Dear Therapist:

I was wondering what your opinion was regarding taking anti-depressants. I have been feeling extremely tired and fatigued recently and when I went to my doctor thinking I needed some blood work he prescribed me an anti-depressant. Is this an advisable course of treatment? Do you think it would be more beneficial for me to see a therapist in addition to, or perhaps instead of, medication?

Response:

I’m not a psychiatrist and do not dispense medication, so I cannot speak to specific medication issues.  However, if your only symptoms are tiredness and fatigue, there are certainly various medical, lifestyle, and other issues that should be ruled out.  If your doctor prescribed an anti-depressant based simply on these two symptoms without ruling out other possibilities, you would do well to seek a second opinion.

Some of the many medical causes of tiredness and fatigue are: Anemia, Chronic Fatigue Syndrome, Kidney Disease, COPD, Diabetes, Emphysema, Heart disease, Hyperthyroidism, Hypothyroidism, Inflammatory Bowel Disease, and Sleep Apnea.  I don’t know why your doctor didn’t do blood work.  You could ask him, in order to get a better sense as to his thought process.

Possible lifestyle causes of fatigue include: use of alcohol or drugs, excess physical activity, lack of physical activity, lack of sleep, certain medications (like antihistamines and, cough medicines), and unhealthy eating habits.  If your tiredness and fatigue began recently and are of short duration, other factors—like work stress or relationship issues—can be the culprits.

Once medical and other issues are ruled out, and it is determined that there is no physical cause for your tiredness and fatigue, you might want to consult with a mental health professional to help you deal with your symptoms and their root causes.  A psychotherapist or a psychiatrist can help you to determine whether there is a mental health concern.  A therapist can work with you to identify possible triggers and problems, and a psychiatrist can help ascertain whether medication is necessary and, if so, which one makes sense for you.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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