Chronic Fatigue in Prostatitis

[Richard.N]

Apologies for the length. You can cut to the last lines to get to the point.

When I wandered into a chronic fatigue state (like that feeling the day you start coming down with flu but for months on end) I was skeptical that it had anything to do with prostatitis. It was a big thing and as dibilitating as the prostatitis had been in the early stages. Where was this described in the Nickel book? Why didn't my doctor know about it? Why was I experiencing it some months into my prostatitis?

It took a while, expert opinion, a bit of reading and a some of the voices here to reassure me that it was just another aspect of this disease. Not everyone gets it, some people get it worse, some not so bad. Others get other aspects which I didn't get. Others get multiple aspects. Imagine that.

Now I have for the most part come out of that state, I have reappraised some of the earlier texts I looked at and realise that this fatigue is what is described by the 'malaise' some briefly mention.

Don't get me wrong: I still very much suffer from prostatitis but the fatigue seemed detatched from the main illness.

Some find the fatigue is self limiting. Mine diminished when I started Elavil. I'm trying to work out what in the Elavil helped: antihistamine properties, serotonin re-uptake inhibition...who else has a similar story where chronic illness begat chronic illness? Was yours self limiting? What helped? Thanks for staying around until I got to the point

[webslave]

My angle on this is that mast cell degranulation releases a lot of chemicals, some of which can result in malaise and fatigue. Do some web research on this, eg:

Cytokines are potent mediators of immune activity. These chemicals carry messages from one cell group to another and invoke the most powerful of whole-body defense responses. The cytokines include the interferons and interleukins, which cause many of the symptoms of bacterial and viral infections - fever, headache, generalized aching, fatigue, weakness, and clouded consciousness. The same symptoms are produced by cytokines during food allergic reactions. Overproduction of one or more cytokines may be responsible for non-specific hypersensitivity. Patients presenting with chronic fatigue, muscle aching, and brain dysfunction often have increased blood cytokine activity. If they are reacting to food (and most are) the elevations of cytokines would be variable and inconsistent and are therefore are not likely to be reliable tests of food allergy.

from http://www.nutramed.com/immunology/hypersensitivity.htm

[Richard.N]

Cheers Mark.

[hodologica]

Another angle on fatigue: sleep disturbance, in particular alpha wave (awake-like brain activity) intrusions, which - whether they actually wake you or not - prevent you from achieving the very physically-restorative phase 4 non-REM sleep. I read that these disturbances commonly develop in chronic pain patients. Also that these alpha intrusions are charecteristic of (and probably one of the roots of) fibromyalgia (a diagnosis which has some overlap/ambiguity with chronic fatigue syndrome), but - important - this sleep disorder does not necessarily lead to fibromyalgia.

And, fortunately, it seems to be pretty treatable. Ambien seems to be of use for most people suffering alpha intrusion. The antidepressants amitriptaline/Elavil and mirtazapine/remeron are also effective and certainly better for long-term use (they are non-habituating).

My case: despite having had CPPS/PM fairly well-tamed for months, since 3-4 weeks ago I experienced occasional fatigue episodes, along with frequent feelings of extreme unrestedness upon awakening. During those weeks I observed that I would, on occasion, (evidently) wake myself up by moving my toes or clacking my teeth. I was also bruxing heavily (and experiencing bad headaches). Last week I developed continuous fatigue with very light full-body muscle soreness. At the same time I had become unable to sleep for over 5 hours a night, and was often waking up quite a lot. I rapidly became too weak to write with a pencil or walk more than a kilometer. Ambien did nothing for me; I woke up every 20 min when I took it. Insomnia and anxiety then ballooned, and I spent 48 hours in a mental hospital.

15 mg mirtazapine/Remeron relieved my fatigue almost completely in one night, presumably by facilitating phase 4 non-REM. It's also all I need to get to sleep (not that I ever had any insomnia in my life before last week). I've been on it 3 days now. This is the same drug Richard N. settled on for fatigue (see ref in some other thread). It is a new-ish, well-tolerated antidepressant.

[webslave]

Mirtazapine also demonstrates important anxiolytic and sleep-improving effects, which may be related to its pharmacodynamic properties.

http://www.biopsychiatry.com/mirtazapine.html

Mirtazapine is a tetracyclic piperazino-azepine, which has a different structure from any other currently used antidepressant. It enhances central noradrenergic and serotonergic activity by blocking alpha2 receptors and selectively antagonizing 5HT2 and 5HT3 receptors. Thus, it is being classified as a noradrenergic and specific serotonergic antidepressant and referred to as an NaSSA.

[Richard.N]

I've been on Mirtazipine/Zispin/Remerol 15mg/night for over a year now. I've previously had problems with Prozac, Effexor and Elavil - but this one has a particularly suitable side-effect profile.

I have to namecheck Elavil though. That was the one that first pipped the fatigue - even at a tiny dose. I settled on Mirtazipine after reasoning that it was the most similar to Elavil but without the nasty anti-chlorinergic effects.

[hodologica]

By the way, it occours to me that there are 2 kinds of fatigues in my experience.

1. milder, with a more "weary" feeling, and the muscle pain is achey

2. flu-like fatigue, you feel sick, weird, and quite weak, and the muscle pain is a soreness like that from unaccustomed exercise, sort of pleasant in a way.

#1 has been part and parcel of chronic prostatitis / chronic pelvic pain syndrome for me, comes and goes... I like the explanation of it posited by Mark above. However I did get more and more intense #1 fatigue when I started having symptoms of sleep disturbance. #2 seems to be, in my limited knowledge, the result of alpha wave intrusion sleep disturbances (non-repair of muscles, etc, due to failure to achieve deep non-REM).

If anyone now or in future needs to check up on this info about alpha wave stuff, I learned it all in 2 hours using google, FYI. Its something people with chronic pain should probably keep an eye out out for.

[latte]

I have experienced both types of fatigue and, by the way, thanks for describing them as I have not seen many posts addressing the fatigue factor of CPPS. At my worst the fatigue was the most prominent symptom for me. When I went to UCLA two years ago the uro asked me what my most troubling symtom was and I said, without hesitation, weakness. For me the fatigue did not seem related to sleep disturbance as I slept pretty good but was tired, weak, and almost dizzy a lot of the type. Felt like I had the flu. Steroids seemed to knock it out. I think the Webslave hypothesized that the flood of cytokines probably makes one feel sick, weak and just plain weirded out. Glad you have some relieve and can rest comfortably now. I did have some sleepness nites during my worst chronic prostatitis / chronic pelvic pain syndrome nites but it was more due to pain.