here is a list of my symptoms..all beginning around January 3rdish.

1. chronic fatigue- i could sleep the entire day. i am often tired
when i wake up.
2. intolerance to alcohol - i used to drink pretty much every day and
now even the smell makes me nauseous.
3. chronic back pain - it is primarily in the middle of my back. the
pain is sometimes so severe that it can only be controlled with
narcotic pain-killers.
4. chronic neck-stiffness- i do stretching exercises and it doesn’t
seem to be getting any better.
5. blood in my stool- i also often have difficulties (painful) going
to the bathroom.
6. indifference - i have lost interest in most of the things that i
used to care about.
7. sudden stop in cigarette smoking - i used to smoke. i can’t even
stand the smell anymore. i’m glad that i don’t..but seeing that i
wasn’t even trying, i find it to be very peculiar.

i am not pregnant. i also do not believe that i could be depressed
enough to cause the other problems. the only medication that i take
is vicodin ES when my back pain is intolerable.

Dr. Joshua’s Answer:

Symptoms 1,2,6, and 7 could all be due to depression. Especially chronic fatigue and indifference. It’s of course good that you don’t smoke and drink anymore, but these may be symptoms of anhedonia, which means inability to experience pleasure from normally pleasurable things, and is strongly associated with depression.

Whenever depression is suspected, physical causes of depression should be ruled out by performing a thorough physical examination including a neuro exam, lab tests such as thyroid hormone levels, and blood count. Sometimes further investigations may be needed, such as head CT or MRI.

Symptoms 3 and 4 require evaluation including a thorough physical examination, and multidisciplinary approach including evaluation of lifestyle, exercise, work ergonomy, etc. A specialist may need to be consulted, in which case a physiatrist may be able to help with the back pain. A good physiotherapist may also be able to help. Also, your medication may need to be reconsidered - vicodin should be used for limited time, and alternatives should be considered.

Symptom 5 may be in part related to Vicodin use. It sounds like you may have hemorrhoids which are made worse by constipation, which is worsened by Vicodin. Make sure you eat enough fibers, get exercise and try not to sit on the toilet too long at a time. Have a primary care physician look at the possible hemorrhoids - they can be treated. Also, blood in stool is always cause for a visit to the doctor’s even if hemorrhoids seem the most likely cause. Other causes need to be excluded.

See your doctor about these symptoms, with these things in mind.

If you are diagnosed with depression, tricyclic antidepressant such as amitriptyline 25 mg 3 times daily might be a good choice for you because it would likely also ease the back and neck pain. The problem with amitriptyline is that it may also cause constipation, but still it might be worth a try.

Good luck,

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