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Hobbes
A friend of mine has been suffering for quite a few years with various levels of tiredness, muscle ache in many areas of the body, and fluctuating amounts of energy. After several visits to doctors, some of her own research, and talking to sufferers of similar symptoms, she diagnosed herself as having ME (myalgic encephalomyelitis, aka chronic fatigue syndrome).

She takes painkillers most days to ease the aching and, more recently, she has begun to feel rather down. After me repeatedly telling her to hassle her doctor for more help (tests? advice? coping techniques?), she visited him today.

The doctor said he didn't want to label her as having ME quite yet, which seemed sensible, but then said she has severe depression, and gave her a prescription for some anti-depressants, saying that would be the most likely thing an ME expert would begin with.

Now, personally, I find this a little worrying in some respects. My main worry is that, based on a 5-minute visit to the GP, she has been prescribed anti-depressants. Surely this is massively premature?

My only hope is that maybe there's a chance that the drugs will ease the other symptoms somehow (if, perhaps, they are psychosomatic?), and then the Doctor will know what best to do from there - i.e. counselling?

Just wondered what other people think about this, and also if anyone else here has been diagnosed with ME?
Pikasyuu
The makers of tramadol really need to start paying me.
I don't know how to help and I would really like to, but might I suggest her trying it? It's a combination synthetic painkiller and anti-depressant, and unlike most anti-depressants, it doesn't require 3-6 weeks for the effects to start setting in.
Outside of that, good luck.
Hobbes
You should get yourself some shares in the company smile.gif

The drug my friend has been prescribed is Citalopram?

As a rule, how do anti-depressants affect people that do not "need" them? i.e. Do they just lift a person's mood by a factor of X, regardless of whether they are depressed or not? Obviously, I'm aware that the effects will differ between everybody anyway, but would a normally 'happy' person feel any effect?
Tarantio
I'm on Citalopram myself at the moment, and it's been pretty good for me so far. From what I read about it, it's a mood enhancer; It increases your seratonin levels, basically. In a person that doesn't need it, though, I'm not sure it would do much, possibly just potentially give side-effects?

It gets diagnosed for a lot of anxiety disorders, so I think it's one of those "first line" drugs that doctors like to throw at a problem in the hopes that it'll just go away. I know the doctor who originally prescribed it for myself was more concerned with the fact I was living in a different town from my GP and should change to something more local than the fact that I was telling him my depression had returned. I've since avoided going to him again, and had much more success with other doctors in the same practise. My point is, modern GPs seem to treat this sort of drug much like penicillin; a magical cure-all that can't hurt to try (except, of course, it can, in certain cases, and its list of side-effects is looong).

However, it has helped me greatly, and I'd recommend your friend give it a shot for at least four weeks or so to see if they notice any difference in their mood.
Daria
Wytukaze has chronic fatigue but his computer has run out of battery so I'm the typing monkey.
He was prescribed Amitriptyline in low doses for a combination of chronic fatigue (CFS) and migraines. Also, at the time, he was seeing a therapist for depression as they apparently had to rule out depression before properly diagnosing him with CFS as the symptoms can be similar (aside from the chronic pain) and misdiagnoses are common. So prescribing Amitriptyline was a triple-whammy cure-all.
Doctors often dig their heels in about diagnosing CFS or ME, especially in teenagers, because it's not really much of a diagnosis- saying that it's CFS is seen as like giving up because they don't know for sure what causes it and there certainly aren't any cures.

The issue with your friend is that you said she has recently started to feel down even though the other symptoms were present first. In many ME/ CFS sufferers, as those with other chronic illnesses, depression is quite common once the reality of how much it affects your life and quality of living really hits. It's easy enough to shrug off feeling tired and achey, but when it looks like you have a chronic problem that will never get better unless a huge breakthrough in medicine occurs, you really start re-evaluating things.


With regards to Tramadol, I'd be wary. And I wouldn't be saying this if I hadn't been taking it for the last 4 weeks or so and am now trying to stop taking it. It is horrible to withdraw from (I have new-found respect for you, Syuu), it causes utterly horrible constipation, dry mouth, skin itches, shivers, it is very very addictive, makes you feel high, sleepy and utterly non-functioning when you first take it. Then again, these are only my experiences of it and I have been taking two 50mg pills every four to six hours- which I doubt you would do if you're using it as an anti-depressant. Also, it works (as a painkiller) on the CNS rather than locally unlike, say, a non-steroidal anti-inflammatory (like ibuprofen, mefenamic acid etc etc).
Wytu's experiences of taking tramadol weren't good- it made him feel paranoid, shaky and generally not good. However his family have a trait of incompatibility with opioids.

Back to ME/ CFS: it is very tempting to take naps and try to have a "normal" sleep cycle. Naps are the worst thing you could do because you'll either sleep too long or if you do manage to sleep the correct amount of time, you'll be exhausted for the rest of the day until you have a proper sleep. It's just like teasing your body with sleep. Many sufferers also get insomnia (the irony isn't lost)- in Wytu's case, he can't predict when he'll get insomnia so we have no advice I'm afraid. Except: imposing an artificial sleep-cycle on yourself can exacerbate the situation of insomnia. Trying to work with when your body wants to sleep and when you have the most energy in the day is the best thing; although obviously this can cause problems if you're used to holding down a nine-to-five and have to get up at 7am every morning. In Wytu's case, he has most energy in the early evening after waking up around midday and going to bed around 11pm. (This was fun to explain to the jobcentre.)
Also, the intensity of his CFS fluctuates over months and cold weather can make it worse. (He blames the British climate "I had more energy when I was nearer the Equator")

One of the most annoying things about CFS is that people don't take it seriously. It's seen as just being tired, or worse- lazy. Much of the time the muscle and joint pain isn't known about and it can be very difficult to get people around you to understand the condition and accommodate for it. There will probably be a CFS support group in her area- she could either use the internet to find one, or ask at her local health centre. Even if she hasn't been diagnosed by a doctor, I am sure they would be very supportive and helpful and would have way more advice than we do.

Good luck to her, and keep us posted with how she gets on.
Daria
Oh, and Wytu consumes a terrifyingly vast quantity of coke. The caffeine and the sugar keeps him going- without it, he's almost bed-bound and can do nothinng. Not saying that an addiction to a fizzy drink from a nefarious company is a good way to go, but it helps him wink.gif
Hobbes
QUOTE (Tarantio @ Nov 19 2010, 12:06 PM) *
I'm on Citalopram myself at the moment, and it's been pretty good for me so far... has helped me greatly, and I'd recommend your friend give it a shot for at least four weeks or so to see if they notice any difference in their mood.


I guess I worry that, if it does have the desired effect, then it will become a permanent prescription. I don't really support the long-term usage of anti-depressants, unless it is absolutely, totally, 100% necessary. My view of the drugs is that they are a "cover up" for something underneath; a something that requires direct action. As I said in Yannick's recent thread, I totally understand that there are plenty of people that DO rely on anti-depressants to retain stability in their lives. But my concern is that my friend will remain on the drugs indefinitely, should they work for her, without looking at other possible options (I'm rather pro-counselling).

QUOTE (Daria @ Nov 19 2010, 12:32 PM) *
Trying to work with when your body wants to sleep and when you have the most energy in the day is the best thing; although obviously this can cause problems if you're used to holding down a nine-to-five and have to get up at 7am every morning.


Unfortunately, her work involves varying shifts and occasional night-work (although this usually just involves sleeping at work, with it being very rarely interrupted). I'm not sure if she ever really gets a chance to maintain a routine for her body-clock.

QUOTE (Daria @ Nov 19 2010, 12:32 PM) *
One of the most annoying things about CFS is that people don't take it seriously. It's seen as just being tired, or worse- lazy.


Two of my exes had ME, and my friend's fiancee has also been diagnosed (and then 'undiagnosed', and then diagnosed again, and then... etc...) with ME, so - to me - it seems as though everyone has got it smile.gif and I've been somewhat more capable at understanding it.

QUOTE (Daria @ Nov 19 2010, 12:43 PM) *
Oh, and Wytu consumes a terrifyingly vast quantity of coke. The caffeine and the sugar keeps him going- without it, he's almost bed-bound and can do nothinng. Not saying that an addiction to a fizzy drink from a nefarious company is a good way to go, but it helps him wink.gif


Hehe... well, if it works smile.gif My friend gets adverse reactions to coke, but does consume an awful lot of coffee. However, she's considering cutting back on it because she heard that caffeine can actually exacerbate the problems? Difficult to know what to do for the best. When I first knew her, she was always knocking back Lucozade and Red Bull, and was also working a lot of hours, and I would never have considered she had ME. But then, I didn't know her that well at the time so... blink.gif
Phyllis
QUOTE (Play-Doh Hobbes @ Nov 18 2010, 07:03 PM) *
My main worry is that, based on a 5-minute visit to the GP, she has been prescribed anti-depressants. Surely this is massively premature?

Yes, I think so.

Antidepressants are much more effective when combined with some form of counselling (be it one-on-one, group therapy, whatever). Generally, counselling should be the first step, before medication is dispensed — not an afterthought. Antidepressants aren't some sort of panacea. They can bring massive relief to those who genuinely need them, of course, but they really shouldn't be taken lightly and handed out on the basis of a 5-minute chat, at least in my opinion.

Can't comment on the CFS aspect, as I have very little knowledge of it (and anyway, Becky already covered it!). I just wanted to add my 2p on the pills, as I'm rather pro-counselling myself. smile.gif
Daria
Hobbes, caffeine can sometimes have the opposite effect on people if they have a small amount but we've not heard it being bad for CFS. However, cutting back on caffeine probably can't be a bad thing. Again, it's all about figuring out a lifestyle plan/ schedule/ regime that works for you. It's a shame that she has really choppy work hours. If she's seriously worried about the ME, maybe changing jobs should be considered? (because it's ohhhhh so easy to just pick up a job at the moment.... >_> )
gothictheysay
Eurgh, yes, it's not a good idea to just throw on an antidepressant for someone feeling depressed. It's easy to do and unfortunately far too common. Maybe she has a chemical imbalance, but you should try counselling first unless she has been feeling very direly upset. And even if she has, depression is very often situational and not clinical.

She should be completely honest with her doctor about how she's feeling, and if she's feeling unsure about things, switch her doctor. Not saying he isn't fine in other respects, but he might just have a tendency to overmedicate or to turn to medication first, which can be bad. For people who don't need antidepressants, it usually doesn't lift their mood - quite often it causes them to feel sort of 'numb', where they won't get upset but they won't feel anything else, either. I'm sure it varies from person to person how they react. And maybe she does need the medication, but who knows. I hope things go well with her.

The other problem with medication is depending on how much you end up taking, you often end up either forming a dependency or altering your brain in a way that perhaps makes it worse because the medication isn't needed. So again, I'd advise her to be careful and totally honest with her doctor about everything. I have no idea about any of the ME or CFS stuff, but it sounds like something depression could go hand in hand with - or like Daria mentions, could be mimicking when it isn't.
Hobbes
Thanks for the responses. She has yet to actually take the anti-depressants, but I have altered my stance somewhat. I now think that it could be worth her giving them a try... the results of which might then lead to some treatment/therapy that could be more permanent and beneficial?

In the back of my mind, I am rather interested to know how I would react to taking a course of such drugs. But I'm not the type of person to give such things a try, "just for a laugh". A friend or two, a couple of years ago, was pushing me towards visiting a doctor in order to get prescribed for anti-depressants, but I stood fast and chose to attend regular counselling, and I am very glad I did.
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