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Dysthymia with chronic fatigue.

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Hi, As long as I can remember, I've been tired. All day, every day. I nap almost daily and then sleep a full 10 hours every night. My mother always brought me to the doctor about my "chronic tiredness" and they would say that nothing is wrong. I've had blood tests done for anemia and tyroid problems every year of my life to make sure nothing is wrong with me. At some point, I decided that it is normal to be tired. I joined the military, and just pushed on. I brought up my issue again with a military doctor, who told me it was all in my head. The next doctor told me I was depressed and put me on Prozac and Welbutrin. These antidepressants don't help my tiredness at all. I feel happy all day, but I'm still exhausted.

Because of the continued exhaustion I went back to my doctor, and she gave me the Epworth Sleepiness Scale, score of 21. The doctor thought I had Sleep Apnea, since I sleep so much and never feel well rested. She also took into account that I had a sister die of SIDs. She sheduled me for a PSG, which came back normal. Recent blood draws have also come back normal.

I have a great job in a Marketing department, which I love, but I can't concentrate during the day. I have to write everything down in meetings, and then I forget where I put the notes! My boss and coworkers get frustrated with me, because my short term memory is really poor. I can't go out on the weekends with my friends, because I fall asleep in bars and clubs. I can't go to the movies with my husband because I fall asleep. I just want, (need) something to change.

Here are my symptoms/family history/random things about me:
22 y/o female
Constant tiredness (I can sleep anywhere, anytime...and do it. This has been going on for as long as I can remember)
No relief from sleeping (I never feel awake)
Extremely low sex drive (I am married, used to have sex every other day with my husband, now it's once a month at best...and even then, I use over the counter remedies to "get me going")
Forgetfulness
Random numbness in tips of fingers
Cold hands and feet
I work out every other day (cardio, then a muscle group specific workout)
I am not overweight - 5'3", 130 lbs, muscular build
I do not "mouth breathe", even while asleep, unless I am very sick
I do not snore
I dream every time I sleep - whether is for the night or a short nap
Maternal grandmother - hypothyroidism, fibromyalgia, hypertension, 2 heart attacks
Maternal grandfather - cancer (lung, brain tumor, liver), deceased
Paternal grandmother - cancer (lung), deceased
Paternal grandfather - caner (lung), deceased
Mother - no known health problems
Father - no known health problems
I had thyroid tests/PSG done recently, both of which came back normal.
My doctor also ordered complete blood count, Vitamin B12, among other tests, which have not come back.
She is not qualified in sleep medicine. I am seeing military doctors, because I am married to a servicemember overseas, and fall under Tricare.
I really hope that you may have an idea of what's going on. I know that you can't diagnose over the internet, but I want to bring ideas to my next appointment with my doc.
Thanks, and have a fantastic day!


Category: Psychiatrist

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Category: Sexologist
Dr. Srikanth Reddy is online now

Expert:  Dr. Srikanth Reddy replied 4 Days.

Hello
Thanks for using doctor spring for posting your query. I have gone through your question in Detail and i can understand what you are going through.
There are two possible diagnoses for your illness
1. Dysthymia
2. Chronic fatigue syndrome.
You need to be on an antidepressant treatment. I understand that you have already tried prozac and welbutrin and they have not shown much improvement. But such happenings are very common in the treatment and multiple drugs have to be tried. I would suggest you to go for a combination of venlafaxine and mirtazapine.
Along with this, I would syggest you to seek help from a psychologist to put you on cognitive behvaioural therapy and behavioural activation.
Further in the recent advances ketamine injections have shown improvement in the resistant cases of dysthymia.
Hope I am able to help yiu with your concerns.
Let me know if you need any further help.
Kind regards
Wish you good health.
Dr. Srikanth Reddy MD



Patient replied :

Dr. Reddy,
Thanks for your reply. I have a lot of trouble believing that I am any form of depressed. I am an extrememly happy-go-lucky, optimistic person, and that's on my bad days. Very happy in my marriage, happy in my job, happy with life in general. Another reason I am having trouble with Dysthymia as a diagnosis is because I have had a problem with constant tiredness since I was a child. I find it hard to believe that I was "depressed" as a 10 year old and younger. And from what I can read about Chronic Fatigue Syndrome doesn't really add up for me either...according to the internet, it can't be actually diagnosed. It's the catch-all if doctors can't find anything else wrong with you.
Are there any doctors who are sleep medicine certified that could provide a second opinion? I respect your views, but do not agree with them. I hope this doesn't offend you - I promise, that is not my intention. Thanks for your response, have a great day.


Expert:  Dr. Srikanth Reddy replied 3 Days.

Hello
Thanks for the follow-up information.
I thought it could be a Dysthymia cause most of the patients of dysthymia that I have seen in my practice have never remembered when the symptoms started. The symptoms generally start early in the childhood. I am not suggesting that you need to have a full blown depression during childhood. The symptoms could have been minimal. Infact the severity of depression in dysthymia is much much less than that of a depressive episode. Believe me its still possible.

Regarding sleep apnoea, yes this could be a possibility. Mild apnoeas may miss from polysomnography but invariably contribut towards the symptoms that you have stated.

But one diagnosis which is more likely is that of "attention deficit hyperactivity disorder". Many times it is only a predominantly attention deficit ADHD and starts from early childhood and persists in adulthood as well. Your symptoms of not paying attention and missing out on the work all suggest this diagnosis. Its possible that there could be a combination of Adult ADHD with sleep apnoea. For both the diagnosis, administration of methylphenidate and bupropion can help. Methylphenidate has to be started at 10 mg in the morning and then gradually increased to 20-30mg per day to cover up the symptoms. This will certainly reduce the drowsiness. You will require a prescription for these.
You may agree with the diagnosis or not. I did my best to understand your symptoms and suggest you the possible options which you can discuss with your doctors in your next visit. Unfortnatley our forum does not have any sleep specialist separately as psychiatrists are the people who take care of the sleep issues as well mostly.
Wish you good health
Regards
Dr. Srikanth Reddy MD


Dr. Srikanth Reddy
Category: Sexologist
Experience: 
Doctor of Medicine (MD), Psychiatry Residency Program,2001 – 2012
M.B.B.S,Mahatma Gandhi Institute Of Medical Sciences, Sevagram

Certificate Course in sex Therapy and Counselling, Sexology and Counselling, A
Sexology,Medikon Sexual Sciences, Mumbai

Training in Advanced Neurology at a leading corporate hospital (CARE hospital) in Hyderabad

Child Psychiatry Training in National Institute of Mental Health and Neuro-Sciences, Bangalore

Sex Therapy and Counsellingat MEDIKON Sexual Sciences, Mumbai.
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