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Dr. David
Dr. David, Board Certified MD
Category: Medical
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Experience:  Board Certified Physician
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I have been diagnosed with Depression, however before and after

Resolved Question:

I have been diagnosed with Depression, however before and after my depressieve episode I have been feeling extremely tired and have no energy. I have had my bloods done and my thyroid is fine (well borderline normal). I also have a fast heart beat, but my main concern is relentless exhaustion. Any information would be greatly appreciated.
Regards,
Drewan
Submitted: 3 years ago.
Category: Medical
Expert:  Shantal-Mod replied 3 years ago.
Hello Drewan,

I'm Shantal and I'm a moderator for this topic.

We have been working with the Experts to try to help you with your question. Sometimes it may take a bit of time to find the right fit.

I was checking to see if you had already found your answer or if you still need assistance from one of the Experts.

Please let me know if you wish to continue waiting or if you would like for us to close your question?

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Shantal

Expert:  Dr. David replied 3 years ago.
This is Dr. David

what was your thyroid level testing result?

what was your TSH level?
Customer: replied 3 years ago.
My free T4 was 12.4pmol/L range (12-22). My TSH was 2.41 mIU/L range (0.4-3.8). Also I had 3 unexplained miscarriages. My brother was recently diagnosed with an over active pancreas.
Expert:  Dr. David replied 3 years ago.
TSH is within normal limits

how fast is your heart rate?

have you had an EKG to test your heart rate?
Customer: replied 3 years ago.
My heart rate at rest is 100 to 120bpm. I have had an ECG done on my heart which was considered normal.
Customer: replied 3 years ago.
Also recently I took 2 bottles of the tonic Fosfor which contains Phosphorylcholine. I got some relief however minimal from it.
Expert:  Dr. David replied 3 years ago.
heart rate at rest of 100-120 is not normal.

you could be in normal sinus rhyth. but it is not normal for your heart to race that fast at rest

it doesn't look like your thyroid gland is what is causing your racing heart rate.

your depression and fast heart rate might be two separate issues.

if your heart is beating that fast, the amount of blood coming out of the heart is decreased. it is impossible for the heart to be efficiently at that fast heart rate.

you need more testing of your heart such as a cardiac echo study and to consult with an electrophysilogist cardiologist who specializes in electric signal conduction in the heart which is what causes these contraction impulses

if you drink a lot of caffeine, this can cause your heart to race this quickly

if you take other stimulants, it can cause your heart to race this quickly

your fast heart rate could be part of why you are feeling so fatigued.
Customer: replied 3 years ago.
My main concern is not with my heart bear more so my exhaustion which has been a feature for years before the on set of my depression. I was hoping for more information on the cause of my tiredness/exhaustion as opposed to my fast heart rate. I am not satisfied with the answer. You've basically trust told me I have a fast heart beat which I know. The only other thing I did not mention was that once I was told I hah had Epstein Barr virus which I don't remember having any symptoms. Could this be related to my 20 years of fatigue?
Expert:  Dr. David replied 3 years ago.
usually ebstein barr virus infections cause fatigue for several months, sometimes 6-12 months in some cases, but usually it will not cause 20 years of fatigue

chronic depression would be much more likely to cause long term fatigue, if your depression is not being well treated.

I see you are taking lithium and Rivotril (clonazepam) and CLOMIPRAMINE (ANAFRAANIL)

do you have a history of bipolar depression?
Customer: replied 3 years ago.
No I do not have bipolar depression. I was put on Li to augment the anafranil. My psychiatrist on weaning me of lithium in the near future. Can you explain further what you mean by 'chronic depression would be much more likely to cause long term fatigue, if your depression is not being well treated'? What do you mean if my depression is not being well treated?
Expert:  Dr. David replied 3 years ago.
well, if you are still having symptoms of depression, part of depression can be fatigue.

so if you are still having chronic long term depression from difficult depression, then this can cause fatigue

if you have long term depression of 20 years which has been tough to treat, then you could very well have long term fatigue for 20 years.
Customer: replied 3 years ago.
My first depressive episode started in August 2007 after my first miscarriage which I had fertility treatment for (clomid and puregon). Prior to this my only symptom was fatigue which I had for approx 10 years prior to a major depressive episode in 2007. I then had 2 more natural pregnancies which I miscarried both. So if the tiredness before my depressive episode was the only symptom, is it possible I had chronic depression with a single symptom of complete exhaustion and no other depressive symptoms? Also you said ' , if your depression is not being well treated.' , how do you suggest I treat it? I thought, the tiredness and miscarriages may be related. I thought I might have endocrine problems.
Expert:  Dr. David replied 3 years ago.
it is impossible to say if you had depression for 10 years prior or not.

it sounds like you definitely had post partum depression which is an entity in itself.

what is more important is your symptoms now.

if your symptoms of depression are well controlled now with lithium and anafranil, that this a good thing.

hopefully your symptoms of fatigue are better now.

many things can cause fatigue.

depression,
sleep apnea
being overweight.
not getting enough sleep
not getting enough exercise
poor diet
low iron
low B12
low Vitamin D.

so all of these issues need to be checked if you are having fatigue.

hopefully your depression is not part of the cause of your fatigue at this point.
Customer: replied 3 years ago.
My symptoms of fatigue are not better now. I'm still completely exhausted. Can depression just have a single symptom of tiredness/fatigue? You still haven't answered your comment ' if your depression is not being well treated. ' what did you mean by that and what do you recommend for well treated depression? What outcome should I expect?.
Expert:  Dr. David replied 3 years ago.
not all depression can be fully treated.

I do not know if you still have symptoms of depression or not.

post partum depression does not come into play currently.

if you still are feeling down, have low energy, feeling depressed, have no joy or enjoyment of things in life, then it sounds like you could still be depressed and this can cause fatigue.

your doctor is already using lithium along with anafranil. this is a regimen used for treatment resistant depression.

so there are not a lot of other options to treat tough depression

you might want to talk to your doctor about those other causes for fatigue to make sure you don't have any of them.

if they are all ruled out, then your fatigue might be part of your depression disorder.
Customer: replied 3 years ago.
Ok thanks
Expert:  Dr. David replied 3 years ago.
you are welcome

let me know if you have other questions.

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Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45937
Experience: Board Certified Physician
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