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What Causes Constant Fatigue When Under Stress?
Posted on
Fri, 21 Aug 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Fri, 21 Aug 2015
Answered on
Sat, 12 Sep 2015
Last reviewed on
Question : Hi, i am 53 years old and extremely fatigued all the time. Any stressers take the XXXXXXX right out of me and I have to lie down. I have recently tried Remeron per my DR. and that makes me dream even more so I get up exhausted from working in my dreams. How do I turn off my brain?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
It seems that your doctor seems to think that the main cause for your fatigue is anxiety, which may well be the case considering the effect stress has on you. Of course it's not possible to completely turn off your brain but there are medications which may help.
Remeron (mirtazapine) is a widely used antidepressant. However I don't know whether it is the best choice for anxiety, there are other antidepressants which are more indicated for that purpose. Furthermore it has a high potential for sedation which may affect fatigue and exhaustion feeling.
I believe that a more appropriate choice may be antidepressants of the SSRI (citalopram, escitalopram) or SNRI (venlafaxine) group which are effective for anxiety with fewer side effects compared to Remeron. You should talk about your issues with Remeron and a possible switch in therapy with your doctor.
Also it is important to try and make changes to your lifestyle, light exercise, activities like yoga, which are as important.
Additionally potential factors like thyroid function alterations should be investigated through blood tests (perhaps have been done already). Menopause may also be an important cause, hormonal treatment may be considered in that case.
I remain at your disposal for further questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
It seems that your doctor seems to think that the main cause for your fatigue is anxiety, which may well be the case considering the effect stress has on you. Of course it's not possible to completely turn off your brain but there are medications which may help.
Remeron (mirtazapine) is a widely used antidepressant. However I don't know whether it is the best choice for anxiety, there are other antidepressants which are more indicated for that purpose. Furthermore it has a high potential for sedation which may affect fatigue and exhaustion feeling.
I believe that a more appropriate choice may be antidepressants of the SSRI (citalopram, escitalopram) or SNRI (venlafaxine) group which are effective for anxiety with fewer side effects compared to Remeron. You should talk about your issues with Remeron and a possible switch in therapy with your doctor.
Also it is important to try and make changes to your lifestyle, light exercise, activities like yoga, which are as important.
Additionally potential factors like thyroid function alterations should be investigated through blood tests (perhaps have been done already). Menopause may also be an important cause, hormonal treatment may be considered in that case.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thx, I am currently on (venlafaxine} and I do have GAD and depression. When I lay down I can feel my heart pump in my chest. I have had anxiety for a long time.
I do get panic attacks alot more lately. I also take clonazipan for restless legs and that does help, I have tried to sleep with out it and I jerk myself away if I don't.
Is there any other sleep meds or OTC that I could try?
I also had my thyroid check again and it is at 3.8 i felt it was high by Dr. thought ok level? My Vit D is good, but I am low on iron so taking supplement for that as well.
I feel I have chronic fatigue syndrome or ISO now they are calling it something different now.
I do get panic attacks alot more lately. I also take clonazipan for restless legs and that does help, I have tried to sleep with out it and I jerk myself away if I don't.
Is there any other sleep meds or OTC that I could try?
I also had my thyroid check again and it is at 3.8 i felt it was high by Dr. thought ok level? My Vit D is good, but I am low on iron so taking supplement for that as well.
I feel I have chronic fatigue syndrome or ISO now they are calling it something different now.
Brief Answer:
Read below.
Detailed Answer:
Thank you for the additional information. I am a little confused though, first you say to be taking Remeron and now it turns out you are on Venlafaxin as well. The two are not used together as they interact with each other. You have also put amitriptyline in the medications tried field, I assumed and hope that was before and you are not on it now.
Regarding sleep, you seem to have tried many options looking at the medications tried field (lunesta, Zzzquil, Melatonin, lifestyle changes) which makes your case a difficult one. If hot flashes are a causative factor as I mentioned hormone therapy might be considered. Another option for sleep might be the use of quetiapine at low dose only.
If for 3.8 you meant TSH levels then your doctor is right that value is normal. Iron deficiency is also a possible cause of restless legs syndrome so perhaps its correction will help it.
Clonazepam is effective for sleep, anxiety and restless legs syndrome, so it's understandable if its use is beneficial. It has the risk of developing tolerance and dependence though so it's preferable not to be used long term. If you are still getting panic attacks with venlafaxine perhaps its dosage can be increased depending on how much you are taking.
As for chronic fatigue syndrome, it is a possibility. It is to considered only when all other possibilities are excluded though. Lab tests like complete blood count, liver function, electrolyte panel, erythrocyte sedimentation rate (ESR), antinuclear antibodies, cortisol levels are recommended. One abnormality which is pretty consistent is the low ESR, if normal or high it suggests against that diagnosis.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for the additional information. I am a little confused though, first you say to be taking Remeron and now it turns out you are on Venlafaxin as well. The two are not used together as they interact with each other. You have also put amitriptyline in the medications tried field, I assumed and hope that was before and you are not on it now.
Regarding sleep, you seem to have tried many options looking at the medications tried field (lunesta, Zzzquil, Melatonin, lifestyle changes) which makes your case a difficult one. If hot flashes are a causative factor as I mentioned hormone therapy might be considered. Another option for sleep might be the use of quetiapine at low dose only.
If for 3.8 you meant TSH levels then your doctor is right that value is normal. Iron deficiency is also a possible cause of restless legs syndrome so perhaps its correction will help it.
Clonazepam is effective for sleep, anxiety and restless legs syndrome, so it's understandable if its use is beneficial. It has the risk of developing tolerance and dependence though so it's preferable not to be used long term. If you are still getting panic attacks with venlafaxine perhaps its dosage can be increased depending on how much you are taking.
As for chronic fatigue syndrome, it is a possibility. It is to considered only when all other possibilities are excluded though. Lab tests like complete blood count, liver function, electrolyte panel, erythrocyte sedimentation rate (ESR), antinuclear antibodies, cortisol levels are recommended. One abnormality which is pretty consistent is the low ESR, if normal or high it suggests against that diagnosis.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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