"Chronic medical illness is often
accompanied by fatigue, and at times depression. This often makes
overcoming the effects of the illness more difficult, and leads
to more and more limitations in the person's life. The continued
loss of energy and interest in life eventually results in an
inability to work, do activities of daily living, and have the
resources needed to interact with friends and family.
I am a psychiatrist who treats many people with chronic illnesses. I see these kinds of problems frequently. I have learnt that the best treatment for my patients is one that presents with as few side effects difficulties as possible and targets the most problematic symptoms.
Because Behcet's Disease is very rare in my country, in the United States, I have not treated many Behcet's patients. I have, however, treated many patients with other autoimmune connective-tissue diseases, such as Lupus. The difficulties of fatigue and depression are similar in all of these disorders.
What I have observed in these patients is that the sicker they become, the more and more likely they are to have extreme fatigue and depression. It is easy to become discouraged as your life becomes more and more limited.
I work with my patients to help them regain as much of their former life as possible. This usually involves helping patients learn to pace themselves, so that they can figure out how much activity is manageable, before it becomes too much, and then it takes them several days to recover. I also work with various types of medications to help with the fatigue and depression.
There are two main classes of medication I focus on with my patients. The first class of medicines are the antidepressants. There are some antidepressants that are activating, and can help with both fatigue and depression. These include Prozac, Zoloft and Wellbutrin in my country.
It is often difficult to recognise depression in those with serious chronic illness. Some of the most common symptoms of depression in the medically ill can also look like those in depression. In particular fatigue, loss of appetite, lower or depressed mood, lack of sexual interest. Therefore it is easy for depression to be overlooked in the medically ill person. If the ill person also shows a lack of pleasure in usually enjoyable activities and feels pessimistic or discouraged about the future, they are probably also suffering from depression.
Untreated depression has been shown to increase the risk of the progression of many diseases, as well as it increases the mortality of the affected person. Therefore it is very important to treat depression in the medically ill person. This may minimise the progression of their disease, and at the same time maximise their quality of life.
The second class of medicines that I use in my chronically ill patients, who have fatigue and possibly depression are psychostimulants. This class includes dextroamphetamine-sulphate and methylphenilate, known as and dexedrine in my country. These drugs were first used in the 1930s. However, in the 1960s these medications became drugs of abuse. First in Japan, then throughout the industrialised world, thus their use fell out of favour, particularly in the United States, and in other countries, and their use became strictly regulated. As a result of this period of abuse, many doctors in my country are still reluctant to use the psychostimulants, despite their clear benefit for certain persons. Overall I feel this class of medicines is now underused in my country.
The fear of addiction or abuse continues to be the reason that many doctors side for not using the psychostimulants. I have extensive experience in the use of these medications. At present, I have never had to stop one of these medications because the patient was addicted to them or was inactively abusing them. I feel these are problems which have been exaggerated, and with the careful choice of the patient, need not be a concern.
I general, I have found the psychostimulants very effective for treating significant fatigue and depression. They help antidepressants to work better to alleviate depression, and they have been known to offer pain relief properties from narcotics in treatment of chronic pain. Psychostimulants often help with concentration, mental clarity, energy and motivation. They are well tolerated, and usually have minimal transitory side effects. The most common side effects are headache, loss of appetite, insomnia, feeling anxious or nervous, sweating and increased heart-rate." (Dr. Susan Legacy)
Ms. Bettina Bailey, a BD patient of Dr. Susan Legacy's followed, with her own story of the benefit of psychostimulants.