Ask MetaFilter questions tagged with medicine and depression

Should I seek a second opinion about possible physiological sources of my fatigue, depression, and anxiety before contacting a psychiatrist?

Anonymous — Thu, 23 Feb 2012 09:08:49 -0800

Should I seek a second opinion about possible physiological sources of my fatigue, depression, and anxiety before contacting a psychiatrist? I recently saw a general internist regarding three separate concerns that I thought might have a shared physical source. The doctor advised me to contact a psychiatrist to obtain psychopharmacological medication. I intend to follow his advice, but I also wonder whether I should seek a second opinion. (Relevant details (?): I am a 29 year old male, employed full-time in a challenging but not overly stressful job.)

1) For the past six or seven months, and on a daily basis, I have felt fatigued to the point of being unable to perform my normal daily tasks. This seems largely independent of the amount of sleep I get (sometimes I sleep for 8-10 hours, and I still wake up feeling as though I’ve only slept two). However, more often than not, I am having trouble falling asleep or staying asleep for more than 5 or 6 hours. In the past, I’ve functioned without noticeable fatigue on 5-7 hours of sleep a night. Lately, however, I’m OK until about noon, after which point my day is an agonizing struggle to focus on or pay attention to anything. I am so tired that the thought of walking to the subway, making dinner, or even talking to friends seems impossible. I can’t remember ever feeling this kind of sustained fatigue. I am also shocked to discover deep dark circles under my eyes whenever I see myself in the mirror.

2) About four months ago, I discovered a small lump on my neck, just to the left of my adam’s apple. The lump is about the size of a pea. It has never gone away, but it seems to shrink or swell slightly from time to time. There is no pain associated with it, and I can move it with my finger. I have assumed it was a swollen gland, but I am concerned that it hasn’t gone away. A friend suggested that it may be thyroid-related.

3) I have been dealing with pretty severe social anxiety and less severe depression for about the past year. I feel like I have forgotten how to talk to people; in even the most casual social situations, I get so flustered that I literally can’t think of anything to say, and remain silent until I can figure out a way to excuse myself and hide. I don’t speak to anyone at work and I hide from my roommates. I see friends maybe twice a month, and, apart from that, I spend almost every day by myself—waking up, coming into work, and heading home, all the while speaking to no one. The fatigue has aggravated this anxiety: it takes such effort for me to remember how to interact with people, that the prospect seems downright impossible when I feel as tired as I do. I’ve been in talk therapy for about six months, but do intend to contact a psychiatrist and look at medication.

The internist felt my neck and told me that the lump was small, and he was not worried about it (he did not share any guess as to what it might be). He surmised that my fatigue was entirely the result of the depression and anxiety. Then he advised me to contact a psychiatrist. He did a general check-up, but no bloodwork or more extensive tests were performed.

No one here is my doctor or therapist, and I am not looking for a diagnosis. But I wonder whether I should seek a second opinion about a possible physiological basis for my fatigue/depression/anxiety. I am particularly intrigued by the idea that this might be thyroid-related. I am worried that if I go straight to the psychiatrist, I will end up treating the symptoms without identifying the (possible) root physiological problem.

Thank you all so much. Anyone who wants to contact me outside askme may use the dummy email address: lumpinthethroat@gmail.com

Anti-depressants: do they eventually stop working?

Anonymous — Thu, 24 Sep 2009 09:11:48 -0800

Anti-depressants: do they eventually stop working? I have been diagnosed with anxiety and depression. I started receiving treatment ~2 years ago. The first drug I tried was Lexapro and it worked great, for a while. After 2-3 months of use, I started to becoming increasingly drowsy and unmotivated.

Next, I tried Prozac for it's reported 'activating' effects. I was on this drug the longest, but eventually started to experience side effects similar to those of Lexapro.

Now, I am on Cymbalta and am starting to think these exact same side effects are setting in.

Is this a common phenomenon? Is there something else I could try? Should I bring this up (again) to my doctor ASAP?

I have considered getting off SSRI's / SNRI's but they do, in fact, work very well at controlling my anxiety. I did realize but I had spent most of my (relatively short) life with pretty severe anxiety. I managed to find different mechanisms to control it and would outwardly appear very collected. There was a specific (and common) incident in college where I had to give a group presentation about a topic that I was very knowledgeable about--and I thought I was going to vomit moments before it was my group's turn to present. However, before starting medication I wouldn't have considered myself to have social anxiety. But certain things trigger an anxious response that I couldn't stop.

For what its worth, my anxiety and depression have diminished after starting these medications. The reason I bring this up is because today I felt "high" and "floaty" even though I didn't miss a dose of my Cymbalta and it got me thinking...

St. John's wort + ADHD medications?

Anonymous — Sun, 13 Sep 2009 18:36:45 -0800

What are your experiences with St. John's wort? In particular, have you ever taken it at the same time as ADHD medications like Ritalin/Focalin (methylphenidate), Adderall (amphetamine) etc? Some sources seem to warn against taking then together, some say only that one will might decrease the effectiveness of the other, and many don't say anything at all, so I'd like to know if there's anything to worry about. Even if you have never taken the two together, I'd still be curious to hear what you thought of St. John's wort in general.

Throwaway email: sjwquestion@yahoo.com

(Please don't tell me to ask a doctor; I'm asking because the doctors that wrote all the information I've read seem to disagree.)

It's all in my head, or is it?

Anonymous — Sat, 16 Jun 2007 21:11:42 -0800

I think I may have some sort of depression, but my parents don't really believe in mental health care for that. What do I do? [a bit long] So, I think I'm depressed. I'm pretty sure it's not normal to cry every day. Frequent crying for no apparent reason, little to no motivation, have lost interest in things I care about, significant libido drop, bizarre sleeping habits alternating between insomnia and sleeping way too much. This has been going on at a somewhat low level for a while now (probably at least a year). It doesn't help that I'm home from college for the summer, and all of my friends and my boyfriend are all hundreds of miles away.

I am technically an adult, but I am still financially dependent on my parents. My parents don't really, uh, believe in psychiatric medicine or therapy. At the very least, my mom dismisses the entire field as being full of quacks. I don't really know where my dad stands, but minor anecdotal evidence leads me to believe he's more normal about the issue. (He has at least asked me if I were sick, given my odd sleeping patterns, and I said I didn't know.)

I don't know what to do. Were I at school, I could do something about it, because I could probably afford the subsidized treatment there without my parents having to know. (My school takes mental health very seriously.)

I do not consider myself a danger to myself. Although I think about suicide on a fairly regular basis, it's more in an abstract sense, and I am very sure that I couldn't bring myself to end my own life, as I have a pretty good one and don't want to give up on it. So, it's not a potentially deadly condition at the moment, it just makes life suck, and my mom continues to yell at me for having no motivation to do anything.

I'm also rather torn about the issue myself. On the one hand, I know rationally that depression-like diseases are chemical in nature, and there's only so much one can do. On the other hand, from my upbringing I'm thinking to myself that I'm just being a wimp, that I'm just making myself out to be a victim, and it's something I should just deal with on my own. And that therapy/drugs are just giving in due to lack of willpower. I am constantly trying to convince myself I am not depressed, but if I weren't, I assume I wouldn't have to. I've been this way so long I don't even know what normal is anymore. Again, I know on a rational and abstract level that this is not sound thinking, but if your brain is affected by a mental illness, it's kind of hard to get around thinking that way.

So, what can I do? I have read other depression threads on here, and I noticed exercise was a common suggestion. I have just started exercising today again after a hiatus for several months. (I used to be on my high school varsity team, but wasn't good enough to be on the team at my university. I've been taking gym classes for my particular sport, but I sort of lapsed this past semester after I fulfilled my PE requirement.) It was good, albeit tiring, and it reminded me how much I missed doing that.

How could I possibly approach my parents about this? I don't even know how I would approach my mom about this. My parents are very supportive, but my mom can be a bit conservative and traditional in some of her beliefs. I suppose I could approach my dad, but I don't really talk to him about medical issues (which are mostly female-related ones), so I don't know.

If you want to contact me personally, you can do so at allinmyhead.askmefi@gmail.com.

SSRIs

Anonymous — Fri, 11 Feb 2005 11:51:40 -0800

For those on SSRIs, does anything weird happen if you accidentally miss a dose?

Paxil Withdrawal

Anonymous — Tue, 30 Nov 2004 20:02:28 -0800

Psychotropicdrugfilter:
I'm probably getting off Paxil after seven (!) years and I wonder:
(1) Anyone gone through the withdrawal syndromes and have any advice or heads up on what to expect? I'm terrified.
(2) I have had no "sexual" problems on Paxil. What anti-depressants should I stay away from if I really really want my libido intact?
I'm male and 29.

Wellbutrin Experiences

dejah420 — Thu, 08 Apr 2004 20:22:16 -0800

Wellbutrin. Anybody tried it? Experiences you want to share? Good, bad, indifferent? Weight gain? Sex drive? I've read the pharmacology, and chemically understand it...but clinical studies often leave a lot to the imagination when it comes to side effects, or lack thereof.