What May Have Caused My Specific Case Of Chronic Fatigue Syndrome
If I wanted, I couldve easily been diagnosed with chronic fatigue syndrome, but knew that most of the medications used to treat the condition, I had already tried . I didnt see a point in having another diagnostic label tacked on what was already: major depression, severe anxiety, and premorbid schizophrenia . Below are some hindsight speculations as to what may have contributed to my antidepressant-induced chronic fatigue.
Ketaminefrom Anesthetic To Depression Miracle Drug
Interestingly, studies from Yale research labs showed that the drug ketamine, which was widely used as anesthesia during surgeries, triggers glutamate production, which, in a complex, cascading series of events, prompts the brain to form new neural connections. This makes the brain more adaptable and able to create new pathways, and gives patients the opportunity to develop more positive thoughts and behaviors. This was an effect that had not been seen before, even with traditional antidepressants.
I think the interesting and exciting part of this discovery is that it came largely out of basic neuroscience research, instead of by chance, says Gerard Sanacora, MD, PhD, a psychiatrist at Yale Medicine who was also involved in many of the ketamine studies. It wasnt just, Lets try this drug and see what happens. There was increasing evidence suggesting that there was some abnormality within the glutamatergic system in the brains of people suffering from depression, and this prompted the idea of using a drug that targets this system.
This is why Dr. Sanacora believes that ketamine may be most effective when combined with cognitive behavioral therapy , a type of psychotherapy that helps patients learn more productive attitudes and behaviors. Ongoing research, including clinical trials, addressing this idea are currently underway at Yale.
What To Expect At Your Providers Office
There is no laboratory test for chronic fatigue syndrome. But your health care provider may use tests to rule out other illnesses. Your provider will go over your symptoms, check your medical history, and do a physical examination.
If you have CFS, your provider may prescribe drugs to treat your symptoms, or suggest herbs, vitamins, or dietary changes to help you. Get plenty of rest, exercise regularly, and learn to pace yourself. Often this combination of treatments will help you get better.
If the usual treatments do not work, your provider may check for other conditions that can cause symptoms similar to those of CFS.
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Implications And Future Directions
Given the positive results of the dietary supplements in reducing depressive symptoms, we suggest that people with depression consult with a specialist before selecting the type of supplementation. The lower and upper permissible levels of consumption of these supplementations also need to be considered . Further studies focusing on substances that showed no positive results, with more carefully selected groups, doses, and combinations are needed to provide a more comprehensive and up-to-date overview of existing supplementations to reduce depressive symptoms.
Geriatric Depression: The Use Of Antidepressants In The Elderly
ABSTRACT: Depression in the elderly significantly affects patients, families, and communities. Awareness of predisposing and precipitating factors can help identify patients in need of screening with tools such as the Geriatric Depression Scale. After diagnosis, regular follow-up and active medication management are crucial to maximize treatment and remission. Selection of an antidepressant medication should be based on the best side effect profile and the lowest risk of drug-drug interaction. If remission is not achieved, then add-on treatments, including other drugs and psychotherapy, may be considered. In cases of severe, psychotic, or refractory depression in the elderly, electroconvulsive therapy is recommended.
Depression is a common but undertreated condition in the elderly.
Depression is the most common mental health problem in the elderly and is associated with a significant burden of illness that affects patients, their families, and communities and takes an economic toll as well. Prevalence studies suggest that 14% to 20% of the elderly living in the community experience depressive symptoms, with higher rates among the elderly in hospital and even higher rates in long-term care facilities .
There is also often a tendency for people to see their symptoms as part of the normal aging process, which they are not. Depression in the elderly still goes undertreated and untreated, owing in part to some of these issues.
Competing interests
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Discussing Treatment Options With A Doctor
The medical community differs over the exact treatment courses for those living with CFS. Youll need to work closely with a healthcare team to determine which symptoms are impacting your quality of life the most.
You may start with treatment of these issues and progress to others in time. Many treatment options are available, ranging from over-the-counter drugs to alternative therapies.
The most effective treatment for CFS is the one thats catered to you and your specific symptoms. A doctor may suggest a variety of treatments depending on what youre experiencing and what your treatment goals are.
Spravato Nasal Spray For Depression
In March of 2019, the U.S. Food and Drug Administration , in conjunction with an oral antidepressant, for adults who have tried at least two other antidepressant medications, but have not benefitted from them. Spravato© is considered high risk and is only available through a system of tight distribution and monitoring. Spravato© is only to administered under supervision from the health care provider in a health care clinic or office and is not self-administered. Possible side effects after administration include sedation, disassociation, attention and judgement problems, and possibly worsening suicidal thoughts, patients will be monitored at the providers facility for at least 2 hours.
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Its Harder To Exercise When Youre Depressed
Exercise is a great source of energy, but feelings of depression might make it harder for you to want to work out on a regular basis. Depression can cause you to experience a lack of motivation in many aspects of life, and this can channel into a lack of desire to exercise.
But dont think that this lack of exercise is because of laziness. This couldnt be further from the truth!
Summoning the motivation to exercise is already hard enough. But feelings like reduced self-esteem and pessimism are specific depressive attitudes that research suggests may be interfering with your exercise.
Its completely understandable that you might not be working out as much as you used to or would like to. Recognizing that these thought patterns are a result of depression means youre better equipped to deal with the challenge of motivating yourself to exercise.
Selective Serotonin Reuptake Inhibitors
Selective serotonin reuptake inhibitors are a commonly prescribed class of antidepressants. Taking these drugs doesnt cause significant side effects, even at higher dosages. They can help to alleviate mild to moderate depression.
Selective serotonin reuptake inhibitors, or SSRIs as theyre commonly referred to, target only serotonin. These antidepressants prevent serotonin from getting absorbed back into neurons.
Consequently, this increases the brains supply of available serotonin, enhancing a persons mood and outlook on life.
The effect of SSRIs on anxiety is often described as turning down the volume on anxious thoughts.
It may have similar or higher effects to practicing mindfulness and participating in psychotherapy.
Apart from reducing physiological symptoms of depression and anxiety , SSRIs may also reduce psychological symptoms.
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Whats The Best Herb For Anxiety And Depression
While some herbs, such as rhodiola and chamomile, may be helpful for reducing or managing symptoms in some individuals, there is no best herb for treating anxiety or depression .
Furthermore, even if you find that taking an herbal supplement is helpful, it shouldnt be used in place of a prescribed antidepressant medication.
Side Effects And Interactions
These drugs come with a long list of potential side effects. Some of the more dangerous ones include seizure, hallucination and out-of-control actions.
SSRIs/SNRIs can interact negatively with drugs other than those that increase serotonin. These may include anti-inflammatories , blood thinners, and several others.
Side effects and interactions vary by drug. To check on specific drugs, you can look them up at Drugs.com or RxList.com. Theyâre also generally available in packaging information.
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How Long Does It Take For Antidepressants To Start Working
Depending on the medication used, traditional antidepressants like SSRIs and SNRIs can take up to 4-6 weeks for full effect, Alonzo said. Spravato© is fast-acting and can potentially help those experiencing thoughts of suicide more quickly, however, it is not appropriate for long term treatment of depression. SSRIs and SNRIs provide a more long-term relief, but take longer to become effective.
Speak with your health care provider if you are not noticing an improvement in your symptoms of depression after taking your antidepressant medication every day for at least 2-4 weeks. They may decide to adjust your dosage or try a different treatment plan.
Myth #: Visible Ms Symptoms Are The Most Disabling
Truth: As MS progresses, it can affect numerous bodily systems. This can cause issues such as muscle spasms, vision problems, difficulty walking or problems with bowel and bladder function. These physical challenges can be incredibly frustrating and may seem like the worst part of MS, especially from the perspective of someone who doesnt have MS.
But what may not come up in conversations and can be hard to notice, are mood and cognitive issues associated with MS. Emotional difficulties, including depression and anxiety, can often interfere with daily functioning more so than physical symptoms. Apathy or anxiety may have more power than muscle spasms or dizziness to hold someone back from enjoying life.
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What Is An Antidepressant
Antidepressants, sometimes in combination with psychotherapy, are often the first treatment people get for depression. If one antidepressant doesnât work well, you might try another drug of the same class or a different class of depression medicines altogether. Your doctor might also try changing the dose. In some cases, your doctor might recommend taking more than one medication for your depression.
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Ketamine And Esketamine For Depression
Ketamines and esketamines are not used as a first-line treatment for depression. They are often only prescribed when the patient has treatment-resistant depression, or depression that has not responded to other medications and therapies. Ketamine and esketamine are very similar in composition, but esketamine is remarkably more potent than ketamine. Ketamine is approved by the FDA as an anesthetic, but it is being used for treatment-resistant depression off-label, meaning it does not currently have FDA approval for this use.
Ketamines and esketamines can be used for very severe or life-threatening cases of depression that include suicidal ideation that can help the person long enough to give other antidepressants adequate time become effective.
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The Severity Of Side Effects
During a consultation with your doctor, you will be asked whether you experienced any side effects while using antidepressants in the past.
A doctor also strives to select one with the fewest side effects if you take any other medicine with side effects that you cant stand. You may have to try a few before finding the right one.
Serotonin Norepinephrine Reuptake Inhibitor
Serotonin Norepinephrine Reuptake Inhibitors or Selective Serotonin-Norepinephrine Reuptake Inhibitors or SNRIs are a class of antidepressant medication used for depression, anxiety and sometimes other uses. Some SNRIs also licensed for chronic pain including nerve pain, e.g. cymbalta , fibromyalgia, or used off-label for other non-psychiatric conditions.
SNRIs include:
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Take Medications At Night
Pop your pill at bedtime. Unless theres some reason your doctor would prefer you down your depression medication in the morning or during the day, taking it at night may help you fall asleep more easily so you get the rest you need to feel more alert during waking hours.
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Possible Mechanisms Of Fatigue
Fatigue is a complex concept involving both somatic information and the cognition that the intellectual or physical activity requires a higher share of the individual’s energy or that the individual is less productive than usual. Probably a multiplicity of pathways and substances are related to this complex feeling, especially serotonin, dopamine, the HPA axis, and inflammatory cascades involving substances like cytokines.
Information from basic sciences and sports medicine indicates that increased serotonin in certain areas of the brain, like the lateral hypothalamus, plays a role in the genesis of central fatigue. Serotonin agonists increase fatigue, and general serotonin antagonists reduce fatigue in animal models. It has been hypothesized that serotonin may induce fatigue through inhibition of the dopaminergic system and/or through the HPA axis.18,19
Dopamine has long been associated with fatigue, and the most potent stimulant agents currently available are dopaminergic. Central dopamine seems to be related to fatigue in an inverse way to serotonin. Dopamine metabolism is enhanced during exercise in the hypothalamus and other areas of the brain, and exercise endurance is impaired after destruction of dopaminergic neurons in animal models. Clinically, fatigue, a prominent symptom in Parkinson’s disease, improves with both L-dopa and bilateral deep brain stimulation.20,21
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Whats The Newest Antidepressant On The Market
SSRIs and SNRIs are newer antidepressants among the five major classes, and
vortioxetine, or Trintellix, is one of the more recent SSRIs to come on the market, says Dr. Dimitriu. Approved by the FDA for treating major depressive disorder in 2013, it works a bit differently than other SSRIs by directly interacting with serotonin receptors.
It touts lower sexual side effects and possibly improved cognition as its features, Dr. Dimitriu explains. These benefits have seen mixed results in clinical practice, for people who have not responded to the older SSRIs, Trintellix may offer hope.
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Seeing A Doctor About Depression
Big changes in your life, like bereavement, losing a job, or even having a baby, can cause symptoms of depression. You’re also more likely to experience depression if you have a family history of depression. However, it’s also possible to become depressed without there being an obvious reason.
You can learn more about depression causes here.
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List Of The Best Antidepressants For Depression And Anxiety
SSRIs and SNRIs can treat both anxiety and depression.
They typically include the following:
Due to concern over safety and tolerability and potential somatic symptoms, tricyclic antidepressants often come as an afterthought.
TCAs used to treat depression and anxiety are:
Schedule your appointment with a mental health professional to get the most suitable treatment for anxiety or depression.
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Everything You Might Want To Know About The Top 13 Antidepressants On The Market
Depression is a debilitating disorder that is widely affecting people all over the world. There are many antidepressants that are designed to help all types of depressive disorders. So which ones are the best for managing certain types of depressions? Well, a list was put together by IMS Health where they talk about the 100 most prescribed drugs. Some of the antidepressants on this list were quite high on the overall list. The likes of Cymbalta was three times more prescribed that than the next most prescribed antidepressant.
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Myth #: People With Ms And Depression Always Look And Act Depressed
Truth: Its important to note that depression in MS may look different than our typical notions and assumptions about depression, says Hughes. Sometimes, an individual with MS may experience depression as irritability, anger, not feeling like oneself and/or uncertainty about the future.
Symptoms of depression based on recognized diagnostic criteria include fatigue and difficulty concentrating, which overlap with symptoms of MS. Therefore, they are not always a good indicator that someone with MS is depressed, explains Hughes.
A physician might use a questionnaire to help identify signs of depression in MS patients. If a patient comes to the appointment with a family member, it can be helpful for the family member to share their observations and provide examples of specific behaviors. Keeping a daily diary to track the frequency and severity of mood symptoms can also be helpful, suggests Hughes.
How Long Will It Take For Them To Take Effect
According to the United Kingdoms National Health Service , people may begin to feel the benefits of the antidepressants after 12 weeks if the person has not missed a dose.
Some people may stop taking them because they believe the medications are not working. However, it is important to keep taking the medication exactly as their doctor has prescribed.
If a person has not felt any benefit after 4 weeks, they should speak with a doctor.
According to the NHS, doctors will typically suggest a person takes antidepressants for at least 6 months.
People should take their antidepressants exactly as their doctor has prescribed.
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Should You Treat Your Depression With Medications
You might be asking your healthcare provider this question if you have been feeling low and your friends and family have mentioned this to you. Your provider might have mentioned medication if your mood interferes with work, family or socializing for more than two weeks. Some people with depression might even have legal troubles linked to outbursts.