![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by blueberry on November 30, 2006, at 17:52:35
For 2 years now I have experienced a strange daily pattern. I have tried to change it with things like high carb meals vs protein meals. Also tried different med dosing times. Even with supplements...like tyrosine that gives me a nice boost...the afternoon crash happens regardless. Xanax gives me a real nice mood...but fails me in the afternoon. Nothing changes the pattern. I will rate mood on a 1 to 10 scale, 10 being suicidal, 1 being fantastic.
Waking = 8
Morning = 5
Afternoon = 9
Evening = 3I feel really bad upon waking. I improve throughout the morning. The afternoon sinking, as I call it, is viscious and highly predictable no matter what I eat or anything. The evening bounce, as I call it, is fairly predictable no matter what I eat or anything. I've tried various meds the last 2 years. Different doses. I've tried my longtime zyprexa at 2pm, 4pm, 8pm...no difference. Even with a steady state of the long halflife of prozac there was no difference. The evening bounce comes with or without zyprexa. I drink decaf coffee.
What is this pattern? Some kind of hormonal thing? Some kind of glucose thing? Some kind of bipolar thing? I don't understand it except that it is relentless. Any ideas? What am I overlooking?
Posted by dreamboat_annie on November 30, 2006, at 18:32:14
In reply to Any Ideas What This Daily Pattern Is?, posted by blueberry on November 30, 2006, at 17:52:35
I was experiencing the same thing for quite some time, and for me it was a blood sugar thing. My blood sugar is low, so the mornings were not very pleasant - shaky, anxious, tired even the times I managed to get more than 6 hours of sleep . . . I would get the afternoon crash and would seem to come back to life about 9 p.m. or 10 p.m. A regular doctor did not find the hypoglycemia, but I did see a naturopath who did tests, including blood tests (glucose tolerance test, which is done over a period of 2 - 3 hours). I started taking chromium 3 times a day, increased the amount of protein I was eating, ate 6 small meals a day instead of three, added in some protein snacks like almonds and used a few other natural things for a few months that the naturopath suggested. It took a couple of months until I started waking up not shaky, etc., afternoon energy and mood improved and I seemed to sleep better. Anyway, it's happening to me again (not to the same degree), but I am pretty sure it's my blood sugar because I started drinking coffee again, and being the addict that I am, I have gone overboard in my consumption.
Sorry this was so long.
> For 2 years now I have experienced a strange daily pattern. I have tried to change it with things like high carb meals vs protein meals. Also tried different med dosing times. Even with supplements...like tyrosine that gives me a nice boost...the afternoon crash happens regardless. Xanax gives me a real nice mood...but fails me in the afternoon. Nothing changes the pattern. I will rate mood on a 1 to 10 scale, 10 being suicidal, 1 being fantastic.
>
> Waking = 8
> Morning = 5
> Afternoon = 9
> Evening = 3
>
> I feel really bad upon waking. I improve throughout the morning. The afternoon sinking, as I call it, is viscious and highly predictable no matter what I eat or anything. The evening bounce, as I call it, is fairly predictable no matter what I eat or anything. I've tried various meds the last 2 years. Different doses. I've tried my longtime zyprexa at 2pm, 4pm, 8pm...no difference. Even with a steady state of the long halflife of prozac there was no difference. The evening bounce comes with or without zyprexa. I drink decaf coffee.
>
> What is this pattern? Some kind of hormonal thing? Some kind of glucose thing? Some kind of bipolar thing? I don't understand it except that it is relentless. Any ideas? What am I overlooking?
Posted by Phillipa on November 30, 2006, at 19:35:37
In reply to Re: Any Ideas What This Daily Pattern Is? » blueberry, posted by dreamboat_annie on November 30, 2006, at 18:32:14
Blueberry don't they say that if you're depressed you wake up at night and stay up late. I know I do and hated mornings. Always have. So you work though so maybe you're just tired? Love Phillipa
Posted by blueberry on November 30, 2006, at 19:51:30
In reply to Re: Any Ideas What This Daily Pattern Is?, posted by Phillipa on November 30, 2006, at 19:35:37
> Blueberry don't they say that if you're depressed you wake up at night and stay up late. I know I do and hated mornings. Always have. So you work though so maybe you're just tired? Love Phillipa
No Jan, what I am experiencing is really severe. It is not normal daily fluctuations. And it makes no difference if I am going 100mph all day at work or whether I am sitting on a couch all day. And my sleeping pattern is healthy. The afternoon crash is so severe that if I ever commit suicide, that's when it will happen. I've tried all kinds of different lunchs and afternoon snacks but that makes no difference.
Posted by Phillipa on November 30, 2006, at 21:38:10
In reply to Re: Any Ideas What This Daily Pattern Is? » Phillipa, posted by blueberry on November 30, 2006, at 19:51:30
Blueberry there is this MD here where I live that deals in nutrition for all sorts of illnesses. He has a long waiting list of people from other states that come to see him. I am on his waiting list. Is there someone near you like this? Love Jan
Posted by saturn on November 30, 2006, at 22:08:55
In reply to Any Ideas What This Daily Pattern Is?, posted by blueberry on November 30, 2006, at 17:52:35
Hi Blueberry,
Is your mood at all related to wakefulless or sleepiness?
I may be way off but if so it could be related to a circadian rhythm variation/"abnormality".
Personally I feel worst in the morning and get overcome by exhaustion/depression midday and then recover later in the evening, when I usually feel best. I believe it's at least partly in part to a sleep disorder (though it does have pattern resemblences of depression). Again, just my two cents related to my personal beliefs and experience...I could be way off in your case.
Posted by polarbear206 on December 1, 2006, at 8:02:42
In reply to Any Ideas What This Daily Pattern Is?, posted by blueberry on November 30, 2006, at 17:52:35
> For 2 years now I have experienced a strange daily pattern. I have tried to change it with things like high carb meals vs protein meals. Also tried different med dosing times. Even with supplements...like tyrosine that gives me a nice boost...the afternoon crash happens regardless. Xanax gives me a real nice mood...but fails me in the afternoon. Nothing changes the pattern. I will rate mood on a 1 to 10 scale, 10 being suicidal, 1 being fantastic.
>
> Waking = 8
> Morning = 5
> Afternoon = 9
> Evening = 3
>
> I feel really bad upon waking. I improve throughout the morning. The afternoon sinking, as I call it, is viscious and highly predictable no matter what I eat or anything. The evening bounce, as I call it, is fairly predictable no matter what I eat or anything. I've tried various meds the last 2 years. Different doses. I've tried my longtime zyprexa at 2pm, 4pm, 8pm...no difference. Even with a steady state of the long halflife of prozac there was no difference. The evening bounce comes with or without zyprexa. I drink decaf coffee.
>
> What is this pattern? Some kind of hormonal thing? Some kind of glucose thing? Some kind of bipolar thing? I don't understand it except that it is relentless. Any ideas? What am I overlooking?What meds are you taking routine? This is very familar to me. Sounds like an underlying bipolar disorder. You circadium rhythm is way off. Bright light therapy in the morning and med changes are your best bet. Have you tried Lamictal with an antidepressant?
Posted by stargazer on December 1, 2006, at 15:34:58
In reply to Any Ideas What This Daily Pattern Is?, posted by blueberry on November 30, 2006, at 17:52:35
BB,
What meds, dosages, times usually taken...What does Zyprexa do for you?
Are you followed by a pdoc and what explanation is given for the variability in daily mood.
If you stopped meds, what symptoms would reappear?
It doesn't sound like you are getting much benefit from the meds in terms of mood stability.
SG
Posted by ronaldo on December 2, 2006, at 15:44:21
In reply to Any Ideas What This Daily Pattern Is?, posted by blueberry on November 30, 2006, at 17:52:35
Hi blueberry
What activity do you do in the afternoon?
How do you rate your activity during the day on a one to ten scale with 1 being very active and 10 being slumped semi-comitose on the couch (or equivalent).
Waking =
Morning =
Afternoon =
Evening =Does it make any difference to consider it this way?
...ronaldo
Posted by blueberry on December 2, 2006, at 20:25:00
In reply to Re: Any Ideas What This Daily Pattern Is?, posted by stargazer on December 1, 2006, at 15:34:58
> BB,
>
> What meds, dosages, times usually taken...What does Zyprexa do for you?
>
> Are you followed by a pdoc and what explanation is given for the variability in daily mood.
>
> If you stopped meds, what symptoms would reappear?
>
> It doesn't sound like you are getting much benefit from the meds in terms of mood stability.
>
> SGProzac 20mg. Pooped out. Higher doses caused severe worsening of depession.
Zyprexa 5mg. Does nothing. Higher doses caused severe worsening of depression.
I've been on these for 10 years and they worked pretty good for 7 years with no instability at all.I am currently without a pdoc. Four of them have been useless and had no good ideas. The best ideas I've ever had were either my own or fellow pbabblers. I saw a naturopath doctor who tested me for all kinds of stuff. Cortisol was slightly low, but everything else you can think of was normal.
Symptoms that would reappear as I stop the drugs? Well, it's been 14 days off prozac and I'm now at 1mg zypexa and these daily cycles seem significantly softened. The cycles seem to be improving as the drugs disappear.
Posted by blueberry on December 2, 2006, at 20:28:39
In reply to Re: Any Ideas What This Daily Pattern Is? » blueberry, posted by ronaldo on December 2, 2006, at 15:44:21
> Hi blueberry
>
> What activity do you do in the afternoon?
>
> How do you rate your activity during the day on a one to ten scale with 1 being very active and 10 being slumped semi-comitose on the couch (or equivalent).
>
> Waking = 8
> Morning = 1
> Afternoon = 1
> Evening = 5
>
> Does it make any difference to consider it this way?
>
> ...ronaldo
>I've wondered the same thing. Honestly though, whether I spend a hectic day at work going as fast as I can, or if I sit around on a weekend and do nothing, there is no difference.
Posted by Phillipa on December 2, 2006, at 21:54:06
In reply to Re: Any Ideas What This Daily Pattern Is? » stargazer, posted by blueberry on December 2, 2006, at 20:25:00
So what you're saying is that you're doing better off meds? Any reason to think the ECT could have contributed to this or is there no corolation? Love Phillipa
Posted by stargazer on December 8, 2006, at 17:52:35
In reply to Re: Any Ideas What This Daily Pattern Is? » stargazer, posted by blueberry on December 2, 2006, at 20:25:00
Well the daily cycling seems insignificant now as you have decided to stop the meds since they were not working anyway.
We all get to this point at sometime in our treatment. I have stopped meds a few times and usually have had a relapse of depression again, no surprise, since many of us with chronic depression are predisposed to having more episodes.
Interestingly, sometimes the times off meds seem to be the best, leading up to what can be another crash. I typically get hypomanic, which feels great temporarily, but is usually followed by insomnia and the inability to handle any minor stresses.
If you have not come off meds before, your experience may be different.
If I were you, I would keep track of any and all of my symptoms as you go forward. Since you do not have a pdoc that you are currently seeing, the difficulty will be finding someone to treat you down the road if you really need someone.
Else it will be treating your symptoms as they develop or perhaps just keeping track of your mood and trying to keep it from elevating or depressing too much. How to do that effectively is the challenge.Good luck and keep in touch.
SG
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.