Psycho-Babble Medication Thread 82451

Shown: posts 1 to 23 of 23. This is the beginning of the thread.

 

Sleeping too much effects depression?

Posted by adamie on October 27, 2001, at 19:23:55


hi. I have recently been sleeping 10 to 12 hours a day. Does too much sleep worsen depression? I am not feeling too well.

 

Re: Sleeping too much effects depression? » adamie

Posted by JohnX2 on October 27, 2001, at 20:37:08

In reply to Sleeping too much effects depression?, posted by adamie on October 27, 2001, at 19:23:55


Sleeping too much/too little is a sign of
depression, not necessarily a cause. Too much
is more lumped into what is called "atypical
depression". Anyways I think it could exacerbate
things a bit as this is my experience. If I am
only mildly depressed, and I force my self out
of bed to get up and do things, even just taking
a shower, I often feel good. In fact long term
sleep deprivation has in some studies anecdotally
been shown to have an anti-depressant response.
Ever stayed up to late studying for a Final or
something and got a little "slap-happy" ?. ;)

PS. you ask a lot of questions recently
on this newsgroup. Could you please review for us your diagnosis
and any failed/positivite medical trials?
I'll try to dig through
your old posts, but I just want to make sure that
we don't give advice inconsistent with your
diagnosis and experiences.

-john

>
> hi. I have recently been sleeping 10 to 12 hours a day. Does too much sleep worsen depression? I am not feeling too well.

 

Me and my situation » JohnX2

Posted by adamie on October 27, 2001, at 21:54:27

In reply to Re: Sleeping too much effects depression? » adamie, posted by JohnX2 on October 27, 2001, at 20:37:08


My diagnosis so far is clinical depression caused by accutane but it's very possible I may be bipolar. Lets just say once during my depression even though it was for an extremely short time... I actually felt a little decent and I lacked inhibitions in the form of commiting theft at a theme park in which I got caught. I forget what happened afterwards but somehow my depression became quite severe again. And generally has been severe but if I am off meds it's not too severe. As in livable and not painful to be alive. Whenever I have gone on AD's they all made me worse. Some much more than others. The first day I tried prozac I felt significantly worse. Effexor made me suicidal and caused me to admit myself to a mental hospital. Paxil was my first med. One week into it was when I commited the theft and was feeling a bit decent. Then I felt worse and worse (dont remember though). Wellbutrin made me feel worse. I also tried some natural stuff. SAM-e I felt worked the first few days I tried it but it could have just been coming off a certain med which made it seem that way. I dont remember too well. The 2nd and 3rd time I tried SAM-e (ordered it a few times) I felt no improvement. I also tried Salmon Oil which seemed to have no effect. Also 5-HTP, first time I tried it I felt as if I was better. I tried it again just a few days ago... felt as if it was making me worse but it was probably just the usual me.

All AD's have made me worse so far. I dont want to try them anymore unless it's a non usual AD such as an MAOI or Remeron. I'll be trying Moclobemide in a few days if it arrives.

I am currently on Zyprexa. It's the only thing which hasn't made me feel worse! yet no improvement eighter. Something in those AD's is very bad for me. Celexa caused me to want to escape from the mental hospital where I stayed for 1 month. I was on it for over a week. The longer I stayed on it the worse I felt. By the end it was starting to become very painful to be alive, then it got even worse to the point where I couldn't even function. Also during the celexa period I got almost no sleep at all. I am talking about 2-3 hours of sleep each night. So much mind torture. The celexa was stopped and so was anafranil which I was put on for a few days. I was put back on only zyprexa. The next few days I was recovering from extremely severe suicidal depression. And then I was discharged home.

My depression takes the form of inability to enjoy things. Extreme inability to think, concentrate, and my memory is extremely poor. When the depression was at it's worst periods it would be even hard to read. Also during the depression my sleep has not been effected. If anything this depression causes my sleep to be better than when I was normal. When I was normal I would have a huge imagination and I would just always think of things so it would be hard to fall asleep. yet now I have no imagination. I cant think or concentrate. Such abilities for me are extremely poor. All I do every day is try to pass the time. Every minute is so boring. I am tired of being like this. It is hard for me to do things which I used to with ease. Nothing interests me. I have no motivation to do anything. My life is empty. Before this 'depression' I would always be an extremely happy person. Also my depression seems less severe in the evenings.

Oh and I also have tried 6 treatments of ECT. It seemed to not help. Possibly it helped very very little.

I am planning to try a mood stabilizer. I want to try other classes of medication. AD's are generally not good for me at all.

And regarding the worsening effect they create, Aside from the depression becoming much much worse, they cause the sides of my head to be extremely hot. Also my heart would be pounding constantly. Once I actually had heart pain on one of the worst days.

Regarding side effects from meds... I have dealt with almost none at all. Side effects from all the meds I've tried were almost none.

> Sleeping too much/too little is a sign of
> depression, not necessarily a cause. Too much
> is more lumped into what is called "atypical
> depression". Anyways I think it could exacerbate
> things a bit as this is my experience. If I am
> only mildly depressed, and I force my self out
> of bed to get up and do things, even just taking
> a shower, I often feel good. In fact long term
> sleep deprivation has in some studies anecdotally
> been shown to have an anti-depressant response.
> Ever stayed up to late studying for a Final or
> something and got a little "slap-happy" ?. ;)
>
> PS. you ask a lot of questions recently
> on this newsgroup. Could you please review for us your diagnosis
> and any failed/positivite medical trials?
> I'll try to dig through
> your old posts, but I just want to make sure that
> we don't give advice inconsistent with your
> diagnosis and experiences.
>
> -john
>
>
>
> >
> > hi. I have recently been sleeping 10 to 12 hours a day. Does too much sleep worsen depression? I am not feeling too well.

 

Re: Me and my situation » adamie

Posted by judy1 on October 27, 2001, at 22:23:04

In reply to Me and my situation » JohnX2, posted by adamie on October 27, 2001, at 21:54:27

Like John mentioned you seem to be suffering from an 'atypical' depression which is consistant with a bipolar diagnosis. The other consistant fact here is your worsening/non response to AD's- while zyprexa may be a decent choice, have you been tried on lithium or depakote? The best action you might want to try is see a bipolar expert, I may be wrong but I think it's turning into somewhat of a trendy diagnosis and one episode that was not psychotic or obviously manic may not warrent it. Either way your meds need to be reevaluated and I hope you feel better soon- Judy

 

Re: Me and my situation » judy1

Posted by adamie on October 27, 2001, at 22:56:25

In reply to Re: Me and my situation » adamie, posted by judy1 on October 27, 2001, at 22:23:04


yes it seems my depression may deffinetly be atypical. and no i haven't tried the meds you mentioned. I hope to try a mood stabilizer soon. Nov 8th i'll be seeing a new pdoc. hopefully i can convince her to try me on a new class of meds such as the md's.

> Like John mentioned you seem to be suffering from an 'atypical' depression which is consistant with a bipolar diagnosis. The other consistant fact here is your worsening/non response to AD's- while zyprexa may be a decent choice, have you been tried on lithium or depakote? The best action you might want to try is see a bipolar expert, I may be wrong but I think it's turning into somewhat of a trendy diagnosis and one episode that was not psychotic or obviously manic may not warrent it. Either way your meds need to be reevaluated and I hope you feel better soon- Judy

 

Re: Sleeping too much can worsen depression » adamie

Posted by jay on October 28, 2001, at 0:26:01

In reply to Sleeping too much effects depression?, posted by adamie on October 27, 2001, at 19:23:55

This is an area I have been doing some of my own research in, as I have found ways to somewhat help my depression via sleep. Again, YMMV, and as always, take caution. Of course, I am no doctor of any sort.

A number of research items and good books suggest one of the important mechnisms of many antidepressants is that they suppress REM sleep.
Why we with depression likely feel so tired and horrible after long lengths of sleep, is because we tend to spend most of our sleeping hours in and out of dreamy REM sleep. We rarely ever enter the deep Stage Four stage of sleep. I have found after sleeping long lengths, and when I am having a difficult time with stress and my depression, my dreams seem *very* real, so much that it feels kinda disturbing.

Of course, spending most of your night dreaming in the REM stage, without much or any deep Stage Four sleep, will leave us tired, exhausted, and contribute to depression and anxiety.

It usually takes good high doses of antidepressants over a period of time to slow down the 'hyper-REM' sleep.

One other suggestion, and again I must underline this is experimental and affects everyone different, is that decreasing your sleep time on purpose will help the hyper-REM activity throttle down. It is sort of a minor form of 'sleep deprivation', which is a sort-of valid, but not widely discussed antidepressant itself. You might be best at starting out trying a 5 or so hour a night sleep, even if you feel like crap first thing.

Here are a couple of journal abstracts to further and better explain sleep, or partial-sleep, deprivation:

Sleep deprivation as a model experimental antidepressant treatment: findings from functional brain imaging.

Gillin JC, Buchsbaum M, Wu J, Clark C, Bunney W Jr.

Department of Psychiatry, UCSD and VA San Diego Healthcare System (116a), 3350 La Jolla Village Drive, San Diego, CA 92161, USA. jgillin@ucsd.edu

This paper reviews the functional brain imaging studies in depressed patients treated with sleep deprivation. Sleep deprivation is an excellent experimental model of antidepressant treatments which offer new opportunities to understand the basic neural mechanisms. Its antidepressant effects are efficacious and rapid; sleep deprivation is easy to administer, inexpensive, and relatively safe; it can be studied in patients, normal controls, and animals; and it may lead to new treatments and new paradigms for antidepressant therapies. Seven published papers, coming from five different research centers, using either positron emission tomography (PET) with 18fluorodeoxyglucose (FDG) or single photon emission computerized tomography (SPECT) with Technetium-99-bexamethyl propyleneamine oxime (HMPAO) have relatively consistent findings. First, before sleep deprivation, responders have significantly elevated metabolism compared with non-responders, and usually the normal controls, in the orbital medial prefrontal cortex, and especially in the ventral portions of the anterior cingulate cortex. Secondly, after sleep deprivation, these hyperactive areas normalize in the responders. The magnitude of the clinical improvement was significantly correlated with decreased local glucose metabolic rate or cerebral blood flow in three studies. The results are consistent with some but not all functional brain imaging studies of antidepressant medications in depressed patients. Finally, a SPECT study using a radioactively labeled D2 receptor antagonist suggests that the antidepressant benefits of sleep deprivation are correlated with endogenous release of dopamine.

Depress Anxiety 2001;14(1):29-36

Potential mechanisms of the sleep therapies for depression.

Ringel BL, Szuba MP.

University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Sleep deprivation for one night has been investigated as a treatment for depression since the first publications describing its antidepressant properties almost 30 years ago [Pflug and Tolle, 1971: Int Pharmacopsychiatry 6:187-196]. It remains a field of active research. It is the only intervention consistently demonstrated to produce next-day antidepressant results. This makes sleep deprivation an exciting and unique tool to study the pathophysiology of depressive disorders and to formulate targets for novel antidepressant agents. Importantly, it is also an effective, but underused, clinical treatment for unipolar and bipolar depression.
--

There is caution because this can trigger mania even in 'soft' of BP2 bipolar patients. The best combination would appear to be a partial-sleep deprivation by setting a couple of alarm clocks to let you get 5-6 hours sleep, as well as a good high dose of an antidepressant.

You may really be suprised, as the affects are quick and immediate. Of course, it is not sustaining, so if you fall back into a lengthy sleep, depression will likely just as quickly return. The results for partial-sleep deprivation are worth a shot for anybody who is depressed, considering the power and effectiveness of it.

Good luck...if you decide to try, let us know how you make out.

Jay

>
> hi. I have recently been sleeping 10 to 12 hours a day. Does too much sleep worsen depression? I am not feeling too well.

 

Re: Me and my situation

Posted by JohnX2 on October 28, 2001, at 0:47:10

In reply to Re: Me and my situation » adamie, posted by judy1 on October 27, 2001, at 22:23:04


I think we are somewhat in agreement here.
Time to go down the more traditional bp
routes. Its possible you are bipolar II which
is often difficult to diagnosis. Atypical
depression symptoms anecdoctally accompany
bipolar II.

Here is my suggestion: start a Lamictal trial.
It has a very good track record here of treating
difficult bipolar depression. It is more likely
stimulating than sedating like other anti-convulsants.
I would just add this slowly under doctor supervision on
top of the zyprexa. Lamictal itself seems to
have some of the best anti-depressant effects
as well as mood stablization of the anti-convulsants
. The fact that zyprexa doesn't make things worse for you
is also an indicator that you may be bipolar (zyprexa treats
bipolar). According to Cam, when Lamictal was
studied for epilepsy it only helped a small portion
for the epilepsy itself, but curiously 2/3 of the
patients continued to take the med because it made
them feel better. This spurred a lot of interest
by psychiatrists with regards for its potential
in treating bipolar illnes.

I searched long and hard for a med to get me out
of a severe major depression, and lamictal saved
my life. I was left with residual dysthymia, but
have been able to tinker with meds on top of lamictal
to address this (currently zyprexa is working well).

I really wish you the best of luck. You have been
through a lot.

Anyone else agree with my thoughts here?
I'd like adamie to avoid going down more bad
paths, and I question moclobemide at this time.
Incidentally this is what I tried before lamictal.
Check the "levity" thread to see how much *hit i
tried before finding solice in lamictal. Not to
mention trying unsuccessfully all the non-traditional
routes you are recently asking about.

good luck!!!!!!!!!!
John

>1 Like John mentioned you seem to be suffering from an 'atypical' depression which is consistant with a bipolar diagnosis. The other consistant fact here is your worsening/non response to AD's- while zyprexa may be a decent choice, have you been tried on lithium or depakote? The best action you might want to try is see a bipolar expert, I may be wrong but I think it's turning into somewhat of a trendy diagnosis and one episode that was not psychotic or obviously manic may not warrent it. Either way your meds need to be reevaluated and I hope you feel better soon- Judy

 

Re: Sleeping too much can worsen depression » jay

Posted by adamie on October 28, 2001, at 12:02:22

In reply to Re: Sleeping too much can worsen depression » adamie, posted by jay on October 28, 2001, at 0:26:01


i will try to force myself to get up after the first time I awake. What happens is after waking up I am still sleepy, tired, and want to sleep more. so instead of 8-9 hours of sleep I get 10-12. Also my sleep is filled with dreams.

there was one time (10 days) where I got almost no sleep at all. Like 2-3 hours of sleep a day. This was the period when my depression was being made worse by celexa. I felt completely horrible. sleep deprivation didn't seem to help then. but perhaps I would have felt even worse without it.

> This is an area I have been doing some of my own research in, as I have found ways to somewhat help my depression via sleep. Again, YMMV, and as always, take caution. Of course, I am no doctor of any sort.
>
> A number of research items and good books suggest one of the important mechnisms of many antidepressants is that they suppress REM sleep.
> Why we with depression likely feel so tired and horrible after long lengths of sleep, is because we tend to spend most of our sleeping hours in and out of dreamy REM sleep. We rarely ever enter the deep Stage Four stage of sleep. I have found after sleeping long lengths, and when I am having a difficult time with stress and my depression, my dreams seem *very* real, so much that it feels kinda disturbing.
>
> Of course, spending most of your night dreaming in the REM stage, without much or any deep Stage Four sleep, will leave us tired, exhausted, and contribute to depression and anxiety.
>
> It usually takes good high doses of antidepressants over a period of time to slow down the 'hyper-REM' sleep.
>
> One other suggestion, and again I must underline this is experimental and affects everyone different, is that decreasing your sleep time on purpose will help the hyper-REM activity throttle down. It is sort of a minor form of 'sleep deprivation', which is a sort-of valid, but not widely discussed antidepressant itself. You might be best at starting out trying a 5 or so hour a night sleep, even if you feel like crap first thing.
>
> Here are a couple of journal abstracts to further and better explain sleep, or partial-sleep, deprivation:
>
> Sleep deprivation as a model experimental antidepressant treatment: findings from functional brain imaging.
>
> Gillin JC, Buchsbaum M, Wu J, Clark C, Bunney W Jr.
>
> Department of Psychiatry, UCSD and VA San Diego Healthcare System (116a), 3350 La Jolla Village Drive, San Diego, CA 92161, USA. jgillin@ucsd.edu
>
> This paper reviews the functional brain imaging studies in depressed patients treated with sleep deprivation. Sleep deprivation is an excellent experimental model of antidepressant treatments which offer new opportunities to understand the basic neural mechanisms. Its antidepressant effects are efficacious and rapid; sleep deprivation is easy to administer, inexpensive, and relatively safe; it can be studied in patients, normal controls, and animals; and it may lead to new treatments and new paradigms for antidepressant therapies. Seven published papers, coming from five different research centers, using either positron emission tomography (PET) with 18fluorodeoxyglucose (FDG) or single photon emission computerized tomography (SPECT) with Technetium-99-bexamethyl propyleneamine oxime (HMPAO) have relatively consistent findings. First, before sleep deprivation, responders have significantly elevated metabolism compared with non-responders, and usually the normal controls, in the orbital medial prefrontal cortex, and especially in the ventral portions of the anterior cingulate cortex. Secondly, after sleep deprivation, these hyperactive areas normalize in the responders. The magnitude of the clinical improvement was significantly correlated with decreased local glucose metabolic rate or cerebral blood flow in three studies. The results are consistent with some but not all functional brain imaging studies of antidepressant medications in depressed patients. Finally, a SPECT study using a radioactively labeled D2 receptor antagonist suggests that the antidepressant benefits of sleep deprivation are correlated with endogenous release of dopamine.
>
> Depress Anxiety 2001;14(1):29-36
>
> Potential mechanisms of the sleep therapies for depression.
>
> Ringel BL, Szuba MP.
>
> University of Pennsylvania, Philadelphia, Pennsylvania, USA.
>
> Sleep deprivation for one night has been investigated as a treatment for depression since the first publications describing its antidepressant properties almost 30 years ago [Pflug and Tolle, 1971: Int Pharmacopsychiatry 6:187-196]. It remains a field of active research. It is the only intervention consistently demonstrated to produce next-day antidepressant results. This makes sleep deprivation an exciting and unique tool to study the pathophysiology of depressive disorders and to formulate targets for novel antidepressant agents. Importantly, it is also an effective, but underused, clinical treatment for unipolar and bipolar depression.
> --
>
> There is caution because this can trigger mania even in 'soft' of BP2 bipolar patients. The best combination would appear to be a partial-sleep deprivation by setting a couple of alarm clocks to let you get 5-6 hours sleep, as well as a good high dose of an antidepressant.
>
> You may really be suprised, as the affects are quick and immediate. Of course, it is not sustaining, so if you fall back into a lengthy sleep, depression will likely just as quickly return. The results for partial-sleep deprivation are worth a shot for anybody who is depressed, considering the power and effectiveness of it.
>
> Good luck...if you decide to try, let us know how you make out.
>
> Jay
>
>
>
>
>
> >
> > hi. I have recently been sleeping 10 to 12 hours a day. Does too much sleep worsen depression? I am not feeling too well.

 

will try to get lamictal » JohnX2

Posted by adamie on October 28, 2001, at 12:08:58

In reply to Re: Me and my situation, posted by JohnX2 on October 28, 2001, at 0:47:10


hi. I will deffinetly try to get lamictal prescribed to me on Nov 8th. Which will be my next visit to a pdoc. I will mention how all AD's made me worse among other things.

Until then I might as well try something so I will try Moclobemide if it arrives. Many of the AD's made me worse after the first day. So I'll see how I am after a few days on it.

>
> I think we are somewhat in agreement here.
> Time to go down the more traditional bp
> routes. Its possible you are bipolar II which
> is often difficult to diagnosis. Atypical
> depression symptoms anecdoctally accompany
> bipolar II.
>
> Here is my suggestion: start a Lamictal trial.
> It has a very good track record here of treating
> difficult bipolar depression. It is more likely
> stimulating than sedating like other anti-convulsants.
> I would just add this slowly under doctor supervision on
> top of the zyprexa. Lamictal itself seems to
> have some of the best anti-depressant effects
> as well as mood stablization of the anti-convulsants
> . The fact that zyprexa doesn't make things worse for you
> is also an indicator that you may be bipolar (zyprexa treats
> bipolar). According to Cam, when Lamictal was
> studied for epilepsy it only helped a small portion
> for the epilepsy itself, but curiously 2/3 of the
> patients continued to take the med because it made
> them feel better. This spurred a lot of interest
> by psychiatrists with regards for its potential
> in treating bipolar illnes.
>
> I searched long and hard for a med to get me out
> of a severe major depression, and lamictal saved
> my life. I was left with residual dysthymia, but
> have been able to tinker with meds on top of lamictal
> to address this (currently zyprexa is working well).
>
> I really wish you the best of luck. You have been
> through a lot.
>
> Anyone else agree with my thoughts here?
> I'd like adamie to avoid going down more bad
> paths, and I question moclobemide at this time.
> Incidentally this is what I tried before lamictal.
> Check the "levity" thread to see how much *hit i
> tried before finding solice in lamictal. Not to
> mention trying unsuccessfully all the non-traditional
> routes you are recently asking about.
>
> good luck!!!!!!!!!!
> John
>
> >1 Like John mentioned you seem to be suffering from an 'atypical' depression which is consistant with a bipolar diagnosis. The other consistant fact here is your worsening/non response to AD's- while zyprexa may be a decent choice, have you been tried on lithium or depakote? The best action you might want to try is see a bipolar expert, I may be wrong but I think it's turning into somewhat of a trendy diagnosis and one episode that was not psychotic or obviously manic may not warrent it. Either way your meds need to be reevaluated and I hope you feel better soon- Judy

 

lamictal

Posted by judy1 on October 28, 2001, at 17:05:38

In reply to will try to get lamictal » JohnX2, posted by adamie on October 28, 2001, at 12:08:58

I agree it is an excellent mood stabilizer for treatment resistant bipolar 2's- in my case it caused a manic episode the two trials I was on it (through UCSD's STEP-BD program). I am however bipolar 1 which I'm learning through this board seems to be a great deal different than bp2- which seems to have more depressive than manic episodes. Please correct me if I'm wrong here- Judy

 

Re: Sleeping too much can worsen depression » adamie

Posted by jay on October 29, 2001, at 2:14:08

In reply to Re: Sleeping too much can worsen depression » jay, posted by adamie on October 28, 2001, at 12:02:22

>
> i will try to force myself to get up after the first time I awake. What happens is after waking up I am still sleepy, tired, and want to sleep more. so instead of 8-9 hours of sleep I get 10-12. Also my sleep is filled with dreams.
>
> there was one time (10 days) where I got almost no sleep at all. Like 2-3 hours of sleep a day. This was the period when my depression was being made worse by celexa. I felt completely horrible. sleep deprivation didn't seem to help then. but perhaps I would have felt even worse without it.
>

Well, if you are still on Celexa, and it is causing nasty effects, it may not be the med for you. I don't think 2-3 hours of sleep is a good idea, (that's why I prefer partial-sleep-deprivation...or just coming slighty under the 'normal' amount of sleep) but try for 5-6 hours. Set your alarm for *exactly* 5-6 hours. It is not even really so much sleep deprivation, as it is preventing yourself from entering light, irritating dream-filled sleep.

The next night, you will be a bit more tired, and likely dip into a bit deeper of sleep, but you have to keep that 5-6 hour schedule *every* night. Ask your doc, but there is no evidence that amount of sleep will do any harm. What meds are you on now?

Jay

 

Re: Sleeping too much can worsen depression

Posted by adamie on October 29, 2001, at 12:47:37

In reply to Re: Sleeping too much can worsen depression » adamie, posted by jay on October 29, 2001, at 2:14:08


i'm not on celexa anymore. i'm on zyprexa, adrafinil, ginseng, and ginko biloba. i am stopping the ginko and adrafinil though.

> > i will try to force myself to get up after the first time I awake. What happens is after waking up I am still sleepy, tired, and want to sleep more. so instead of 8-9 hours of sleep I get 10-12. Also my sleep is filled with dreams.
> >
> > there was one time (10 days) where I got almost no sleep at all. Like 2-3 hours of sleep a day. This was the period when my depression was being made worse by celexa. I felt completely horrible. sleep deprivation didn't seem to help then. but perhaps I would have felt even worse without it.
> >
>
> Well, if you are still on Celexa, and it is causing nasty effects, it may not be the med for you. I don't think 2-3 hours of sleep is a good idea, (that's why I prefer partial-sleep-deprivation...or just coming slighty under the 'normal' amount of sleep) but try for 5-6 hours. Set your alarm for *exactly* 5-6 hours. It is not even really so much sleep deprivation, as it is preventing yourself from entering light, irritating dream-filled sleep.
>
> The next night, you will be a bit more tired, and likely dip into a bit deeper of sleep, but you have to keep that 5-6 hour schedule *every* night. Ask your doc, but there is no evidence that amount of sleep will do any harm. What meds are you on now?
>
> Jay

 

Re: Sleeping too much effects depression?

Posted by Noa on October 29, 2001, at 17:39:09

In reply to Sleeping too much effects depression?, posted by adamie on October 27, 2001, at 19:23:55

Personally, I have found that--at times--getting too little sleep improves my mood in the SHORT run, and getting too much sleep makes it worse. However, over time, I am less irritable if I am getting sufficient sleep.

Last week, I was very sleep deprived and felt great, and then this weekend "caught up" a lot and then felt extremely unmotivated, kind of down, etc. But as I said, I think this is a short-term effect for me. If I were to go on not getting enough sleep, I'd be pretty miserable. Also, there is a difference, for me, between what is sufficient sleep and what is too much.

 

Re: lamictal

Posted by JohnX2 on October 31, 2001, at 2:49:04

In reply to lamictal, posted by judy1 on October 28, 2001, at 17:05:38


You are correct. Technically bpii patients
do not have "manic" episodes, but may be more prone
to short lived hypo-mania. The hypo-mania can be confused with
ADHD at times. Anyways, from doing a lot of studying
I have learned that bipolar patients generally can not
expect to get the typical response to an anti-depressant
that a vanilla major depression has. The "tide" doesn't
tend to just roll in (with regards to lifting the
depression), a lot of bipolars if not on mood stabilizer
can immediately get worse, trigger mania, or worse yet
become cyclothymic.

If adamie wants to try something quicker acting
one may want to consider Depakote or Trileptal
for the model stabilizer. Don't worry, any
anti-manic effect wont prevent an anti-depressant
response. Lamictal for some reason seems to have
its own anti-depressant characteristics and is
sometimes helpful for unipolar depression. A lot
of people who had trouble getting stabilized on
anything seem to do well on lamictal, even if
it is a bitch to titrate the dose.

-john


> I agree it is an excellent mood stabilizer for treatment resistant bipolar 2's- in my case it caused a manic episode the two trials I was on it (through UCSD's STEP-BD program). I am however bipolar 1 which I'm learning through this board seems to be a great deal different than bp2- which seems to have more depressive than manic episodes. Please correct me if I'm wrong here- Judy

 

Re: will try to get lamictal » adamie

Posted by Cam W. on November 1, 2001, at 18:23:58

In reply to will try to get lamictal » JohnX2, posted by adamie on October 28, 2001, at 12:08:58

Judy - Personally, I have not seen much success using Lamictal™ (lamotrigine) as monotherapy in clinical situation (mind you, I have only seen a few Lamictal monotherapy regimens at the stores I have worked at). It is usually used as an adjunct to other mood stabilizers, like lithium and Epival™ (Depakote™ - divalproex).

A few placebo-controlled trials (both company- and NIMH-funded) have been done using Lamictal as a monotherapy and in conjunction with another mood stabilizer, in both Bipolar I and Bipolar II patients. Although there were some potential methodologicaal errors in the ways the studies were conducted (eg. no rapid cyclers in a couple of studies; one study was all rapid cyclers; one study was open label; one study, only BPII responded; one study incl. tapering off of lithium which can lead to relapse; one study only used patients already stabilized on Lamictal; etc.) all the studies seemed to end up with about a 50% lamictal response rate and a 20% placebo response rate (weird, huh?).

So, no matter what you do (use Lamictal with lithium, or by itself), you seem to have a 50-50 chance of having a response to it. I'd be interested to see a "Lamictal Monotherapy v. Lamictal-Depakote" study, but I haven't seen one, yet.

Sorry to make your decision even more confusing. - Cam

 

Re: will try to get lamictal » Cam W.

Posted by judy1 on November 1, 2001, at 18:50:28

In reply to Re: will try to get lamictal » adamie, posted by Cam W. on November 1, 2001, at 18:23:58

Hi Cam,
I was part of the study you mentioned and agree with your assessment- although UCSD was delighted with their results and I'm sure we'll see some 'massaging' of the data- particularly placebo results (Maybe I'm cynical). I was in the rapid-cycling group for bp1 and lamictal as a monotherapy. Well you go with the one's paying the bills, but I agree a depakote (a very depressing med but awesome anti-manic for me) lamictal study would be a great study to see- especially for rapid cyclers. Actually I was on that particular combo, but I had to be monitored so much with biweekly blood test and very slow titration of lamictal- it takes very experienced pdocs to do it and extremely motivated patients. BTW, I had a good response, less cycling (but then I got pregnant) so I would recommend it to others. Take care, judy

 

lamical with ssri? » Cam W.

Posted by jazzdog on November 2, 2001, at 12:38:42

In reply to Re: will try to get lamictal » adamie, posted by Cam W. on November 1, 2001, at 18:23:58

> Judy - Personally, I have not seen much success using Lamictal™ (lamotrigine) as monotherapy in clinical situation (mind you, I have only seen a few Lamictal monotherapy regimens at the stores I have worked at). It is usually used as an adjunct to other mood stabilizers, like lithium and Epival™ (Depakote™ - divalproex).
>
> A few placebo-controlled trials (both company- and NIMH-funded) have been done using Lamictal as a monotherapy and in conjunction with another mood stabilizer, in both Bipolar I and Bipolar II patients. Although there were some potential methodologicaal errors in the ways the studies were conducted (eg. no rapid cyclers in a couple of studies; one study was all rapid cyclers; one study was open label; one study, only BPII responded; one study incl. tapering off of lithium which can lead to relapse; one study only used patients already stabilized on Lamictal; etc.) all the studies seemed to end up with about a 50% lamictal response rate and a 20% placebo response rate (weird, huh?).
>
> So, no matter what you do (use Lamictal with lithium, or by itself), you seem to have a 50-50 chance of having a response to it. I'd be interested to see a "Lamictal Monotherapy v. Lamictal-Depakote" study, but I haven't seen one, yet.
>
> Sorry to make your decision even more confusing. - Cam


Cam - do you know if any studies have been done with lamictal and ssris? I am about to start on lamictal along with 50 mg. zoloft (which I already take) in an attempt to treat my chronic derealization. The depersonalization unit at Maudsley Hospital in London claim they have had some success with this protocol. Are you familiar with this work? Thanks - a fellow Canadian

 

Re: lamical with ssri? » jazzdog

Posted by JahL on November 2, 2001, at 13:04:06

In reply to lamical with ssri? » Cam W., posted by jazzdog on November 2, 2001, at 12:38:42


>
> Cam - do you know if any studies have been done with lamictal and ssris? I am about to start on lamictal along with 50 mg. zoloft (which I already take) in an attempt to treat my chronic derealization. The depersonalization unit at Maudsley Hospital in London

I met the director of this unit just the other day. Anything you want to know?

>claim they have had some success with this protocol. Are you familiar with this work?

It's pretty much the only treatment they have found to be of significant help. However Sulpiride & Amisulpride were mentioned as reliable anxiolytics, anxiety being thought to be an exacerbating (if not causal) factor in DP.

I was on 400mg/Lamictal + 40mg/Prozac-the rec'd dose range-to little effect (though the Lamictal on its own helps a little). I've just switched to Celexa 20mg, possibly with the aim of going higher.

Apparently Zoloft & Celexa are the preferred SSRIs in this instance. Prozac is thought to be too activating.

BTW-did you know that only the 2nd DP unit in the world was recently-ish set up in, I think, NY?

J (who also has chronic derealisation).

(have you read the Maudsley website?)

 

Re: lamical with ssri? » jazzdog

Posted by Cam W. on November 2, 2001, at 13:26:40

In reply to lamical with ssri? » Cam W., posted by jazzdog on November 2, 2001, at 12:38:42

Jazzdog - I'd be interested in seeing SSRI-Lamictal study. It does makes sense that this combination will be tried clinically, anyway.

Thanks Jazzdog - Cam

 

Re: lamical with ssri? » JahL

Posted by jazzdog on November 2, 2001, at 17:23:34

In reply to Re: lamical with ssri? » jazzdog, posted by JahL on November 2, 2001, at 13:04:06


> I met the director of this unit just the other day. Anything you want to know?
>
>
>
> It's pretty much the only treatment they have found to be of significant help. However Sulpiride & Amisulpride were mentioned as reliable anxiolytics, anxiety being thought to be an exacerbating (if not causal) factor in DP.
>
> I was on 400mg/Lamictal + 40mg/Prozac-the rec'd dose range-to little effect (though the Lamictal on its own helps a little). I've just switched to Celexa 20mg, possibly with the aim of going higher.
>
> Apparently Zoloft & Celexa are the preferred SSRIs in this instance. Prozac is thought to be too activating.
>
> BTW-did you know that only the 2nd DP unit in the world was recently-ish set up in, I think, NY?
>
> J (who also has chronic derealisation).
>
> (have you read the Maudsley website?)

JahL - I'm sorry the lamictal and prozac haven't been helpful. I read various earlier posts that turned up with a search of 'lamictal', and yours were some that gave me hope. Didn't you say you responded at 25 mg? Do you think you might have done better if you'd stayed there instead of titrating upward?

Thank god for the dpunit at Maudsley - otherwise there'd be no hope at all. There's so little research on this dissociative state, probably because its sufferers appear normal from the outside. But inside, we feel like we're sleepwalking through a dream. I have an incredibly fragmented sense of self, and feel disconnected from everything pretty much all the time.

Yes, I have seen the Maudsley site. Have you seen the depersonalization boards at www.dpselfhelp.com?

 

Re: lamical with ssri?

Posted by jazzdog on November 2, 2001, at 17:32:33

In reply to Re: lamical with ssri? » jazzdog, posted by Cam W. on November 2, 2001, at 13:26:40

> Jazzdog - I'd be interested in seeing SSRI-Lamictal study. It does makes sense that this combination will be tried clinically, anyway.
>
> Thanks Jazzdog - Cam

Cam - I'm sorry I don't have any studies to refer you to. My psychiatrist emailed the depersonalization unit at Maudsley to find out if anything had been helpful with derealization. They emailed back and said they'd had about 50% success with a combination of about 250 mg lamictal and an ssri. I don't know how large their sample was. This gave me hope, because I've also read - here and elsewhere - that lamictal can be useful for atypical depression, which I also suffer from. I'm a lifelong eat-and-sleep depressive who burst out gloriously about fifteen years ago in a prolonged psychotic mania - most fun I've ever had!

While we're on the subject of lamictal, my shrink was speculating on what its mechanism of operation might be. I've read a couple of people on the depersonalization board talk about lamictal working for them by 'more clearly defining and separating the sleeping state and the waking state.' Any theories? JohnX2, feel free to jump in.

Thanks - Jane

 

Re: lamical with ssri? » jazzdog

Posted by VMBW on November 3, 2001, at 18:52:20

In reply to Re: lamical with ssri?, posted by jazzdog on November 2, 2001, at 17:32:33

> >
I just thought I'd add my two cents. I was on Effexor only for 3 years with only minor success. Added lamictal about 8 months ago and it has really helped. In fact, I am about to taper off of the Effexor suspecting that it may be the cause of my lethargy so I'll see how monotherapy works. Pdoc says he's seen many cases (in his and others practice) where the monotherapy of Lamicatal has been successful but he also is unaware of any SSRI and Lamicatal studies at this time.Seems to be just a matter of time now that Lamicatal is being prescribed more often.

Jazzdog - I'd be interested in seeing SSRI-Lamictal study. It does makes sense that this combination will be tried clinically, anyway.
> >
> > Thanks Jazzdog - Cam
>
> Cam - I'm sorry I don't have any studies to refer you to. My psychiatrist emailed the depersonalization unit at Maudsley to find out if anything had been helpful with derealization. They emailed back and said they'd had about 50% success with a combination of about 250 mg lamictal and an ssri. I don't know how large their sample was. This gave me hope, because I've also read - here and elsewhere - that lamictal can be useful for atypical depression, which I also suffer from. I'm a lifelong eat-and-sleep depressive who burst out gloriously about fifteen years ago in a prolonged psychotic mania - most fun I've ever had!
>
> While we're on the subject of lamictal, my shrink was speculating on what its mechanism of operation might be. I've read a couple of people on the depersonalization board talk about lamictal working for them by 'more clearly defining and separating the sleeping state and the waking state.' Any theories? JohnX2, feel free to jump in.
>
> Thanks - Jane

 

Re: lamical with ssri? » jazzdog

Posted by JahL on November 3, 2001, at 19:07:55

In reply to Re: lamical with ssri? » JahL, posted by jazzdog on November 2, 2001, at 17:23:34


> JahL - I'm sorry the lamictal and prozac haven't been helpful. I read various earlier posts that turned up with a search of 'lamictal', and yours were some that gave me hope. Didn't you say you responded at 25 mg? Do you think you might have done better if you'd stayed there instead of titrating upward?

No. My 'response' was characterised by mild hypomania which, whilst enjoyable in small doses, was never going to be sustainable. I don't think the response was related to the dose; it was actually the addition of Klonopin (which does nothing alone) that kick-started things, almost immediately. From the very first high I could feel the effect gradually dwindling & I continued to raise the dose only to chase that original feeling.

I wonder how significant the fact that Klonopin reinforces the Lamictal is. I think that Cam said it elsewhere that Lamictal, whilst being increasingly recognised as a useful agent, is probably best viewed as an adjunctive MS. As my case demonstrates, Lamictal alone has the potential to precipitate mania. I think the addtn of more MSs is the way forward for me...

That said, I think you have fair cause for optimism. Currently I think a little more clearly which obviously helps re: connecting to the real world and my DP/R is certainly better at present than it has been in the past. I intend to stick with Lamictal for the time being...

> Thank god for the dpunit at Maudsley - otherwise there'd be no hope at all.

I've been less than impressed with previous Maudsley pdocs I've met but (so far) I like this unit. The people running it are pretty young & still have that 'youthful zeal' so often missing in the jaded types I tend to see.

>There's so little research on this dissociative state, probably because its sufferers appear normal from the outside.

I think that has alot to do with it. Also, it's so hard to quantify ["so, how removed from reality do you feel today?" "what's reality?"]. There's plenty of pdoc ignorance surrounding the condition. It took a year of me talking about 'being stuck in a trance', of persistent visual distortions and of feeling like I was permanently stuck 'on a trip' before some bright spark suggested derealisation.

> But inside, we feel like we're sleepwalking through a dream. I have an incredibly fragmented sense of self, and feel disconnected from everything pretty much all the time.

I would say at this point that I empathise incredibly but as you no doubt know, DP frequently involves detachment from emotion; can't say I experience anything other than anger. But yeah, I know exactly how you feel.

> Yes, I have seen the Maudsley site. Have you seen the depersonalization boards at www.dpselfhelp.com?

Just had a look. Looks a bit 'chatty' for unsociable old me, but it's obviously early days there. Have you seen the board affiliated to the Maudsley? I have enough trouble keeping up with this board (PB) but a friend of mine speaks highly of it. Now defunct but plenty of archives...

Best,
J.


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