MEDICATIONS FOR FATIGUE AND MOOD SWINGS

[lollybob818]

Hello, I'm currently dealing with extreme fatigue due to my condition. I sleep between 8-10 hours a night, and awake and stay groggy for hours. Then, after school (college) classes, I come home, take a 2-3 hour nap. Then my husband and daughter come home, and I take another nap.

I can't continue to sleep so much. I'm getting very little done. Even though my symptoms are worthy of a reasonable amount of rest, the 6-8 hours of napping I do a day is really ridiculous.

I won't see my Neurologist until January due to scheduling issues, and therefore I want to present my primary care physician with some suggestions for therapy for me.

I've heard of Symmetrel, and it's ability to help with mood and fatigue. But as far as side effects, I'd like to keep them to a minimum.

Someone also recommended asking for ritilan. But I somehow don't see that going over very smoothly, as it's a controlled substance. Even if I have MS, it seems unlikely that I'd get it.

What are your thoughts?

[SNOOPY]

Hello lollybob,

Fatigue is quite normal for those with MS. However, it's always a good idea to rule out any other cause for an increase of fatigue such as medications, sleep disorders or other medical problems.

Your PCP can order blood work to check for other medical causes and a sleep study, which your PCP can order, will show if there is a sleep disorder. You can check online as well as ask your PCP if any medications you are on will cause fatigue.

The medications to try and treat MS fatigue:

- Amantadine (Symmetrel)
- Provigil
- Nuvigil
- Attention Deficit Disorder(ADD) medications such as Ritalin

[knuckle]

Malic Acid and Magnesium has been shown to reduce fatigue and pain in Fibromyalgia patients.

Alpha Lipoic Acid and Acetyl L Carnitine has been shown to improve energy and mental alertness.

Both combinations, while not "medications" are cheap supplements, non-toxic, and may be worth a try.

Low Dose Naltrexone (LDN), an off-label use of the prescription drug, Naltrexone, has also been shown to reduce fatigue and pain in Fibromyalgia patients and people with MS who take LDN usually report the same. LDN will improve your mood as well as it works by increasing endorphin production. Endorphins reduce pain and increase pleasure. LDN is also non-toxic.

[hunterd]

dittto to both

[lollybob818]

Great ideas guys!

I'll look into it!

[lollybob818]

RE:

Fatigue is quite normal for those with MS. However, it's always a good idea to rule out any other cause for an increase of fatigue such as medications, sleep disorders or other medical problems.

Your PCP can order blood work to check for other medical causes and a sleep study, which your PCP can order, will show if there is a sleep disorder. You can check online as well as ask your PCP if any medications you are on will cause fatigue.

The medications to try and treat MS fatigue:

- Amantadine (Symmetrel)
- Provigil
- Nuvigil
- Attention Deficit Disorder(ADD) medications such as Ritalin

I've been tested for many other diseases, and causes of my condition, and have finally honed in on MS, so it's likely that the sleep study will be the last thing we need to do. I did do one, however 4 years ago, and I'm not sure if that still counts toward my current records or not. Obviously I'm stressed by the MS, but before this discussion of MS, I was a reasonably happy person, with very little unhappiness in my life. Anyway, I'll defininely take your advice into consideration. Thanks so much!

[jumpinjiminy]

Lollybob, it's possible you could have developed a sleep disorder from the MS, depending on where the lesions are.

My neuro ordered a sleep study because he wanted to prescribe provigil for my fatigue. It showed I wasn't getting any REM sleep (from the Cymbalta) which is why I always felt foggy-brained and tired. Then there was the hypothyroid they found before I went on the Cymbalta.

So I went on the Cymbalta before starting thyroid meds (because my thyroid levels weren't technically low enough to warrant it - they found the antibodies to thyroid though), then started thyroid meds. Slowly, I started feeling a little more clear-headed, but still tired. After the sleep study, I found out why, and I had to go get my own copy because the report didn't say anything more than I had grossly abnormal sleep architecture.

After being on thyroid meds for about 9 months, then going off the Cymbalta, I have quite a bit more physical and mental energy, but still needed something to get me through the day. Since I didn't have narcolepsy, my insurance wouldn't cover the Provigil. He prescribed Ritalin instead. It worked, but talk about mood swings. I get very irritated when they where off. It's like your brain has all of this dopamine, and then all of a sudden, nothing. Not good if you have any challenging children in your house.

I ended up finding a generic for Provigil overseas that I ordered online cheaper than the copay would have been on the name brand had my insurance agreed to cover it. I like it. It works well and does not make me irritable when it wears off. Plus, it doesn't keep me awake and exhausted, like Ritalin does.

Sorry for the long, explanation, but sometimes there is more going on than the obvious. My fatigue had/has multiple causes that up to make for a miserable existence. I'm so glad to have done all of that testing because it helped solve the riddle. Every little thing has chipped away at it to where it's bearable and I'm awake and functioning all day most days now. Last year, I was sleeping 12 to 16 hours a day.

[Lori J]

Modafinil works very well for me. I tried Amantadine, with little improvement and my neuro had also suggested ritalin, I chose the modafinil.
Good luck
Lori

[lollybob818]

Thanks for the explanation

Lollybob, it's possible you could have developed a sleep disorder from the MS, depending on where the lesions are.

My neuro ordered a sleep study because he wanted to prescribe provigil for my fatigue. It showed I wasn't getting any REM sleep (from the Cymbalta) which is why I always felt foggy-brained and tired. Then there was the hypothyroid they found before I went on the Cymbalta.

So I went on the Cymbalta before starting thyroid meds (because my thyroid levels weren't technically low enough to warrant it - they found the antibodies to thyroid though), then started thyroid meds. Slowly, I started feeling a little more clear-headed, but still tired. After the sleep study, I found out why, and I had to go get my own copy because the report didn't say anything more than I had grossly abnormal sleep architecture.

After being on thyroid meds for about 9 months, then going off the Cymbalta, I have quite a bit more physical and mental energy, but still needed something to get me through the day. Since I didn't have narcolepsy, my insurance wouldn't cover the Provigil. He prescribed Ritalin instead. It worked, but talk about mood swings. I get very irritated when they where off. It's like your brain has all of this dopamine, and then all of a sudden, nothing. Not good if you have any challenging children in your house.

I ended up finding a generic for Provigil overseas that I ordered online cheaper than the copay would have been on the name brand had my insurance agreed to cover it. I like it. It works well and does not make me irritable when it wears off. Plus, it doesn't keep me awake and exhausted, like Ritalin does.

Sorry for the long, explanation, but sometimes there is more going on than the obvious. My fatigue had/has multiple causes that up to make for a miserable existence. I'm so glad to have done all of that testing because it helped solve the riddle. Every little thing has chipped away at it to where it's bearable and I'm awake and functioning all day most days now. Last year, I was sleeping 12 to 16 hours a day.

I guess everything has a process, and therefore I may have to expect some sort of long term process for getting the fatigue situated as well. Since I won't be seeing my Neuro until January (scheduling issues) and he is now in charge of my meds (which is a huge hassle) I may have to switch to a more available and less busy Neurologist. The fatigue is the biggest concern of mine, though it's not my worst symptom. I feel that if I could at least feel rested I could withstand some of the symptoms that pop up. But instead I feel exhausted and then it feels like one thing after another. But really I shouldn't be exhausted at all.

When I did the sleep study 4 years ago, they said I was not narcoleptic. However, I may have some sort of sleep problem now, due to the meds, or maybe due to the disease, like you said. So that's definitely worth looking into. I appreciate the suggestion.

I have to say, I like the idea of ritalin and the idea of having the energy, but I really would like to keep my family and social life at a healthy level. It's not just about the energy. Its about getting the moods more settled as well. I keep going from extreme to extreme. I dont feel depressed, and i've never been bi-polar (until now, maybe) but I really need a solution.

But one thing at a time.

Thanks so much for the advice!

[lollybob818]

Malic Acid and Magnesium has been shown to reduce fatigue and pain in Fibromyalgia patients.

Alpha Lipoic Acid and Acetyl L Carnitine has been shown to improve energy and mental alertness.

Both combinations, while not "medications" are cheap supplements, non-toxic, and may be worth a try.

Low Dose Naltrexone (LDN), an off-label use of the prescription drug, Naltrexone, has also been shown to reduce fatigue and pain in Fibromyalgia patients and people with MS who take LDN usually report the same. LDN will improve your mood as well as it works by increasing endorphin production. Endorphins reduce pain and increase pleasure. LDN is also non-toxic.

These are all great suggestions! I'm going to write them all down, and do some research on them, so I can narrow down which I feel might be the best match for me. I'll take a list of which ones I feel best suit me to my doctor.

Are you a doctor? Or a natropathic healer?

[lollybob818]

Modafinil works very well for me. I tried Amantadine, with little improvement and my neuro had also suggested ritalin, I chose the modafinil.
Good luck
Lori

With the ritalin, what sort of effects did you have? I've heard it helps with fatigue, but not mood. And can often make mood worse, or more volitile. Would you say this is so?

How about the Amantadine? Did it help improve your fatigue? How about mood?

What made you chose Modafinil? Is that its generic name? Does it go by another name?

I ask all of this because if there are other medicines out there that may be available to me, and that (when I research them) I can present to my doctor, I can be prepared with information on them.

Thanks so much!

[jumpinjiminy]

Lollybob, I hope you don't mind me chiming in to answer the above question. Ritalin can help your mood when it's active in your system. It doesn't work this way for everyone, but it does increase the amount of dopamine available to your nervous system, and how it increases mood. It's an amphetamine, like cocaine. I believe Adderal is more likely to cause mood swings that Ritalin, if I remember correctly.

The thing that scared me away from Ritalin was, over time it can impair your brain's ability to use dopamine, which is not good if you ever have to stop taking it. It can take weeks to months to get back what you had once you quit. If you're low on dopamine, it's hard to concentrate, be happy, stay motivated, etc. I don't know about you, but those things aren't going to work for me in my life. I much preferred to go with the med that didn't have that long term effect. And I felt sad, depressed, unmotivated after it wore off.

Ritalin down-regulates the dopamine transporters in your nervous system. It takes time for them to start functioning properly again once it's withdrawn. This is why they like to give the kids with ADHD drug holidays on the weekends and during the summers.

As far as figuring out the fatigue issue, one neuro (trying to find a dx of the neuro issues) found the thyroid abs, my GP did the testing for the T3, T4, free T3 and free T4 (TSH was fine, they had to dig deeper) then sent me to an endo for further work-up - which showed nothing, and the other neuro ordered the sleep study.

Honestly, my GP would have ordered the sleep study if I had asked him. A lot of MSrs are also hypothyroid. If you haven't been tested, it might be worth looking into. Like I said, my TSH was barely off and so they didn't think thyroid was an issue for many years. But there it was, all along. It's just that the screening test didn't flag me as clinically hypo. And I don't think my GP knows they changed the level needed to dx hypo from 5 to 3.

Hypothyroid used to be a TSH between 5 and 10. If you are symptomatic between those numbers, they'll treat you as hypo. Just in the last year or so, the official number is a TSH value over 3. If you're symptomatic and have a TSH over 3, they can treat you as hypo to see if it helps. Some endos will do it, some won't.

Your GP can probably order all of the tests. I can tell you I've had symptoms of hypothyroid most of my life, but my TSH never was a flag until they lowered the level required to dx it. My hair fell out, my nails were thin, I even had air bubbles grow under my toenails, foggy headed, cold all the time, you name it. It was there all along. They had to dig to find it. It takes months to notice a difference after starting treatment. Mood swings are a symptom of thyroid too.

As tired as you are, it might be worth giving your GP a call to see if he/she can start eliminating some possibilities before you see the neuro.

[knuckle]

Are you a doctor? Or a natropathic healer?[/QUOTE]

Lollybob,

No, I'm just someone who has had MS for over 20 years.

And those 20 years have taught me that many people with MS tend to do lot's of drugs and that can have serious consequences.

I've had several neurologists, and they all immediately reach for the the prescription pad when you complain of a new symptom of this rotten disease. The result is you turn around in a few years and find yourself with a medicine cabinet full of drugs, many quite toxic.

I believe you should always start with the least toxic treatment first and see how you do, but usually you won't hear about that from a neurologist because they are trained to treat you with drugs.

Another problem is having MS is a slow learning process. I developed my MS in the early 1990s. How I wish I had Internet access back then like people do now.

In respect to MS-related pain, fatigue, some spasticity (badder control) and disease progression, there are many "alternative" treatment options.