When testosterone isn't enough - major fatigue and brain fog.

Nelson Vergel said:

Antidepressants are not a way to resolve depression, but to give someone that has no drive to change circumstances (he mentions fatigue, etc) a way to take charge to make those changes. I have been in dark holes where I felt frozen and could not see the light. The last thing I wanted is to have people list the things I needed to do to "snap out of it".

Trintellix worked right away for me. I took it for three months and stopped when I had made enough changes because I had the energy to do so.

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First off I’ll start by saying I’m really glad to hear you pulled out of it. Depression is the worst thing I’ve ever experienced so I’m always glad to hear about happy endings.

I’d also say that your implementation is a perfect example of how they should be used when someone decides to utilize them. Unfortunately in our current system that typically isn’t how they’re viewed or used. Now we start throwing them at teenagers and adults at the first sign of issues. Then if they aren’t as effective as the patient had hoped, they just give them another to take on top of it. The majority of people on antidepressants have been on them for over two years, and a very significant number have been on them for over a decade. That is the issue I was bringing up in my earlier post. Again, your usage is a perfect example of how they can be a temporary tool to get a person back on a positive track.

EnlightenedViking said:

I've had this issues on and off again, coming in cycles for most of my life but always able to manage it with exercise, diet, and sleep. This is the first time I've slipped down the hill this far with no foothold to make progress back to my baseline.

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Is it seasonal by any chance? I'm not a psychiatrist, but from my own MDD experience I'd recommend a PHQ-9 first. See if you're barking up the right tree.

For depression meds, some people respond really well to serotonin meds like SSRI's (also the studies on serotonin agonists like psilocybin look promising), some respond well to Dopamine/NE meds like Welbutrin/Bupropion. It's really hard to say, but I'd recommend figuring out what's going on first.

Regardless, it sucks, I've been there, I'm still there to some degree, good for you for reaching out, keep it up. Do you have a good support system? It seems like the more people reach out to others for help and talk about things the better. Personally, I think depression is an "all of the above" thing, social support, meds, diet, exercise, TRT, supplements, sleep hygiene, meditation, etc. etc. Keep trying till you find something that helps.

Phil Goodman said:

I agree that it could be depression, though I’m of the mindset that people should avoid medication to treat depression unless absolutely necessary, and it certainly shouldn’t be the first tactic utilized to resolve the issue. I think that in many cases, particularly when dealing with life events or other issues, depression is a signal the brain sends much like a part of the body sending a pain signal that something is wrong. If you break your arm, you fix the arm…you don’t just interrupt the signaling or else it will likely get worse. If you’re stuck in a bad environment or situation then your mind will tell you something needs to be addressed, whether that be dealing with external factors or processing internal feelings in order to come to peace with various things. Obviously these medications can be a useful tool, but should only be considered a longterm solution in rare instances. That’s just my view on it, though I would say it’s obvious anti-depressants are over-prescribed in this country. And as mentioned earlier, there could be other factors like inflammation that may not be easily recognized or considered key contributors to depression yet it is proven that in many cases they are. But if it sprung up suddenly after stressful life events, then diving into what factors may be contributing on that front would probably be a good place to start.

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Depression that doesn't result from acute life events, such as the loss of a loved one, often stems from a neurochemical imbalance involving serotonin and dopamine. Changes to lifestyle factors and cognitive behabioral therapy can help, but it is often a combination of these along with medication that provides stable remission of depression.

DS3 said:

Depression that doesn't result from acute life events, such as the loss of a loved one, often stems from a neurochemical imbalance involving serotonin and dopamine. Changes to lifestyle factors and cognitive behabioral therapy can help, but it is often a combination of these along with medication that provides stable remission of depression.

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I think that’s a broad blanket statement that is too simplified. There can be other causes of depression besides just neurochemical imbalances. I’d also say it doesn’t necessarily have to be a traumatic life event, but an overall feeling of an unfulfilling life(like dead end job, lack of overall purpose in life as a whole, etc.) There are also pretty clear links between inflammation and depression. So that’s another factor to consider(which I’m assuming you recognize it’s since you say improved diet can help with depression). It could also be something as simple as vitamin D levels. Vitamin D, exposure to sunshine in general, and time in nature also help with depression. And again, plenty of studies show that exercise helps as much or more with depression than antidepressants. Plus there are recent studies that throw into question just how much of an impact serotonin and dopamine has on depression.


Not saying I agree with their summary, but I would that our understanding of it is more limited than people like to think, and we have a long way to go on this front.


As stated above, I think antidepressants can be a valuable tool. However, I also think they are DRASTICALLY overprescribed. Do you agree or disagree that they are over-prescribed?

EnlightenedViking said:

and don't have the energy to do anything until I've been awake for 4 hours+

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Reminded me of 2 times that I experienced something similar:
1) Are you taking generic Adderall XR? I ask because I noticed fatigue, anxiety, and a bunch of weird stuff when my pharmacy changed brands of generic Adderall XR due to a supply shortage. I didn't think there was a difference in generic brands until the pharmacy switched back to their regular supplier and I felt way better again.
2) Also, by any chance have you tried psilocybin recently? This is anecdotal but I responded well to micro dosing. So I tried a large dose, did well after that too. 5 months after the large dose, I do well, but if I micro dose now, I start getting really bad fatigue, not depression, just fatigue/zero energy/everything is a struggle. Anyways, wanted to pass that along on the off chance that it might be helpful.

Phil Goodman said:

I think that’s a broad blanket statement that is too simplified. There can be other causes of depression besides just neurochemical imbalances. I’d also say it doesn’t necessarily have to be a traumatic life event, but an overall feeling of an unfulfilling life(like dead end job, lack of overall purpose in life as a whole, etc.) There are also pretty clear links between inflammation and depression. So that’s another factor to consider(which I’m assuming you recognize it’s since you say improved diet can help with depression). It could also be something as simple as vitamin D levels. Vitamin D, exposure to sunshine in general, and time in nature also help with depression. And again, plenty of studies show that exercise helps as much or more with depression than antidepressants. Plus there are recent studies that throw into question just how much of an impact serotonin and dopamine has on depression.

No evidence that depression is caused by low serotonin levels, finds comprehensive review

After decades of study, there remains no clear evidence that serotonin levels or serotonin activity are responsible for depression, according to a major review of prior research.

www.sciencedaily.com

Not saying I agree with their summary, but I would that our understanding of it is more limited than people like to think, and we have a long way to go on this front.


As stated above, I think antidepressants can be a valuable tool. However, I also think they are DRASTICALLY overprescribed. Do you agree or disagree that they are over-prescribed?

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Genetics, life events, hassles, and traumatic events serve as triggers or catalysts for depression. The pathophysiology of the depression is thought to be rooted in issues with availability of and receptor sensitivity to serotonin, dopamine, glutamate, epinephrine, and BDNF.

The causes of depression discussion is more of a chicken or egg scenario. From a genetic standpoint, some people are born with issues with neurotransmitter function, making them highly susceptible to depression and other mood disorders. From a life event, hassle, or traumatic event standpoint, each of these stressors serve as catalysts that create an episode of depression. These episodes of depression will also show similar patterns of issue with the previously mentioned neurotransmitters, but was triggered from the event itself.

Does that make sense?

Depression - StatPearls - NCBI Bookshelf

DS3 said:

Genetics, life events, hassles, and traumatic events serve as triggers or catalysts for depression. The pathophysiology of the depression is thought to be rooted in issues with availability of and receptor sensitivity to serotonin, dopamine, glutamate, epinephrine, and BDNF.

The causes of depression discussion is more of a chicken or egg scenario. From a genetic standpoint, some people are born with issues with neurotransmitter function, making them highly susceptible to depression and other mood disorders. From a life event, hassle, or traumatic event standpoint, each of these stressors serve as catalysts that create an episode of depression. These episodes of depression will also show similar patterns of issue with the previously mentioned neurotransmitters, but was triggered from the event itself.

Does that make sense?

Depression - StatPearls - NCBI Bookshelf

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Yes, that makes sense and I think we have a general understanding of the phenomenon, but there is a lot we still don’t understand with regard to all of the pathways and processes at play.







There are also studies which show that improving your diet can greatly help with depression. Do you think antidepressant medications are overprescribed in America?

The brain is not a soup of neurotransmitters... plus the chicken egg problem with neurotransmitters

Phil Goodman said:

Do you think antidepressant medications are overprescribed in America?

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I'll take a crack at this one. 13% of American adults are taking an antidepressant, or roughly 1 in 8 people.

YES, they are overprescribed, especially considering they worsen long-term outcomes and increase vulnerability to future episodes of depression: The Case Against Antidepressants

FunkOdyssey said:

I'll take a crack at this one. 13% of American adults are taking an antidepressant, or roughly 1 in 8 people.

YES, they are overprescribed, especially considering they worsen long-term outcomes and increase vulnerability to future episodes of depression: The Case Against Antidepressants

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Agreed, and I believe we don’t really know what types of downstream effects they are having…possible that we never will. Usage among teenagers is skyrocketing, which adds a whole other aspect to it. As a teen your brain isn’t even fully developed, so it seems irresponsible to go in and start tinkering with it when we don’t fully understand what is happening. Actually I’d say it’s irresponsible to keep almost anyone on them for extended periods of time(though yes there are exceptions), but that irresponsibility aspect is magnified when dealing with a brain that is still developing.

And that’s just the antidepressant aspect. There are also tons of people on anti-anxiety medications, and a very substantial percentage of people are on both. And again, the number/percentage of teens on these medications is ballooning year over year. Why? Because we have an unhealthy environment but prefer to throw drugs at problems instead of getting to the root of them.

It's definitely a concern, and for sure it's frustrating for all parties involved.

If you're passionate about the prescribing of antidepressants, I suggest calling your senator and house representative because I believe it will literally require an act of congress.

From what I understand:
1) People that are doing well usually don't go to the doc looking for antidepressants
2) There's a serious shortage of psychiatrists who are trained to prescribe these
3) Family med docs are put in the crappy position of trying to help these patients because they can't get in to see a psychiatrist

In this current situation, I'd argue it's probably better to over-prescribe and treat someone that doesn't need it than it is to under-prescribe and deny treatment to someone that truly does.

To address this, we need to increase the number of psychiatrists (by increasing residency spots) and take the burden off family med docs.

This year 50,413 people (who graduated and passed the board exams) applied for 38,494 residency positions

Residency positions are tied to Medicare. Congress recently added 1000 residency positions plus another 200 specifically for psychiatry. That's helpful but we literally need 10X that many.

I didn't read the whole thread, but I would look at your DHEA-S and Pregnenolone levels, the latter being very tricky to test so I would rely more on the former and assume that if DHEA-S is tanked, so will Preg/Progersterone, etc...

A lot of men become deficient in neurosteroids on TRT and it takes a different amount of time for different men to feel the effects of those deficiencies.

If you haven't tried yet, I would try supplementing with Pregnenolone (first) and/or DHEA and see whether those make a difference.

If you can, go with compounded pharma from a reputable compounding pharmacy. OTC supplements are typically underdosed or at least not dosed consistently enough.

SparkyNeuron said:

It's definitely a concern, and for sure it's frustrating for all parties involved.

If you're passionate about the prescribing of antidepressants, I suggest calling your senator and house representative because I believe it will literally require an act of congress.

From what I understand:
1) People that are doing well usually don't go to the doc looking for antidepressants
2) There's a serious shortage of psychiatrists who are trained to prescribe these
3) Family med docs are put in the crappy position of trying to help these patients because they can't get in to see a psychiatrist

In this current situation, I'd argue it's probably better to over-prescribe and treat someone that doesn't need it than it is to under-prescribe and deny treatment to someone that truly does.

To address this, we need to increase the number of psychiatrists (by increasing residency spots) and take the burden off family med docs.

This year 50,413 people (who graduated and passed the board exams) applied for 38,494 residency positions

Residency positions are tied to Medicare. Congress recently added 1000 residency positions plus another 200 specifically for psychiatry. That's helpful but we literally need 10X that many.

Powerful Senate committee takes up physician shortage

Proposal from bipartisan Senate Finance Committee working group aims to address mounting doctor shortages. Physicians call for more residency slots.

www.ama-assn.org

Results and Data: 2024 Main Residency Match

This report contains statistical tables and graphs for the 2024 Main Residency Match® and lists by state and sponsoring institution every participating program, the number of positions offered…

www.nrmp.org

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“ In this current situation, I'd argue it's probably better to over-prescribe and treat someone that doesn't need it than it is to under-prescribe and deny treatment to someone that truly does.”


We will have to agree to disagree on this point, and the statistics seem to support my case. We have DRASTICALLY increased prescriptions for antidepressants and anti-anxiety medications, yet our rates of depression and anxiety are worse than ever. Why? Because we are not getting to the root causes of the issues in most cases. Simply throwing pills at problems is almost never an optimal approach.

Our diet is terrible and often results in inflammation along with numerous other issues.

We are more sedentary than pretty much any other time in history.

We spend less time in nature than basically any other humans in history.

Artificial lighting is impacting our circadian rhythm and moods.

Our bodies are bombarded with endocrine-disrupting chemicals and other toxins throughout our entire lives and even before we’re born.

Excessive time(particularly social media) is known to be significantly detrimental to mental health, and this is likely a big driver in the explosion in depression rates among teens and young adults.

Our leaders and media promote narratives that drive fear and confusion.



The list goes on and on with regard to the issues driving the rise in depression and anxiety. And throwing pills at the problem has not made it better. In fact, a good argument can be made that it has resulted in worse outcomes, if for no other reason than it has resulted in less people addressing the root causes. The continued rise in rates strongly support this argument.

Could similarly discuss ADHD and medication, or even TRT. And what about alcoholic beverages.

SparkyNeuron said:

It's definitely a concern, and for sure it's frustrating for all parties involved.

If you're passionate about the prescribing of antidepressants, I suggest calling your senator and house representative because I believe it will literally require an act of congress.

From what I understand:
1) People that are doing well usually don't go to the doc looking for antidepressants
2) There's a serious shortage of psychiatrists who are trained to prescribe these
3) Family med docs are put in the crappy position of trying to help these patients because they can't get in to see a psychiatrist

In this current situation, I'd argue it's probably better to over-prescribe and treat someone that doesn't need it than it is to under-prescribe and deny treatment to someone that truly does.

To address this, we need to increase the number of psychiatrists (by increasing residency spots) and take the burden off family med docs.

This year 50,413 people (who graduated and passed the board exams) applied for 38,494 residency positions

Residency positions are tied to Medicare. Congress recently added 1000 residency positions plus another 200 specifically for psychiatry. That's helpful but we literally need 10X that many.

Powerful Senate committee takes up physician shortage

Proposal from bipartisan Senate Finance Committee working group aims to address mounting doctor shortages. Physicians call for more residency slots.

www.ama-assn.org

Results and Data: 2024 Main Residency Match

This report contains statistical tables and graphs for the 2024 Main Residency Match® and lists by state and sponsoring institution every participating program, the number of positions offered…

www.nrmp.org

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You're presenting a false dichotomy. "under-prescribing" is not "denying treatment" . What others are saying is that better treatments focused on root causes should be pursued, and "anti-depressants" looked at as a short-term crutch at best. And where is the evidence that mainstream psychiatry has a net benefit for resolving depression? AFAIK they are predominantly just more specialized pill pushers. What we do need are more holistic/integrative doctors.

Also, note that resolving emotional trauma is a big, difficult factor and has not been mentioned here once.

Phil Goodman said:

The list goes on and on with regard to the issues driving the rise in depression and anxiety. And throwing pills at the problem has not made it better.

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I think we agree on more than we disagree: poor diet, environmental factors, social media, etc. are all factors in depression. Antidepressants aren't perfect but I wouldn't trash them on a whole. Meds helped give me the ability to address diet, exercise, sleep hygiene, etc. that I didn't have the ability to do before the meds. There's also a lot we don't know. Just as there's changes in the androgen receptor affecting response to androgens, I would imagine there's genetic variations in other receptors as well.

Guided_by_Voices said:

resolving emotional trauma is a big, difficult factor and has not been mentioned

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Good point!!! Especially in children as trauma appears to effect the way the brain develops. The fMRI brain studies of trauma are really interesting. The books "The body keeps the score" and "What happened to you" are both really good introductions to the topic for those that are interested.

Phil Goodman said:

Yes, that makes sense and I think we have a general understanding of the phenomenon, but there is a lot we still don’t understand with regard to all of the pathways and processes at play.

Dopamine and Depression – Separating Fact from Fiction - MHM Group

Depression and dopamine are often mentioned together, but what is the truth behind the link? Explore the relationship between dopamine and depression.

mhmgroup.com

Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression: a systematic review and network meta-analysis of randomised controlled trials | British Journal of Sports Medicine

Exercise more effective than medicines to manage mental health

Physical activity is 1.5 times more effective than counselling or the leading medications to manage depression, say UniSA researchers.

www.unisa.edu.au

There are also studies which show that improving your diet can greatly help with depression. Do you think antidepressant medications are overprescribed in America?

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I think medications in general are overprescribed in the Western world. So, yes.

You are right about there being things we don't know. There is no question that genetics and lifestyle factors play two of the largest roles. When it comes to lifestyle factors, overconsumption of media, consumption of low quality foods, overeating, being sedentary, lack of socialization and strong social network, lack of family support, are all things that come to mind that will influence inflammation and neurotransmitters levels leading to downstream depression.

EnlightenedViking said:

I started testosterone at 30, when my labs consistently came back around 250-300 ng/dL. Like most of you, it took a few years to dial in a protocol that worked. I had 3-4 years of great results that improved my life tremendously(career, workouts, relationships, etc)

Fast forward to the last 3 years. As I moved up in my career, moved states, and started a long-term relationship, I've slowly been going downhill.

After leaving my job last month after experiencing weeks of waking up with anxiety, and knowing it was the wrong environment for me, I'm nowhere near my best.

After I quit my job, I spent weeks sleeping until 11-noon, still feeling exhausted. I could get myself on a walk or two the gym, but the next day I felt the same.

Now, almost 6 weeks later, I wake up with poor motor function(spilling my coffee, dropping things, very tired) and don't have the energy to do anything until I've been awake for 4 hours+.

If you were in my shoes, where would you start? I'm doing a full comprehensive blood panel this week and without a job, I don't have insurance to cover finding a new Doctor to monitor my progress or new protocol.

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Please look into the carnivore lifestyle. Lookup dr Anthony Chaffee, dr Shawn Baker online. Feel free to PM me, I'll be happy to share my journey.

EnlightenedViking said:

I started testosterone at 30, when my labs consistently came back around 250-300 ng/dL. Like most of you, it took a few years to dial in a protocol that worked. I had 3-4 years of great results that improved my life tremendously(career, workouts, relationships, etc)

Fast forward to the last 3 years. As I moved up in my career, moved states, and started a long-term relationship, I've slowly been going downhill.

After leaving my job last month after experiencing weeks of waking up with anxiety, and knowing it was the wrong environment for me, I'm nowhere near my best.

After I quit my job, I spent weeks sleeping until 11-noon, still feeling exhausted. I could get myself on a walk or two the gym, but the next day I felt the same.

Now, almost 6 weeks later, I wake up with poor motor function(spilling my coffee, dropping things, very tired) and don't have the energy to do anything until I've been awake for 4 hours+.

If you were in my shoes, where would you start? I'm doing a full comprehensive blood panel this week and without a job, I don't have insurance to cover finding a new Doctor to monitor my progress or new protocol.

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Just my opinion as i have years of experience with both -
kratom and modafinil. Obviously, see what your blood work shows first, but kratom (in my opinion) is a great mood booster, and modafinil (in my opinion) will wake you up without feeling jittery like too much caffeine can.