Allison
Posted by allisonm on February 9, 2001, at 19:20:49
In reply to Re: Did Celexa sap your energy? » sundog, posted by allisonm on February 3, 2001, at 19:18:32
I took 20mg for the first time this morning, and no fatigue. I don't get it.
How are you doing?
Allison
Posted by sundog on February 9, 2001, at 20:45:41
In reply to Sundog, posted by allisonm on February 9, 2001, at 19:20:49
Isn't that strange? Either you were just at the point where you were going to adjust anyway, or there's some kind of paradoxical effect, like I've heard of with Remeron. Anyway, congratulations! And good for you for sticking with it.
In yesterday's pdoc/therapy appointment we decided to stay with 20 mg for another week at least, since I have some hints of improvement in mood. I *think* I'm starting to feel slightly more cheerful (esp. in the mornings, as you mentioned about yourself) and a little more outgoing, if not confident. If so it's pretty subtle, and subject to the usual ups and downs; I'm not really certain. I still feel overwhelmed and frightened by my ever-increasing pile of work-related tasks, and the strain of trying to pretend I'm completely OK and not falling behind. Still floundering in the procrastination-perfectionism nexus. That feeling of being repelled by some kind of negative force field when I approach any of this stuff is still there. But I have had moments of feeling . . . slightly less hopeless? And still tolerating the meds well.
Oh, also, I've lost somewhere around three pounds in the last three weeks. Not that I feel the need to lose a lot more (I'm within five pounds of what I'd consider my ideal weight, which to me is pretty darn good already), but I am glad that I haven't started out gaining. On each of my three Prozac trials I dropped about 10 pounds quite quickly, then regained gradually to the starting point but not beyond. Maybe this is my SSRI pattern.
Glad to hear good news, and may it continue! Keep in touch, and thanks for the support.
Lynn
> I took 20mg for the first time this morning, and no fatigue. I don't get it.
>
> How are you doing?
>
> Allison
Posted by allisonm on February 9, 2001, at 21:53:55
In reply to Re: Sundog » allisonm, posted by sundog on February 9, 2001, at 20:45:41
> > I still feel overwhelmed and frightened by my ever-increasing pile of work-related tasks, and the strain of trying to pretend I'm completely OK and not falling behind. Still floundering in the procrastination-perfectionism nexus. That feeling of being repelled by some kind of negative force field when I approach any of this stuff is still there. But I have had moments of feeling . . . slightly less hopeless? And still tolerating the meds well. < <
Boy do I know that feeling!!!
Do you see the same person for meds and therapy (I do.)?
Take care, Lynn.
Allison
Posted by Ron Hill on February 10, 2001, at 11:30:32
In reply to Sundog, posted by allisonm on February 9, 2001, at 19:20:49
Allison,
I'm happy re your improvement. May it continue! I've been following this thread because I also have periodic episodes of extreme fatigue. You and I are on somewhat simillar meds but we have different dx's. I'm BP II taking 600 mg/day Lithobid, 20 mg/day Prozac, and 100 mg/day Wellbutrin. You probably recall my request for help re insomnia, and that is no longer a problem (Thnaks!).
This fatigue thing is the pits though. I think it is the SSRI that zaps my energy. I was in real trouble before I added Wellbutrin about three months ago. Wellbutrin gave me the typical initial high energy boost for about five days, and then leveled at a very acceptable effectiveness. But now then the fatigue/lethargy thing shows up.
I think I can overcome this with a consistent and rigorous exersize program. Exersize was my "self-medication" drug prior to my BP dx. It's just so hard to make myself do anything when all I want to do is sleep and watch TV!
Please take time to keep us informed on your fatigue symptoms. I gain some good insight from other peoples experineces. And vice versa; if I can be of any assistance to you, just yell.
-- Ron
--------------------------------------------> I took 20mg for the first time this morning, and no fatigue. I don't get it.
>
> How are you doing?
>
> Allison
Posted by allisonm on February 10, 2001, at 11:53:23
In reply to Glad to Hear, Hope it Continues » allisonm, posted by Ron Hill on February 10, 2001, at 11:30:32
Thanks, Ron. I do remember your post on insomnia. I'm glad things seem to be working better.
I am wondering whether I spoke to soon. I feel pretty tired today, but then again, we had a terrific wind storm last night and couldn't sleep much. Also, I haven't been hungry so haven't been eating, which is bad. Maybe I am just my own worst enemy. SSRIs always made me way too jittery, which is why I was so surprised when Celexa socked me so hard.
Thanks again. Keep in touch.
Allison
Posted by sundog on February 11, 2001, at 21:07:10
In reply to Re: Sundog, posted by allisonm on February 9, 2001, at 21:53:55
Allison,
Yes, I do therapy and meds with the same person. In fact I did therapy only with him for about a year while I was trying to see if I could reasonably avoid going back on medication..That is what allowed me to develop enough trust in him to allow him to prescribe for me (I could do this because my problem was more chronic than acute, and I'd always managed to muddle along somehow, under my grey cloud). I had found my previous experiences with the managed-care med-check model so alienating -- having only 15 minutes a month with a total stranger who was prescribing drugs that directly affected my brain(!) made me feel like a machine on a conveyor belt. Or like I was being shuttled back and forth between a Dad authority figure who dealt with facts and a Mom who dealt with feelings. I don't know how I would've experienced it if I'd gone to a female psychiatrist and/or a male therapist, or gone outside the list of "approved providers" to find the *right* MD and therapist for me. But as it was, the whole thing made me really resentful and mistrustful of psychiatric treatment, which was a big factor in why I kept ditching the meds prematurely.
On this round of seeking help, one visit to the provider assigned by my health-care plan convinced me to stop messing around and just find the best person I could find regardless. I initially went to my current doctor for evaluation and advice or referral, but wound up choosing to stay with him. He is an exceptional person who is very knowledgeable about medical treatment, but originally came out of a humanistic-psychoanalytic background and has never lost that bent. This way both sides of therapy feel unified, and I trust him with both. I also know that he knows what I'm like off meds, and what I'm like period. I pay a lot more, but luckily the insurance still covers about a third of it, though I have to pay up front and submit bills myself. I can just barely afford it, but feel very lucky that I am able to do this.
So how's your energy level now? Hope it was just the windy night. On the other hand, I try to remind myself sometimes that improvement happens in a sawtooth pattern of ups and downs, but the general trend can still be up.
Best wishes,
Lynn> > > I still feel overwhelmed and frightened by my ever-increasing pile of work-related tasks, and the strain of trying to pretend I'm completely OK and not falling behind. Still floundering in the procrastination-perfectionism nexus. That feeling of being repelled by some kind of negative force field when I approach any of this stuff is still there. But I have had moments of feeling . . . slightly less hopeless? And still tolerating the meds well. < <
>
> Boy do I know that feeling!!!
>
> Do you see the same person for meds and therapy (I do.)?
>
> Take care, Lynn.
>
> Allison
This is the end of the thread.
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