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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by smart.drug on May 12, 2008, at 18:48:20
Hi everyone,
I'm a 21-year-old university student, majoring in biochem with plans for med school. Unfortunately, I've struggled almost my whole life with dysthymia. Almost every semester, I'm '"fine" at the beginning, but towards the end, everything crumbles and topples over on me. I'm tired of naming my "symptom" to the psychiatrist, to have him write me for another magic bullet. I want to take charge, and be pro-active about this.
When I go back to school for the fall semester, I want to present him with a comprehensive treatment plan that I want to undertake. So any help or guidance would be appreciated. I need a treatment plan which addresses the "core" symtoms of depression, but does not cause impairment in memory and cognition, nor anxiety. I will present my problem, piece by piece, in subsequent "episodes." I think the very first thing I have to undertake is improve my sleep.
Beyond the old advice of improving my sleep hygeine, etc, is there any medication that can help? I'm not looking for a medication to knock me out. It's not enough for it to be free from "hangover" side-effects; it must be able to improve sleep in such a way that it improves alertness in the daytime. Does such a thing exist, or am I day-dreaming?
I'm thinking of a combo of kava, valerian, tryptophan, and glutamine... Would it do what I'm looking for? Would a medication like gabapentin be any better? Or how about a different strategy, with Rozerem? Or should I try my luck with a sleep study, in the hopes of getting a narcolepsy diagnosis, and subsequently a prescription of Xyrem?
See, if I take an anti-histamine, I drag my feet around and constantly nod off the next day. But if I take a stimulant like Adderall, I can't sleep! Yes, even if I take the dose very early in the morning...
Please help!
Posted by Phillipa on May 12, 2008, at 21:06:52
In reply to Medication Management: Episode 1, posted by smart.drug on May 12, 2008, at 18:48:20
Welcome to babble see you are new. Hope the answers you find here can benefit you. Again welcome. Phillipa
Posted by Sigismund on May 12, 2008, at 21:38:46
In reply to Medication Management: Episode 1, posted by smart.drug on May 12, 2008, at 18:48:20
>I'm thinking of a combo of kava, valerian, tryptophan, and glutamine... Would it do what I'm looking for?
I think glutamine can be stimulating.
How about tryptophan, skullcap and zizyphus?
Posted by ncrainbow on May 13, 2008, at 0:16:18
In reply to Re: Medication Management: Episode 1, posted by Sigismund on May 12, 2008, at 21:38:46
Sleep has always been a huge issue for me so I can relate. I am a very inconsistent night time sleeper with a life long history of pervasive daytime fatigue. I did score in the severe range on the sleep latency test (daytime part of sleep study) basically just confirmed for me that i am not imagining it. I am sleepy a lot. Although it kinda resembles narcolepsy...for me, it is more complex than that.
Good news is that I have made big changes to my "sleep hygeine" lately and they seem to help some.
Here they are...note that some are meds and some are lifestyle:
1. 1-2 mgs of klonopin at night. And nothing else for sleep. I often alternated between ambien, ativan, benadryl so that I never took one for more than a few days in a row and I think I just did more harm than good.
2. I am on Wellbutrin xl during the day which for me is very activating. Seems to help me resist (to some degree, but not completely) my urge to nap. I nap pretty uncontrollably in kind of an addcitive way but now it has decreased to a more reasonable frequency or at least the naps are shorter.
3. No TV in bedroom. No Computer or other electronic visual stimulation (PDA, Blackberry, videogame, laptop, etc) after 9:00 p.m. I take klonopin by 10:00 and I try to be asleep by 11:00.
4. Cutting down on napping helps but it is hard...for me it is always hard....I would trade meds, food, wine, shopping, just about anything for my nap. Kinda sick, huh?
I should note that with pretty intense ADD/hypomania, napping is also my version of "brain containment" I don't have a lot of tools to clear or slow my brain down. I am sure meditation, yoga, or even regular exercise would help a lot but heck I am 40 so if it isn't happening by now, I am not feeeling that confident about htis old dog learning new tricks. I wake up most days promising myself that I am not going back to bed....but soon I cave and just check out for awhile.
Now this works fine when I keep a normal schedule but tonight for instance I got in from the airport at 10:30 p.m. and had 2 hours worth of email to deal with....so for me no system is perfect. I am sure I will be sleepy tomorrow
Posted by smart.drug on May 13, 2008, at 2:58:53
In reply to Medication Management: Episode 1, posted by smart.drug on May 12, 2008, at 18:48:20
Yes, Philipa, I am indeed a noob. And thank you for the hospitality.
>Sigismund,
I kinda want to stick to things that have some evidence behind them. Valerian has strong support as a hypnotic, and kava can enhance slow-wave sleep. Neither of them cause a hangover. The thing with glutamine is that the brain can convert it to either GABA, or glutamate--so yes, it can go either way. Tryptophan can enhance REM. I'm hoping that the quadruple combo can be synergistic, and give me the effect I'm looking for--i.e., consolidated sleep, without the hangover in the morning.>ncrainbow,
Wow... sounds like you're in a similar kind of mess as me. My problem is, I'll try ANYTHING, except for two classes of medications: SSRIs, and benzos. I refuse to touch them. But for the sake of brevity, I'll just say that benzos, as a class, suppress REM, so I don't want to try one for my sleep issues.Anyway, what you're describing to me sounds like narcolepsy... what happened, though? The sleep study found you negative for it? Well, in any case, I'm not a doctor. At any rate, I'd like to stick to sleep issues for now. I'll discuss other issues with you in subsequent episodes, unless you'd like to e-mail/IM some time?
P.S. This is finals week for me, so that means lots of all-nighters. So I won't be able to implement any sleep hygeine measures in the immediate future. Also, it's kind of hard for me to avoid computer/TV before bedtime--but I agree that avoiding them can be beneficial. I just wonder whether the benefit of a medication can outweight the sum total of sleep hygeine measures?
Posted by ncrainbow on May 13, 2008, at 17:45:52
In reply to Re: Medication Management: Episode 1, posted by smart.drug on May 13, 2008, at 2:58:53
> >ncrainbow,
> Wow... sounds like you're in a similar kind of mess as me. My problem is, I'll try ANYTHING, except for two classes of medications: SSRIs, and benzos. I refuse to touch them. But for the sake of brevity, I'll just say that benzos, as a class, suppress REM, so I don't want to try one for my sleep issues.
>
> Anyway, what you're describing to me sounds like narcolepsy... what happened, though? The sleep study found you negative for it? Well, in any case, I'm not a doctor. At any rate, I'd like to stick to sleep issues for now. I'll discuss other issues with you in subsequent episodes, unless you'd like to e-mail/IM some time?
>
> P.S. This is finals week for me, so that means lots of all-nighters. So I won't be able to implement any sleep hygeine measures in the immediate future. Also, it's kind of hard for me to avoid computer/TV before bedtime--but I agree that avoiding them can be beneficial. I just wonder whether the benefit of a medication can outweight the sum total of sleep hygeine measures?Okay...more on sleep issues ..here is my deal....
Although my score of 5 on the sleep latency study was indicative of narcolepsy, there are lots of factors that can cause day time sleepiness that have to be ruled out before the diagnosis can be made. Plus, there are some potential drawbacks to carrying a narcolepsy dx.
I have never found a drug that could improve the quality of my night time sleep enough that I wasn't sleepy during the day. In fact, I think night time sleep quality is one factor in my daytime sleepiness but definitely not the main or only one.
So, here are my experiences (separating out night time sleep from day time sleep:
Night time:
Falling asleep:
The things that interefere with my falling asleep are 1) missing the sleepy window..i.e., staying up during the hour my body is naturally slowing down, 2) electronic stuff like laptop and tv makes my mind racy and even though I feel sleepy after watching it, I just don't fall asleep, 3) guilty thoughts, stress about something left undone (which for me is practically everything since I live a pretty disorganized life), 4) caffeiene, and 5) hormonal stuff...a couple days of the month before i start, I bascially CAN'T fall asleep.Staying Asleep/Falling Back Asleep if woken:
The things that interefere with this are usually more physical or material....too hot, too cold, room is stuffy, allergies bothering me, little light on smoke alarm, flashing light reflecting from bathroom appliance, partner snoring, etc. I often wake up around 2:30 and then stay awake until 5:00 a.m. or so. I don't do this as much now on the klonopin bit it still happens maybe once a week.Daytime sleepiness
#1 cause is avoidance of a task that is too big for me to break down...here is where the ADD comes in, i.e. inability to tune out all other thoughts to focus just on getting up getting dressed and going to work.Most days, I lie in bed wondering about whether I should take a shower first or eat breakfast,weighing the benefits of each, pondering what to wear which leads to thoughts and guilt about the growing piles of laundry which leads to thoughts about which load to tackle first which brings me to wondering whether I should just skip work and stay home and do laundry (more guilt about messy house and being a bad mom and partner)or go to work but maybe wait until after shower to start at least one load of laundry and then trying to decide if I need to buy gas on my way to work and where my ATM card is since I couldn't find it last night, more guilt about messy lifestyle....after about fifteen minutes of pondering, I am exhausted and feel physically unable to get up without an hour of more sleep....then I basically wake up an hour later, and do it all again...changing some of the details or the things I am pondering or feeling badly about but basically the same.
#2 Cause of daytime sleepiness - Inability to rest any other way but in a horizontal position pondering things....basically I go at 100 miles an hour most of the day, interacting with the kids, playdates, juggling stiuff at work (I am a lawyer so lots to juggle), socializing, talking on the phone , tunneling in on the net, etc....When I feel overstimmed or like I need a break, I automatically start craving a nap...its the only way I can turn it all off and escape. I can't say for sure, but I would bet the farm that my craving is as strong as one someone might have for a cigarette, drink, or any other kind of fix.
Napping or going back to sleep in the morning for me mimics how most addictions affect people's lives. I wake up every morning promising I won't do it (even though I know I will), it negatively affects my ability to parent and be a partner, I hide the quantity of it from friends and colleagues, I am always coming up with ways to avoid it but bascially end up feeling powerless over it, and lastly, there are moments where I feel like there is NOTHING I would enjoy as much as a nap. I have tried provigil, traditional stimulants, caffeine, and all of them wind me up so I am not as "sleepy" but still leave me with all the racy thoughts or the hypomania that make me crave naps in the first place so I end up having less enjoyable, more agitated naps but I still take them. Of the lot, dexedrine was the best but still not perfect.
My new PDOC thinks napping for me could be equated to depression for rapidly cycling cyclothymia (low grade bipolar) so after failing on Lamictal due to evil rash, I am trying Wellbutrin. The Klonopin was prescribd since I basically just stopped 8 years worth of an SSRI cold turkey (over 2 weeks)...with the added benefit that Klonopin is supposed to regulate mood.
Posted by undopaminergic on May 16, 2008, at 3:02:49
In reply to Medication Management: Episode 1, posted by smart.drug on May 12, 2008, at 18:48:20
>
> I'm thinking of a combo of kava, valerian, tryptophan, and glutamine...
>Last time I experimented with valerian, I had an attack of irritability and rage, the last of which is out of my usual characer. It may be a coincidence, but I'd be interested in knowing if others have noticed any such reactions to valerian.
> Would it do what I'm looking for? Would a medication like gabapentin be any better? Or how about a different strategy, with Rozerem?
>Rozerem is a melatonin agonist - why not use the real thing instead? Melatonin can be useful for sleep, especially if you have a delayed sleep phase.
> Or should I try my luck with a sleep study, in the hopes of getting a narcolepsy diagnosis, and subsequently a prescription of Xyrem?
>There are many cheaper and easier ways to get your hands on GHB (or GBL).
> See, if I take an anti-histamine, I drag my feet around and constantly nod off the next day.
>Which anti-histamines have you tried? Probably due to it's antagonism of serotonin 5-HT2A-receptors, cyproheptadine (Periactin) is the best choice with regard to sleep quality, at least as judged on the basis of EEG. Mirtazapine (Remeron) and quetiapine (Seroquel) may be similarly effective in that they share the characteristics of 5-HT2A- and H1-antagonism, but especially mirtazapine's antagonism of alpha2-adrenergic receptors is likely to be detrimental to sleep.
This is the end of the thread.
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