Desperate for help - Overwhelming lethargy

[Stephanie]

My name is Stephanie, I’m 30 years old, I live in Canada. I have had some kind of anxiety or depression since I was very young. I had a lot of health problems when I was younger, which I think contributed to my anxiety, and the depression started when I was a teenager and runs in my family. I am looking for some advice, I feel like the state of my mental health has gotten out of control and I am at a complete loss of what to do. I am sure I have written way too much, but I really appreciate anyone who could read and offer any suggestions, I feel like I am right on the edge of this ruining my entire life.

The situation right now is that I am having days where I am unable to function. I wake up in the morning and I physically can’t make myself get out of bed – it’s like I feel sedated. I feel trapped in my own body, I am screaming at myself inside my head to just GET UP but I can’t do it. I go to bed at night thinking, “I sure hope I can get up tomorrow”. And more times than not, I do. But every once in a while, I just can’t. The other day, I woke up at my normal time, took about 40 minutes to write an email on my phone of just a few lines to tell my boss I wasn’t coming in, fell back asleep and was dead to the world until 4 in the afternoon. Other days, I am able to get up and about but I am very lethargic. On a weekend, if I manage to get groceries, it’s a productive day. I just lie on the couch, thinking about all the things I want to do, feeling guilty that I’m not doing them, and mad at myself that I can’t just make myself do it.

I have been to my GP and the psychiatrist at the local hospital, who have put me on medications, none of which are fixing the problem. I am currently taking: Effexor (150), Gabapentin (300), and my doctor has added in Wellbutrin to give me more “get up and go”. I have been on the Wellbutrin for 6 weeks, and am only finally feeling less jittery, shaky, and able to sleep through the night without waking up in a terrified panic. But I haven’t experienced any noticeable increase in energy to be productive. Now my doctor wants me to start taking amytriptiline at night to go to sleep, but I am scared to do it because I am already so tired – even if I can’t sleep.

Background:
When I was about 21, my anxiety started to get really severe. I was having panic/anxiety attacks and became essentially agoraphobic. I saw doctors and specialists, was put on medication, and managed to sort of cope. I was able to leave my home, but anything outside of my regular comfort zone caused a lot of anxiety and often panic.
This started after I met my to-be husband and continued throughout our relationship, up until we were married when I was 26. He left me just over a year after we were married and I was devastated. My anxiety skyrocketed.
I went to an anxiety and panic support group at the local hospital and through exercises and coping strategies I learned to get a handle on my anxiety. At the same time, I was seeing the psychiatrist who changed my meds a bit and I finally felt in control of my life.
The depression, or whatever this is, took the anxiety’s place. That is when the lethargy and the guilt and the weird sleeping all got worse and worse. I told my psychiatrist, but he said I “seem fine” and that if I can go to work more days than not, that’s good.

I am missing work, not able to get things done, and the helplessness of it is starting to make me feel crazy. I am terrified that I’m going to lose my job, I hate going to bed at night because I don’t know if I am going to be able to get up in the morning, and I feel miserable. I feel like I have done everything I’m supposed to do, but I just feel like things are getting worse. I really need some help.

[imsosad]

Hi Stephanie and welcome. Knowing something isn't right and wanting to get help are signs you're already on your way to finding what works for your recovery. You will find lots of help and feedback here. You don't say how long you've been on these meds or how often you see your drs. I am a very impatient person and hate that it can take weeks to get to a therapeutic dose before you can know if a med works or not. You may want to discuss with your drs taking some sick leave from work. Taking the time to get better can make a huge difference. I also don't know if you're doing any sort of therapy or just trying to cure the depression/anxiety with meds. Usually a combination works best.
I have been dealing with major depression and anxiety for that last year or so, off work for the last 10 months. There have been some terrible days where I'm sure nothing will ever get better again...but I've been working in therapy, taking my meds and this week have felt some relief, hope, a bit of happiness...things I thought were gone forever. It's possible for you too.
Good luck and keep posting.

[Stephanie]

Hi there,

Thanks so much for your kind reply.
I have been on the Effexor for a few years (before that, I was on Cipralex, before that Celexa and before that something else - I have been on something for the anxiety for the past 8 years), the Gabapentin for about a year, the only really new one is the Wellbutrin. And the amitryptiline, if I start taking it like my doctor has prescribed - though I have taken it in the past, so it's not "brand new" in that way.
I was seeing a counselor until recently, when my anxiety got much better and I felt like I was getting enough support through the anxiety group at the hospital. For the last several months, I have just been seeing my GP and psychiatrist, so no real counseling. I have seen therapists and psychologists before and have never found it all that helpful at alleviating these physical symptoms.
I do use meditation and progressive muscle relaxation for my anxiety, but I don't have those sort of 'tricks' for this depression stuff - if it even is depression?? I'm just assuming that's what the lethargy is - my thyroid and all that have been normal in tests to see if it's something physical.
I definitely don't feel like this is something new I am dealing with, it is the same thing that has been present for the last decade - it's just gotten so much worse and is having so much more impact on my ability to lead a normal life.

[paul m]

Hello Stephanie and welcome. Please always feel welcome to write as much as you like. Sometimes it takes a lot of words to get our story out. I can't diagnose you nor can I say what may work for you but I can give you some facts.

When you say"I physically can’t make myself get out of bed " . I know how awful this feels. It is a classic symptom of depression that docs often don't give enough consideration too.

In regards to antidepressants(A/Ds). Sometimes taking A/D's is more trial and error than scientific. What is known is that for any one person any one A/D only has a 50-50 chance of working. Not only that, if we were to try 6 different A/Ds, then the 7th one we try still only has a 50-50 chance of working.

So it's quite possible that the A/D are not working for you. Unfortunately the remedy often is very slow trail and error. However, don't let your doctor waste time by putting you off, if an A/D hasn't started working for you after 3 mths at maximum dose it is not going to work.

The following statements are not necessarily medical opinions, but I've heard them often enough from doctor to consider them factual. 1) Gapapentin has very limited use in treating depression. 2) Doctors should consider alternatives prior to prescribing 3 A/Ds (effexor, wellbutrin and amytriptiline are all A/D's). For some reason, amytriptline is becoming popular again after years of being considered out of date or at least out of fashion. I suspect that drug reps are reselling it as a sleeping product.

So what to do. Well, you are still depressed and depression is a major illness, so please try and stop feeling guilty about not being able to do things. I know that this is wayyyyy easier to say than to do, but feeling guilty only contributes to our illness. (I know from personal experience). We wouldn't feel guilty about not having energy if we were taking chemotherapy and depression can leave us just as bed ridden.

So try starting out by saying " I'm a good person with a bad illness" . Being a good person with a bad illness is much different than being a bad person with good excuses.

Keep posting here and keep telling your doctors how lousy you feel. Remember that it is your doctors job to cure your illness. So don't let doctors lay a guilt trip on you about how this may be as good as it gets etc. Take Care. paul m

[Determined]

Hi Stephanie and welcome. First of all I am sorry to hear of your struggles and secondly your story parallels mine in a number of ways. It sounds to me like you are doing all the right things in order to be well again. But Paul is right in stating that depression is a serious illness. I have been challenged with it for over 30 years but don't let that trouble you. Like any illness depression can be brought under control. Over those many years I have had far more good and productive years than bad. My last major episode began just over a year ago and it was a long and difficult climb to pull myself out of the pit. The meds that had worked before didn't seem to work this time. It was brutal. I ended up in hospital for a week and as you said the dr's said I "seemed fine". Well, they were wrong so I had to keep pushing for proper treatment. In so doing I was able to see a pdoc (shrink) who took the time to see me as a hurting human being. Shortly thereafter, and with a slight change in meds I began to get my life back and I am happy to say I am almost back to my old, crazy (in a good way) self.

I don't get into details about how bad I was doing but suffice it to say that it was pure hell and I wanted nothing more than to go to sleep at night and not wake up in the morning. What I will say is that it is a difficult journey but it is far from impossible to be well again. Be good to yourself. Understand that it is not your fault for feeling the way you do. Keep pushing for answers from your doctors and if you have to, seek other professionals for fresh opinions.

Again, you are doing all the right things. As imsosad says, arrange for some sick leave if you have to. You must allow yourself to do whatever it takes to recover; and you will recover. It's just a matter of time. I know this isn't what anyone likes to hear but unfortunately that is the nature of the beast.

Take care and let us know how you are doing

[astronaut]

Welcome to the forums, Stephanie.

I don't have much else to say right now, I would just like to back-up what Paul said in his post. He's a pretty knowledgable guy and I think his insights into the medication and the guilt, etc., are bang-on here.

astronaut

[Kaight]

Welcome Stephanie!

I'm glad you have found this forum. I found it 2 years ago when I was feeling very similar to you. I have found the best support and advice from the people on this forum.

I look forward to reading more of your posts!
Kaight

[AJ]

Welcome to the forums Stephanie. Thank you for sharing something of yourself with us. I don't have anything to add to what others have said at the moment.

[uni]

Hello Stephanie, and welcome.

Thanks for explaining your situation. I'm glad you found this forum, it's definitely a valuable place to come. Please feel free to post as and when you like. With your experience I'm sure you have a lot to offer others too.

The description you give about how hard it is to get out of bed, missing work, lying around, and feeling guilty and mad at yourself is exactly how I have been each time depression has hit. It's not an easy thing to get through, and trying different meds can be very frustrating to say the least. It sounds like you have already done a lot to help yourself and are willing to keep on doing so, which is huge!

I can understand that therapy and counseling work in some ways but don't address the physical part. I'm wondering if you are really being "heard" by your doctors. Do you think you have good communication with them? Are they in touch with each other regarding your treatment? Who is prescribing the medications?

It sounds like you got a lot out of the anxiety support group, which makes me wonder if a depression support group might help. Do you know if there's one in your area?

Depression is one of the most treatable things around. As Determined has said, it does take time but you can get there. I hope you'll let us know how things go.

[Stephanie]

I just want to say Thank You to everyone for their kind words of encouragement, it's very much appreciated.

[Stephanie]

Hi Paul,

Thank you for taking the time to read my rambling and to write such a thoughtful reply.
I completely understand what you mean about different A/Ds working differently. I feel like I have been 'trial and error'ing for several years. While it helped my anxiety, now I just feel like I am taking more and more without any improvement, and that bothers me. Especially because I feel like if it's not helping, I should definitely stop taking it. And then my fears about coming off the drugs kick in because I have had some terrible experiences with that in the past... Never easy!
I appreciate your thoughts on the medications - I definitely don't feel good about being on 3 antidepressants at the same time! And I was really confused by the Gabapentin script. The psychiatrist I saw said that it would help my "mood swings" - which has never been my complaint. I think I definitely need to ask for a referral to a new psych...

And thank you for your thoughts about the guilt. It's funny because I would say the exact same thing to someone else, but can't take it on for myself. My work is not understanding for the most part and I have been 'in trouble' with HR twice already for missing too much time at work (I also have Colitis, which flares up pretty regularly and causes me to stay home).

Thank you again!

[Stephanie]

Did you eventually find a med/combination of meds that took care of this fatigue/feeling lazy and lethargic? I was so hopeful about Wellbutrin, and I got really jittery and jumpy on it but no actual increase in energy, *sigh*.

I think I am going to go back to my GP and ask to be referred to a different psychiatrist. He never seemed to be interested in what I was saying because he'd respond in ways that weren't appropriate to what I had said. And he would 'remember' things from previous appointments that never happened - like me insisting on being called by my first name and never my last, which is very strange and certainly never happened.
I don't know how much communication goes on between the GP/Psychiatrist, I would guess not a ton. I would like to join another group, but unfortunately they are all during 'office hours' and I wouldn't be able to leave work to go to the meetings.

Thanks for your reply.

[astronaut]

You have colitis too? Hmmm.... who do you see about your colitis? Have you done much research into how your meds might be affecting your colitis? Unfortunately, your meds might be causing flare-ups. Severe and chronic anxiety and stress can also contribute to a worsening of autoimmune disorders such as colitis and crohns. Chronic stress response in the body (which can be measured through blood or saliva to check levels of stress hormones such as glucocorticoids and cortisol), can contribute to physical depressive symptoms like the ones you are experiencing, as well as a worsening of autoimmune diseases. Another issue is that if you are having constant flare-ups of colitis and are losing nutrition, you may have to be monitored more frequently for vitamin and mineral deficiencies which may contribute to lethargy, i.e. low iron and low B12, and low red blood cell count, etc. Sorry if you know all this already, but some doctors don't make connections between different disorders and both disorders can have common links and the worsening of one disorder may give you clues about another one.

astronaut

[Lost@40]

Hi Stephanie, welcome to the forums.

I struggle with lethargy too. I'm tired all the time. And, like you, I feel like I'm over medicated and think my Pdoc doesn't listen to me. With the help of my therapist, I have finally talked my Pdoc into letting me phase out some of my meds. I'm currently trying to eliminate the meds I was given to help me sleep (Seroquel) to see if that helps. My GP only gets updates about my anxiety and depression from me, so you're right, there's next to no communication between the GP and the Pdoc.

I know depression can cause lethargy too. And the days I don't want to get out of bed are usually from my thoughts and not my tiredness. I also sleep to avoid my thoughts.

I too was put on Wellbutrin to see if it would boost my energy, and I was hopeful too cuz I'd heard a lot of good things about it, but I didn't feel any difference at all. So after I'm done tapering my Seroquel (3 more weeks cuz we're doing it slowly), I will start tapering off Wellbutrin too.

My hubby works nights and we have a dog that needs breakfast. So even when I want to sleep all day I make myself get up for my dog. And then I try to find things to do during the day that keep me awake. Sometimes playing puzzle games, grocery shopping, playing with my dog. Whatever it takes, I try to make myself stay awake all day.

Even when I'm tired, which is all the time, I force myself to go to the gym 3-5 times a week. I haven't felt any impact yet (only been going regularly for about 2 months now), I remember before I got ill how much energy I got from going to the gym regularly.

I don't know whereabouts you live but some places have group therapy sessions in the evenings. I went to an 8 week anxiety group that ran on Wednesday evenings. So it might be worth checking with your GP or your Pdoc if there are any groups they can refer you to that are outside of the 9-5.

Also, I haven't been to one yet but am trying to work up the courage, there are peer support groups that usually meet outside of working hours. Something like that might be helpful for you.

If your GP is helpful, I know mine is, then that's prob where I would start if I were you. Not all Pdocs are good at the talking side of things, usually just the med side, so maybe your GP can refer you to a therapist too. Like meds, therapists and Pdocs are trial and error too. My current therapist is my sixth. And I finally feel like I'm working with someone who can actually help me change the way I think and act, instead of trying to control things with meds.

You can usually tell when talking to someone if they're coming from a place of understanding or a place of text books and stats. I've found that the understanding has been more helpful for me than the text books and stats.

Good luck to you, I hope you find someone that can help you.

[Stephanie]

My colitis is pretty well managed at this point and if I have a flare up, I usually can trace why - food, stress, antibiotics, going too many days without sleep, etc. The colitis definitely triggers my anxiety, even if I'm not actually having a flare up but am just worried about getting one.
I haven't heard of/talked to my doctor about the chronic stress response/stress hormones thing, so I will bring that up at my next appointment. I actually saw a hormone doctor fairly recently because I just got diagnosed with having polycystic ovaries (PCOS) - just one thing after another! Anyway, I had a whole slew of hormone tests then, but I don't know if they check for what you are talking about specifically.

Thank you for the ideas and thoughts, I absolutely appreciate it. I really did feel at the end of my rope in terms of what there was left to do, so any new idea gives me some hope.