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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by sid on February 3, 2002, at 11:57:21
Hello all,
when depressed, unlike the majority of depressive people, I sleep too much and eat too much carbs. When I say sleep too much, I mean 10 hours+. If there is no disruption, I could sleep 16 hours nonstop. And during my major depresison, I never remembered a dream, as if I didn't dream. I'd wake up groggy and feel sleepy for a few more hours, no matter how many hours I had slept (8 vs. 16).
That got better as the major depression lifted, but I still tended to sleep a lot (10 hours if no disruption, 8 otherwise; less than 8 hours, I had trouble functioning), and I never remembered a dream.
Now I'm on Effexor XR for dysthymia and anxiety, although I am still at a low dose - unsure if it's effective yet. One of the side effects I've experienced (the most enduring one) is insomnia. I sleep less, sometimes having trouble to sleep at all. And I remember more dreams when I wake up, or perhaps I dream more altogether?
Does anyone know what happened when I slept so much during the major depression, and why I seem to remember more dreams these days? I don't want to get back to the sleepy head I used to be, but I do need to sleep more than I have lately if I want to keep my job. And I don't understand what is going on. Gravol seems to help some nights (thanks IsoM for the suggestion), but not always. Basically, I'd like to understand better why my sleep pattern is so intricately linked to my depression history and now to my medical treatment.
Thanks in advance.
- sid
Posted by Ritch on February 3, 2002, at 13:04:36
In reply to Sleep and depression, posted by sid on February 3, 2002, at 11:57:21
> Hello all,
>
> when depressed, unlike the majority of depressive people, I sleep too much and eat too much carbs. When I say sleep too much, I mean 10 hours+. If there is no disruption, I could sleep 16 hours nonstop. And during my major depresison, I never remembered a dream, as if I didn't dream. I'd wake up groggy and feel sleepy for a few more hours, no matter how many hours I had slept (8 vs. 16).
>
> That got better as the major depression lifted, but I still tended to sleep a lot (10 hours if no disruption, 8 otherwise; less than 8 hours, I had trouble functioning), and I never remembered a dream.
>
> Now I'm on Effexor XR for dysthymia and anxiety, although I am still at a low dose - unsure if it's effective yet. One of the side effects I've experienced (the most enduring one) is insomnia. I sleep less, sometimes having trouble to sleep at all. And I remember more dreams when I wake up, or perhaps I dream more altogether?
>
> Does anyone know what happened when I slept so much during the major depression, and why I seem to remember more dreams these days? I don't want to get back to the sleepy head I used to be, but I do need to sleep more than I have lately if I want to keep my job. And I don't understand what is going on. Gravol seems to help some nights (thanks IsoM for the suggestion), but not always. Basically, I'd like to understand better why my sleep pattern is so intricately linked to my depression history and now to my medical treatment.
>
> Thanks in advance.
>
> - sidHi Sid,
My sleep patterns almost exactly mirror my mood states-I am not sure whether it is the chicken or the egg, however (does poor sleep architecture create the affective state or is the poor sleep a result of the affective state, or both-they reinforce each other?). I feel the best when I go to sleep easily, sleep soundly, dream a *little*, remember *some* of the dreams, and get up quickly in the morning after about 7 hrs. sleep.
Medications *definitely* alter all of this greatly. You mentioned Effexor. When I was on it I had the most vivid dreaming than any other med. Interestingly, I also noticed an obvious increase in color intensity during the day (esp. reds, yellows).
If I do not take a stimulant or stim-likeAD (like Wellbutrin) during my major depressions I have the same symptoms. I will tend to just hang-around in bed for hours after I should be getting up. The worst I can remember is about 12 hours of sleep and remaining sleepy the remaining 12 hrs! It really sucked(also absolutely NO focus and NO interest in anything). I also get into the complex carb craving thing big time-too-lots of potatoes, starches, pastas, rice, etc. My depressions are very seasonal. Are your depressions seasonal (fairly predictable-timing and duration)? If so, you might investigate specific meds/treatments that target SAD type symptoms.
Mitch
Posted by Anyuser on February 3, 2002, at 14:22:32
In reply to Re: Sleep and depression » sid, posted by Ritch on February 3, 2002, at 13:04:36
Posted by OldSchool on February 3, 2002, at 14:57:34
In reply to Sleep and depression, posted by sid on February 3, 2002, at 11:57:21
> Hello all,
>
> when depressed, unlike the majority of depressive people, I sleep too much and eat too much carbs. When I say sleep too much, I mean 10 hours+. If there is no disruption, I could sleep 16 hours nonstop. And during my major depresison, I never remembered a dream, as if I didn't dream. I'd wake up groggy and feel sleepy for a few more hours, no matter how many hours I had slept (8 vs. 16).
>
> That got better as the major depression lifted, but I still tended to sleep a lot (10 hours if no disruption, 8 otherwise; less than 8 hours, I had trouble functioning), and I never remembered a dream.
>
> Now I'm on Effexor XR for dysthymia and anxiety, although I am still at a low dose - unsure if it's effective yet. One of the side effects I've experienced (the most enduring one) is insomnia. I sleep less, sometimes having trouble to sleep at all. And I remember more dreams when I wake up, or perhaps I dream more altogether?
>
> Does anyone know what happened when I slept so much during the major depression, and why I seem to remember more dreams these days? I don't want to get back to the sleepy head I used to be, but I do need to sleep more than I have lately if I want to keep my job. And I don't understand what is going on. Gravol seems to help some nights (thanks IsoM for the suggestion), but not always. Basically, I'd like to understand better why my sleep pattern is so intricately linked to my depression history and now to my medical treatment.
>
> Thanks in advance.
>
> - sidAt least you could sleep during your major depression. I couldnt sleep at all. My sleep "locked up" on me totally. Total insomnia without taking drugs to knock me out. Id be super tired and sleepy, but couldnt fall asleep. Talk about a living hell. Also I had severe night sweating, Id have to take benzos or low dose trazodone at bedtime to knock me out into this shitty, shallow sleep. Id jerk awake repeatedly during the night and my bed would be soaked in sweat. My covers would be all over the place and my bed pushed about three feet from the wall.
Talk about existing in a world of shit.
Remeron changed all of the above. First Remeron I took and it was zzzzzzz time. Thank God for Remeron, its a wonder drug.
Old School
Posted by IsoM on February 3, 2002, at 16:32:53
In reply to Sleep and depression, posted by sid on February 3, 2002, at 11:57:21
Sid, sleep & depression & all other moods, I think, are so tied together. Normal, for me, means 8-11 hours light sleep with frequent awakening (4-8 times/night), too much dreaming & groggy when I get up - never feel well rested. My best sleep will occur shortly before I'm due to get up. If I do nap in the afternoon, I sleep good for 1-2 hours but dislike doing that. I honestly never remember having slept well even as a child.
I've been back on my adrafinil for 17 days now & the last 2 nights, I only woke twice each night. Last night I slept 11 hours & other than wakening twice, slept very solid too. Surprising! Maybe my body's catching up on deep sleep?? I'll have to wait to see what the long-term benefits of adrafinil are, sleep-wise. I'll check the write-up on adrafinil from the CNS Drug Review on it but I think it said that it did improve sleep for many. (Who knows? It may even help my headaches. Solid sleep = less headaches?)
You do know, don't you Sid, that just because you don't remember your dreams, doesn't mean you don't dream? I think I remember mine so easily as I awaken briefly after my dreams throughout the night & so am aware of what they are. If you cycle from your REM sleep down through the layers to stage 2, 3, & 4 without surfacing, you wouldn't remember them. So if you're remembering them more, it probably means that you're not sleeping as deeply as before - a common side-effect of SSRIs. Your dreams might be more vivid, but it's likely you're still dreaming the same amount as before. Your deeper, more restorative, sleep may be suffering though.
Gravol has served to help me fall asleep easier, but it's never helped me stay asleep in the least. I'm hoping adrafinil will enable me to chuck out the Gravol completely.
Years ago, in th early '80s, I read a article in a science journal on sleep. It mentioned that most people fall into 2 categories with falling asleep & wakening. They tend to either have "thick" boundaries or "thin" ones. Those with thick boundaries could feel themselves growing sleepy, sinking deeper & deeper into sleep. They usually could be easily aroused from sleep then. They also rose slowly from sleep when awakening. But paradoxically, couldn't be easily aroused into wakefullness but would slip back into sleep. The thin boudaries were those whose head hit the pillow & they were out. Same with wakening - they'd open their eyes & were awake.
It seemed few people with thin boundaries had sleep disturbances/problems. It was those with thick boundaries that had the most disturbances or were more likely to at some point in their life. Sleep science being in its relative infancy then, had no explanation for these differences. I'd still loved to know myself & have never read anything new about it yet.
Posted by sid on February 3, 2002, at 21:28:37
In reply to Re: Sleep and depression » sid, posted by Ritch on February 3, 2002, at 13:04:36
> My depressions are very seasonal. Are your depressions seasonal (fairly predictable-timing and duration)? If so, you might investigate specific meds/treatments that target SAD type symptoms.
>
> MitchHi Mitch,
yes they tend to be seasonal, but then so does my stress level, following the school year. Since my depression and stress intensity are related (two-way relationship, both chicken and egg), it's hard for me to be sure about seasonality. I'll think about your suggestion some more. Thanks.- sid
Posted by sid on February 3, 2002, at 21:30:54
In reply to Re: Sleep and depression, posted by OldSchool on February 3, 2002, at 14:57:34
> At least you could sleep during your major depression. I couldnt sleep at all. My sleep "locked up" on me totally. Total insomnia without taking drugs to knock me out. Id be super tired and sleepy, but couldnt fall asleep. Talk about a living hell. Also I had severe night sweating, Id have to take benzos or low dose trazodone at bedtime to knock me out into this shitty, shallow sleep. Id jerk awake repeatedly during the night and my bed would be soaked in sweat. My covers would be all over the place and my bed pushed about three feet from the wall.
>
> Talk about existing in a world of shit.My life with Effexor XR is like that some nights! It was not any easier to have a life when I slept 16 hours a day and felt sleepy the other 8 hours though. Oh well.
Posted by sid on February 3, 2002, at 21:41:20
In reply to Re: Sleep, depression, and meds » sid, posted by IsoM on February 3, 2002, at 16:32:53
> (Who knows? It may even help my headaches. Solid sleep = less headaches?)
I think so. I had a headache on Th and Fri this week because I did not sleep enough all week. Then Fri and Sat night I took Gravol to fall asleep more easily. Did not wake up during the night = headache gone. I hope sleep does the same for you.
> You do know, don't you Sid, that just because you don't remember your dreams, doesn't mean you don't dream?
Yes, I know. But I never heard of someone other than me who did not remember a dream in 2 years +. I did sleep a lot and very very deeply during my depression. In general I sleep pretty deeply but not as many hours. I rarely wake up at night without meds. With Effexor, when I change dosage, I wake up several times per night, for about a week, and then it's one time per night or none. But the falling asleep part is problematic. If I manage to fall asleep early enough, then I'm fine. Otherwise, it's up most of the night if not all night.
> So if you're remembering them more, it probably means that you're not sleeping as deeply as before - a common side-effect of SSRIs. Your dreams might be more vivid, but it's likely you're still dreaming the same amount as before. Your deeper, more restorative, sleep may be suffering though.
Yes, it seems like it. They may be more vivid, I wouldn't really know since I very rarely remembered any dream.
> I'm hoping adrafinil will enable me to chuck out the Gravol completely.Cross my fingers.
About the article: I usually fall asleep as soon as I hit the pillow but I take a lot of time in the morning to wake up and not be groggy. So I seem to be a mixture of thick-thin (!)... Once again, I don't fit in the usual categories! Oh well.
- sid
Posted by Ritch on February 3, 2002, at 23:44:30
In reply to What is your opinion of Wellbutrin? (nm) » Ritch, posted by Anyuser on February 3, 2002, at 14:22:32
Well,
I have to say something I say about a lot of different medications...It works, but...
WB doesn't help with my attention as well as a standard pstim. Even nortriptyline helped with ADHD a little better. I can't tolerate more than 75mg a day. I am extremely med sensitive and I go by the 1/4 rule generally with meds. That is what most folks take I divide by 1/4 and that is about what I can stand to tolerate. I must say it got me through my seasonal depression this winter, so that says quite a lot. The seasonal depression has lifted and now I am facing several weeks of mood cycling, so I don't need to take much of it now-in fact if I take more than a 1/4 tab of WB now I can't sleep right. That's what I like about standard pstims like Adderall, they work during the day when I need to be awake and then they get lost at bedtime so I can sleep. The reason I think that "certain" antidepressants are less likely to result in bipolar cycling than "other" antidepressants generally has to do with their half-lives. The shorter the half-life generally the less troublesome they are with cycling simply because they don't keep you up at nite when you need to sleep. (just a theory, now).
Mitch
Posted by Ritch on February 3, 2002, at 23:55:47
In reply to Re: Sleep and depression » Ritch, posted by sid on February 3, 2002, at 21:28:37
> > My depressions are very seasonal. Are your depressions seasonal (fairly predictable-timing and duration)? If so, you might investigate specific meds/treatments that target SAD type symptoms.
> >
> > Mitch
>
> Hi Mitch,
> yes they tend to be seasonal, but then so does my stress level, following the school year. Since my depression and stress intensity are related (two-way relationship, both chicken and egg), it's hard for me to be sure about seasonality. I'll think about your suggestion some more. Thanks.
>
> - sid
Sid,There is one upside to all of this.. If you can't control what time of year it is you might be able to control you sleep.. Fix your sleep-fix your mood? I can't do it without chemical help-but I am optimistic that I *might* have some way to control it.
Mitch
Posted by johnj on February 4, 2002, at 20:41:39
In reply to Re: Sleep and depression, posted by OldSchool on February 3, 2002, at 14:57:34
I am just like you, I couldn't sleep at all and had terrible anxiety too. How did you get off the benzo when switching to remeron? I have had sleep problems recently and the doc says the pamelor, lithium, tranxene combo needs to be tweaked. Remeron sounds interesting to me. Did any other AD work for you?
Posted by OldSchool on February 4, 2002, at 21:00:51
In reply to OldSchool Question for you, posted by johnj on February 4, 2002, at 20:41:39
> I am just like you, I couldn't sleep at all and had terrible anxiety too. How did you get off the benzo when switching to remeron? I have had sleep problems recently and the doc says the pamelor, lithium, tranxene combo needs to be tweaked. Remeron sounds interesting to me. Did any other AD work for you?
I was taking Xanax daily before Remeron, mainly for sleep. I just went off it cold turkey when I started Remeron and never noticed any problems whatsoever. I had been taking Xanax for about three months when I did that.I dont understand the biggie people have about going off benzos. Ive done it several times and it was no big deal. Maybe if youve been taking benzos for years it might cause probs.
Remeron is indeed one of the better ADs for sleep. You take it at bedtime for its strong sedative properties. Its actually too sedating for most though. But I had agitated depression in the beginning REAL bad and had pretty much total insomnia ie; "sleep lockup." Classic melancholia type depression...losing weight real bad, severe insomnia, total loss of sex drive, cognitive slowing and decline, psychomotor agitation and anxiousness. Remeron helped all of the above and did it rather quickly.
Posted by BLPBart on February 7, 2002, at 0:18:19
In reply to What is your opinion of Wellbutrin? (nm) » Ritch, posted by Anyuser on February 3, 2002, at 14:22:32
I had the kind of depression which resulted in way too much sleeping and then feeling groggy and out of it for the rest of the day. I've always been the kind of person who takes a long time to fall asleep and then has a hard time getting up in the morning so the depression made that even worse. I'm now on wb and it has worked well for me. My depression is gone and I'm more energetic and motivated than I was before.
Posted by Anyuser on February 7, 2002, at 2:19:14
In reply to Re: What is your opinion of Wellbutrin?, posted by BLPBart on February 7, 2002, at 0:18:19
Had you tried an SSRI before Wellbutrin? If so, how would you compare them?
Was it tough getting used to Wellbutrin?
Posted by johnj on February 7, 2002, at 11:24:44
In reply to Re: OldSchool Question for you, posted by OldSchool on February 4, 2002, at 21:00:51
How long have you been taking Remeron and is it the only thing you take now(no more xanax)? Have you had or heard of anybody having it stop working after a short period of time? I seem to see people saying thinkg like this, but I don't find any doctors talking about this. My old doc didn't seem to want me to try anything new due to hearing things about this, but he was talking about the SSRI's. Thanks
Posted by OldSchool on February 7, 2002, at 13:29:03
In reply to Re: OldSchool Another Question for you, posted by johnj on February 7, 2002, at 11:24:44
> How long have you been taking Remeron and is it the only thing you take now(no more xanax)? Have you had or heard of anybody having it stop working after a short period of time? I seem to see people saying thinkg like this, but I don't find any doctors talking about this. My old doc didn't seem to want me to try anything new due to hearing things about this, but he was talking about the SSRI's. Thanks
I havent taken Remeron since late 1998 dude. I took Remeron a lot the first year of my depression. It pooped out on me but I think that had more to do with the fact I was taking it with a half mg of Risperdal. I found that soon after adding Risperdal it pooped out and ever since then Ive never had a good antidepressant response to any antidepressant. Probably the best antidepressant effect Ive had since then was with dopaminergic ADs like Wellbutrin SR and high dose Effexor XR.
Remeron is a good antidepressant, particularly for agitated depression and people with severe insomnia. Under normal circumstances it should not poop out on you or stop working. It stopped working for me, however I am far from a typical case and what happened to me probably wouldnt happen to you.
Old School
Posted by Reneeb on February 7, 2002, at 15:31:43
In reply to Re: What is your opinion of Wellbutrin? » BLPBart, posted by Anyuser on February 7, 2002, at 2:19:14
> Hi, I have been on wellbutrin for a year now. The first couple of weeks were awful. I was dizzy and very lightheaded,after that I was fine. I like it because I don't feel like I am on anything. I am also weaning myself off of effexor and the more I am off of effexor, the more energy I seem to have. I contribute that to the wellbutrin.
Renee
Posted by johnj on February 7, 2002, at 16:29:20
In reply to Re: OldSchool Another Question for you, posted by OldSchool on February 7, 2002, at 13:29:03
Thanks for the info. I have been hesitant to try it for the reasons of poop out. I am on a TCA with lithium because I had the same type of depression and agitation as you did. I felt better, but recently have had problems and am losing lots of sleep. You said you were on Remeron for a year? Have you thought of trying it again? What did your doc say about it pooping out? Did the doc explain the reason for it pooping out? Thanks again
Posted by OldSchool on February 7, 2002, at 19:16:22
In reply to Re: OldSchool Another Question for you, posted by johnj on February 7, 2002, at 16:29:20
> Thanks for the info. I have been hesitant to try it for the reasons of poop out. I am on a TCA with lithium because I had the same type of depression and agitation as you did. I felt better, but recently have had problems and am losing lots of sleep. You said you were on Remeron for a year? Have you thought of trying it again? What did your doc say about it pooping out? Did the doc explain the reason for it pooping out? Thanks again
No, I was on Remeron for about eight months. It shouldnt poop out on you. My psychiatrists at the time gave me no explanation whatsoever as to why the Remeron pooped out on me. Keep in mind that ALL antidepressants I tried at that time pooped out on me and I have never gotten a truly good response from ADs after I took low dose Risperdal. I have no idea why this happened to me, I have my own suspicions why it happened but I dont really know and couldnt give you an answer.Psychiatrists dont know the answer to many cases of antidepressant poop out. One of the few technical explanations Ive read about is that serotonergic antidepressants like SSRIs tend to deplete dopamine levels over time and this can lead to poop out, as well as apathy and a flattening of emotions effect. Another reason why antidepressants can poop out on you is thyroid problems (hypothyroidism).
Another thing that can make antidepressants not activate good is "playing games" with your meds. By this I mean repeatedly going on and off the same antidepressant in a relatively short period of time. Many find that when they go off an AD and return to it a short while later, it doesnt activate good like the first time. I always recommend to people to not go on and off an antidepressant repeatedly as this tends to do things which makes meds poop out and lose their punch.
But if you go off a antidepressant gradually and then wait a long time to return to it, it should activate good the second time. Its just this biz of going off an AD and trying it again like the next week or month or two where it wont work again.
The only thing that ever seemed to make my antidepressants activate better was getting on an exercise kick for a couple months. Like doing a lot of aerobic exercise everyday, after a few weeks of that my meds would activate some. I also found my meds seemed to work a little better after my rTMS sessions. But not much. Some people say if you add a dopaminergic med to your antidepressant that this will reactivate your antidepressant. Like Ritalin, amphetamines, Amantadine, Mirapex, etc.
Ive read of people who said their meds started working good again after they had bilateral ECT done.
Another thing I have found that seems to make my antidepressants work better for me is to take vitamin E daily. If I take 400 IU vitamin E with a selenium supplement daily, I notice some mild improvement in how my AD works. However I dont think this is typical and is very particular to just me.
Posted by johnj on February 7, 2002, at 20:56:29
In reply to Re: OldSchool Another Question for you, posted by OldSchool on February 7, 2002, at 19:16:22
Can you tell me what Risperdal is for? I have never heard of it before. I was on my meds before I had the net and now I find myself trying to catch up with all that is going on.
I had pnuemonia last summer and ever since then my meds seem to be acting funky on me. I wonder if the anti-biotics hurt me somehow? I am barely functional at work and am nervous about getting worse and losing my job so go to a new doc on Monday. The guy I see for med adjustment is just sitting behind the desk and charging me a bundle for doing nothing. I am just trying to arm myself with as much knowledge to make the visit worthwhile. I am thinking of serzone or remeron as a possible alternative AD. Pamelor's side effects are coming back and they really suck. Thanks for your responses. Take it easy
John
Posted by OldSchool on February 7, 2002, at 21:46:02
In reply to Re: OldSchool Another Question for you, posted by johnj on February 7, 2002, at 20:56:29
> Can you tell me what Risperdal is for? I have never heard of it before. I was on my meds before I had the net and now I find myself trying to catch up with all that is going on.
>
> I had pnuemonia last summer and ever since then my meds seem to be acting funky on me. I wonder if the anti-biotics hurt me somehow? I am barely functional at work and am nervous about getting worse and losing my job so go to a new doc on Monday. The guy I see for med adjustment is just sitting behind the desk and charging me a bundle for doing nothing. I am just trying to arm myself with as much knowledge to make the visit worthwhile. I am thinking of serzone or remeron as a possible alternative AD. Pamelor's side effects are coming back and they really suck. Thanks for your responses. Take it easy
> JohnRisperdal is an atypical anti-psychotic similar to Seroquel and Zyprexa. I took it in low dose (half a mg) along with Remeron for two months back in early 98, in the beginning stages of my depression. I found the Risperdal to cause bad EPS in me (muscle stiffness and tightness, muscle twitches, tongue numbing, tightness feeling in my head, etc) and really messed up the antidepressant effect I was getting from the Remeron. I should have gone off the Risperdal quicker than I did, but I was stupid and listened to my psychiatrist and stayed on it for about two months. By the end of that two month period, the Remeron no longer would even activate...at all.
I still dont really know what happened to this very day, all I know is that ever since antidepressant response has been mediocre with bigtime "poop out." Before Risperdal, I enjoyed extremely good full activation responses with simple SSRIs like Paxil. So I do know what it feels like to have your meds work fully, cause I experienced it for a while on Paxil prior to the Remeron/Risperdal fiasco.
Whenever I take atypical anti-psychotics basically all that happens is I get stiff and twitch a lot and my tongue gets numb feeling. And my depression worsens, sadness and suicidal thoughts increase on atypical anti-psychotics. However I never told my psychiatrists that cause Im afraid it would freak them out. They help with sleep some, thats about it.
I dont know, this is just a wild card idea but maybe if your meds are not working good since pneumonia, maybe your system needs a jumpstart with ECT? I never had it myself but am considering it heavily. ECT stimulates the brain to release massive amounts of neurotransmitters and that would have to be good for the immune system, making you more robust and stuff. ECT has strong neuroendocrine effects and I would think ECT would make you able to fight off infection and disease better cause youd be healthier overall after it. The main side effect is memory loss.
take care,
Old School
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