The 12th Invest in ME Research Conference June, 2017, Part 2
MEMum presents the second article in a series of three about the recent 12th Invest In ME International Conference (IIMEC12) in London.
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ME or depression? If ME, do fluoxetine anti-depressants help?

Discussion in 'General Treatment' started by Alex1, May 12, 2017.

  1. Alex1

    Alex1

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    I had thought I had ME but my doctor is convinced I have depression, or at least the cause is psychological. He prescribed me fluoxetine. After seeing what so many sufferers say about doctors I am sceptical that it has a psychological cause. If I describe my symptoms, could I have advice on whether it's ME or if it's psychological cause? And if it is ME, does fluoxetine (a type of prozac I think) help anyway?

    Symptoms: fatigue, mind fog, tired eyes, "tunnel vision", droopy eyelids, stiff-feeling neck, tinnitus, even just going for a short walk makes my legs pretty tired afterwards, constantly thirsty and drinking just makes me urinate it all out soon after, bowel problems including diarrheoa, blood and mucus in stools. Exercise payback has been hard to monitor as I haven't been doing exercise other than some walking. One day when I walked fast for 20 minutes two times, I had to rest in bed for after both (in fact in bed most of the day).

    So, does this look like depression, or am I right and it's ME? And should I take the anti-depressant even if it is ME?
     
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  2. TigerLilea

    TigerLilea Senior Member

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    If you are having bowel problems including diarrhea with blood and mucus in your stools then you definitely need to get that checked out. That isn't depression or ME. Have you been checked for diabetes due to your constantly being thirsty and drinking?

    Has your doctor run tests to rule out all other illness that include fatigue as a symptom? If not, then you need to get that done. Getting a diagnosis of ME is only possible after ruling everything else out. Do you suffer from Post Exertional Malaise? That tends to happen usually a day or two after physical exertion, not right away. And that is a must have for CFS/ME. Do you feel hopeless? That is more a symptom of depression.

    Do you feel depressed? Antidepressants don't work for ME to relieve symptoms. However, if you are feeling depressed then it might help. And for the record, ME is NOT psychological just in case your doctor tries telling you otherwise.
     
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  3. adreno

    adreno PR activist

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    There is no "psychological" depression. Everything involves biology. If you are depressed, an SSRI might help. But there are also side effects to consider, especially with higher dosages. I would try other options first.
     
    Last edited: May 12, 2017
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  4. Deltrus

    Deltrus Senior Member

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    In my experience ME type symptoms often happen alongside depression because they have a similar root pathology which includes inflammation. But antidperessants don't really get rid of inflammation, they are better at just making you not terribly sad and unmotivated. Imo if I were you, if I didn't obsess with sad thoughts and just experienced what you were experiencing, I'd skip the anti depressants.

    But you should definitely look into some serious probiotics if you have blood nad mucus in your stools.
     
  5. Valentijn

    Valentijn Senior Member

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    I don't think it can be certain to be ME, but it definitely isn't depression. Those are not symptoms of depression, and you haven't listed a depressed mood as one of your symptoms. Your doctor believes you have a psychosomatic disorder, and you taking a anti-depressant isn't going to fix that problem :p

    I strongly recommend finding a new GP. That will fix one problem at least.
     
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  6. wherearemypillows

    wherearemypillows

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    I don't think this is depression.

    Speaking from personal experience: I have less symptoms than you (with brain fog being the most debilitating/notable) and I've tried 3 different antidepressants since my illness started. None of them had an effect on me whatsoever, good or bad. On the brightside, the lack of response has made me stop questioning whether it's just "all in my head" (not that that was ever a huge question to me in the first place). It's also helped convince my local Canadian GP and has made her more willing to work together (as far as rewriting prescriptions) with my doctor in the US.
     
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  7. Alex1

    Alex1

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    Well, I've had blood tests that rule out diabetes, thyroid etc. And a colonoscopy that ruled out cancer and colitis (waiting for biopsy results though)
     
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  8. hellytheelephant

    hellytheelephant Senior Member

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    I'm interested that in all the symptoms you list none of them are classic symptoms of depression ( lack of interest in life, unwillingness to interact with others, feelings of desperation etc) Having to rest in bed after exercise is classic ME.
    In addition to ME, Chronic pain and other chronic problems I DO have depression.. I had Depression before I had ME and they are not the same illness at all!

    My current GP prescribed Citralopram for me, when I was at the end of my tether with pain and being a carer in addition to being sick. In my case anti-depressants have helped me. Some of us do have a tendancy to depression and we will need meds from time to time. Many on here have found them unhelpful.

    Your GP should be sending you for testing for gut and bladder problems....and you need to get a GP who actually gives a **** never mind one who knows about ME.
     
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  9. Alex1

    Alex1

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    One thing I will add is the physical fatigue is not as bad as the mental fatigue.
     
  10. hellytheelephant

    hellytheelephant Senior Member

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    I have a friend with ME who is the same.-that doesn't mean you have depression. My friend functions at a much higher level of function than me, but we still have the same illness. Have you looked at the criteria for having ME?
     
  11. Tunguska

    Tunguska Senior Member

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    I definitely think now it's possible for some of the popular antidepressants to help brain symptoms associated with CFS/ME separately from depression, but at any rate they're suboptimal for that purpose such that you might not even notice. In the worst case they make you worse through indiscriminate increases in serotonin (and for some the receptor re-regulation).
     
  12. Alex1

    Alex1

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    Okay thanks for all your help.
    Would a ten-minute jog tell me if I had CFS/ME? So I've done a ten-minute jog (actually managed it) and if I wait two days and there is no, or not much payback, I'm alright?
     
  13. Webdog

    Webdog Senior Member

    I have ME/CFS and a very similar symptom cluster to you.

    Fluoxetine didn't help. Rest and low-dose naltrexone have been beneficial in managing my symptoms.

    Do your eyes droop more or even close when you are walking? This happens to me, but I've never heard it from another ME/CFS patient.

    If you are also having problems with muscle weakness, eyelid droop and facial expression, have your doctor evaluate you for Myasthenia Gravis, a neuromuscular disease.
     
  14. Deltrus

    Deltrus Senior Member

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    Personally I only get PEM (post exercise malaise) around 1/3rd of the time. Generally I can tell when I'l get it because I'm already pretty tired.
     
  15. Basilico

    Basilico Florida

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    ^^^This

    @Alex1 nothing in your description of your symptoms indicates you have depression since you didn't mention any of these major criteria. While depression often has a comorbidity with insomnia and fatigue, that doesn't seem relevant to your specific situation. I agree with the advice to pursue another doctor if this one refuses to consider other possibilities for your symptoms.

    Unfortunately, many doctors are both inept and overconfident, and when they don't see an obvious answer they jump to the conclusion that the issue is psychosomatic because they don't want to admit that they don't know what to do next. This means that it's up to you to be your own advocate, and to not accept BS answers like "you're just depressed" if depression isn't even one of your symptoms.

    Have you also had your ferritin/iron checked? That's an easy issue to rule out with testing, usually this is tested to rule out anemia when fatigue is a symptom.

    My husband doesn't get PEM consistently...some days he is surprised with how much he's able to do (although it's never as much as he could do before getting sick), and other days standing in the kitchen cooking for 10 minutes is enough to trigger it. So I'm not sure if being able to run for 10 minutes without crashing would definitively rule out anything...maybe it would be helpful to document what physical activity you do and whether it results in needing recovery time in bed afterward or not. If anything, it might just be useful for you to understand what your boundaries are.
     
    Last edited: May 12, 2017
  16. Alvin2

    Alvin2 If humans were rational...

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    Not depression, those symptoms could be different conditions and could be ME/CFS but i can virtually guarantee they are not caused by depression

    Prozac will typically make you feel wired, and is addictive and can cause symptoms of psychosis or suicidal ideation, it can cause permanent brain damage as well as untreatable akathisia and diskinesias, and some people find its impossible to withdraw from.
    I would personally avoid it like the plague, though your doctor will think your resisting treatment hence it has to be depression. I can't technically advise you to fill the prescription and not take it just to make the doctor search for the real cause... ;)
     
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  17. NelliePledge

    NelliePledge plodder

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    I was on fluoxetine for years for mild situational depression. I have come off it in the last year very gradually as the situation causing the depression ended. I was only diagnosed 18 months ago with ME/CFS and fluoxetine hasn't made any difference in preventing ME or neither has coming off it worsened my symptoms. My conclusion it helped with depression ( although counselling was what really helped) and it had no impact whatsoever on ME. I was relieved to come off it successfully as I was worried I might have to keep taking it to avoid withdrawal problems.

    Good luck
     
  18. JES

    JES Senior Member

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    Fluoxetine has anti-enteroviral activity, especially against CVB3 and CVB4 in high doses (source). Other than that, there is no particular reason for why fluoxetine would help with CFS/ME.

    Fluoxetine has been in use for 30 years, I would say its safety is pretty well established at the current time. I haven't seen reports of permanent brain damage, but correct me if I'm wrong. Also, SSRI's aren't really addictive in the sense that you get a drive for taking them, this is misinformation. Of course, you will develop a tolerance for SSRI's like for most medications, so if you suddenly quit taking them instead of reducing the dosage slowly, your body will react. From my short trial with fluoxetine against enterovirus I'd describe it more as a dulling drug, I just became an incredibly boring person, but maybe you've had a different experience.
     
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  19. Alvin2

    Alvin2 If humans were rational...

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    You are welcome to look further into this, start with the symptoms i mentioned. Also there is a withdrawal forum with crazy bad stories of people who are desperate to be off them and incredibly sorry they ever started.
     
  20. Woolie

    Woolie Senior Member

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    I was given fluoextine once very early in my illness, by a doctor who also believed I had depression. I learned two things from this:

    1. Doctors really don't know what they're doing here. You think at the time that they do, but it turns out they are clueless and just making it up as they go along. So don't let your doctors apparent "knowledge" and "expertise" be sufficient on its own to convince you to take this medicine.

    2. Fluoextine is not a great antidepressant for anyone having difficulty sleeping. The tricyclics (e.g. amitryptiline) are much better. If taken before bedtime, they have a sleep sustaining effect.
     

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