Major Depressive Episode - physical symptoms, OMG!

[swampgas]

Hey there, I 'm new to the forum (and mental health issues) and have searched the forum for answers, but I just wanted to ask if anyone has tips on dealing with the extreme fatigue, nausea, weight loss, and dizziness (and it's not from medication) while trying to keep working to pay the bills. There has got to more than pills that don't work and talk therapy which costs a small fortune.

My employer has noticed that something is up (used up all my sick time and vacation) and I'm not sure how to approach the topic. Should I just leave him in the dark? Any advice on this would also be very much appreciated.

I thought depression was all about feeling sad and hopeless. I am shocked by the physical symptoms that can result from chronic stress. I've been literally been knocked off my feet for much of the last 10 weeks. As many of you probably know - it's brutal! I've been on Wellbutrin for 7 weeks and I'm told it will take time. The intensity of the symptoms varies with no rhyme or reason, and it's quite a strange and troubling ride. Initially I thought that I had the flu, or something worse, but after 3 weeks I got a diagnosis that seems to make sense after eliminating other suspects.

Cheers

[Determined]

Hi Swampgas (cool name btw). Just want to welcome you to the forum. No words of wisdom at the moment but you nailed it when you said "it's quite a strange and troubling ride." There is one website I bookmarked that was quite good. I'm sure there are many others but here is the link to that one. http://www.depression.com.au.

[paul m]

Hello Swampgas and welcome. There are multiple answers to your seemingly simple questions, so please bear with me. First, Determined has given you a link to a pretty good site.

7 wks on wellbutrin and you should be seeing some change. If you do not see a change in 2 wks, ask your doc for a different anti-depressant(A/D) . Most people think that if they take an A/D they will get better, maybe, but not always. Any given A/D only has a 50-50 chance of working for any given individual and that percent doesn't change no matter how many different types of A/D's you try. So if one type doesn't work, never hesitate to ask for another type. SOME docs have a favourite type that they prescribe all of the time. I have no idea why, but it happens and the same doc will have an unrealistic belief that this A/D is the best available.

In regards to physical symptoms, chronic fatigue is a common problem, unfortunately chronic fatigue can also cause depression. So you first have to figure out if it's a mental or physical problem.

If you haven't had a complete physical you should do so. Many times depression is caused by physical problems. If your thyroid is out of wack, you are going to be tired no matter how many A/D's you swallow. Same goes for diabetes, vitamin b-12 defiency and many other physical problems. A surprising # of docs don't include routine thyroid cks etc during physicals.

If you have someone who sleeps near you ask them is you snore. (or tape yourself). If you snore ask your doctor about getting a referal to a sleep clinic as snoring can cause chronic fatigue. Again, a surprising # of docs don't ask about this and a number of people will often claim that they don't snore anyways. You should probably have a referral to a sleep lab anyways if your symptoms don't get better. Even if you don't snore, you may not be getting a good nights sleep. This is often a cause of chronic fatigue. A sleep clinic can tell for sure.

I'm sure that you have been told this, but try and maintain a decent diet, limit the amount of booze that you drink and catch some extra sleep when ever possible.

As impossible as it may sound, try and get some vigourous exercise 2-3 times per week. It may help, but I know it's difficult to do.

Should you tell your employer. That I can't decide for you as each employer is different, but I would wait for a couple of weeks to see if things will improve before making any decisions. Take Care. paul m

[astronaut]

Welcome swampgas,

Paul's post was very informative and I agree with the things he wrote. He is right about the Wellbutrin. Many antidepressants take a month or more to start to have a full effect but Wellbutrin is a bit different than many A/D's and it tends to work much faster. If you haven't seen any changes in the past seven weeks, I would think that it isn't going to work. Wellbutrin can also cause nausea and dizziness. I know I had pretty bad nausea and dizziness when I first started Wellbutrin although it went away after about 4-5 weeks. Eating often helps me with nauesea. Wellbutrin can also cause weight loss. One in four people on Wellbutrin have weight loss. I am one of those people. After raising my dose of Wellbutrin this spring from 300mg to 400mg I lost nearly 9 pounds which is a lot for someone who initially weighed 115 pounds soaking wet. Why are you so sure that the nausea, dizziness and weight loss aren't from the Wellbutrin?

Also, weight loss can cause nausea and dizziness in itself, especially if you become underweight. Dizziness often occurs when blood pressure is low. Gaining weight again can sometimes help with the nausea, dizziness and tiredness. I don't know how much weight you have lost but if you are under weight, try eating more! If you can't eat because you feel sick, try to eat many small but frequent meals rather than trying to stuff yourself.

I think that Paul's idea about getting a full physical is a good one if you haven't already done so. Thyroid problems (for instance) can cause all of the physical symptoms that you are describing plus they can cause low mood symptoms too.

If you are too debilitated to work, ask your doctor for an assessment and you may be given a note to go on a sick leave from work. This can be complicated in terms of getting compensation while you are off, etc., but it is also a way to give you more time to get better if work stress is contributing to the problem. Modified work may also be helpful (i.e. cutting back hours, etc.). I can't tell you whether or not to tell your employer because I don't know enough about you, your illness, your employer, your job, your relationship with your employer, etc. Context is everything.

I hope you get some answers.
take care,
astronaut

[AJ]

I don't have anything to add to what others have already said except I'd like to welcome you to the forums.

[Determined]

Hi Swampgrass. Paul and Astronaut give sound advice. In terms of work so much depends on your employer's understanding of a mood disorder. Whether or not they see it as a legitimate illness; will they be empathetic; will they accommodate you with the time needed for recovery at least to the point of being able to work efficiently without further jeopardizing your health. So many factors. Do you have short term disability? If you need an extended leave of absence will they be able to get along without you for as long as necessary. My last employer was unable to do so. They were not at all sympathetic towards my condition and rather than get a temporary employee they checked with the labour board and discovered that they could terminate my position; which they did. That was them. I suppose each employer has a different outlook and value their employers differently. I was a very good employee, hard working, etc but whatever.

As Paul said I would give it some more time. I tried that as well but unfortunately I was unable to improve in time. If it does come to the place where you must have time off you will be entitled to EI sickness benefits for up to 15 weeks. You just need a doctor's form filled out.

I hope you begin to recover before it comes to that but I just wanted to put that out there for you

Oh, I forgot to mention; my employer can bite me. Don't know if that is an infraction or not but there ya go

[swampgas]

Thank you all for the thoughtful responses. Thank you for taking the time to read this. This can be a very isolating experience with not a lot of empathy or support - even from the healthcare system.

First I’d like say to Determined - wow, that really sucks that you lost your job! Sorry to hear that.

The 50-50 chance of the A/D working is not very encouraging either. Especially when nobody seems to be sure about what is going on physiologically or how the A/D’s work. Everything I read seems to start out with “it is believed to work by…” Believed” they don’t even know for sure but I’m putting in my body. It sounds like a crap-shoot. Fortunately I’ve been sleeping well the last few days thanks to some sleeping pills from my doctor. But I’m sure I was sleeping okay before all of this happened. Prior to April I was training for a triathlon and I can’t imagine doing any vigorous exercise while feeling like this.

I didn’t think my symptoms were a result of the A/D because I’ve had them from the beginning. I did not think that I could be transitioning over into side-effects. The trend over the last couple weeks has been improving, but I don’t know if it is the med’s or just time. With my new education (thanks to the melt-down) and looking back I believe I’ve had some minor episodes that I was able to get over with time. But this time was intense and persistent. It seems I’ve not recognized the warning signs due to my ignorance about mental health and the fact that this has been my normal.

Over the last year I’ve been to see my doctor about being light-headed and faint feeling, and feeling that I was having heart palpitations. All which seemed to be inconsequential. I had a full physical in January.

In early May I went to see my doctor to talk about the fact that I was having a hard time shaking off the winter blah's and that I've been feeling really stressed, tired, and maybe a little depressed despite exercising, resting, and eating well. He recommended that I try vitamins for a month before going to medication.*

I have been physically ill since May 27 with what I*initially*thought was the flu. Although my physical symptoms are now beginning to ease-up, I am still feeling unwell and have difficulty working through the day. Over the course of 10 weeks and a couple of visits to the hospital with flu like symptoms the doctor at the hospital informed me that it does not appear to be viral or bacterial and that these symptoms also present themselves in depression. At this point I had just started taking the Wellbutrin (June 17) and he told me it would take*several*weeks to feel the*benefits. When my doctor could not see me soon enough, I spoke to the nurse practitioner who confirmed the diagnosis and encouraged me to speak to the social worker who is part of my doctors health care team. The social worker had me take a depression survey and an anxiety survey on which I scored*surprisingly*high. She could not offer a diagnosis, but stated that I clearly have some issues and that my physical symptoms are in keeping with a major depressive episode. When I finally saw my doctor to explain the symptoms and 20 lbs of weight loss, he*just dismissed my symptoms as having caught a bug and told me to keep taking the medication.

If I am experiencing a major depressive episode, then I am certain that I have experienced many minor ones over the years. My doctor has always offered the same diagnosis (I must have caught a bug) which is why I never considered mental health issues. However, I am now*beginning*to educate myself about this topic. My family doctor never took the time that the nurse practitioner and social worker took to evaluate and talk to me. The later two seemed to take mental health very seriously, unlike my doctor.

It is hard to believe that I can’t cope with the simple act of living my life.

[Determined]

First of all let me apologize for calling you swampgrass. And thanks. That's the way she goes with work sometimes.

I said the same thing about meds. It's like a crap shoot. In some ways depression is like a flu bug. It just takes a hold of you and you just have to do your best to ride it out. Getting help asap is important. I remember having the same physical symptoms you described but I usually just worked through them until I felt better. This time I believe I got very run down with an actual cold/flu and shortly after the nasty depression latched on to me. There was a saying on the website I posted earlier that goes "after the flu comes the blues". Apparently viruses can trigger depressive episode. That website explains it quite well.

I agree about the health care system. The resources just aren't available and months go by before you finally see someone. It is quite frustrating but you learn to cope in the meantime. There are a lot of hoops to jump through to get the help you need, at least where I am.

Living should be and is a simple act, as you called it, when we are well. But depression is just like any physical illness. It takes you out of the game for a while until it runs its course; and it will eventually. Just keep on sluggin' and keep pushing for answers.

[astronaut]

Hi Swampgas,

Just curious, 20lbs is a lot of weight to lose, is it weight that you could afford to lose or are you now underweight because of this? Are you seeing the social worker on a regular basis?

If you think that you have may have suffered major depressive episodes before and this one is particularly severe, it may be worth while to ask for a referral to a psychiatrist. Psychiatrists specialize in diagnosis and treatment of psychiatric disorders. They mainly focus treatment techniques on medications for the biological aspect of the illness. Sometimes they will suggest alternative forms of therapy or refer you on to support groups, specific education programs on your illness or individual therapy. Getting a referral to a psychiatrist takes advocating for yourself and communicating to your doctor that you are suffering and need more answers and more help. Once you are referred it can take months to actually make it up the wait list to see a psychiatrist (pdoc as we say on the forum). It is important to get a referral as early as possible so that you get on the wait list and get the ball rolling.

thanks for sharing your story and good luck with everything
astronaut

[paul m]

Hello Swampgrass. Meds are always a crap shoot, but that applies to all meds, whether taken for physical or mental reasons. I must admit that 50-50 is a lousy number, but it's better now that there are more alternatives.

In regards to the complete physical that you had, I'd be willing to bet that the doc didn't ck you out for at least some the of illnesses that cause depression. An interesting website is posted. I don't agree with everything that they say, but they do give a good list of physical problems that cause depression.

Sometimes it doesn't matter how the depression starts, we sometimes need a hand to get past it.

If you soon don't start to feel better soon, demand another antidepressant. In the meantime, keep trying to learn about depression, knowledge is power. I'm not a great believer in vitamins, fish oils, magnesium supplements etc. But I also know people that they have helped. You might want to do some reading in those areas too. Take Care. paul m

http://www.alternativementalhealth.com/articles/depression.htm

[swampgas]

Hi astronaut, thanks for the info.

I'm not yet underweight, my BMI is still in the normal range. I've seen the social worker a couple of times over the last month and have weekly visits scheduled starting next month. The social worker is free, but I'm limited to 12 visits. I sought out a psychologist on my own and finally got in to see one last week. It takes so long to get all the help setup and now it seems that I have both a social worker and a psychologist. I pay for the psychologist and I'm not sure if I should see both, or just the free one for now. I guess I'll discuss the pro's and con's with the psychologist.

If these meds don't work in the next couple of weeks I'll be demanding a referral to a psychiatrist. I might do that regardless. Might as well see the expert.

Thanks again to all.

[astronaut]

Yes, demand to see the pdoc!

As for seeing a social worker and a psychologist at the same time, I personally only see one person at a time. Part of that reason is cost. Another reason is that different therapists have different methodologies/interpretations. Sometimes they can seem confusing or conflicting. If one therapists methods really work for me, I will stay with them as long as possible. When I can no longer see them because of time restrictions, cost, etc., I either work on implementing the tools she has given me in my life by myself or if I still need to see someone, I will try another therapist when cost or opportunity allows.

Discussing the pros and cons with one of them is a great idea though! It might not even be a really hard decision for you because you might decide early on that you work better with one of them than with the other and that will make your decision for you. Also, it is good to ask each of them what they can do to help you. How are they going to help you? With what methods? Test them out a little bit.

As for the weight loss. BMI is an estimate of healthy body weight but it does not take into consideration enough factors about individual body type to be the most accurate indicator of healthy body weight. For instance, people who are very slight but have more muscle to fat ratio may register as being "normal weight" but are under weight because muscle is heavier than fat. This is especially problematic in females who need a certain percentage of body fat to maintain their menstrual cycle and regulate hormone secretion. Once menstrual cycles cease, women become at risk for a whole slew of other problems including changes in mood and osteoporosis. (I don't know your *** so this might not pertain to you per se).

Are you still continuing to lose weight or are you more or less stable now? Why did you lose/or why are you losing weight? Is it because you don't eat well? Have you lost your appetite? Stomach pains? Something else?

Good luck with everything,
astronaut

[swampgas]

I spoke to the psychologist today and explained my situation regarding the social worker and he echoed your thoughts. He suggested that I see her and then he can pick-up where I leave off with her. That would give me the best bang for my buck. Since it will be a month before I see her he offered to see me until then. So, that's what I'll do. I need the support right now and it'll give me a chance to evaluate him so I'll know if I want to go back to see him.

As a 150 pound 5' 10" male I don't think I'm underweight yet. I did stabilize, or so I thought, but I've lost 5 pound over the last two weeks despite eating healthy meals at regular intervals. I just don't have the appetite to eat a lot. Fatigue, dizziness, and nausea are not conducive to stimulating ones appetite.

Thanks for the thoughtful advice. This forum is fantastic!

[uni]

Hello Swampgas. There's nothing helpful I can think of to say, that hasn't already been said by others here. But I do want to welcome you to the forum. I find it fantastic too!

[swampgas]

Does reading, or watching TV make anyone else feel nauseous?
Just wondering if this is a normal symptom.