Posted by Cecilia on September 26, 2005, at 5:20:15
In reply to Re: Questions re cortisol levels:SLS » Cecilia, posted by SLS on September 25, 2005, at 8:37:29
> 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.
>
>
> - ScottI`ve been working evenings or nights since 1978, so I`m defiitely not a morning person. I use 2 alarm clocks to wake up at 1230 in order to leave for work at 230. I usually take sleeping pills which of course makes waking up even harder but even when I`ve managed to get to sleep without them, waking up is excruciating-a combination of depression, anxiety and exteme exhaustion. It seems to get harder every year. When I was younger I used to force myself to get up and do things to try to overcome my depression and anxiety, but I no longer have any expectation that anything I do will make any difference, I just want to sleep all day. It has nothing to do with sunrise, I keep my curtains closed. Years ago I tried a light box for a month but didn`t notice any benefit from it. Melatonin made my insomnia worse, plus worse nightmares when I finally slept. I don`t think I ever have deep sleep, just endless unpleasant dreams. I really can`t say when my depression started, I don`t remember ever not being depressed. But it definitely worsened in college. I suppose I was angry at the time, but I`m not a person who often expresses anger-more the classic anger turned inward. I`ve tried a number of tricyclics but the only one I was ever able to get to a therapeutic level on was nortriptyline. I was able to stand that one by increasing very slowly, though there were still plently of side effects and no benefits. I did try a small dose of zyprexa for a couple of weeks-no benefit. Having recently been diagnosed with diabetes, I wouldn`t take it again-I can`t afford to gain any more weight. Mood stabalizers-I tried lithium as a augmentor to zoloft but gave it up fairly quickly because of the side effects. I tried lamictal for quite a long time with celexa and trazadone-no benefit. I tried neurontin as an augmentor to celexa-ironically I`m taking it again now for peripheral neuropathy-doesn`t work any better for that than it did for depression and anxiety. My doctor, who`s supposed to be the expert on treatment resistant depression at my HMO, basically just has the attitude "if you`re not willing to try ECT you must not really be depressed." And that`s the one thing I`m just too afraid to try. I`ve tried: Desipramine, imipramine, amitriptyline, Prozac, Nardil, zoloft, Paxil. welbutrin, Effexor, serzone, buspar, remeron, lithium, nortiptyline. celexa. neurontin, lamictal, trazodone, SAM-e, ritalin, dexedrine, parnate, amisulpride, reboxetine, adrafinil, lamictal, moclobemide, tianeptine, St. John`s wort, 5-HTP, trytophan, duloxetine, miilnacipran clonazepam, Xanax and rTMS. I`ve had no benefit from anything except the benzos and sleeping pills (temazepam and ambien). Cecilia
poster:Cecilia
thread:555263
URL: http://www.dr-bob.org/babble/20050921/msgs/559706.html