Expert: Ivan Goldberg, M.D. - 6/16/2009

Question
I am deeply concerned about my husband.  There is something seriously wrong with him and we are having no luck finding out what it is.  He has almost no energy.  It takes all his energy just to do the necessities of life (work, bathe, etc).  We go grocery shopping and when we get home he needs to lie down, because he is exhausted.  After every meal, he needs to take a nap.  He has periods of what he calls "anxiety" that he finds difficult to describe to me, but states he is not thinking anything in particular before or during feeling that way (so thinking doesn't cause the feeling, and feeling anxious doesn't make him think bad thoughts).  He states that the feeling "just comes out of nowhere" for no apparent reason.  From my outside perspective, he appears agitated at these times.  Frequently when he is laying down resting because he is exhausted, one of his feet will be jiggling away at high speed.  He has mood changes where he becomes snippy and sarcastic, while his usual mood is very pleasant and even-tempered.  He has been self-medicating with alcohol his entire adult life (he is 50 years old) and currently consumes 1/2 gallon of vodka about every 3 - 4 days.  This is consumed in the afternoon/evening after work.  He has tried to cut down, but states that when he reduces his alcohol intake, then all he wants to do is sleep.  He takes caffeine pills in the morning to get up.  His libido is non-existent (no interest in sex at all, although physically his body functions normally).  He has lost interest in many things he used to enjoy (for example, motorcycle riding).  We never do anything recreational because he is so exhausted all the time.  He has had all the "usual" tests, thyroid, testosterone, etc., and all have come back in the normal range.  He was put on Wellbutrin XL for a while, but all it did was make him gain weight.  His condition has been gradually getting worse for years.  In 2004 he was diagnosed with sleep apnea and now sleeps with a CPAP machine.  We hoped that getting sleep would help some of the other stuff, but that hasn't happened.  In spite of the machine, he says that when he sleeps, he still feels like he isn't really getting quality rest.  We are both on the edge of despair because we can't find any help for him.  Any insight or recommendations you could provide that we might suggest to a physician here would be most appreciated.  Thank you.

Answer
Hi Donna . . .

You seem to recognize that your husband's situation is very complex with alcohol abuse and sleep apnea playing an unknown role in causing his difficulties. It certainly is possible that your husband has both an anxiety disorder, and a mood disorder but it is impossible for me to make a diagnosis based on the information you provide.

I think what he needs is a psychiatric work-up by a psychiatrist with better than average skills in diagnosing individuals with complex situations. A list of such expert psychiatrists may be found at:
http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .

Ivan
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