Depression Questions

December 28, 2008 10:12 AM

I've been having a bunch of worrying but seemingly unrelated symptoms while dealing with depression. Which of them should be tested? Which are psychosomatic?

A few weeks ago, I was diagnosed with major depression and started on 150mg of Welbutrin. In the past, I have taken the drug with few problems. I am also on 70mg of Vyvanse. The depression causes me to be mildly anxious, have mental fogginess and trouble concentrating, trouble motivating myself, and it caused me to get terrible grades in the past semester of college. I also tend to feel anything I've been striving to do this semester gets terrible grades, regardless of how much effort I put in. I think I've had the depression since at least early October, but it's likely it even goes as far back as September.

I am a 20 year old male and I've been suffering some symptoms that worry me. I've had pain in my upper back for the past month and a half or so. It's a pain on the surface, which has no rash. I suspect it's either from bad posture or it's psychosomatic, but I've been consciously trying to improve my posture to get over it. It was worse after I tried to shovel snow. I also have been having trouble getting to sleep and waking up at a normal hour, partly from an odd college schedule, but also likely because of the Vyvanse, which I have phoned my psychiatrist to lower to a smaller amount, but have not received a reply yet. I also was shaking one day when I was angry about something, but I think I was particularly tired that day, and at the time, I wrote it off as either being cold or having a lack of sleep, and it hasn't arisen again. I also generally feel more disorganized and have trouble concentrating.

What worries me most is that this morning around 11 AM after being up for 3 hours, I began to feel faint and dizzy, which is not normal for me at all. It may have been related to stress, but I've never really felt faint that late in the day for seemingly no reason. The strange thing is that when I felt faint, my back's pain was worse than normal. I don't think it's flu, as I have a normal temperature, and I had a flu shot this year. When I first felt it come about, I thought it might have been low sugar or something (I'm not diabetic) and had some juice and a cookie, but that did not help. In terms of diet, I ate a bowl of Mini-Wheats and a coffee with milk, all the milk being skim. This is my normal breakfast, and I've had it since high school, more or less. My meals yesterday were pretty normal as well. It started while I was at church with my family, and I did feel a bit short on breath while singing. I did work out at the YMCA for the first time in a while, staying on an exercise bike for about an hour but going at a steady pace. It could very well be related, but I wouldn't expect the reaction to be delayed. My legs are not sore.

I should note that I'm also under a bit of stress because I haven't had as much time to take a break as I'd like since I got home from college. The first couple of days, I had to help pet sit an incontinent dog my mom agreed to take in, thinking I would have no problem, which took up a lot of my time because I had to clean up after the dog and make sure it was not lonely or bored. My mom works, and I was diagnosed only a week or so before heading home, so my mom had already made these commitments. After that, my grandparents were set to come in under a week, and I needed to do chores around the house to get it clean for them. I also have an incomplete class to make up, and the professor is not returning my emails when I have questions about the class. I also find it difficult to deal with my grandparents when they are over for reasons I don't want to get into in the initial question. They're just really needy, and we're the only family they're on speaking terms with.

Does this sound like anything I should be concerned about? I'm planning on having therapy to discuss my depression and get back on track, and I'm debating taking a hiatus from school next semester. I've planned to get some basic blood work done tomorrow morning to look for any problems, in particular thyroid issues. Are there any tests I should be looking into, or a specific type of doctor other than my GP and psychiatrist? How do I know if a symptom is psychosomatic or not?

Thank you for your help.

posted by mccarty.tim to health & fitness (9 comments total)

Stress and depression can cause a lot of physical effects, but I wouldn't worry about that now. I would call your psychiatrist and insist on speaking with him. You've got a lot of new meds running through your system, amphetamines and then wellbutrin which affects dopamine and norepinephrine. You know, brain chemicals. Not a place to dally.

Your doctor as a medication manager has to work with you closely, and not returning a call is unacceptable.

As an aside, I was on Wellbutrin and had horrible effects, a numbness in my arms and significant aggrevation of the shaking I have from essential tremor. I switched off and to an SSRI and am better.
posted by kingfisher, his musclebound cat at 10:23 AM on December 28, 2008

I called him on Saturday about it, so I'm expecting him to get back to me tomorrow.
posted by mccarty.tim at 10:25 AM on December 28, 2008

As for back pain and its possible origin as a psychosomatic disorder, check into John E. Sarno, who argues that the majority of back pain has a psychosomatic origin. As I recall he claims our body deliberately causes the pain (so it is real, not imagined) in order to distract our thinking from deeper, troubling issues. Physical pain is easier to focus on than psychological despair apparently.
posted by kingfisher, his musclebound cat at 10:27 AM on December 28, 2008 [1 favorite has favorites]

Talk to either your Dr or your Psychiatrist. Sadly, we don't yet have the tools to do complicated diagnoses over the internet.

Any of your symptoms could by psychosomatic. Just like any of them could have a physical cause. Back pain could be caused by sleeping in a new bed/position, or it could be caused by stress.

Talking to your Dr is the fastest, most comprehensive way to get a clear answer.
posted by Solomon at 10:33 AM on December 28, 2008

re: dizziness- I experienced bouts of vertigo my first month or so on wellbutrin XL.
posted by sunshinesky at 10:34 AM on December 28, 2008

Seconding kingfisher. Your meds need to be adjusted or changed. That's your first order of business. The second order of business is to take good care of yourself. That includes distancing yourself from things that are stressful. Explain to your mother that you are ill, are under the care of a doctor, and are taking prescription meds. If you were sick with the flu, she wouldn't expect you to do everything she wanted/expected you to do. Thirdly, don't sweat the little stuff, and all the rest is little stuff — the class and all the other stressors. They can wait until you get your meds squared away. Be good to yourself.
posted by exphysicist345 at 10:55 AM on December 28, 2008

If you're still taking the vyvanse daily while waiting for your doctor to change your dose, you can open the capsules and pour the contents into a glass of orange juice to take that way--you can lower your dose by only pouring half into the juice, for example. It won't be exact but it'll certainly be less than 70 mg.

About the back pain: it could very well be a symptom of anxiety or stress which is getting exacerbated by the medication you're taking, since both vyvanse and wellbutrin are "activating" (ie, speedy). Plenty of people carry stress in their neck, back and shoulders (see?). You could be clenching your back muscles unconsciously, for example (I do the same thing with my jaw). Try soaking in a warm bath with epsom salts, or springing for a massage, if you can. If nothing else, it'll probably make you feel better anyway.

Good luck with everything--it takes time to get medications right, and I did not tolerate wellbutrin (zyban) well at ALL when I took it to help me quit smoking, and I was also taking vyvanse at the same time. My feeling is that although you tolerated it well in the past, taking it concurrently with amphetamines is exacerbating the side effects of both drugs--certainly the sleeping problems, shaking and probably the faint feelings, too.

Definitely go get checked out by a GP (probably a good idea, anyway) but know that "psychosomatic symptoms" with no clear underlying cause are most likely symptoms of your anxiety or side effects from the medication you're taking. Get the meds sorted, get into therapy to work on your depression and anxiety and I bet you'll feel a lot better soon, mentally and physically. This too shall pass.
posted by cosmic osmo at 12:02 PM on December 28, 2008

You might also want to check with a pharmacist if you think any of this is med related.
posted by St. Alia of the Bunnies at 12:39 PM on December 28, 2008

I find that I need a day or two a month off of Vyvanse to stop things like this from happening. Don't know why. Also, Wellbutrin is supposed to be "activating" and maybe it's stacking some of the speedy effects of itself and the Vyvanse.
posted by gjc at 4:27 PM on December 28, 2008