Nursing & Depression - page 39
While visiting in the lounge one day, we discovered that every nurse there was on an anti-depressant. I have had 'Treatment Resistant Depression' for about 20 years--as long as I've been a nurse. ... Read More
Dec 23, '02Joined: Nov '00; Posts: 931; Likes: 18Have there been any studies on fatigue and depression? Does one automatically mean the other? If there is one, does it presume the second? Is it physiological? Hereditary? What about "treatment resistant fatigue?" Women who c/o fatigue get labelled crazy just like if they c/o depression. "Women problems." I don't have fibromyalgia or narcolepsy. I'm mentally alert and in a good mood. But, if I decide to vacuum and dust the house today, that will be all I can do for the rest of the day, just an overpowering fatigue will set in. WHERE is this coming from ?!?
Dec 23, '02Joined: Oct '02; Posts: 228; Likes: 2Sometimes depression causes fatigue. Fatigue also causes depression. Pain can cause fatigue and depression.
I'm lucky, never had chronic pain. Have always had chronic fatigue, chronic depression. At one point, my psychiatrist said, "I've done all I can to treat your depression, maybe you should see a doctor about your fatigue."
I see a doctor about fatigue, they blame on depression. So, I didn't do anything. Until I read about provigil as an adjunct in treatment resistant depression.
Went back to psychiatrist and told him about it. He said, "whoa, other things to try." He switched me from zoloft to celexa (good move) and my depression did start to get a bit better. Still fatigued. He tried Wellbutrin, Effexor. He wanted to try Serzone but I said, no, I was too tired.
Finally he told me about this new drug they were using called Provigil. An experienced pt, I kept my mouth shut.
Now, for the first time in my life I am neither chronically fatigued nor chronically depressed. I've pretty much stopped the Provigil and I am carefully, under the supervision of a PCP, cutting back my Celexa. I stopped seeing the shrink when he wanted to put me on neurontin. I figured it made more sense to cut back before starting another med.
Hey, I'm a good nurse. I'm also a good nurse practitioner. If somebody's BP med starts working too well, I cut back the BP med before I try adding something to raise the BP.
When will psychiatrists figure that out?
So, I believe I had two separate but very interrelated problems.
Dec 23, '02Joined: Oct '02; Posts: 228; Likes: 2Oh, Sphinx.
I don't know if your psychiatrist was lazy or not. I've gotten insurance companies to pay for meds not covered - all it took was a phone call or two or a letter. Sometimes I had to get a doc to call instead. It's rather easy.
Dec 23, '02Joined: Sep '02; Posts: 672; Likes: 29Well, he did write them a letter......but they were adament about this particular off label use. Granted, he was not the best psychiatrist in many ways, but this one med he did push for.....even got me coupons for 5 days of samples, but only at half the dose he wanted to even *start* me on. Not sure what the big deal was.....they've oaid for other stuff they normally wouldn't.....ie Lupron when I didn't have a definitive diagnosis, and others........oh well. For now we'll wait and see how I do on the newest meds. It's also hard for me this time of year. I have a big seasonal compnent.......not that I don't have problems other times of the year, but the fatigue is a big one that kicks in when this time of year hits. I could literally hibernate. Scary, driving around on crappy roads half asleep. Thank God I won't be doing that much longer!
Dec 28, '02Joined: Oct '02; Posts: 228; Likes: 2Hey, Sphinx.
Just cause something worked for me, doesn't mean it will work for you.
The seasonal component may have a lot to do with it too. Hope Christmas went well.
Dec 28, '02Joined: Sep '02; Posts: 672; Likes: 29Uh huh, I know.....I just never got a real chance to try. I wanted to at the time, but now......I'm waiting on the Lamictal. You have to taper up so slowly to prevent this rash which can be so bad. He wants me up to 200mg, says some people go up to 300mg. I'm currently at 75mg. Every 2 weeks I increase my dose by 25mg. I still have those weird days where I feel deeply depressed but agitated and racing thoughts or giddy, or days I'm just depressed. But some days I feel a tad less depressed than before. And I had a very nice Christmas, much to my surprise. Leading up to it was so horrid, so stressful, I thought for sure I'd have a terrible time. But we had Christmas eve at my parents, which is always great fun. I confess to having a couple glasses of wine (I know, not good on psych meds....), but was feeling on top of the world, wonderful. Didn't have to work on Christmas, had a nice morning with the kids and all, and in the evening, we had our typical non-traditional "celebration". This year we went out for chinese food, and our yearly X-Mas trek to the movies. This year we saw Lord of the Rings (saw the first movie on Christmas day last year also). All in all a nice time, but the exhaustion just won't let up, esp as I was on call the 26th, and was out on a call late. Slept in this morning.
I am counting the days till I am out of the field. I talked things over with my husband, and decided I can't go without working at all. Not financially (no problem there), but when I have too much idle time, no structure...I always, always deteriorate mood-wise. Depression always worsens for me when I am not working. That happenened when I lost my first job. At first I was handling it ok, then after a while, ended up trying to kill myself and in the psych ward. Then after, when I had problems again and was out on disablility on my 2nd job, it eventually became clear that I was getting worse being home than working. So, whew! All that rambling! Anyway, I decided to go for my bosses offer and take an in-house office position starting 1/6/03. So I work the next 4 days (am on New Years), than I asked for Friday off, since I'd already been signed up on the on-call schedule for the 4th and 5th, which I can't get out of. So that's 6 more days of the field. Then it's 7:30-4.....go home from work, and I'm home....no paperwork, just home. Sure, like anybody else, I could come home with my job on my mind, and obsess about it, let it get to me, but I certainly will work not to let that happen. It'll be tough to learn, I know, but in the end, I think it will be worth it.
Whew, didn't realize I had so much rambling in me today. I've been too tired to think, these days, let alone ramble on as usual!
Dec 28, '02Occupation: RN and blogger extraordinaire Specialty: 20 year(s) of experience in LTC, assisted living, med-surg, psych ; From: OR, US ; Joined: Sep '02; Posts: 26,949; Likes: 44,637Sphinx....sure sounds like you're doing better! Every day above ground is worth the effort, I guess, although I'm going through a bad patch myself these days, and some mornings I wake up thinking I'd be so much better off if I weren't here. Sometimes I just get so tired of the struggle.......I'm still unemployed, and I had to fight hard just to get unemployment benefits, which haven't even started coming in yet. The full impact from being fired from a nursing home with a bad reputation has hit me, and I wonder how big a loser I really am to have had this happen to me. I mean, the place has been on every state surveyor's hit list for years---long before I ever set foot in it---and they're constantly crying for nurses, yet they wouldn't even give me a chance to work in another capacity. So, if I'm that bad of a nurse, what the hell am I supposed to do, go work at Wal-mart for minimum wage?
On top of that, I'm peri-menopausal and have been bleeding, often heavily, for 3 1/2 solid weeks. I'm dealing with a ****ed-up thermostat that has me freezing half the time and sweating like a horse the rest of the time. I'm up to 40 mg of Paxil a day as well as taking the occasional Ativan for anxiety, but even though I'm trying hard, I still have these mood swings and I feel sometimes like I'm losing my mind. I'm also carrying around about 150# I don't need, and every diet known to man has failed me time and time again. So I'm a wreck, both physically and emotionally.
Then I think how I personally might be better off dead, but my family would not, and I know if God wanted me right now He'd take me, but that's His decision to make, not mine. At this point that's about all that's standing between me and an OD, but it's enough. This BB helps too, and I know I can hang on until things get better, because "this, too, shall pass". Thanks to all of you for sharing your experiences as well, it helps me to know that others who have had it far worse than I have been able to fight back and regain a sense of purpose and self-respect.
Dec 28, '02Joined: Sep '02; Posts: 672; Likes: 29Well, as far as being fired from a place with a bad reputation, don't take it as a reflection on you, as in if even they won't give me a chance.....try and think of it as, they have a bad reputation, so they clearly have problems, and perhaps one of their problems is their inability to hold onto a good employee who is merely in an "acute"state of a very real illness? What ever happened to disability? I mean, I guess maybe that could have been talked about, but I think letting you go was not exactly a wise move for them. But it was likely a good thing for you, although you'll likely have to go through a period of adjustment before you really can shine again. I wouldn't be surprised if you went through the "stages of grief", whether quickly or not, I don't know, but a big change can be very difficult to overcome. When I was fired, it nearly killed me. Don't let that happen to you! You've got a lot on your plate: you're depressed, you've got this perimenopausal bleeding and other symptoms........But you are still holding on, and have found a reason to live, even when you personally feel you might be "better off dead".
I'm tired and think I'm not making much sense. But just know that you aren't alone, I still am struggling everyday, even if in someways it may seems I have been improving. I have some things to look forward to coming up this month, and hope that will pull me through. often little things like that are what help me make it from day to do. But those bad days.......they feel so long.......too long.
Dec 28, '02Joined: Dec '02; Posts: 191Ladies, are you taking hormones? If not, is there any reason why you're not? My doctor (a woman) took me off Premarin over a year ago and put me on Tri-estrogen. I thought I was doing very well before the change in hormones and certainly didn't expect that it would make any real difference, but it certainly did. I felt and feel MUCH better on the Tri-est. I was like the frosting on the cake.
Dec 28, '02Joined: Sep '02; Posts: 672; Likes: 29alas bella terra, not I.......am only 34 myself.....and while I did have a total hyst, I was left with one very nice tube and ovary. Sometimes I wonder if my hormoes are a little goofy (uhhhhh, zero, I mean zero sex drive), but was on many different types of pills over a long period of time......can you say, tired of hormones?
Curious to know about the others here though....I think it may have been mentioned before, but to be honest I don't remember........
Dec 29, '02Joined: Dec '02; Posts: 191Sphinx, I had two great ovaries left. Then five years later I had a doctor tell me that after about five years the ovaries quit funcioning, so I got put on hormones. Has your hormone level been checked lately? I had one doctor check it and even though it was VERY low he refused to put me on hormones. But the woman doctor said the level was WAY too low, so she put me on them.
A psychiatrist friend of mine says that there is a BIG connection between hormones and depression -- they just don't know exactly why or how.
Secondly, and I just remembered, there is evidence that depression is a 'warning' sign of a heart problem, particularly when depression starts in the 40s (which I guess doesn't apply to you, Sphinx). Anyone had their hearts checked lately?
Dec 29, '02Joined: Jan '02; Posts: 1,614; Likes: 2When your hormones are fluxing, can you feel it is hormones? To understand estrogen is important for me. For example, when there is too much or too little estrogen for you, can you tell it's the estrogen level? Or is it an uncontrolable/confusion feeling? Makes you grumpy? Guys are kinda lucky because they don't have troubles with testosterone.
Does hormones problems feel like low blood sugar, perhaps?
Thank you, in advance, for take me honestly.
Dec 29, '02Joined: Sep '02; Posts: 672; Likes: 29I for one can't *feel* my hormonal changes. I used to be able to feel when I ovulated, but even though I still have one ovary, I don't feel it anymore. I think I only felt it on the "bad" side anyway. I also used to have raging PMS, so a week before onset of menses, I would become more depressed, irritable, angry, tearful. I wouldn't always know right away what it was, but then it'd hit me. It was also pointed out to me that the 3 times I was hospitalized were all in the premenstrual period. The other way I "used to" be able to tell was the excruciating pain I had. Then that pain started to last all month long, so that clue became useless. For ages I was on one type of "the pill" or another (continously, so no break every month), so hormonal changes were moot. (would go off every 3-4 months for 1 week, but knew I was going off them, so could easily "know" I was having a hormone shift).
Anyhoo, after my hysterectomy, even with one ovary, things have changed. Everything is more subtle. I still have hormal stuff going on, but I can't really pinpoint it down to a cycle or anything. I can tell a hormonal shift is going on because my face breaks out. That's about it.
Now that I say that, I wonder if I am cycling at all. It hasn't even been a year since my hyst, but I have heard your ovary function can quit anytime afterwards, or never fully return after the initial "shock" phase. You're right, Bella, maybe I should get my hormones checked. It could explain a lot of things.
I see I'm rambling again. In anycase, on the hystersisters "sister site" called the hormone jungle, they have a nice list of possible symproms you may (or may not) have if your estrogen OR progesterone level is low. Unfortunately, lots of the items on the list can be attributed to other thing as well. (sound familiar?)
Bla......my thought have been racing all weekend, yet I've been sitting like a lump. A srange combination. I feel like I am going a thousand miles an hour when in fact I am but sitting still.Last edit by sphinx on Dec 29, '02