Posted by: Andre T. Dreyer | 2009/08/24

Coping with " disability" 

I have Marfan' s and Mitral/Aortic valve prolapse with regurgetation. Even though it is supposedly " mild"  and I am taking beta-blockers, I am non-the less having a really tough time at work, as I take twice as long to do a task as what it does other people. We have recently gotten a new employee that is capable of doing everything I can....only much faster. I just don' t have enough energy to work full steam the whole time.

I am at the point of breaking down and I don' t know how to handle it. To make matters worse, I also have borderline personality disorder and/or bipolar disorder, for which I am taking Fluoxitine.

I slept almost the whole weekend and I am even more tired than when the weekend started. I feel worthless yet I know, I am able to do my job...just not fast enough.

I need some sort of help as my health is declining ... not just due to the MFS but also due to neglect because of my lack of energy. It is also a problem as my family does not understand how much it takes for me to do even the simplest of tasks.

Do you have any advice?

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Our expert says:
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Coping with disabilities myself, I may understand your concerns more than some of the healthier and bouncier docs. It sounds as though you need a fresh and thorough assesssment by the best available local psychiatrist ( who could therefore take your cardiac condition into account).
Generally, there wouldn't be doubt about disinguishing between a personality disorder, such as Borderline, and Bipolar Disorder. And the former should not complicate your cadiac problems, nor would it respond to medication, while the latter if causing significant problems, might respond to a mood stabilizing drug, with the antidepressant like prozac only during depressions. And not all antidepressants suit everybody. Much of what you describe of your current distressing state suggests a Depression not responding well to the current treatment, and which might do better on a different drug, perhaps best combined with Cognitive-Behaviour Therapy (CBT ) if available.
Whenever more than one condiion is present, one needs to look at which symptoms could be caused by which, and to ensure that the treatment for one doesn't complicate the treatment of the other. Not all beta-blockers are equal in all of us, some may not help a depression, for instance. And their use needs to be taken into acount when selecting an antidepressant.
With a better and clearer psychiatric diagnosis, and treatment appropriate to that, you should have a good chance of lifting the fog of this weariness, retuning to efficiency at work and more enjoyment in life.

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