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Excessive Daytime sleepiness/fatigue+Anxiety+Depression

Hi,
I suffer from extreme tiredness from the time I wake (worse around noon and entire afternoon) + anxiety (at times) and finally able to admit this--chronic depression. I have had this fatigue since I became pregnant and thereafter (going on 9 years now) and other maladies-- migraines (use Relpax), dysmenorrhea, fibroids/cysts, high blood pressure, recently--diabetic. I am 37 yrs. old. My Dr. has prescribed nearly all the anitdepressants out there. I had bad side-effects with each, jaw tightening, teeth grinding, more headaches, insomnia, more anxiety, more tense and agitated (which is not like me)-- Prozac did help the monthly period oddly enough! But I could not tolerate side effects. Recently tried Cymbalta for it's so called 'pain' inhibitors--- I felt suicidal, a zombie, extremely lethargic-- yet felt wired at the same time. The only antidepressants I can somewhat tolerate are those in the tricyclic family (mainly Pamelor--started a few months ago, also has worked wonders on cutting down migraines)-- 25 mg. taken at night. I was prescribed Xanax two years ago, and it works wonders for the anxiety, especially when I have to leave the house I've been seeing a therapist for nearly a year. On a 'normal' day I can barely keep my eyes open (even when not taking a Xanax) and feel a dire need to sleep in the daytime (usually have to take a nap, only to wake up more sleepy)-- this is all before Pamelor or Xanax use. I do snore and often wake myself up (or my family will sometimes shake me awake!). Had sleep study done-- insignificant (could not really sleep for the study). Have been given B-12 shots, Provigil, did nothing for the chronic tiredness--the feeling of a need to sleep. Was prescribed Ritalin, did nothing for fatigue, stopped because it made my heart race. Recently, started having problems falling asleep, even though tired (with or without a daytime nap), so my doctor prescribed Restoril 15mg. Took it two nights in a row, did not make me sleepy. Third night I took a Xanax instead (which I would normally use in the daytime (0.5mg); low and behold, I was asleep within 2 hours.  I have not noticed if it is Xanax in the day that increases my sedation (tiredness) because even when I skip it, I'm still very tired and was before I ever started Xanax. So, I wondered is there another drug like Xanax for anxiety which wouldn't increase my already fatigued state during the day such as Ativan, Valium, etc.? Or are these equally sedating? Thank You.
9 Responses
Avatar universal
1) Have you recently had a COMPLETE physical workup with blood work to see if there is a physical reason for your tiredness such as low B-12 or iron levels, thyroid problems, lymes disease, etc, etc, etc, etc.  Is your diabetes under control?  You mentioned that you have had B-12 shots - is that because your B-12 level is actually low or did your doctor decide to give you the shots to see what impact it had on you?  Has CFS (chronic fatigue syndrome) been considered?  You may want to seek a second opinion from another doctor it you havent already done so.

2)  The sleep study was to determine whether you suffer from sleep anea which could cause  extreme tiredness.  Since the results were insignificant, it would seem appropraite to repeat the test.

3) How long did you try the various antidepressants for?  More often than not, when ones starts these medications they experience side-effects for a few days to a few weeks.  It sometimes takes 6 weeks for the medication to take effect.  If you didnt take the medication for long enough you have no way of knowing whether there would be a positive impact on your condition (in some cases it may not be possible to "ride out" the side-effects  if they are too severe).  Also, have you seen a physchiatrist for your mental health?  They would be able to correctly diagnose you and talk about appropriate medication for your condition - this is something they are experts at, afterall.

4) How often do you use xanax?  Xanax does have sedating effects but more importantly, it is ONLY intended for the occasional use when needed (during a panic attack).  It should NOT be used on a daily basis as this is not what it is indicated for - it is highly addictive and can be very hard to get off of.  Moreover, its effiacency decreases over time meaning, you require more and more of the drug for the same therapeutic effect.  It is possible the xanax is contributing to your problems.

5) Klonopin is recommended for the long-term treatment of anxiety.  Once it reaches steady-state it is non-sedating and many people on this site recommend it.  Search though this forum and look for posts directed toward RCA regarding klonopin - he provides some excellent information on this drug.  Klonopin is indicated to PREVENT anxiety (compared w/ Xanax which TREATS an immediate panic attack) and may be useful in your case.  Again, discuss this with a doctor -preferably a physchiatrist who can make the appropriate recommendations in your case and moniter your progress.
Avatar universal
Thank You for your response. Greatly appreciated!
Yes, I have had blood work done here and there for nearly 7 years now. I don't know exactly what's been checked but I assume everything. Diabetes is under control with meds (Glucophage 2,000mg a day). B-12 shots were given nearly 7 years ago and yes, it was to see if it could help my tiredness/fatigue. All of my blood tests have been normal, until diabetes appeared. One test (back when this fatigue really started taking a toll) in 2000 had something to do with a titer, something regarding Epstein-Barr. The physician said I had either 'had' mono or was exposed at some time in my life but research had found (in 2000 or prior) this virus has nothing to do with CFS. Was told back then, many people have been exposed or had Epstein-Barr in their lifetime, so the test no longer pertained. None of my doctors (Primary, Endo., Psych.) have ever used the term 'Chronic Fatigue Syndrome', but as I have read online, nearly everything I have been prescribed is often used with these CFS patients. It wasn't until diabetes came up that my new diabetes Dr. (Endo.) suggested (after all these years with different doctors) to have a sleep study done. I am very happy this doctor went the extra mile to find what is causing this fatigue and asked me if I snored. It seems the few doctors I have seen (with exception to the Endo.) eventually began to allude to the possibility of depression (but I didn't feel depressed when it all started-- just extreme tiredness). Again, it seems it started during pregnancy but never went away. For a while I wondered if it was because I needed RH shots during and after pregnancy because I am type O- , my child is type O+ . I thought of just about everything. From the spinal shot (epidural?) to the C-section. So now, after years of dealing with this extreme daytime tiredness, I'm coming to believe it may be depression-- because nothing can be found or measured. I've just about given up and this is depressing in itself. I have been out of work for nearly two years but even at work I felt sickly with a need to sleep, yawning and blurriness, just feeling like I would drop. Seems when I get this extreme tiredness, my heart/chest starts feeling weird, as if my heart is beating faster with a very wired/jittery feeling in the chest and temples of head. I feel I must  lie down. Had an ECG(?) done some years ago, read that my heart rate was slow, like that of an athlete. So hearts ok. When a doctor or two suggested depression, I looked at them like they were surely joking. They say depression can manifest itself through sleep. Who knows(?) I've been told they can't 'test' CFS, so depression is next on the list when nothing can be found. Nevertheless, you are right about the sleep study, I may have a go at it again. I have been told since my 20's that my snoring/holding breath was kind of scary to the person listening! However, my siblings/parent also sleep like this but are not terribly sleepy all day......(?) By the way, neurologist believes I may have something called atypical trigeminal neuralgia with migriane (buringing, searing, pains in nasopharnx, forehead, eyeball, ear pain, jaw, part of throat prior or during migraine-- sometimes have it without developing full blown migraine. All on same side. Dealing with my migraines alone probably did cause depression or maybe had depression all along but didn't know it. Migraines (started at 20) and the first few days of my monthly cycle (8 days long) had caused such pain. I felt these things alone threw a curve ball into my life. Also, I was a passenger in a bad car accident at 21, minor concussion/ forceful whiplash; was never the same since then. About the antidepressants: First antidepressant given was Effexor (30 yrs. old at the time)--6 months of shaky, wired but still tired, more headaches, maybe a tad better in mood, don't remember. Switched to Prozac for nearly two years; dealt with the side-effects but was still horribly tired during the day. Sometimes mood seemed better. Teeth grinding (had this already but even more on the SSRI's, more strange head pain, increased jaw pain, insomnia at night (never had insomnia before Prozac). Paxil 4 months-- gave me really bad anxiety/insomnia, agitation, still very tired. Wellbutrin-- got sores in my mouth both times I tried it, constant nerve pain in my head/ear/neck/tongue (same side as migraines), wired but still tired. Sores in mouth and pain dissapeared almost immediately after stopping Wellbutrin. Psych told me never heard of sores from Wellbutrin, said it was a 'first'. Then Zoloft (same as Prozac, Paxil, Celexa, Lexapro). Cymbalta (horrible for me; 2 weeks and 1 day. Tried it again, this time one week (same as before but this time throwing up, stomach problems-- may be due to Glucophage which I was not on the first time with Cymbalta). I was was looking forward to Cymbalta with such anticipation, so happy to finally get a prescription to try this.  It took nearly 2 years with my insurance only to find it made my depression worse--much worse. However, I've met a person who swears by Cymbalta (but sometimes he seems like a robot now and can't answer questions as quick-- reminds me of how I felt on it; a zombie, withdrawn, terribly tired but couldn't sleep, no more laughing, somber, slow, suicidal feeling, felt I was sleep walking, under a dark cloud..........interesting, it would not 'allow' me to take a nap even though I felt ready to hit the ground from the daytime sleepiness. I have always been known as the 'life of the party'--- not on this med. On Remeron I saw what a person might describe on an LSD trip with my eyes shut-- bright spurts of colors (while trying to go to sleep), with quick zaps of electric sound---frightening. Threw both (Cymbalta & Remeron) away immediately. Basically, SSRI's are no good for me and the others are equally as bad. I will never try Cymbalta, Remeron, Wellbutrin again. Interesting, I see a psych. now and he doesn't give anything but antidepressants. If I was running out of Xanax, he suggested I call my primary care physician. He doesn't believe in mixing anitdepressants either. He's never suggested switching my Xanax; he doesn't want to touch that for some reason. He only prescribes Pamelor after going through all of those antidepressants.You made a good point here about the Xanax. I try not to take it often but sometimes, especially if I am going to leave the house, the panicky feeling starts to come. That can be oneday to the next. Whether I take Xanax or not, I am still extremely sleepy all day. I will ask my primary care Dr. about the Klonopin. Thanks for the info. I appreciate your suggestions.
    
Avatar universal
It does sound like the sleep apnea study is worth repeating ESPECIALLY if you snore and "hold your breath"!  This could very well be contributing heavily to your problems.  Depression can certainly make one very, very tired too.  

I dont know a lot about CFS other than something "triggers" it and it isnt something that can be diagnosed with standard tests.  Since this all started after the birth of your child, the "trigger" could have been set off around that time.  Try posting in the undiagnosed symptoms forum - some people there may have additional insight.  I believe "platelet girl" knows a lot about CFS and may have some suggestions for you in that regard.
Avatar universal
Thank You Spade!
Again, I greatly appreciate your suggestions. I just noticed what a long-drawn-out story I typed; my goodness. Will see if my insurance will allow another sleep study. Thank You for your patience! :)
Avatar universal
Unfortunately, you seem to going through a lot right now - I am not a doctor and can only offer advice based on extensive reading I have done on various medication conditions.  Are you overweight?  Someones the onset of sleep apnea can be correlated w/ an increase in weight as can diabetes.  Weight loss (if you are acutally overweight) may help both of these conditions but I would imagine that a different eating progam and physical exercise might be difficult in your case due to your extreme fatigue you experience.  Here is a link to a recent post in which I gave some of my views on "raising the anxiety threshold" - I think some of the suggestions could help you too.
Avatar universal
Hi Spade22,
You must have the gift of insight! Yes, I am overweight. The only problem is, when this extreme tiredness started, I was thin, back down to high school size-- I had lost a lot of weight after having my child. I am 5 ft.10 1/2 and I weighed about 135-40 after the weight loss. I had lost the 24lbs from baby gain (pregnancy) and I lost the extra 30 I was carrying, just prior to being pregnant. I left my husband and went through a horrible custody dispute (he wanted our child full-time). Nect thing I knew, I ballooned up to..........brace yourself------ 268 lbs. as of right now!  I know for sure, this caused the diabetes, however, my father is a bad diabetic (sometimes uses insulun), my grandma died from diabetes in her 60's, she was thin but got gangrene from injurung her foot. Nearly all of my father's brothers and sisters have diabetes-- 10 out of 13 children! So, I was told I can reverse this by diet and exercise (but too sleepy; drop dead tired all day) or I could lose the weight and possibly still have it. I guess it's better to drop the weight and find out! But now it's very difficult. I always remind my doctors that I was thin at the time the fatigue started back in 1999 during pregnancy. One last thing. I've been smoking since I was 21, I'm now 38. I never mention this at first because people like to blame everything on smoking, which I know is bad. I have tried every patch, gum, Wellbutin (awful), and hope to try a new drug called Chantix soon. I've known many smokers who are totally energetic. I just don't understand. I guess I just put all the pieces together for you now.
Thanks for your help.    
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