Dr. Bob's Psychopharmacology Tips

Fatigue not responding to antidepressants

Date: Fri, 24 Feb 95 12:53 PST
From: lgribble@wimsey.com (Dr. Len Gribble)
Subject: Fatigue not responding to antidepressants

In my practice I see a number of people with depression whose mood responds favourably to antidepressants (usually SSRIs but sometimes TCAs), but who complain of a persistent tiredness and easy fatiguing.

Date: Fri, 24 Feb 1995 16:07:08 -0500
From: "Dr. Willie Yee" <wyee@mhv.net>
Subject: Fatigue not responding to antidepressants

I have had good response in at least half of such patients to adding a stimulant (methylphenidate or pemoline). Tolerance and dependence do not appear to be a problem in these patients.

For patients who are into natural remedies and want to avoid "drugs" I have them try whatever they want. When those don't work, I suggest a short trial of stimulants -- there is nothing to lose, the response is rapid, the the risk of addiction minimal over a few days. This usually settles the issue.

Date: Fri, 24 Feb 1995 15:48:18 -0800 (PST)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Fatigue not responding to antidepressants

If bupropion does not work, methylphenidate or dextroamphetamine nearly always does.

Date: Sat, 25 Feb 1995 10:28:11 -0500 (EST)
From: Charles B. Nemeroff <cnemero@emory.edu>
Subject: Fatigue not responding to antidepressants

These patients, when they respond at all, do so when treated with MAOIs, especially phenelzine. It's worth a try.

Date: Thu, 2 Mar 1995 13:43:24 -0500
From: "Dr. Willie Yee" <wyee@mhv.net>
Subject: Fatigue not responding to antidepressants

How long do you use the stimulants? What happens when you stop?

Some practicioners take their patients off stimulants every weekend, but this is controversial. On the one hand, it may help prevent the development of tolerance. On the other hand, the on-again off-again regimen may be introducing another instability into a system we are trying to stabilize. Mostly, I go to keeping them on stimulants all the time.

Date: 27 Nov 1995 10:35:10 EST
From: "Dan Oren NIMH" <DOREN@aoamh4.ssw.dhhs.gov>
Subject: Fatigue not responding to antidepressants

I've had a couple of patients with non-seasonal major depression who in wintertime have had additional SAD-like symptoms, including overwhelming fatigue. Light therapy has proved useful in increasing energy in these patients.

Date: 30 Nov 95 23:10:16 EST
From: Troy Caldwell <75112.1676@compuserve.com>
Subject: Fatigue not responding to antidepressants

I agree with using augmenting strategies in patients whose fatigue does not recover with their mood, including stimulants, Cytomel (T3) 25 mcg bid x 2 wks, etc. It seems to me this phenomena occurs more with SSRIs than other antidepressants. A change to buproprion also makes sense to me as well.

I would also like to add to this thread the recommendation that psychiatrists, psychologists, family practitioners, etc., educate themselves about chronic fatigue syndrome and fibromyalgia. In a high percentage (rough guess = 30-40%) of patients who are depressed & whose fatigue does not recover with their mood, if I do a tender point examination, these patients meet criteria for fibromyalgia. This seems particularly true when there is a comorbid chronic PTSD or dissociative disorder. Also when the depression has been long lasting, I think I tend to see it more as well.

A good place to start ones education on FM & CFS is the CFS FAQ. "This is a document whose development is in progress. It is being developed by the CFS Internet Group (that is, the participants of the Internet mailing list CFS-L and the Usenet newsgroup alt.med.cfs). For further information about the group and this project, send electronic mail to CFS-L-REQUEST@LIST.NIH.GOV.

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