[38F] Experiencing fatigue, detachment, and mood changes

Patient Description

A 38-year-old female reports feeling unusually tired and detached for the past three months. The fatigue comes on suddenly and lasts for a few hours before she feels okay again. She has lost interest in social activities and prefers to keep to herself, a change from her previously social nature. Additionally, she has experienced a complete loss of sexual desire since her partner moved out. The patient sweats on her face, especially after showering and when she gets to work, which has been happening off and on for about a year. She has noticed changes in her mood, feeling more sad and irritable than usual, and has experienced panic attacks and episodes of intense fear or discomfort. She has had thoughts of harming herself and others but clarified that she does not wish to harm herself. She has experienced difficulties with concentration and decision-making, as well as feelings of worthlessness and excessive guilt. The patient has a history of smoking tobacco, though she smokes much less now, and drinks alcohol socially once or twice a week. She has a history of PTSD, diagnosed in 2016, and has experienced severe head trauma in the past. Her menstrual cycle has been sporadic and odd recently, and her IUD has expired but has not been removed or replaced yet. She is not allergic to penicillin, but amoxicillin gives her yeast infections. She has a family history of cancer, with 14 family members lost to different cancers over the past 10 years. She is currently taking Allegra occasionally for allergies.

Arora's Assessment

What might be happening

It sounds like you are experiencing a combination of physical and emotional symptoms that could be related to several underlying conditions. Here are some possibilities:

1. Depression and Anxiety

Rationale: Your symptoms of fatigue, loss of interest in social activities, loss of sexual desire, mood changes, and feelings of worthlessness are common in depression and anxiety disorders. The history of PTSD and emotional abuse can also contribute to these conditions.
Typical Treatments: Treatment often includes a combination of therapy (such as cognitive-behavioral therapy), medications (like antidepressants or anti-anxiety medications), and lifestyle changes.

2. Hormonal Imbalance

Rationale: The changes in your menstrual cycle, increased sweating, and fatigue could be related to hormonal imbalances, possibly due to the expired IUD or other underlying conditions like thyroid disorders.
Typical Treatments: Hormonal imbalances are often diagnosed through blood tests and treated with hormone replacement therapy or other medications.

3. Chronic Stress

Rationale: Chronic stress from your personal and work life can lead to physical symptoms like fatigue, sweating, and changes in appetite and sleep patterns.
Typical Treatments: Stress management techniques, such as mindfulness, exercise, and therapy, can be beneficial.

What you can do

Depression and Anxiety

Seek Professional Help: Consult a mental health professional for a proper diagnosis and treatment plan. Therapy and medications can be very effective.
Self-Care: Engage in activities that you enjoy and that help you relax. Regular exercise, a healthy diet, and adequate sleep can also improve your mood.
Support System: Reach out to friends, family, or support groups. Sharing your feelings with others can be very helpful.

Hormonal Imbalance

Medical Consultation: See your healthcare provider to discuss your menstrual irregularities and other symptoms. They may recommend blood tests to check your hormone levels.
IUD Management: Consider getting your expired IUD removed or replaced. Discuss this with your gynecologist.

Chronic Stress

Stress Management: Practice stress-relief techniques such as deep breathing exercises, meditation, or yoga.
Healthy Lifestyle: Maintain a balanced diet, stay hydrated, and get regular physical activity.
Limit Stimulants: Reduce your intake of caffeine and alcohol, as they can exacerbate stress and anxiety.

General Tips

Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider.
Stay Connected: Even if you prefer to be alone, try to maintain some social connections. Isolation can worsen feelings of depression and anxiety.

What you should look out for

Given the complexity of your symptoms, it's important to seek medical care to get a comprehensive evaluation. Here are some reasons to seek care more urgently:

Worsening Symptoms: If your fatigue, mood changes, or other symptoms worsen or become unmanageable.
New Symptoms: If you develop new symptoms such as severe headaches, chest pain, or shortness of breath.
Safety Concerns: If you ever feel like you might harm yourself or others, seek immediate help from a healthcare provider or emergency services.

Remember, while I can provide information and suggestions, it's crucial to consult with real health professionals to receive a formal diagnosis and appropriate treatment. Take care, Sarah.