Posted by jrbecker on July 28, 2003, at 23:18:20
In reply to Lexapro and dirurnal variation, posted by Bela on July 28, 2003, at 10:05:00
> I have a question for Lexapro users and those that who have experienced the poop-out syndrome with other SSRIs. Over the years of experiencing the SSRI merry-go-round, the main depression symptom I experience when they all quit working, was diurnal variation (DV). DV involves no motivation in the morning, dragging the butt out of bed, etc., with improvement as the day progresses. At present, the Lexapro is working for me and basically eliminated the DV, but I am not optimistic about it working forever. For any of you that have experienced DV, do you have suggestions for psychotherapeutic coping mechanisms? Do any of you know what happens during the night to cause the cycle to repeat itself the next day?
> Bela
>diurnal variation is also a major symptom of my [atypical] depression. My body's natural clock wants me to sleep til noon and stay up past 2am. And taking antidepressants only exacerbates the daytime sleepiness.
The best tips I can give (besides finding the best AD that won't sedate you) are:
1.Take a sleep agent at night if you aren't on one already. Whether it's Ambien, a regular benzo, or something stronger like trazodone, find something that will get you a good night's rest. In some of us, this is just not possible while taking an AD montherapeutically. In my case, even though I'm tired all day, I still won't get a good night's rest -- this is a symptom of the daily phase shift most depressive sufferers exhibit as well the insomnia from the AD. Take a good look at your sleep efficiency: if you can sleep through the night, but sometimes toss and turn and wake-up intermittently, your sleep pattern might be dysfunctional and could probably be made a lot more efficient by the addition of a sleep aid. For a lot of depressed people, this realization isn't always an apparent one, and remains the missing link to getting over a good deal of the daytime sleepiness.
Equally important, make sure that your sleep agent doesn't have too much overhang sedation the next day. Finding the right one for you is the tricky part. A dose of Ambien and some short-acting xanax were a good combo for me (the ambien on its own didn't keep me asleep the whole night). But something like klonopin left me too tired the next day. There is a new sleep med, much like Ambien, but much more potent and with a longer half-life, called Estorra, that is due out near the beginning of '04. There was a lot of great data to show that this will be a better drug -- with no daytime overhang. I suggest you check it out when it surfaces on the market.
2. Take the AD at night if you can. I found that when taking Lexapro, this was possible. The catch-22 is that you might have to take more sleep agent to compensate.
3. Exercise at the peak of your daily schedule. This would be around mid-afternoon for someone's normal sleep-wake cycle. This will definitely put you to sleep earlier and also shift your clock to be arouse earlier in the morning. A more reliable option is that you can try exercising vigorously right as you get up in the morning for more than a half hour. As much as the idea of running right as you first get up strikes you as pleasant, it might just be worth it if it actually keeps you energized the rest of the day.
4. Try B12. Important: make sure it is Methylcobalamin form - this is really the only form that crosses the BBB efficiently. Some people find it to help moderately (for me it probably gives me a 10% overall boost). It helps maintain energy during the early part of the day and helps with getting to bed by inducing the a timely release of melatonin earlier in the evening.
5. Tried light therapy? Take advantage of the summer weather and get as much light as you can throughout the early part of the day.
In the darker/colder months, get outside around noon and catch the sun at its zenith -- take a walk or something. This will help wake you up.Good luck
poster:jrbecker
thread:109458
URL: http://www.dr-bob.org/babble/20030728/msgs/246348.html