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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by NKP on July 11, 2022, at 10:37:16
Following years of chronic undersleeping, I am now trying to get into the habit of going to bed earlier and getting more sleep. My psychiatrist, psychologist, and occupational therapist, have all identified inadequate sleep as the root of my difficulties.
Despite getting enough sleep these last few nights, I feel very sleepy during the day, and very unmotivated, actually worse than when I get too little sleep. Is it normal to feel this way when one starts to catch up on a long-term sleep deficit?
I suggested to my psychiarist that I should go back on flupenthixol or some other dopaminergic medicine, but he poured cold water on the suggestion. I'm currently on venlafaxine 225 mg/day, and lamotrigine 100 mg/day. I still have some left-over flupenthixol from a year back. Do you think I should use it for a few days to see if it helps?
Posted by undopaminergic on July 11, 2022, at 10:53:55
In reply to Sleepy and unmotivated, posted by NKP on July 11, 2022, at 10:37:16
> Following years of chronic undersleeping, I am now trying to get into the habit of going to bed earlier and getting more sleep. My psychiatrist, psychologist, and occupational therapist, have all identified inadequate sleep as the root of my difficulties.
>
> Despite getting enough sleep these last few nights, I feel very sleepy during the day, and very unmotivated, actually worse than when I get too little sleep. Is it normal to feel this way when one starts to catch up on a long-term sleep deficit?
>I don't know, but you can get burnt out or psychotic from too much sleep deficit, so I think it's a good idea to attend to it.
> I suggested to my psychiarist that I should go back on flupenthixol or some other dopaminergic medicine, but he poured cold water on the suggestion. I'm currently on venlafaxine 225 mg/day, and lamotrigine 100 mg/day. I still have some left-over flupenthixol from a year back. Do you think I should use it for a few days to see if it helps?
>Well, why not? I don't think it can hurt. Unless you take too much, of course, but I think you are talking about a low dose?
-undopaminergic
Posted by SLS on July 13, 2022, at 21:52:02
In reply to Sleepy and unmotivated, posted by NKP on July 11, 2022, at 10:37:16
Two suggestions if you are still experiencing depression:
1. Effexor 300 mg/day
2. Lamictal 200 mg/dayIf you have early morning awakenings and feel worse in the morning than you do at night, you might have more of a melancholic depression rather than atypical. If you tend to lose weight when you are more severely depressed, that would figure in the symptom cluster for endogenous / melancholic depression. I think psychotic depression tends to be an expression of this type of depression rather than atypical. Also, anxiety and psychomotor retardation are more likely to be an expression of melancholic depression.
It is possible that your depression has not been adequately treated, and that this would explains sleep difficulties. There are many other reasons why one can have sleep difficulties.
Again, if your depression has not been sufficiently improved, raising the dosages of Effexor and, especially, Lamictal could produce superior results.
Overall, I would say that someone with an anxious melancholic depression with or without psychotic features can be soothed with antipsychotics.
- Scott
Posted by SLS on July 14, 2022, at 11:01:53
In reply to Sleepy and unmotivated, posted by NKP on July 11, 2022, at 10:37:16
NKP -
Upon further consideration, your fatigue and amotivation is more likely to be a presentation of atypical depression rather than melancholic / endogenous depression.
If you have been chronically sleep-deprived, you might experience a worsening of your depression for a few days as your brain adjusts to a new circadian rhythm. This is especially true if you retard your rhythm - going to bed later and waking up later. Advancing one's' rhythm sometimes has a temporary improvement in depression. Total or partial sleep deprivation is effectively advancing the circadian rhythm. This is produces an anti-depressant effect.
1. Advance circadian rhythm = temporary anti-depressant effect.
2. Delay circadian rhythm = temporary pro-depressant effect.
- Scott
Posted by Jay2112 on July 16, 2022, at 17:37:34
In reply to Sleepy and unmotivated, posted by NKP on July 11, 2022, at 10:37:16
I find SRI's and lithium, which increase serotonin of course, with either benzo's or gabapentin/pregabalin, make me quite drowsy. Effexor...not so much. Low dose antipsychotics are supposed to increase extracellular dopamine.
So, maybe worth a shot?
Best,
Jay
> Following years of chronic undersleeping, I am now trying to get into the habit of going to bed earlier and getting more sleep. My psychiatrist, psychologist, and occupational therapist, have all identified inadequate sleep as the root of my difficulties.
>
> Despite getting enough sleep these last few nights, I feel very sleepy during the day, and very unmotivated, actually worse than when I get too little sleep. Is it normal to feel this way when one starts to catch up on a long-term sleep deficit?
>
> I suggested to my psychiarist that I should go back on flupenthixol or some other dopaminergic medicine, but he poured cold water on the suggestion. I'm currently on venlafaxine 225 mg/day, and lamotrigine 100 mg/day. I still have some left-over flupenthixol from a year back. Do you think I should use it for a few days to see if it helps?
This is the end of the thread.
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