To see a neurologist?

HI all. I just got back from my appointment with my psychiatrist who has now left me feeling hopeless. Right now, I'm on Lexapro (30mg), Abilify (5mg) and Modafinil 200mg. I've been having a huge issue with fatigue, and although I think a lot of it has to due with the Lexapro (or all the SSRI's in general) my doctor finds that its unlikely to be causing me to feel THIS much fatigue. He suggested that, after the holiday's I could try tapering off of the Lexapro which really confused me; I have major depression, is that feasible? Does he not think I really have depression or something or? I explained that the modafinil seems to work in the morning, but poops out on me about 3PM. I got the "but you're 27 and should not feel that tired" line which made me want to punch him because the fatigue holds me back from my depression lifting (which I also explained). I asked if I should maybe switch to a different antidepressant to which he replied "well, you've pretty much tried them all." To clarify, I've tried all but Celexa. I recently had my thyroid checked and all came back fine. Now he wants me to go to a neurologist. Has anyone had their doctor recommend a neurologist? I'm not sure what seeing a neurologist even entails, to be quite honest. I feel so very hopeless and I'm looking for advice as to what my next steps should be. He has been a good doctor and Id hate to go look for a new one, and would like to avoid so if possible, but I'm not sure...has it come that time? How do you know when you need to see another doctor? Any insight would be greatly appreciated

Depression can cause fatigue. Also, you may have a sleep disorder. I don't think a neurologist is going to figure this out. But let us know.

Most medications have their own kind of side effect on every single person. Seeing a neurologist is not a bad thing to rule out any other causes of your tiredness.

Psychiatrists are just people. Some we will click with and others the connection is not there. Never a bad thing to get a second opinion.

I've found neurologists to be the most helpful doctors around by and large. They tend to do very thorough examinations and look for things other doctors wouldn't even think of.

Looking at your "About Me," I see that it so happens that you do have a sleep disorder. You kind of remind me of me, and I'm having a heck of a time trying to cope with daytime fatigue.

I wish I had something to say that would encourage you. Unfortunately, I'm frustrated myself. I really think that physicians don't have a great understanding of the kind of fatigue you're describing. I see, from your other thread, that you've been put on stimulant meds. I was put on Ritalin. I was told to take it in the morning. It did kind of help me to wake up, but it made me want to sit and become awfully busy, thinking and thinking in a non-productive way. I read that's a known effect of stimulants.

Like me, you also report having an anxiety disorder. What you're describing sounds so familiar. How these different aspects of our mental/physical state interact on each other is something I don't well understand. In my opinion, neither do the doctors. I'm much older than you, but I remember having severe problems with daytime fatigue when I was your age. It's just not true that healthy young people shouldn't get as tired as you are getting. I needed even more sleep at age 27 than I did 20 years later.

I think your pdoc is sending you to a neurologist because he just honestly doesn't know what else to do. The trouble is neurologists kind of specialize in pointing out the obvious. A neurologist is always called in when someone seems to have had a stroke or seems to have gone into a coma. (I worked as a nurse most of my life.) Those two conditions are pretty obvious. Neurology, by the way, is one of the lowest paying specialties in medicine. From what I saw, when I was working, what they do is not very impressive.

Getting back to anxiety. (Sorry this is kind of disorganized.) I take hydrocodone for back and beck pain, but I find it also helps my depression. Sometimes, when I am having a hard time with fatigue, I feel less fatigued after taking hydrocodone. One has to wonder why that would be? Opiates are central nervous system depressants that are expected to make people sleepy. But opiates also can lessen anxiety because they are sedating. So I'm guessing that relieving anxiety can free up energy. Opiates also can produce some euphoric feelings, and I suspect that can be energizing. Hydrocodone will help me sleep when pain is making me restless. This med also helps me sleep when I'm genuinely physically tired, but feel just can't relax my mind. But, other times, hydrocodone helps me wake up and apply myself. Modern medicine really doesn't offer a good explanation for that, from my reading on this. But my experience is what it is.

I guess I have to conclude that drugs which enhance a feeling of well-being, as opiates are well known to do, can free up energy that is being otherwise sapped by depression and anxiety.

Now, getting back to sleep disorders. I was referred to a sleep disorder clinic. From what I could tell, all they're really looking for is problems with breathing. They said I could benefit from oxygen at night and from a CPAP machine. I declined those because I don't believe there is anything all that wrong with rhe way I breathe at night. Sixty percent of people who are prescribed CPCP stop using it because it doesn't improve their lives. That doesn't surprise me. The sleep clinic doctors want apnea to be your probkem because they know how to treat that. (If all you have is a hammer, every problem looks like a nail that needs pounding.) Something is very wrong with my sleep pattern, which regularly becomes chaotic. But it's not due to a breathing problem. They even admitted that I almost didn't meet the criteria for having CPAP prescribed. That's how close to normal my breathing pattern is. The psychiatrist said I don't even have a real sleep disorder because over the course of a week, I do get enough sleep. But, when you don't sleep on any kind of a regular pattern, your life is becomes chaotic.

My whole point is that depression, anxiety, sleep disorder and fatigue are inter-related in a way that they just don't seem to understand. So I am not getting meaningful help. I truly hope you'll have better luck. I'll be interested to know how this goes for you.

Amitriptyline, which is an antidepressant that improves sleep patterns for some, has helped me. It might help you. Doctors avoid ordering it nowadays because it has worrisome side effects and is lethal when taken in overdose.

Thanks for your reply (everyone else too!) I guess it makes me feel better to know that I'm not alone. I personally wouldn't categorize myself as an insomniac because my sleep patterns are pretty regular (at least, they are now) but I was given ambien to help sleep on nights where it becomes more difficult. I luckily was able to get in to see a neurologist next Tuesday (November, 21) thanks to a cancelation. Before I found out there was a cancellation, they told me I wouldn't be able to get in to see a neurologist until April (that's through the Cleveland Clinic btw). You mentioned sleep apnea and, I have a funny feeling, they will look there because its pretty easy. I should also mention the neurologist I am seeing specializes in sleep disorders but like i've said, I don't have hope they will find much there. My sleep isn't as chaotic as you report.

Another thing, I did call my psychiatrist today to see if he would be willing to switch me to Nuvigil to see if that makes any difference for me in the meantime. He hasn't gotten back to me yet, so we shall see. I will keep everyone updated as things go along. I appreciate the love

im glad you're going to a specialist. having said that, both ssri drugs and the major tranquilizers can causse sedation, lethargy, fatigue, etc. you may just need different sorts of psych drugs to handle your problem(s), like wellbutrin maybe instead of an ssri (just a random thought, not an actual suggestion).

im glad you're getting thorough care.

Celexa is lexapro's "cousin". They are very similar chemically. In fact when I had no choice but to switch from lexapro (my first ever psych med) to celexa, my anxiety went through the roof!! I also stopped being a zombie. I didn't realize how deadened I was until getting off lexapro.
Sadly, I have also been on just about everything and am tired of nothing working.
Best!
Ps: I'm now working with neurons and having not great experiences. Just saying. They can do a lot of stuff if there USA brain problem, but if all your tests are clear it's a dead end (so I've been told by mine).

Hi, I agree with possum220, on both the meds and the neurologist. Most of the anti-depressants will take at least a month before you know if it is working or not...have you given each one you tried at least that long? I hope you find relief soon.

My keyboard is deciding what to type for me... it's not very helpful when it changes half of what I type

After my inpatient stay a few years ago, they recommended that I have an MRI done to see if that could find anything wrong with me. I was also having headaches that would last days and were very painful so I saw a neurologist who gave me 20-30 needles into my head with some fluid that was supposed to relieve the pressure in my head (it didn't). SO I think it is pretty normal to be recommended to a neurologist, just to rule things out.

For me I've tried pretty much all of the SSRIs, and they all make me very irritable so I will no longer be prescribed an SSRI. I think you're like me and have a negative reaction to SSRIs, and thus should definitley try a different type.

I understand your struggle with the psychiatrist because my first psychiatrist didn't really care about what I had to say, but my current one does so I feel very confident that she will figure out the proper medication combination for me.

Best of luck to you

When I was on Lexapro it increased my hallucinations and I felt as if I was about to have a psychotic break it was very bad. I was being treated a couple months ago for anxiety, and the nurse prescribed me Celexa. The Celexa didn't affect me for 2 months until recently when it started to make me irritable and increased my depression and anxiety. I am no longer on it and my current provider now knows that SSRIs do not work for me.

update: my psychiatrist told me that if I wanted to try Nuvigil, to go to my primary doctor. Wth? I'm really confused as to why he would say this seeing as he prescribed the provigil. Maybe because provigil and nuvigil are more for physical needs; tiredness etc? Does it seem like he's pushing me out the door to find another doctor? I made an appt. to talk with my primary on Monday (yet another cancellation I got in on). Do you think I should just find another psych?

I've been on Lexapro for about 4 months now. When I asked him if he thought I should switch to a different medication he told me that I've almost been on all of them. I feel like he doesn't want to deal with me anymore or something and its an awful feeling. I feel pretty alone again in this battle, like square one.

Another Update: Saw my primary today, he prescribed me Nuvigil hurray! I'm waiting on the pharmacy to order it in and I'll have it tomorrow. I'm pretty excited and hope it works a little better than the modafinil!

hi. personally, im quick to change psychiatrists when/if I feel the need, because of previous experiences. if i was in your situation, id seriously consider a new shrink. in some areas, some psychiatrists even advertise as specializing in adult add/adhd and mood disorders. i would think/assume those psychiatrists would be up on the latest treatments for what ails you.

First laurabean. I think it wouldn't hurt to see a Neuro at least for a 2nd opinion. I know many psychiatrist are board certified both in Psychiatry and Neurology.
Lexapro is Celexa's cousin. This is to me is a good example of tweaking a med to make a new one for Drug firms to make more money with a new drug. IE now that one can be prescribed generic Celexa. Citalapram. Is Lexapro really that different?