Posted by SLS on September 25, 2005, at 8:37:29
In reply to Re: Questions re cortisol levels:SLS, posted by Cecilia on September 25, 2005, at 3:56:10
Hi Cecilia.
> Scott, my depression is much much worse when I wake up (which is usually in the afternoon since my part time job is evening shift- I don`t think there is ANY way I could function if I had to work days.)
What hours do you work? How long have you been working these hours?
Do you wake up too early and lie awake with anxiety or is it necessary for you to use an alarm?
If you didn't have to work, and your sleep/wake cycle were free-running, what do you think your cycle would look like?
> (and then of course not being able to get to sleep when I finally drag myself to bed at sunrise, though even when I`ve had to get up early I still find it extremely difficult to get to sleep the following night).
You might profit from working with your circadian rhythm. That your body is still cued by sunrise might hurt rather that help your situation the way things are now. I think you should either take a sleep aid and get to sleep as soon as possible before sunrise or not go to bed until well after sunrise. If you are able to fall asleep before sunrise, set your alarm for 7:00am or 8:00am and get up for a little while, expose yourself to bright light, and perhaps drink some juice or get something to eat before going back to bed. Hopefully, you can find some way to synchronize your Y clock with your X clock sleep/wake cycle. It might even be a good idea to try taking melatonin at 2:00am. If that makes things worse, then try taking it at 8:00am.
> But I definitely think I have atypical depression. I can definitely relate to the "leaden paralysis" where the idea of getting out of bed seems physically impossible,
People often confuse psychomotor retardation with leaden paralysis. Do your limbs actually feel heavy or is it that you seem to have trouble initiating movement or do things in slow motion?
> the rejection sensitivity
I don't think this is any longer considered to be of diagnostic value.
> overeating, oversleeping
That is pretty typical of atypical depression. However, it is also typical of bipolar depression.
> I have a LOT of anxiety but I really can`t recall any time in my life where I could possibly be considered manic or hypomanic.
How old were you when your illness started?
Were you irritable or angry early in the course of your illness?
> Unless you can be bipolar with a daily cycle,
You can. It is called ultra-dian cycling. It seems to be fairly rare, though.
> where you wake up in extreme emotional pain and gradually get, I don`t know, not happy, certainly, but more detached from the pain.
Now THAT sounds like unipolar endogenous (melancholic) depression.
If you haven't tried a tricyclic antidepressant yet, I would consider doing so. If you have tried tricyclics, which ones were they, and what were the dosages used and for how long?
> 7 years of therapy only made my depression worse and no med has ever helped. I can`t even wrap my mind around the concept of happiness, I look at all the pain in the world and the idea of happiness seems beyond absurd; I just wish there were something to lessen the intensity of the pain of those hours after awakening.
Does this include anxiety?
For the short term, it might be a good idea to experiment with a low dosage of an atypical neuroleptic (antipsychotic). You could start out with Zyprexa 5.0mg. This drug probably demonstrates the greatest efficacy as an antidepressant / mood-stabilizer. Unfortunately, weight gain is a problem. However, I think a short trial of Zyprexa (two weeks) would give you a good idea as to how well an AP strategy would work. You could then try switching to Seroquel or Abilify if the side effects of Zyprexa become problematic.
Are you bipolar? It is difficult to say if there is any bipolarity to your CNS biology. However, it sometimes serves well to consider treatment-resistance to standard antidepressants as a sign of a bipolar diathesis (cause), and that using mood-stabilizers would get you well.
- Scott
poster:SLS
thread:555263
URL: http://www.dr-bob.org/babble/20050921/msgs/559342.html