Fatigue and depression

Drawing all this evidence together, Schildkraut (1965) concluded that depression was caused by a functional deficit of noradrenergic transmission in the brain. He also thought that the rebound depression and fatigue, which are experienced after the arousing effects of amphetamine have worn off, were due to depletion of neuronal stores of noradrenaline. However, Schildkraut made a clear distinction between the effects of antidepressants and the arousal induced by amphetamine, describing the latter as stimulation and excitement . To this day, there is controversy over whether or not amphetamine has a beneficial effect in depression. 

Withdrawal of high doses of androgens or anabolic steroids after the system has become accustomed to them can lead to menopause-like reactions, such as anxiety, chills, tachycardia, anorexia, piloerection, insomnia, sweats, hypertension, myalgia, nausea, vomiting, irritability, and hot flushes. Young men who have used these compounds can experience depression and fatigue for a time after withdrawal. 

Amphetamines not only improve vigilance and accuracy in performing tasks, but they also improve the individual s attitude about doing work, especially when the required tasks are repetitive and boring. The euphoria does not last, however, and is followed by an intense mental depression and fatigue as the amphetamines deplete the neuronal stores of dopamine in the limbic system, the pleasure center of the brain (see Chapter 3). 

Nicotine is highly addictive and is a CNS stimulant and depressant. Ingestion of nicotine results in an almost immediate kick, because it causes a discharge of epinephrine from the adrenal cortex. This stimulates the CNS and other endocrine glands, which causes a sudden release of glucose. Stimulation is then followed by depression and fatigue, leading the user to seek more nicotine. Nicotine is... 

She decided to try hydrogen peroxide. She slowly improved and lost most of her symptoms, including the depression and fatigue. 

Thyroxine (also known as Levothyroxine or T4) is the ultimate metabolism regulator. Its reactions and products influence carbohydrate metabolism, protein synthesis and breakdown, and cardiovascular, renal, and brain function. Thyroxine is essential to an animal s functions and it is essential for development in the young. Tadpoles won t develop into frogs, for example. Untreated human babies will develop cretinism, a condition marked by severe mental and physical retardation. Adult humans with low thyroxine levels (hypothyroidism) suffer mental slowness, weight gain, depression, and fatigue. ... 

Nervous system Interferon alfa has been used to investigate pathways by which innate immune cytokines affect the brain and behavior [38 ]. There were reduced motor speed and reaction times and slower response times in the rapid visual information processing task in patients who were treated with interferon alfa and ribavirin. Reduced motor speed correlated with increased symptoms of depression and fatigue. 

Majer M, Welberg LAM, Capuron L, Pagnoni G, Raison CL, Miller AH. IFN-alpha-induced motor slowing is associated with increased depression and fatigue in patients with chronic hepatitis C. Brain Behav Lnmun 2008 22(6) 870-80. 

Normally, dietary tyramine is broken down in the gastrointestinal tract by MAO and is not absorbed. In the presence of MAOI, however, all of its potent sympathomimetic actions are seen. Other side effects of MAOI include excessive CNS stimulation, orthostatic hypotension, weight gain, and in rare cases hepatotoxicity. Because the monoamine oxidase inhibitors exhibit greater toxicity, yet no greater therapeutic response than other, newer agents, clinical use has been markedly curtailed. The primary use for MAOIs is in the treatment of atypical depressions, eg, those associated with increased appetite, phobic anxiety, hypersomnolence, and fatigues, but not melancholia (2). 

Ephedra is used in diet products as an appetite depressant and stimulant, and in sports drinks to mask fatigue. It is also used as a bronchial stimulator, and to relieve symptoms of the common cold. 

Disulfiram produces a variety of adverse effects, which commonly include drowsiness, lethargy, and fatigue (Chick 1999). Other more serious adverse effects, such as optic neuritis, peripheral neuropathy, and hepatotoxicity, are rare. Psychiatric effects of disulfiram are also uncommon. They probably occur only at higher dosages of the drug and may result from the inhibition by disulfiram of a variety of enzymes in addition to ALDH. Included among the enzymes inhibited by disulfiram is dopamine P-hydroxylase, inhibition of which increases dopamine levels, which in turn can exacerbate psychotic symptoms in patients with schizophrenia and occasionally may result in psychotic or depressive symptoms in patients without schizophrenia. 

In the past, trichloroethylene was used as a human anesthetic. Trichloroethylene has also been used by individuals who intentionally inhale it for its narcotic properties. Therefore, most of the information regarding the effects of trichloroethylene in humans comes from case studies and experiments describing effects of trichloroethylene after inhalation exposure. These studies indicate that the primary effect of exposure to trichloroethylene is on the central nervous system. Effects include headache, vertigo, fatigue, short-term memory loss, decreased word associations, central nervous system depression, and anesthesia. 

Other potential adverse effects from P-blockers include fatigue, sleep disturbances, malaise, depression, and sexual dysfunction. Abrupt P-blocker withdrawal may increase the frequency and severity of angina, possibly because of increased receptor sensitivity to catecholamines after longterm P-blockade. If the decision is made to stop P-blocker therapy, the dose should be tapered over several days to weeks to avoid exacerbating angina. 

Signs and Symptoms Are nonspecific and consist of irregular fever, headache, profound weakness and fatigue, chills and sweating, generalized severe joint and muscle pain (myalgia), anorexia, weight loss, and depression. Joint complications are common. 

Symptoms of withdrawal include depression, altered mental status, drug craving, dyssomnia, and fatigue. Duration of withdrawal from methamphetamine ranges from 3 to 24 days, but these individuals are usually not in acute distress. Occurrence of delirium suggests withdrawal from another drug (e.g., alcohol). 

Once a methamphetamine addict stops taking the drug, the withdrawal symptoms can be very severe and include depression and anxiety, increased appetite, fatigue, paranoia, irritability, aggressive behavior, and intense craving for the drug. Some of these symptoms can be eased with sedative drugs like Valium or antidepressants like Prozac . 

Cognitive/Neuropsychiatric adverse events Use of zonisamide was frequently associated with the following CNS-related adverse events 1) Psychiatric symptoms, including depression and psychosis 2) psychomotor slowing, difficulty with concentration, and speech or language problems, in particular, word-finding difficulties and 3) somnolence or fatigue. 

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