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Mental Health (Expert Forum)
Depression? / Insomnia and meds
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
Depression? / Insomnia and meds
by ajack, Jul 10, 2004 12:00AM
I am 51 year old female. I have been noticing some perimenopausal symptoms off and on for about a year. I have also been noticing insomnia (waking up after about 4 hours of sleep and staying awake for several hours nearly every night), fatigue (less emotional resilience to stressful conditions, decreased motivation and energy for work, some memory problems, mostly word-finding, and forgetfulness) for about 9 months. At the end of January, I was let go from a high stress position that required travel and am currently unemployed, between homes, jobs and city.
Recently a mentor of mine suggested depression as an underlying cause. This mentor is a clinical psychologist well acquainted with the cognitive and behavioral indicators of depression who was observing me over time and has expressed this question on several occasions. I was aware of the changes as above, snd of feeling tired due to poor sleep and having a generally stressful life experience at present but not of depression.
Hx: I had a major depression with obsession/compulsive "confessions" for about 3 weeks when I was 11 and pubertal (no treatment) and another, with anxiety (again no treatment) at age 18 that lasted about 9 mos. Since then I have been chronically mildly dysthymic I believe, for most of my life, but no major symptoms.
Family Hx: I did have grandmother who had a psychotic depression and an uncle who was hospitalized once for depression as an adult. Also my father and mother are both tense worriers and my father used to drink to calm nerves.
Current TX: My GP prescribed nortriptyline 25 mg hs for insomnia which I started at the very end of April. I noticed a good effect on sleep almost immediately - then after about a week to two, I began to notice a very positive effect on my energy, and I felt productive and motivated. Others including my mentor noticed a dramatic change in me - greater confidence, self-assurance, better work performance
I increased to 50 mgs when I seemed to require it and for three weeks total the positive changes remained. Then for no apparent reason the meds seemed to stop working completely. I got no effect even after increasing to 75 mgs hs. and remaining there for 3 weeks; sleep problems have returned, and my mentor is noticing a return to my former presentation.
Now my GP has me on Trazodone 50 mg hs. It doesnt seem to do much good, as it seems to wear off too soon and I wake up at night after 4 hours just as before. It has been less than a week with the Traz however.
My questions:
Should I be treating this as primarily insomnia, which my GP is doing, or as a depression, in which case should I be on a higher dose of antidepressant?
Did I discontinue the nortrip too soon, and why would it stop working after a good response?
How much of this can be attributed to my age/change of life? I am on a low dose contraceptive to regulate menstruation and have been told I am in early stage menopause tho all hormones, incl thyroid are normal
ajack
Recently a mentor of mine suggested depression as an underlying cause. This mentor is a clinical psychologist well acquainted with the cognitive and behavioral indicators of depression who was observing me over time and has expressed this question on several occasions. I was aware of the changes as above, snd of feeling tired due to poor sleep and having a generally stressful life experience at present but not of depression.
Hx: I had a major depression with obsession/compulsive "confessions" for about 3 weeks when I was 11 and pubertal (no treatment) and another, with anxiety (again no treatment) at age 18 that lasted about 9 mos. Since then I have been chronically mildly dysthymic I believe, for most of my life, but no major symptoms.
Family Hx: I did have grandmother who had a psychotic depression and an uncle who was hospitalized once for depression as an adult. Also my father and mother are both tense worriers and my father used to drink to calm nerves.
Current TX: My GP prescribed nortriptyline 25 mg hs for insomnia which I started at the very end of April. I noticed a good effect on sleep almost immediately - then after about a week to two, I began to notice a very positive effect on my energy, and I felt productive and motivated. Others including my mentor noticed a dramatic change in me - greater confidence, self-assurance, better work performance
I increased to 50 mgs when I seemed to require it and for three weeks total the positive changes remained. Then for no apparent reason the meds seemed to stop working completely. I got no effect even after increasing to 75 mgs hs. and remaining there for 3 weeks; sleep problems have returned, and my mentor is noticing a return to my former presentation.
Now my GP has me on Trazodone 50 mg hs. It doesnt seem to do much good, as it seems to wear off too soon and I wake up at night after 4 hours just as before. It has been less than a week with the Traz however.
My questions:
Should I be treating this as primarily insomnia, which my GP is doing, or as a depression, in which case should I be on a higher dose of antidepressant?
Did I discontinue the nortrip too soon, and why would it stop working after a good response?
How much of this can be attributed to my age/change of life? I am on a low dose contraceptive to regulate menstruation and have been told I am in early stage menopause tho all hormones, incl thyroid are normal
ajack
Doctor's Answer
by Roger Gould, M.D., Jul 12, 2004 12:00AM
, Jul 12, 2004 12:00AM
I think I can help you most by helping you think about this rather than answer these questions specifically. When we oversimplify complicated life processes into diagnostic labels like depression and insomnia, we lose the real opportunity to do something successfully. Depression, anxiety and insomnia are symptoms of distress. They come in dynamic patterns. If you are sleep deprived and then sleep well because of a medication, your mood and energy and self confidence will increase, as they have. If something bothers you enough and keeps you up, the medications won't work and the cycle starts again. Sometimes increasing the medication or switching works..sometimes it doesn't because the strength of the " bother" is too great and you have to deal with it directly. You are in the midst of several large transitions which require you to be more self reflective and wise about your life, your past and your present. YOu have menopause, mid-life, and mid-career issues..any one of which can keep you up at night. Try seeing a therapist...a better way to approach this problem.
i quit drinking about 7 months ago and insomnia worsened for a while. i work out regularly, eat a healthy diet and do not smoke or do drugs. i still take 1/2 ambien nightly for sleep but i am now averaging about 6 hrs per night. this may sound crazy, but during the winter months when the daylight is shorter, i do not sleep much. up daily at 5am, to work by 7am. while the lack of sleep does affect my concentration and ability to cope, i just deal with it as best as i can (i'm sure my family and friends do not find me a pleasant person when i am consistently sleep-deprived). and i truly believe that most of these so-called anti-depressants that are "non-addictive" leave ppl with horrible side affects as i have read on this forum, and have seen some family members try to get off various antidepressants unsuccessfully, only to be prescribed yet another antidepressant. we live in a society that is all too quick to think there is a magic "pill" to solve our problems. the pharmaceutical co's have their hand in the pocket of almost every household in america.
i think a lot of your symptoms can be related to premenopause.
if you are not exercising or eating right try to do so. i also started taking DHEA about a month ago from GNC which has really boosted my energy level and i am actually sleeping better. when i am going through hard times, i try to think "this too, shall pass" and it usually does change. i hope you do not have to stay on prescription meds for depression. therapy is a good idea too, but it can be hard to find a therapist you can relate to.
good luck to you...
I would seek a therapist, perhaps , except that 1) I have been therpized up the wazoo over the course of my life (three therapies and two psychoanalyses - one a completed psychoanalysis after being on the couch 5 days a week for 4 years and I feel I have benefitted the most one can from therapy; 2) I am a therapist so I know pretty much psychotherpy's benefits and limitations.
Drugs I have never tried, except for now. So this experience is new for me -
Ajack