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Am I depressed?
May 10, 2004

Hello I was diagnosed three years ago and at that time my cd4 was depleted to 100. I had been experiencing severe chronic fatigue and that was why I was tested. I have been on several different regimens and my cd4 hovers between 200-400. My question is: I have had four doctors over the past three years and they all attribute my chronic fatigue to depression. I do not believe I am primarily depressed. I think I am fatigued and no Doctor appears to believe me. They all seem to be very keen to put me on antidepressants saying that my fatigue is a 'classic symptom' of depression. I have tried Zoloft for 6 months (didn't work) then I was on Prozac for several months. That jazzed me up initially but stopped working after a few months. I took a year off antidepressants and did talk therapy for a year and the fatigue remained. I have a new Doctor now and he has once again diagnosed depression and I told him I think my primary problem is fatigue, not depression. I feel antidepressants are over prescribed here (I live in San Francisco). Most of the people I have met here are on Prozac or a similar med! Anyway once again I agreed to try a different antidepressant and I have been on Wellbutrin for 6 weeks (450 mg for the last 4 weeks) and I feel no difference whatsoever. In my last meeting my Doc says he is 99% sure it is depression and wantsd me to go and see a psychiatrist who has more experience and may put me on a combination of meds. Is it possible I am right and the doctors are wrong? I consider myself intelligent and in tune with my body and moods and I have articulated over and over again that fatigue is the primary symptom and being emotionally 'flat' is secondary ie an understandable side effect of being so tired and staying indoors. Why are Docs so keen to contradict what I report and why are they reluctant to agree with my own diagnosis of fatigue, rather than depression? I understand fatigue is one of the symptoms of depression but simply put, my problem 'feels' physical and not emotional, if you understand. What would you suggest? By the way all Docs have continually tested me for all the possible factors associated with hiv and fatigue and everything hiv-related re fatigue has been ruled out. My CD4 is 270 at the moment Thanks

Response from Dr. Horwath

The doctors are correct to say that fatigue is a common symptom of depression. It is also true that depression sometimes feels like a "physical" condition, which it is. However, if you don't feel sad, down, blue or depressed, then it is easy to understand your feeling that you are not suffering from a clinical depression.

Do you have other symptoms? The common symptoms are loss of interest, inability to experience pleasure, social withdrawal (wanting to be alone & away from people), anxiety, insomnia (or oversleeping), loss (or gain) of appetite, decreased concentration, feelings of hopelessness or helplessness.

If you don't have several of these symptoms together, and if they don't persist, then you may well be correct that it's not depression. When you say that you've been tested, then I assume you mean that the doctors have tested for thyroid problems, testosterone levels, infections, hepatitis, etc. It is very important to rule out other medical causes as there are many possible sources of a symptom like fatigue.

Finally, if it's not depression or another medical problem, then it may be the effect of HIV, which often causes fatigue through its direct effects on your body and central nervous system. Several studies have shown that moderate doses of stimulants, such as methylphenidate, can be very helpful to alleviate this fatigue. Ask your doctor about this or ask for a referral to a psychiatrist who is familiar with this type of treatment. It is often quite helpful with symptoms like fatigue, apathy, and slowed thinking.



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