# So damn tired!



## why (Jul 20, 2009)

Until I can get in to therapy, what do you think of "trying" to haul my butt to the gym to "try" to increase my energy? I know at the start it will only be once a week, but this is beyond ridiculous. No matter how much I sleep, I NEED to go back to bed after a couple of hours. If I can't manage to fall back asleep, I'm a zombie all day. Nothing gets done. I need bio-hazard tape for my house :lol: (seriously) My personal hygiene is even taking a major blow. I don't know if it is just the depression, or also my meds (xanax and effexor). But do you think, maybe, trying the gym may help. SO much needs to be done. I STILL have my father's house to take care of and it's been nearly six years!:wacko:


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## Daniel (Jul 20, 2009)

I would definitely talk to the prescribing doctor as a med change/adjustment may help.  

As far as exercise, it can certainly help with the feeling of fatigue. Increasing cardiovascular fitness (with strength training and aerobic exercise) has helped me considerably to feel less tired/depressed.

BTW:

MedlinePlus Medical Encyclopedia: Fatigue


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## Banned (Jul 20, 2009)

When is the last time you saw your doctor, Why?  It could be that your meds may need to be adjusted, or that something else is out of whack.  Based on what you've said, that'd be my first recommendation - rule out anything physical.

If all that is a-ok, we do know that in order to get energy, we need to spend energy, so working out might be a good way to give you a little boost.  It is also helpful for depression, as we know.

But get checked out by your doctor first.


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## why (Jul 20, 2009)

Having my yearly this month 
They have been fiddling around with my meds, since my Paxil stopped working. I was also on Remeron as well as the Effexor, but was waaaay too much. So we will see.

I'm gonna try going to the gym tomorrow.
Thanks:thankyou2:


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## David Baxter PhD (Jul 20, 2009)

How long have you been on Effexor, why?


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## why (Jul 20, 2009)

I've been on Effexor since December. At first 75mg. Nothing. It went up to 150mg, nearly two months ago. I don't cry all the time, and my suicidal ideation is a bit better, but the fatigue is still pretty bad.


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## Retired (Jul 20, 2009)

Why,

Are you taking Remeron along with Effexor and Xanax or was the Remeron replaced by Effexor?

Have you reported these effects to your doctor since the increase in dosage?



			
				Why said:
			
		

> No matter how much I sleep, I NEED to go back to bed after a couple of hours



Is it because you are sleepy or because you feel weak?

Finally, are you taking any other prescription or non prescription (eg herbals, alternative meds) along with your current prescription(s)?


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## why (Jul 20, 2009)

TSOW said:


> Why,
> 
> Are you taking Remeron along with Effexor and Xanax or was the Remeron replaced by Effexor?
> 
> ...



Okay, here is how it went:
On Xanax since '88 (my Dr, periodically checks my liver, and hopes my A.D's will help me to wean off)
Paxil in increasing dosages from 2001-2008. I Started the Remeron along with the Paxil as a "bridge" to move me to the Effexor.

No weakness, just 100% no energy. Every blue moon, I am gifted with some energy for a bit. Cleaning time!!

I have talked about the lack of energy last time I saw her (June 2). I found out my next appt. isn't until late August. I thought it was this month. Grr.

Nothing else but those. Except for the odd Tylenol to fight off my migraines.


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## Retired (Jul 20, 2009)

Why,

The interesting thing about many side effects of this class of medications is that many of these adverse effects tend to subside as the body and brain chemistry becomes acclimated to the new dose.

The time of acclimation varies from person to person.  You mentioned the dose increase to 150mg. ocurred nearly two months ago which is about the time most people report a lessening of some of these effects.

Your doctor likely took into consideration your medical history for either liver or kidney problems, which sometimes require a dose modification, as well as for people over 65 (if this happens to apply)

Are you taking your Effexor with food?

What dosage and frequency is your Xanax prescribed?


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## why (Jul 21, 2009)

Well, the xanax frequency ebbs and flows. I take .25mg. usually 1 - 1/2 on awakening and before bed. I awake with shot nerves and by the time I need sleep, I'm pretty frazzled..although I wonder how much this is simply addiction. I mean, I have been on them for just over twenty years. My Dr. hopes the Effexor will help wean me off them. I used to take 2mg every 4-6 hours, many, many years ago.

Oh yeah, on the bottle it says I'm to take them 3-4 x day as needed


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## Retired (Jul 21, 2009)

Follow your doctor's advice on taking your medications and don't make changes or discontinue any medications without first consulting your doctor.

Based on the information you've provided, according to available data, there should not be any drug/drug interaction between Xanax and Effexor to directly explain the tiredness.  However Xanax does have the potential for drug interactions with other medications that could cause delayed clearance from your system, potentially causing unwanted side effects.



> Benzodiazepines, including alprazolam (Xanax), may potentiate or produce additive central nervous system depressant effects when combined with other psychotropic medication, alcohol, narcotics, barbiturates, antihistamines or anticonvulsants*.



One explanation may be simply the overall calming effect of the medications you have been prescribed, and your body's becoming accustomed to the new sensation.

You may wish to discuss the tiredness you feel with your pharmacist or doctor as there may be other issues related to your medical history that could be involved.

*Xanax Canadian monograph


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## David Baxter PhD (Jul 21, 2009)

Alternatively, some people just never seem to adapt well to Effexor. Again, talk to your doctor about this. It may be necessary to make a medication change to regain your "energy".


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## why (Jul 21, 2009)

Thanks 

I'm going to discuss the crazy fatigue with my Dr. next month.


I ended up going to the gym last night. Hopefully I can drag my butt over there one more time this week


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## devo11 (Jul 23, 2009)

Fatigue is a struggle for me as well. I thought it had to do with the 18 days in March that I couldn't be bothered to eat. Well, I've eaten a lot since then and I try and walk some too but still I'm so so tired.


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## Retired (Jul 23, 2009)

To what do you attribute your fatigue, Devo?   Physical over exertion, diet, medications, insufficient sleep, medical condition?

Have you seen your physician about this?


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## devo11 (Jul 23, 2009)

I'm tired all the time so I don't see how it could be a specific moment of over excertion.

The meds I've been taking for a long time now. They predate the fatigue. 

6 weeks ago I got the Doctor at OPS to add a sleeping pill so I have been having great sleep. 

Diet. It's always been weak. I don't have enough money for a really good diet. But I have tried hard to eat more and better food ie. fruits and vegetables in the last few months.

I think that the 18 days without eating has just really depleted my body.

I have an appointment with the GP next week. I was going to discuss this at that time.


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## Retired (Jul 23, 2009)

Does you doctor perform routine bloodtests to check for diabetes, lipid levels and thyroid function?

It might be worthwhile to ask your doctor's opinion about your thyroid function and whether it may have any effect on your energy level.


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## devo11 (Jul 23, 2009)

Diabetes I have. Every visit I get a blood test form with a bunch of stuff ticked off on it. I popped over to his office yesterday. They gave me a test request for blood sugar, I'm not sure what else is on it. I'm planning getting it done before I see the Doctor so he'll have some up to date results to look at during my appointment.

I'll ask about the thyroid.

My immediate problem is hypertension. I'm on 3 different meds for that but it is still high. A nurse friend took it two days ago and it was 140 / 100.


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## Retired (Jul 23, 2009)

> I'm on 3 different meds for that but it is still high.....140 / 100.



You may wish to speak to your doctor about the possibility of one of your anti-hypertension medications being the cause of your tiredness.  Are you taking a beta blocker, for your hypertension?

You may wish to read the Mayo Clinic section of Hypertension.

The following excerpt is from the Mayo Clinic section on hypertension and explains the significance of the measurements:




> The latest blood pressure guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories:
> 
> ■Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
> ■Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time. Within four years of being diagnosed with prehypertension, nearly one-third of adults ages 35 to 64 and nearly half the adults age 65 or older develop high blood pressure.
> ...




Balancing medications in people with diabetes and hypertension requires the skill of a clinician specialized in internal medicine with an interest in both disorders, because the interaction of the kidneys, liver and pancreas needs close  monitoring for successful treatment.

Be sure to make plenty of notes on when and how you feel the tiredness and fatigue..early morning, mid day or evening.  Sleep difficulties if any, including any sleep disturbances.

Be specific in describing the fatigue, if it includes sleepiness, loss of concentration, muscle weakness, loss of stamina...any or all of these..when and how.

Information is key to your doctor being able to understand the cause(s) and to provide options for treatment.

You may also find the Mayo Clinic information on Diabetes helpful

Furthermore,  Hypertension (defined as a blood pressure ≥140/90 mmHg) is an extremely common comorbid condition in diabetes, affecting ∼20?60% of patients with diabetes, depending on obesity, ethnicity, and age.

Additional information in This Article...Treatment of Hypertension in Adults With Diabetes  posted on the site of The American Diabetes Association.

The American Family Physician site posts this article:Controlling Hypertension In Patients with Diabetes

Last, this article on Dlife.com, intended for a lay audience provides further insights into diabetes and hypertension

Dlife.com says this:



> Normal blood pressure is defined as 120/80 mmHg for people without diabetes and <130/80 mmHg for those with diabetes and/or chronic kidney disease. The National Heart, Lung, and Blood Institute (NHLBI) has established the following clinical levels of hypertension1:
> 
> Stage one hypertension. Consistent (i.e., two or more consecutive) readings of 140-159/90-99 mmHg.
> Stage two hypertension. Consistent readings of 160/100 mmHg or higher.
> Prehypertension. Consistent readings of 120-139/80-89 mmHg. (Editor's note: prehypertension is a clinical category for people without diabetes; blood pressure goals for people with diabetes remain < 130/80 mmHg).


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## Daniel (Jul 24, 2009)

BTW, in case this is relevant to someone:



> ...Mild dehydration is a common and often overlooked cause of fatigue.
> 
> ...Eat breakfast. The brain is fuel-hungry, using up to 30 percent of calories.
> 
> ...


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## Always Changing (Jul 24, 2009)

> 6 weeks ago I got the Doctor at OPS to add a sleeping pill so I have been having great sleep


 Could your tiredness be related this?, is it possible you are on too high a dose? that might be leaving you feeling very tired the day after. 

just a thought! my :2cents:


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## David Baxter PhD (Jul 24, 2009)

Good point. What was the sleep medication prescribed and at what dose?


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