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Monday, July 7, 2008

14 Observations on Fatigue and Depression

  • Physical fatigue or loss of energy is included as a single item in the DSM–IV criteria for major depressive disorder

  • Some think of lack of concentration as a mental form of fatigue and lack of concentration is also a symptom of depression

  • Anhedonia is an inability to experience pleasure from normally pleasurable life events. This is considered to be a core symptom of depression. Some describe it as emotional fatigue

  • Atypical depression is associated with hypersomnia, weight gain or increase in appetite, inertia, and leaden paralysis (i.e., severe lethargy and fatigue; heavy, weighted-down feeling in arms and legs)

  • Patients with atypical depression are significantly more likely than patients with other forms of depression to report fatigue

  • A recent twin study showed that fatigue during a severe major depressive episode is more likely to be reported by women than men

  • Fatigue is common in major depressive disorder

  • Fatigue is more common especially in the atypical subtype

  • Fatigue is the depressive symptom that correlates most strongly with diminished functioning

  • Fatigue is a common prodromal symptom in patients with their first major depressive episode

  • Fatigue strongly predicts progression to a chronic course of depression

  • Fatigue is one of the symptoms that appears to be less responsive
    to antidepressant treatment

  • After remission of major depressive disorder, approximately
    10%–35% of patients continue to experience fatigue

  • Pharmacological augmentation of antidepressant therapy has shown promise in the treatment of residual fatigue. Modafinil and bupropion are the only two augmentation strategies published on this subject

Now lets' be careful, these observations about depression and fatigue were published in a review, not a systematic review. You could at best consider these observations as the opinion of an expert, not the scientific truth about the relationship between fatigue and depression. Moreover most of these observation are recognizable but don't have to be true. I have linked as much as possible to the references used by the author.

To my opinion does fatigue play an important role in depression but you can't say that fatigues always implies depression. Even in science this mistake is often made. It is comparable to using depression severity scales in somatic ill patients and concluding that a large part of these patients have a depression because they have a high score on these scales. They have a high score due to their medical illness not due to a depression, you need a diagnostic scale for that.
Arnold, L.M. (2008). Understanding Fatigue in Major Depressive Disorder and Other Medical Disorders. Psychosomatics, 49(3), 185-190. DOI: 10.1176/appi.psy.49.3.185


Aqua said...

Fatigue was one of the reasons I went to my family Dr. so many times to try to get help, not realizing I was depressed. I have Atypical Depression and the description of fatigue fits me to a T. Right now I wonder though if it is the Prozac making me so fatigued. I am taking Dexedrine to help lift my mood and fight the fatigue, but it always stopps working after a while. I've tried Modafinil twice (didn't help) and Ritalin once...helped for a short while...The fatigue, especially with amotivation, makes it difficult to do anything other than wait for the day to end.

Dr. Shock said...

It is hard to disentangle fatigue from depression, it gets harder when antidepressants side-effects kick in.
Why do you think prozac causes your fatigue?
Modafinil is used for fatigue in depression, what is your experience with modafinil?
Regards Dr Shock

Aqua said...

I am certain it is something chemical in the Prozac that causes much of my fatigue. As soon as I hit 30mgs/day I had the exact same fatigue I had with all the other SSRI's/SNRI's (actually all the antidepressants I tried except Moclobemide...which made me feel like I was covered in bugs (it set off some of my OCD symptoms really badly).

Prozac and the other antidepressants seem to make me extremely "la, la, la"; as though nothing matters, doesn't matter if I clean up, or eat, or ever leave the house, or shower(well I shower, but don't have the energy to brush and dry my hair after I've washed it...sounds stupid, I know), or have sex, or do anything at all, other than just wait to go to bed. (the rea me is the exact opposite of this...I am a bundle of energy, ideas and fun when well)

Prozac definately increases my amotivation, which in turn increases my amotivation...isn't that a law in physics? That which is not in motion stays out of motion unless something bigger than itself forces it into motion???ha, ha. But is also makes me want to sleep(well really lay down...I most often feel the fatigue, but not a sleepy fatigue...rather an exhaution); especially at about 3:30-4pm. I feel so exhausted/fatigued I feel sick.

I think the "throughout the day fatigue is Prozac related, but I don't really think that this "set-time fatigue" is a Prozac symptom, because Prozac's halflife is very long so there should not be that daily fluctuation. Dr. X says atypical depression follows that pattern, so it may be my depression still.

I did try modafinil 200mgs/day and did not find it did anything after a few weeks if even that. I am thinking of trying it again, just in case it works better with the combo I am on now.

Dr. Shock said...

So all antidepressants causes fatigue except moclobemide, is this fatigue new, I mean it wasn't there before using AD. Or did the AD worsen the fatigue?
regards Dr Shock

Aqua said...

Hi Dr. Shock,
I originally sought medical help because of the fatigue and mood symptoms. I have had serious bouts of fatigue over the years (punctuated by times with no fatigue and high energy). I now believe these were MDE's.

When I am well I have absolutely no fatigue; quite the opposite, I am a powerhouse of bubbling over energy.

The last period of wellness I had was 1997-1999. During that time I was working 10-12 hours a day in a fulltime, high paced, challenging career, I'd come home after work and work on the farm for a few hours every night, work on the farm, or at the farmer's market every weekend in the summer, had an active social life, planned and threw tons of dinner parties and did all the things I loved. That is the well me.

Fatigue and wanting to eat more and amotivation are usually the first symptoms I get when a MDE sets in. The A.D's (Prozac incuded) make that fatigue and amotivation worse.

The problem is Prozac is the first A.D. that has lifted my mood. My suicidal thoughts and my obsessive thoughts/worries have slowed down. Although they have not completely disappeared I feel they are much better than before.

However, the Prozac has made my ability, motivation, desire and energy to do anything disappear almost completely. I just feel like sitting at home and doing nothing. It take tremendous will power just to have a shower, or get dressed, let alone paint, or volunteer like I want to do.

Usually I am not a lazy person, I am energived and outgoing. This is a very difficuly way to live and be. I feel like a slug.

Anyways, I am glad there are people like you and my pdoc working towards helping people with depression. Maybe one day either of you, or your collegues will find a way to make depression a thing of the past.

Dr. Shock said...

Make depression a thing of the past.....hmmmm.
Will take it a step at a time but your comments and posts are very explanatory. Thanks and regards Dr Shock