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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by blueberry on March 14, 2006, at 19:43:05
Wake up at 3:30 a.m. like someone shot a pot of coffee in my blood. Shaking, nervous, super anxiety, depressed, right out of bed. Can't hardly handle half a cup of coffee.
Smooths out a tad later in the morning.
Afternoon from 2:00 to 6:00 is the worst in terms of depression and downness. Real despair.
Then after about 7:00pm I actually feel half fairly decent. At bedtime I am wide awake.
This pattern has repeated every day over and over for 14 months now. Lexapro and/or depakote along with zyprexa did not stop the pattern, but modified it...the lows were lower than usual, the evening was better than usual. Lexapro got rid of most of the anxiety, but the very consistent pattern of daily downs and evening ups was a bit more exaggerated.
Not on anything now except lunesta to try to sleep through the adrenaline nightmare.
What is this pattern? I've never heard of bipolar having a consistent daily pattern month after month? How do I fix it? My doc says try lamictal or klonopin or xanax, along with cymbalta. But I'm getting no where with this doc. Worse off than I was.
Posted by Racer on March 14, 2006, at 20:17:45
In reply to What Kind of Pattern Is This?, posted by blueberry on March 14, 2006, at 19:43:05
You know, that sounds like a physical thing, at least enough so that you would probably do well to have physical causes ruled out, before going to psychiatric treatments.
That pattern looks a lot like what diurnal cortisol patterns look like. Cortisol, known as the "stress hormone," rises in the morning to help us wake up, and then decreases in the evenings, so that we can go to sleep. We need cortisol, because it is necessary for our sleep/wake cycle, but if it's out of whack, it can lead to anxiety and disturbed sleep.
So, if I were offering advice, which I guess I am, I'd say go see your GP, and ask for a cortisol test. There's are a couple of different tests, and you want to check the variations throughout the day. Make sure you're not having extremes for some reason. If your GP doesn't know what to do, get a referral to a good endocrinologist.
Good luck, whatever happens.
Posted by Cairo on March 14, 2006, at 22:25:05
In reply to What Kind of Pattern Is This?, posted by blueberry on March 14, 2006, at 19:43:05
Sounds like an atypical depression pattern like I have, but with panic attacks only at night. I wake feeling fairly good, crash and burn in the afternoons, revive just before bedtime, but now have (had) frequent daytime and nighttime panic attacks brought on (unmasked?) by a trial of Topamax; clonazepam helps the panic attacks, propranolol is useful as an adjunct, and adding pregabalin two weeks ago is adding another measure of antianxiety to the arsenal (and is believed to lower norepinephrine) as well as helps my chronic pain somewhat, to boot.
Stay away from all stimulants including caffeine, chocolate, alcohol (1 glass of wine and I'm awake until 3-4am), preservatives, etc. and stress. If any of these intrude, I start with non-stop sweating, shakiness, moving on to full blown panic attacks if I'm stressed too much mentally or physiologically.
You should also consider a sleep study to check for apnea or UARS; panic attacks can be caused by apnea. While I still don't waken refreshed, I must say that I don't get nocturnal panic attacks using a CPAP. Dysregulation of the HPA axis can be a factor in apnea/UARS.
Good luck.
Cairo
Posted by psychopharmacon on March 15, 2006, at 1:58:27
In reply to What Kind of Pattern Is This?, posted by blueberry on March 14, 2006, at 19:43:05
This sounds like what I experienced while taking Zyprexa. Always waking up early in the morning, anxious and deeply depressed, but feeling OK in the evening. I hated it, and now take amisulpride instead.
Posted by SLS on March 15, 2006, at 8:02:17
In reply to What Kind of Pattern Is This?, posted by blueberry on March 14, 2006, at 19:43:05
> What is this pattern?
I'm not sure. I'll be interested to see what others have to say about it.
> I've never heard of bipolar having a consistent daily pattern month after month?
Yes. Usually, it follows a pattern similar to atypical unipolar depression.
My pattern looks something like this:
Early morning: least depressed
10:30 - 12:30 PM: medium depressed
1:00 - 3:00 PM: most depressed
4:30 - 7:30: medium depressed
Late evening: less depressed• What time do you go to bed?
• How does sleep deprivation affect you?
• Have you ever tried taking melatonin? Did it make you feel worse?The cortisol thing sounds interesting. It might be informative to have a basic blood cortisol test taken at 8:00AM and 4:00PM. Racer is a real wiz with that stuff.
- Scott
Posted by TylerJ on March 15, 2006, at 9:34:08
In reply to Re: What Kind of Pattern Is This?, posted by Racer on March 14, 2006, at 20:17:45
Racer,
You know a lot about sleep...here's my problem. Been on Parnate for approx 5 weeks, and am doing very well except for sleep deprivation. My Pdoc has me on Trazodone for insomnia. He won't do Lunesta or ambien because he says they are a type of Benzo. I also take Ativan 4-6 tabs a day...but it doesn't help much as I have been on it for 20 plus years. I am currently trying to ween myself off ativan and my doc is all for it, he says to go down by 1mg or 1/2 mg per week. He said I could go up to 400mgs. of Traz if needed for sleep. I did try 400 a few times and it worked beautifully for sleep, the problem is that the next day I'm wiped out-hungover and tired all day long. Pisses me off because it's ruining my great response to Parnate. I also take 50 mgs. of Benadryl at night. I've tried everything..Traz alone doesn't work, Benadrl by itself doesn't work for me either. But, I did reduce my traz to 250 gs. at night, but it doesn't work all the time at this dose and though it's not as bad, I'm still tired the next day.
I respect your opinions and look forward to what you have to say about this. Can remeron be used with maoi's for insomnia? Thankyou in advance.Tyler
Posted by Racer on March 15, 2006, at 12:27:31
In reply to Re: What Kind of Pattern Is This? » Racer, posted by TylerJ on March 15, 2006, at 9:34:08
I know nothing about Remeron and MAOIs, although my Monkey Brain says loudly "You Could Look It Up..." so I probably will, but I'm flabbergasted to learn that Ambien and Lunesta are benzos. I'll bet most others here will be, too....
My knee jerk reaction is that cutting back on Ativan is A Good Thing, but that's only because Xanax tends to increase depression for me. And I've never had good luck with Traz. I nearly wrote "I never had any luck," but that's not true: I had very bad luck with it... :-0 And I can certainly relate to waking up groggy not improving depression...
The best sleep I ever got was while taking Provigil. And now Adderall seems to be helping, in a similar way. And Ambien works nicely for me.
(And I looked up Parnate-Remeron, which says it's contraindicated, because the serotonergic nature of Remeron has the potential to cause serotonin syndrome. {sigh} Too bad, huh? That's according to the interaction checker at http://www.drugs.com)
You know what interests me, though, is how you would react to sleep deprivation if you weren't taking anything for sleep. I know, nasty thought, huh? But I wonder if you'd find that, once you got off taking Traz and Benadryl, the Parnate improved your condition well enough that it improved your sleep? (Keeping always in mind that some of the hormones and neurotransmitters involved in depression and anti-depressants also affect sleep/wake patterns.)
I doubt I've offered anything useful here, beyond saying that Provigil -- which I think does play well with MAOIs -- helped me sleep. But I'd talk to your doctor again about Ambien or Lunesta -- they're not benzos, and even if they were, so what? If you've safely taken Ativan for many years, and you're not a slavering drug fiend, why should Lunesta be different? (That's assuming, of course, that you're not a slavering drug fiend...)
Good luck. Sorry I couldn't be more helpful wiht this.
Posted by blueberry on March 15, 2006, at 20:04:20
In reply to Re: What Kind of Pattern Is This? » blueberry, posted by SLS on March 15, 2006, at 8:02:17
> > What is this pattern?
>
> I'm not sure. I'll be interested to see what others have to say about it.
>
> > I've never heard of bipolar having a consistent daily pattern month after month?
>
> Yes. Usually, it follows a pattern similar to atypical unipolar depression.Hmmm. Interesting. Maybe I should give a second thought to my doctor's lamictal suggestion.
>
> My pattern looks something like this:
>
> Early morning: least depressed
> 10:30 - 12:30 PM: medium depressed
> 1:00 - 3:00 PM: most depressed
> 4:30 - 7:30: medium depressed
> Late evening: less depressed
>
> • What time do you go to bed?
About 10:00pm with lunesta...otherwise would probably be up all night unable to sleep.
> • How does sleep deprivation affect you?
Don't know.
> • Have you ever tried taking melatonin? Did it make you feel worse?
Yeah, melatonin or tryptophan which converts to melatonin, either one make me feel intensely depressed the next day.
>
> The cortisol thing sounds interesting. It might be informative to have a basic blood cortisol test taken at 8:00AM and 4:00PM. Racer is a real wiz with that stuff.
>
>
> - Scott
Posted by blueberry on March 15, 2006, at 20:14:39
In reply to Re: What Kind of Pattern Is This?, posted by Racer on March 14, 2006, at 20:17:45
Racer, it really does feel like a physical thing. I mean, it shows itself as psychiatric, but it just feels physical.
I have had my cortisol tested. Morning, noon, and early evening were all about half of what normal levels should be. Very low. The only time it was even close to normal, and then only borderline, was at about 10pm.
I think if this is the problem, it is way out of the ballpark for my GP. I called an endocrinologist specialty building, but they only take doctor referalls, so I'm going to ask my GP to send me there. From what I understand, they treat it with low dose hydrocortisone for a few months and then try to taper off and see if the adrenal glands have rested enough to take over. But then again, I think they can do tests to determine whether the adrenals even have the capacity to come back.
I can't help but think that 5 years of prozac and zyprexa did the damage. Prozac being a cortisol/adrenal stimulator, and then zyprexa with its weird metabolic effects throughout the body, who knows.
It's one thing to know what a problem is, but then it's another huge hurdle to find someone to take it seriously and fix it.
> You know, that sounds like a physical thing, at least enough so that you would probably do well to have physical causes ruled out, before going to psychiatric treatments.
>
> That pattern looks a lot like what diurnal cortisol patterns look like. Cortisol, known as the "stress hormone," rises in the morning to help us wake up, and then decreases in the evenings, so that we can go to sleep. We need cortisol, because it is necessary for our sleep/wake cycle, but if it's out of whack, it can lead to anxiety and disturbed sleep.
>
> So, if I were offering advice, which I guess I am, I'd say go see your GP, and ask for a cortisol test. There's are a couple of different tests, and you want to check the variations throughout the day. Make sure you're not having extremes for some reason. If your GP doesn't know what to do, get a referral to a good endocrinologist.
>
> Good luck, whatever happens.
Posted by linkadge on March 15, 2006, at 21:28:02
In reply to Re: What Kind of Pattern Is This? » Racer, posted by blueberry on March 15, 2006, at 20:14:39
Take some time released vitamin C, 1 gram sometime in the evening.
I had a stimilar pattern, but the vitamin C calmed me down and helped make sleep more regular. It lowers cortisol.
Linkadge
Posted by Cairo on March 16, 2006, at 8:32:40
In reply to Re: What Kind of Pattern Is This?, posted by linkadge on March 15, 2006, at 21:28:02
Low cortisol can cause sleep disorders. If his/her evening cortisol has been measured as low, why would you want to lower it more with Vit. C?
Cairo
> Take some time released vitamin C, 1 gram sometime in the evening.
>
> I had a stimilar pattern, but the vitamin C calmed me down and helped make sleep more regular. It lowers cortisol.
>
> Linkadge
Posted by Declan on March 16, 2006, at 14:24:17
In reply to What Kind of Pattern Is This?, posted by blueberry on March 14, 2006, at 19:43:05
Hi Blueberry
I don't have any of the (reliable) mood variations you mention. But I do wake up 2 hours after going to sleep and thereafter have trouble maintaining deep sleep. It is, as you say, as if some stimulatory chemical has jerked me out of deep sleep. The TCM people would say that 2am is the hour when the liver becomes active, so (apparently) if your liver (in the Chinese sense) is impaired some other system, the name of which I forget if I ever knew it, is unable to be controlled. Which propbably amounts to stress hormones. I deal with it best by taking something to settlem me down then. This is absolutely reliable, with or without deprenyl and everything else, although some things make it worse. For more than 10 years now. Is this what they call depression? I thought that was the idea and wasn't impressed by it. It seemed just as likely to be anything. A bad case of what everyone gets with aging anyway? You'd think it would be better understood.
Declan
Posted by TenMan on March 16, 2006, at 20:33:29
In reply to What Kind of Pattern Is This?, posted by blueberry on March 14, 2006, at 19:43:05
Blueberry, I don't want to get this re-directed but have you tried ginseng or licorice yet?
Posted by gibber on March 17, 2006, at 16:41:11
In reply to Re: What Kind of Pattern Is This?, posted by TenMan on March 16, 2006, at 20:33:29
Just wanted to concur and say my depression tends to be the worst at 3pm too. Sometimes its like clockwork. Late evenings tend to be better. Stress plays a big part too. If I have to work then things are worse. I don't have any trouble sleeping now and sometimes I'll wake up refreshed but still moderately depressed. I do remember a time (a period of a few months) when I would consistently wake up at 3 in the morning and always suspected it might be cortisol, but I never got it tested. I'm unipolar.
Posted by Cairo on March 17, 2006, at 19:38:07
In reply to What Kind of Pattern Is This?, posted by blueberry on March 14, 2006, at 19:43:05
You might be interested in this:
http://www.endotext.org/adrenal/adrenal31/adrenal31.htm
Cairo
Posted by Dr. Bob on March 19, 2006, at 9:03:43
In reply to Re: What Kind of Pattern Is This?, posted by TenMan on March 16, 2006, at 20:33:29
> Blueberry, I don't want to get this re-directed but have you tried ginseng or licorice yet?
Sorry, but I would in fact like to redirect follow-ups regarding ginseng or licorice to Psycho-Babble Alternative. Here's a link:
http://www.dr-bob.org/babble/alter/20060313/msgs/621963.html
Thanks,
Bob
This is the end of the thread.
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