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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Roslynn on September 11, 2022, at 14:13:00
Hi all,
I'm having terrible trouble getting up in the morning. I finally get up at about 10:30/11:00 but I'm only up for a few hours before I need a nap. I'm going to bed about 10pm with help from meds to go to sleep.
I haven't been able to really get out of the house. My day is pretty much shot with all the sleeping.
Has anyone else gone through something like this? How do you get out of it?
Thank you for any thoughts.
Roslynn
Posted by Lamdage22 on September 11, 2022, at 15:24:18
In reply to Terrible trouble getting up in morning, posted by Roslynn on September 11, 2022, at 14:13:00
> Hi all,
>
> I'm having terrible trouble getting up in the morning. I finally get up at about 10:30/11:00 but I'm only up for a few hours before I need a nap. I'm going to bed about 10pm with help from meds to go to sleep.
>
> I haven't been able to really get out of the house. My day is pretty much shot with all the sleeping.
>
> Has anyone else gone through something like this? How do you get out of it?
>
> Thank you for any thoughts.
>
> RoslynnDo you dread the day when you are supposed to wake up? If so, I would say analytic therapy. That works for me. I know its not accessible everywhere to everyone.
Posted by Roslynn on September 11, 2022, at 16:53:05
In reply to Re: Terrible trouble getting up in morning, posted by Lamdage22 on September 11, 2022, at 15:24:18
I do dread the day. Thank you for your suggestion.
Posted by Jay2112 on September 11, 2022, at 18:38:14
In reply to Terrible trouble getting up in morning, posted by Roslynn on September 11, 2022, at 14:13:00
> Hi all,
>
> I'm having terrible trouble getting up in the morning. I finally get up at about 10:30/11:00 but I'm only up for a few hours before I need a nap. I'm going to bed about 10pm with help from meds to go to sleep.
>
> I haven't been able to really get out of the house. My day is pretty much shot with all the sleeping.
>
> Has anyone else gone through something like this? How do you get out of it?
>
> Thank you for any thoughts.
>
> RoslynnWell, pro-serotonin meds will contribute to sleeping in. I wondered why, for years, I could not get my butt going until noon. So, I changed thing up, and now I take my sleep meds, mirtazapine and amitriptyline, at about 9-10 pm. I wake up at about 7:00am everyday, and only take 37.5mg's on Effexor with clonazepam and carbamazepine in the morning.
I used to be on 225mgs of Effexor, and slep't till noon everyday. Hope this helps...
Jay
Posted by Roslynn on September 11, 2022, at 19:25:14
In reply to Re: Terrible trouble getting up in morning » Roslynn, posted by Jay2112 on September 11, 2022, at 18:38:14
Thank you for the feedback. In my case I suspect it may be the Seroquel I take at bedtime. But I have a hard time trying to decrease the amount I take.
~Roslynn
Posted by Lamdage22 on September 11, 2022, at 22:29:59
In reply to Re: Terrible trouble getting up in morning » Lamdage22, posted by Roslynn on September 11, 2022, at 16:53:05
> I do dread the day. Thank you for your suggestion.
It may help to discuss why exactly that is. Once fully understood the solution often offers itsself.
Posted by linkadge on September 12, 2022, at 15:39:39
In reply to Re: Terrible trouble getting up in morning, posted by Lamdage22 on September 11, 2022, at 22:29:59
Do you have fatigue throughout the day (once you get going)? Or, is it mostly difficulty getting up?
Linkadge
Posted by Roslynn on September 13, 2022, at 13:21:46
In reply to Re: Terrible trouble getting up in morning, posted by linkadge on September 12, 2022, at 15:39:39
> Do you have fatigue throughout the day (once you get going)? Or, is it mostly difficulty getting up?
>
> LinkadgeYes, I do have fatigue throughout the day as well.
Posted by SLS on September 13, 2022, at 20:20:42
In reply to Re: Terrible trouble getting up in morning » linkadge, posted by Roslynn on September 13, 2022, at 13:21:46
Do you feel *much* worse in the morning, but feel better at night? This is the pattern for those with melancholic (endogenous) depression, who are thought to be particularly apt to respond to tricyclic antidepressants (TCA). From your description, it wouldn't seem so. Your vegetative symptoms are reversed from those of melancholic depression. They are probably considered to be "anergia" - no energy. When "atypical" depression was first identified and described, MAOIs were found to be more effective than TCAs.
There is a difference between sleepiness or somnolence and having a lack of energy all day long. Which of these symptoms predominate in your case? Is "depressed" the best word to describe your experience? Besides sleepiness and somnolence, how else would you describe your depression? Are your thoughts depressed?
How did you respond to MAOIs?
- Scott
Posted by undopaminergic on September 14, 2022, at 8:52:09
In reply to Terrible trouble getting up in morning, posted by Roslynn on September 11, 2022, at 14:13:00
> Hi all,
>
> I'm having terrible trouble getting up in the morning. I finally get up at about 10:30/11:00 but I'm only up for a few hours before I need a nap. I'm going to bed about 10pm with help from meds to go to sleep.
>
> I haven't been able to really get out of the house. My day is pretty much shot with all the sleeping.
>
> Has anyone else gone through something like this? How do you get out of it?
>
> Thank you for any thoughts.
>
> RoslynnHi,
That sounds much like what I've been struggling with. Apathy (lack of desire/motivation) compounded by anergia (lack of energy). Stimulants help. Many people seem to suggest or imply that will-power is the solution, but the apathy robs you of that will-power. I guess they mean determination. Obviously, with enough determination, you can force yourself out of bed. If you do it enough, it becomes easier because it becomes habitual. I've personally achieved this to an extent (it's not perfect) as far as going out for walks is concerned.
-undopaminergic
Posted by Roslynn on September 14, 2022, at 16:12:40
In reply to Re: Terrible trouble getting up in morning, posted by undopaminergic on September 14, 2022, at 8:52:09
Thank you for your feedback:)
Posted by Roslynn on September 14, 2022, at 16:24:01
In reply to Re: Terrible trouble getting up in morning » Roslynn, posted by SLS on September 13, 2022, at 20:20:42
> Do you feel *much* worse in the morning, but feel better at night?
I do feel way worse in the morning,better at night
>
> There is a difference between sleepiness or somnolence and having a lack of energy all day long.I have a lack of energy all day
>
Is "depressed" the best word to describe your experience?Yes.
>
Besides sleepiness and somnolence, how else would you describe your depression? Are your thoughts depressed?Yes
>
> How did you respond to MAOIs?
Very lightheaded from nardil and parnate gave me blood pressure spikes unrelated to diet, etc.
> - Scott.Thank you Scott!
>
>
Posted by SLS on September 14, 2022, at 19:35:29
In reply to Re: Terrible trouble getting up in morning » SLS, posted by Roslynn on September 14, 2022, at 16:24:01
Hi, Roslynn
Based upon your diurnal rhythm, you qualify as the original "endogenous" / "melancholic" depression. Historically, tricyclic antidepressants were observed to be more effective for melancholic unipolar depression. Another hallmark symptom of more severe melancholic depression is psychomotor retardation.
1. Do you find yourself remaining motionless and staring into space for a minute or two (not rigid)?
2. Is it hard for you to get yourself to move in order to start a task - or even get off the couch to go to the bathroom?
3. Do you ever feel like you are posed like a statue without moving a muscle (not rigid)?
4. Do you feel stuck on the couch such that it takes a monumental effort to get yourself to move? Do you struggle to complete tasks because you suddenly "run out of gas" and begin into space?
5. Do you ever feel like you are moving in slow motion?
6. Do you have early-morning awakenings and feelings of doom or dread first thing in the morning?
If this fits your experience, then I would make sure that you try at least 2-3 tricyclics. I strongly advocate the use of low-dosage lithium treatment 300-600 mg/day. It goes well with many treatment combinations. I can't be without it. I tried to discontinue it about 4 months ago as an experiment to see if it was really a necessary component of my drug combination treatment. It was.
* I have bipolar depression, and its features look a lot like a hybrid of melancholic and atypical depression to me.Keep trying. It's not fair, but keep trying anyway.
A thought just occurred to me. 30 years ago, a standard practice was to add lithium to a tricyclic or MAOI for TRD.
Another thought is to use thyroid hormone as an adjunct to tricyclics or perhaps Effexor.
If you do indeed have severe and stubborn endogenous / melancholic depression, I suggest that your angle of attack should be to combine TCA + lithium + Thyroid (T3 or T4). If your improvement is only partial, you can add methylphenidate or amphetamine. I favor amphetamine because it doesn't feel as harsh as methylphenidate.
- Scott
Posted by undopaminergic on September 15, 2022, at 2:37:44
In reply to Re: Terrible trouble getting up in morning » Roslynn, posted by SLS on September 14, 2022, at 19:35:29
> I favor amphetamine because it doesn't feel as harsh as methylphenidate.
>It doesn't necessarily. And if you need a "lighter" stimulant, you should also consider modafinil.
There is also some danger of neurotoxicity with amphetamines, which manifests in particular if you try to quit -- severe and prolonged fatigue and apathy. It's not clear how high a dose is safe; it's probably individual.
-undopaminergic
Posted by Lamdage22 on September 15, 2022, at 2:39:41
In reply to Re: Terrible trouble getting up in morning, posted by undopaminergic on September 15, 2022, at 2:37:44
Is it worse if it is not summer? Then light therapy is a fantastic idea. Better than stimulants.
Posted by SLS on September 15, 2022, at 12:05:21
In reply to Re: Terrible trouble getting up in morning, posted by undopaminergic on September 15, 2022, at 2:37:44
> > I favor amphetamine because it doesn't feel as harsh as methylphenidate.
> >
>
> It doesn't necessarily. And if you need a "lighter" stimulant, you should also consider modafinil.
>
> There is also some danger of neurotoxicity with amphetamines, which manifests in particular if you try to quit -- severe and prolonged fatigue and apathy. It's not clear how high a dose is safe; it's probably individual.
>
> -undopaminergic
>Have you tried modafinil or adrafinil? Historically, people here have had more luck with adrafinil. I tried modafinil without success. More importantly to me, it produced are worsening of depression, especially brain-fog. It took 2-3 weeks after discontinuation for this mental state to begin to
subside.I think most people who commented found that amphetamine is "smoother" for them than methylphenidate (Ritalin). That was my experience as well. Your point is well-taken, though. There is too much interindividual variability in responses to the same drug such that making statements describing a 1 to 1 association is rarely applicable.
- Scott
Posted by Jay2112 on September 15, 2022, at 17:19:13
In reply to Re: Terrible trouble getting up in morning, posted by undopaminergic on September 15, 2022, at 2:37:44
> > I favor amphetamine because it doesn't feel as harsh as methylphenidate.
> >
>
> It doesn't necessarily. And if you need a "lighter" stimulant, you should also consider modafinil.Well, that is very subjective, so it does feel much, much smoother than Ritalin, to me (and many others have said this as well.) Modafinil releases glutamate in the brain, which is also what happens when you have a stroke. If it is considered "lighter", that is again subjective.
> There is also some danger of neurotoxicity with amphetamines, which manifests in particular if you try to quit -- severe and prolonged fatigue and apathy. It's not clear how high a dose is safe; it's probably individual.
I have been off and on amphetamines for years. I may feel a bit 'hung over' for a day, if I quit suddenly. I have had way, way harder times trying to lower my Effexor dose.
Jay
> -undopaminergic
>
Posted by undopaminergic on September 16, 2022, at 4:30:17
In reply to Re: Terrible trouble getting up in morning » undopaminergic, posted by SLS on September 15, 2022, at 12:05:21
>
> Have you tried modafinil or adrafinil?
>Yes, both actually.
> Historically, people here have had more luck with adrafinil.
>For me, modafinil seemed better, but I had to combine it with methylphenidate to get any effect. I felt slightly sharper. I used it in powder form, which may not be as good as the brand tablets, if particle size does play a significant role, which was suggested in some patent(s).
> I tried modafinil without success. More importantly to me, it produced are worsening of depression, especially brain-fog. It took 2-3 weeks after discontinuation for this mental state to begin to
> subside.
>That must be the worst reaction to modafinil that I've come across!
-undopaminergic
Posted by undopaminergic on September 16, 2022, at 6:44:56
In reply to Re: Terrible trouble getting up in morning » undopaminergic, posted by Jay2112 on September 15, 2022, at 17:19:13
>
> I have been off and on amphetamines for years. I may feel a bit 'hung over' for a day, if I quit suddenly.
>Then you have obviously not experienced the neurotoxicity.
I get a withdrawal syndrome that also lasts about a day if I quit methylphenidate after chronic use. It consists of fatigue and sometimes hypersomnia.
> I have had way, way harder times trying to lower my Effexor dose.
>That is not unusual. The serotonin reuptake inhibitors (whether selective or not) are notorious for their difficult withdrawal symptoms, perhaps in particular, or most classically, the electric shock sensations.
-undopaminergic
This is the end of the thread.
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