DD 18 suffering from fatigue

[Rollergirl11]

DD is utterly exhausted all the time and has been for 6+ months. She is at college and is doing her A levels in a few months. She gets in the region of 7 to 8 hours sleep per night but is still so tired that she is regularly having 3 hour naps when she returns from college.

She went to the doctors about it in December and had some blood tests that showed her iron was low so she has been taking iron tablets since. They have made no difference and she feels just as dog tired as she did in December. She spoke to the doctor again today who has arranged for repeat blood tests to see what her iron levels are now. However she said that her levels were not low enough to explain the exhaustion that DD is experiencing. All her other results were normal and she is not deficient in anything. They also checked for things like crohns/cealiac etc.

DD also suffers with anxiety and takes fluoxetine for this. She was originally on 40mg but has spent the last 18 months reducing her dose (under the guidance of the GP) and is now on 10mg. She has been in this dose since around September of last year. The doctor today said that this is a very low dose for a maintaining adult and will probably not be doing anything for her. And that if DD is feeling anxious (she is but she just put this down to A level stress) that it suggests the dose isn’t high enough and this could also be contributing to her fatigue. So she has decided we should up her antidepressants to see if this helps.

Does this sound plausible? That a too low dose of Fluoxetine would be causing the extreme tiredness?

My DD at 16 experienced something similar. Sleeping 14-16 hours a day sometimes and having panic attacks etc She was also flagged for low iron and then I was told to stop iron tablets as then too high. ( however now aged 18 and at uni - tired a lot, lots of colds etc has low iron again.) The thing that helped her massively aged 16 was going on the pill Yasmin. It has a slightly higher dose of progesterone I think and some doctors are unwilling to prescribe it(it’s expensive too coincidentally!) but she now has an alternative with the same levels of hormones. It was a game changer for her as she takes them 3 months back to back no break and then has a weeks break for a period and then 3 months again. Might be worth investigating?

What other bloods were done?

dd is the same, tired, low, no energy etc.

iron was low, as was B12. But it was vit D that was severely deficient. She was put on 10 weeks supplementation and made a huge difference.

Has she had vit D checked and/or does she take supplements?
Has she had covid or something like glandular fever? Could be post-viral fatigue maybe.

Yes OP it’s quite possible that the fatigue is the result of too low a dose of fluoxetine.
Can she get back up to a therapeutic dose and review again in say 3 months?

@sunglasses DD is already on birth control for the past 15 months. At one point I did wonder if the tiredness could be due to this but the doctor didn’t think so.

I don’t know what her Vitamin D was but DD says the doctor checked all the results of the blood test in December and the only one that looked low was iron and only by a little bit.

@FlowerBarrow she is going to go up to a higher dose and revisit in a months time. Thinking about it I think the start of the tiredness could have coincided with her dropping from 20 mg down to 10 but this was at the say so of the GP. Don’t really know why this was suggested if it is too low to be effective.

Vit D isn't routinely tested ime so worth checking it was actually done.

@Rollergirl11 My DD tried a standard birth control pill at first that did no good at all and maybe even worse. The Yasmin pill is different. I had a bit of a time getting any docs to take her symptoms seriously as they all wanted to blame exam stress etc. sounds like you have had other good advice too. I know from experience that even iron levels that are deemed ‘normal’ can still be low in the range and some people still feel symptoms. Would it be worth finding out from docs if she could safely try iron supplements?

It would be helpful to know her iron level and the ranges as they are different depending on the laboratory. I believe you need an iron level of 70 for healthy hair growth but many GPs say a level lower than that is fine and doesn't need treating (yes, it does). Perhaps list her Vit D and Vit B12 levels with ranges too if you know them.

@Rollergirl11 because if the patient is ready and wanting to try reduced doses of antidepressants the gp will facilitate that in whatever safe way they can. In this case the 10mg would have a partial placebo/psychological effect that could have kept your daughter afloat if she was physiologically well enough to come off them.
Plus there are other health risks to reducing too quickly even if you’re on a sub therapeutic dose. It’s always best to taper slowly to avoid this.
It looks though as if she possibly wasn’t ready so the lowest therapeutic dose could be better. You could check whether full benefit of increasing will be seen in just 4 weeks?

She has another blood test booked in for next week so I will tell her to query if they are including Vit B12 and D within that and to ask for a copy of the actual results.

@FlowerBarrow yes she had been tapering slowly. The idea was that she was going to try stopping altogether as she has been on them for almost 3 years. At any rate they thought 40mg was too high as a maintenance dose for a 16yr old. But now in hindsight it definitely seems that 10mg is too low and DD needs higher; at least at this moment in time with A levels looming and increased stress/anxiety. Are you saying that a month is not long enough to see if an increased dose has helped?

My adult DS felt tired all the time. I got him to go to GP for blood test 2 months ago and they said he is pre diabetic. They put him on a diet. He says he's still tired though. He has to go back in 1 more month for repeat blood test. He's lost weight but if diet doesn't control blood sugar I think he might be given meds.

@Rollergirl11 Is 4 weeks long enough to see? I’m not sure but you have to allow longer than 4 weeks in the first place to see effect of anti-ds? I’m sure gp will know this and either when you reincrease then 4 weeks is enough, or they want to checkin after 4 weeks so she’s not left hanging

I was thinking Vitamin D too if Iron and folate levels are OK. Also glandular fever can make people feel exhausted and seems to affect people at this sort of age. Depression can also make people feel tired so increasing that dose again may help. Hope you get to the bottom of it. In the UK we can't make Vit D from sunlight in the winter months so we probably all need supplements but it doesn't get mentioned much!

I would suggest that she checks that vit B12 was done in her bloods...though unlikely it wasn't.
Most path labs and GPs use "TATT" blood screening panel. This means tired all the time and it is set bloods covering all basic possible medical reasons.
Vit D is no longer tested in my nhs area, as majority of UK population is deficient and we should all be on supplements.
Anxiety is exhausting in itself.

So I'd be saying - a good multivitamin, iron tabs, but B12 and vit d supplements. Increase fluoxetine again...and you'll need to give it 3 months to see really if this helps.

The other thing to consider is teens are needing 8-10 hrs sleep and quality of sleep is important too.
Does she put phone down an hr before bed, does she put it outside her room...my dd was waking in the night when notifications pinged through etc.

And it is also reasonable to remember teens are always tired...mine love naps...it's because their circadian rythms are not like adults. They go to sleep later and naturally need to sleep longer into the morning but due to school starts times they can't. So often chronically short on sleep.

If she has anxiety she could be in autistic burnout.

My Dd ASD took fluoxetine. It exhausted her. She stopped taking it.

Has she had covid? Could it be long covid?

What was her ferritin level? You can still feel utterly shit on low normal but in the Uk anything above anaemic is considered fine which is shocking tbh. Try hempalex, it’s very tolerable and has a lot of b12 in it too. Did they do a thryroid panel? My non Uk endo likes her patients to keep their ferritin at 50 or above.

Wow, just did a search looking for advice for my DD and this thread came up; totally forgotten I’d posted this!

So 2 years on and DD (now 20) is still battling chronic fatigue. I’d forgotten just how bad she felt 2 years ago. She upped her dose of Fluoxetine to 30mg and we started her on Vitamin B12 and she felt better for a time. Not sure which contributed to her increased energy levels.

But now here we are again and DD has even feeling exhausted for a few months again. It’s complicated as not only does DD struggle with anxiety but she also has a diagnosis of anorexia and relapses with food restriction now and then. All contributing factors to low energy. She is doing well on the eating front lately; weighs the most she has ever done and is doing CBT to tackle the psychological aspects. The anxiety has stepped up lately and GP suggested going up to 40mg of her fluoxetine to see if helps with both the anxiety and the exhaustion. After a month on new dose she is feeling better mentally but still dog tired.

Has had blood tests and doctor says all looks good; nothing that would be causing her fatigue. And the fact that the dose change has made no difference means that it isn’t dose dependent and therefore they think it’s the fluoxetine in general that is the cause of the fatigue.

So now she needs to go through the process of coming off the meds. She is terrified that it won’t make any difference and she was just end up being an anxious mess on top of it.

Any words of wisdom? She has been on the fluoxetine since she weight restored from anorexia 5 years ago so DD (rightly) is very scared.

has she been checked for coeliac? My only symptom was fatigue and it was only discovered when my GP ran the ‘tired all the time’ panel of bloods. Been off gluten for months now and feel miles better!