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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18444
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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years I have been going to my doctor complaining of the

Resolved Question:

For 3 years I have been going to my doctor complaining of the same symptoms:- extreme tiredness, but cannot get to sleep at night, bouts of depression, back pain, my right arm and leg constantly ache, muscle spasms, really bad short term memory, lack of concentration, loss of balance, bad circulation, migraines, most days I don't want to get up and everyday feeling really unwell, and it seems to be getting worse. My sister seems to think I've got ME, I just need someone to advise please. My doctor has prescribe anti depressants. And I am currently being treated for hypertension.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer.
It will help if you could provide some further information.
When you say bad circulation, what symptoms are you having?
What evaluation has been done thus far?
Were you started on the antidepressant for depression or for another reason?
Which antidepressant and blood pressure medicines are you taking?
Customer: replied 2 years ago.

Constant ache in my right arm and leg, from the waist down I am cold to touch, numbness in hands and feet. For the last week, constant pain in legs, when I climb stairs I get sharp acute pain in my knees.

Evaluation, is I have been put on anti depressants and given a number for a IAPT service. I have to go back to my doctor once a month to check blood pressure. He has now said he will refer me to the hospital for me to see a specialist regarding the blood pressure. I was started on the anti depressants because I broke down in tears in the surgery.

I am on Ramipril, Amlodipine and Fluoextine.

Expert:  Dr. D. Love replied 2 years ago.
Have you had any tests of the circulation, such as an arterial ultrasound?
Have you had blood counts, liver profile, and thyroid blood tests done?
If so, do you know the TSH?
Customer: replied 2 years ago.

No, no other tests. Had my blood counts, liver profile and thyroid done and they came back clear. I don't know the TSH.

Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.

I ask about the symptoms and evaluation for poor circulation because that is a specific issue that cannot be attributed to depression or ME. The symptom that would be most indicative of poor circulation is pain in the muscles that occur with exercises. The classic presentation is pain in the muscles of the calf that occurs with walking or other exercises that involve the legs, but any muscle group could potentially be involved.

On the other hand, constant pain in the extremities, coldness, or numbness could be due to a variety of conditions, including poor circulation. And pain in the knees with exertion is usually not due to poor circulation.

If there is concern about poor circulation, the appropriate next step would be an arterial ultrasound.

As for the remaining symptoms, it is very possible that the symptoms are due to clinical depression or ME. In fact, these two diagnoses share many common symptoms. Clinical depression will commonly have fatigue, difficulty sleeping, difficulty with memory or other cognitive functions, and a variety of chronic pain syndrome, including musculoskeletal pain and migraines. ME can also have similar symptoms, and it is possible that someone that has ME can develop secondary depression.

Differentiation of depression and ME is partly dependent upon the severity and timing of the depression symptoms. If the depression symptoms are significant and are present when the other symptoms develop, it is more indicative that the problem is clinical depression that is causing all the remaining symptoms. On the other hand, if the depression symptoms are not present when the other symptoms develop, but start later as the individual is dealing with the chronic symptoms, that would be more indicative that the primary problem is ME.

After the episode of crying when seeing the doctor, your doctor likely considered the problem to be clinical depression, rather than ME.

In either situation, it is also reasonable to simply consider the use of an antidepressant. It would be the appropriate first-line treatment for clinical depression and also may help many of the other symptoms. There also are certain antidepressants that are sedating that can be used to help promote sleep.

Therefore, it would be appropriate to perform a separate evaluation for poor circulation, but otherwise it is reasonable to continue the fluoxetine, and it may require consideration of a sedating antidepressant.

If I can provide any further information, please let me know.
Customer: replied 2 years ago.

Thank you, ***** ***** been very helpful.

Expert:  Dr. D. Love replied 2 years ago.
You are most welcome.
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