Depression? / Insomnia and meds

[ajack]

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

[Roger Gould, M.D.]

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.

[horse1]

i, too, have been plagued by insomnia throughout my whole life, especially during the past year. i was averaging about 4-5 hours a night even taking ambien at bedtime, sometimes awakening after 3 hours and having to take another (i would only take 1/2 of a 5 mg each time). i was treated w/anti-depressants (paxil, serzone, prozac) several years ago during a divorce in which i lost 35 lbs due to mental state. i am 47 yo female, pre-menopausal as well. have always been depressed and overly sensitive, but do not believe any "pill" is going to solve it, so I just cope with it.

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...

[ajack]

Thank you everyone for your comments.....
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

[hey3]

I am only 31 so I don't know what it is like to perimenopausal.  I understand what insomnia is like though.  I used to spend hours awake at night off and on since I was a teenager.  My father has the same sleep patterns as I do.  I have taken many different meds, Vistaril, Restoril, Valium, Trazadone and other herbal remedies.  I have also made many life altering discions in my life.  Some of which sounds like some of yours.  The lasting med that I have used is Lexapro.  Yes many people have written on this site on BP increase ect.  I didn't have that problem with it.  I never in my life slept that well but I guess I am just a bit vain and didn't like the weight gain.  It also didn't help with my obsessive thoughts that constantly go thru my head.  I tried Paxil for the thoughts and it kept me up all the time and gave me terrible feelings in my arms and head.  One thing that might help is re-set your internal clock.  Get up at the same time and go to bed at the same time.  Also exercise does wonders for you brain and body.  Walk jog get some light weights.  I still have problems with mine and on occasion take valium.  I wake up in the middle of the night worring quit often.  The exercise helps alot.

[pmerc62]

I am a 42-year-old female who is also experiencing perimenopausal symptoms for approximately the last year.  Insomnia is a great part of this picture, as well as night sweats, etc., and it has been, by far, the most difficult for me to deal with.  I had been prescripted Lorazepam in the past, which worked wonders.  I fell asleep within 20 minutes of taking 1/2 tablet of the lowest dose (0.5 mg) and slept soundly throughout the night without any early morning grogginess.  However, my physician pulled me for the medication (as it is a narcotic class) after three months, and my sleep patterns reverted to sheer hell.  Of late, I was tried on Ambien (I also took a 1/2 tablet of the lowest dose), but this has also been discontinued.  Through a friend and some extensive research, I found Alluna in my pharmacy which is sold over-the-counter.  It is a mix of Valerian and hops.  I'm not going to state that it's a miracle cure for my insomnia, but more nights than not it relaxes me enough to fall asleep.  Hope this helps.  Patti