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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by pseudoname on November 1, 2005, at 14:28:25
The other day I had all the classic flu symptoms: achy joints, chills, balloon-head, etc. All I wanted to do was curl up in bed, and that's all I did. But get this: emotionally / cognitively I felt GREAT! My constant depression evaporated. I was *happy* as I curled up. And no, I didn't take any flu meds.
The flu symptoms were gone the next day (fortunately, I guess), but the depression came back like ever.
What's going on? Is there something I can take to duplicate the flu effect?
Posted by Declan on November 1, 2005, at 15:21:41
In reply to flu as antidepressant–?!, posted by pseudoname on November 1, 2005, at 14:28:25
Marx (was it?) said that the only cure for mental distress was physical pain. There's the same idea in King Lear. Compare the flu to an opiate withdrawal which is like the flu with bad depression thrown in.....there's the world of difference between the two, the difference depression makes. The flu's a piece of cake by comparison, no?
Declan
Posted by linkadge on November 1, 2005, at 17:21:52
In reply to Re: flu as antidepressant–?!, posted by Declan on November 1, 2005, at 15:21:41
No, I know what you are taking about. My mother noticed too that the only time I was nice and cheerfull as a child was when I was sick, as soon as I got well again I was back to my bitter, miserable self.
I think it has something to do with the effects of the sickness on sleep. If I recall reading somewhere, a fever actually supresses REM sleep much in the same way that sleep deprivation, or an antidepressant might.
Some people may say thats nonsense, cause you would expect a sickness to depress, but I know what you are talking about, at least with me.
Linkadge
Posted by linkadge on November 1, 2005, at 21:32:07
In reply to Re: flu as antidepressant–?!, posted by linkadge on November 1, 2005, at 17:21:52
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8573663&dopt=Abstract
Linkadge
Posted by katekite1 on November 1, 2005, at 22:05:36
In reply to HEY check it out, I FOUND SOME LITERATURE!, posted by linkadge on November 1, 2005, at 21:32:07
Linkadge that is so cool you found that reference!! I don't know how many hours I spent looking for something along those lines.
So I always felt like everyone else when I was sick (worse) -- until... 2001-2002 when every time I would be ill it was the only time I would sleep normally, the only time I would feel okay. Life got worse and worse where I felt sort of weak and anxious and depressed too, but with no exact symptoms and no good reasons, sleeping only a couple hours a night even with sleep aids. That spring my husband got stomach flu and was really very ill... I didn't get any symptoms at all except I felt normal for 3 days for once, I'd been sleeping a couple hours a night and totally anxious all the time, all of a sudden I slept like a normal person. I was so upset when I got "better". That had been the first time in a while I felt like myself.
For me it turned out to be hyperthyroidism. So here's the rub... my thyroid levels were never and have never since been out of the normal range! At least I started taking medication for it before they did go out of range, though by the end I had had a fever for 2 months so I don't know how "mild" it really was. My thyroid hormone levels were right at the edge of normal, however for me that was highly abnormal. My TSH was mid range the whole time. (Now it turns out I have a thyroid tumor... anyhow that is beside the point unless somehow that is why I didn't have typical lab results\.)
One other thing that made me feel better was starting the birth control pill, something about the estrogen was so great (within a couple hours) I ended up taking two a day for a while. Unfortunately my body adjusted after about a week and that no longer helped. For me what helped was Tapazole to suppress the overactive thyroid.
My own theories on why illness made me feel normal was: 1. when your body is ill you "use up" more thyroid hormone than usual and so a person with a mildly overactive thyroid would feel better. 2. When you are ill the immune balance shifts and immune attack on your "happy neurons", in reality something like high IL-6, this is overwhelmed by the body's immune response to the virus and the immune balance temporarily shifts to something more mood favorable. 3. When you are ill your cortisol is "used up" more (we know this because people who are Addisonian need extra cortisol supplementation when they are ill) so in someone with excessive cortisol, one's brain would be exposed to relatively less cortisol than usual, allowing it to feel less stressed.
It is easy enough to get a dexamethasone suppression test to check for overactive adrenals. And also very easy to get not thyroid function tests but the thing to do is get "thyroid antibody" tests to see if there is the possibility of a problem. IF there is the possibility then every couple months monitor the levels and see if they are jumping around (which feels terrible) or going up or going down, any of those make you feel nuts and is treatable.
I would love to hear back Pseudoname on what other things you find help, or what else you find out. Something like this, finding you feel better when you are supposed to feel sick, this is a major clue. Doesn't mean standard psychoactive medications wouldn't help, but its certainly something I would mention to a doctor and push them to look into it.
Katekite1
Posted by pseudoname on November 2, 2005, at 7:28:33
In reply to HEY check it out, I FOUND SOME LITERATURE!, posted by linkadge on November 1, 2005, at 21:32:07
Thanks for the link, linkadge.
My own experience last week didn't involve sleeping before the mental "benefit" of being ill kicked in, so I don't think the REM question would apply in that instance. But that is a very interesting abstract...
I remember from being a kid that after a fever I felt a *whole* lot better – better than usual – and that was before I developed depression.
Posted by SLS on November 2, 2005, at 8:09:57
In reply to Re: HEY check it out » linkadge, posted by pseudoname on November 2, 2005, at 7:28:33
Unfortunately, infections can also precipitate major depressive episodes.
Many speculate that a chronic inflammatory process is involved with depression as it might also be with heart disease.
Linkadge's idea seems quite likely, though; that the suppression of REM sleep might have produced the antidepressant effect. That there was a REM rebound certainly supports this idea.
This is a very interesting phenomenon. Maybe one of the cytokines acts as an antidepressant for some people, but not for others. I wonder if their choice of endotoxin contributed to the effect.
Personally, I have never noticed an improvement in depression as the result of having an infection, but then again, I don't think I've ever had a true flu.
Linkadge - you are a walking database of knowledge.
- Scott
Posted by Laurie Beth on November 2, 2005, at 8:24:18
In reply to Re: HEY check it out, posted by SLS on November 2, 2005, at 8:09:57
People often stop eating when they have a fever.
For example, a book I read on autism said that many parents of autistics find that their symptoms of autism decrease when they're sick. The author, who is a proponent of the "opioid excess" theory of some autism (incomplete digestion of casein in milk and gluten in grains ---> excess opioids floating around in the body and crossing the blood/brain barrier) believed that this is when her son was sick and stopped eating, his behavior improved because he wasn't eating casein or gluten (or anything else).
I too have noticed that colds with low-grade fever sometimes correspond to better moods. I also notice that on some of my best days, cognitively and emotionally, I am very sleepy - sometimes with follows a night with less sleep, but not always. Unfortunately, I usually end up sleeping too much on those days to take advantage of the better cognition and moods ... but at least the daytime naps feel pleasant.
Posted by linkadge on November 2, 2005, at 8:38:01
In reply to Re: HEY check it out » linkadge, posted by pseudoname on November 2, 2005, at 7:28:33
You can be ill before you know you're ill, so there may have been a reduction in REM sleep even before you felt the symtpoms of the illness.
Just a thought.
Linkadge
Posted by linkadge on November 2, 2005, at 8:48:23
In reply to Another possibility, posted by Laurie Beth on November 2, 2005, at 8:24:18
I have noticed that "certain" sicknesses have resulted in significant mood improvement. Other sicknesses, like SLS mentioned have left me very bitter.
Like I mentioned in the above post, there were many times as a teenager that I would be so miserable and bitter, but when a sickness came on I would be much kinder, and in a much better mood. As soon as I got better, I felt miserable again.
Linkadge
Posted by pseudoname on November 2, 2005, at 9:40:19
In reply to Re: HEY SOME LITERATURE! Pseudoname and » linkadge, posted by katekite1 on November 1, 2005, at 22:05:36
> For me it turned out to be hyperthyroidism.
> the thing to do is get "thyroid antibody" testsHmmm. I've tried ADDING synthetic thyroid (my levels are always normal), but I haven't considered a subclinical overactive thyroid. That may well be worth considering. I will bring this up with Pdoc.
> When you are ill your cortisol is "used up" more
Last time I had my levels checked, cortisols were (supposedly) normal while I was depressed. The one dexamethasone suppression test I had was negative, but perhaps it would be worth repeating. Things change, after all. I would bet my cortisol levels run high: how could they not, given my stress levels?! LOL.
> Unfortunately my body adjusted after about a week and that no longer helped.
That happens so often for me! I believe my brain really WANTS to be depressed.
> I would love to hear back Pseudoname ... this is a major clue ... I would mention to a doctor and push them to look into it
Kate, thank you for your encouragement. I see my pdoc tomorrow and I will bring this up.
I wondered if my "flu cure" might have involved endorphins – either an increase or a reduction of them. I have wondered for a long time whether some regulator in my brain is set way too low and shuts down reward processes at the slightest excuse. Perhaps part of my initial immune reponse involved a release of endorphins that overrode my usually stingy control circuits? Maybe I felt better because of increased endorphins? But I don't know if endorphins are released in an initial immune response...
Alternatively, maybe my endorphin levels were reduced as part of the immune response. Lower endorphin levels allow more dopamine, and high endorphin levels decrease dopamine. I just don't know.
I'm considering this in part because at tomorrow's appt I'm going to try to get my pdoc to help me find a prescriber of buprenorphine, which blocks kappa opioid receptors. The kappas are the ones that shut down the release of dopamine when they detect certain levels of endorphin.
> Now it turns out I have a thyroid tumor...
Are you okay??
Posted by pseudoname on November 2, 2005, at 9:49:05
In reply to Re: HEY check it out » pseudoname, posted by linkadge on November 2, 2005, at 8:38:01
> You can be ill before you know you're ill, so there may have been a reduction in REM sleep even before you felt the symtpoms
Yeah, I wondered about that, too. Quite possible, I guess.
I noticed the flu symptoms about 6 PM, then curled up and first noticed the mood improvement about 7 PM.
Posted by katekite1 on November 2, 2005, at 16:39:35
In reply to thyroid, cortisol, endorphins, DA » katekite1, posted by pseudoname on November 2, 2005, at 9:40:19
Hi Pseudoname,
I remember reading here years ago one person finding buprenorphine was the one drug that helped them. Good luck with it.
Thanks for asking if I'm okay... I'm probably fine... suspicious biopsy but apparently some whopping percent of people have small benign thyroid nodules they don't know about that never cause them a problem, mine would just be an odd one that is growing too fast. But this sure is why I am back reading on the dr-bob website... been gone for a year or more but when someone tells you you -might- have cancer but you have to wait 3 months to find out one way or the other... well after 18 psych med free months I'm stressed out and back on prozac.
(+moclobemide last night which by the way was a cool combination, had a happy day today -- just don't ever try it at home without discussing the possibility of fatal reactions with your doc first).
Anyhow to your point about your brain wanting to be depressed... I know what you mean... sometimes I wonder if my brain simply likes changing chemistry over any one type of chemistry. That taking any drug produces some response that is better than the hum drum of either no drugs or a drug long term. Sometimes things are initially full of side effects so I stop them, right when I stop it I feel really good for a few days. Or conversely I start a medication and feel an initial effect and then right when other people feel better, say 4 weeks or so, I start to feel terrible (that was Paxil for me).
Kate
Posted by pseudoname on November 3, 2005, at 17:37:37
In reply to thyroid, cortisol, endorphins, DA » katekite1, posted by pseudoname on November 2, 2005, at 9:40:19
I saw my pdoc this morning and told her about the depression vanishing just while I "suffered" from flu symptoms. She thought a fever might be related to changes in brain function, but I can't say for sure I had one. I had chills, so maybe...
Posted by katekite1 on November 3, 2005, at 20:38:23
In reply to pdoc wondered about fever, posted by pseudoname on November 3, 2005, at 17:37:37
Makes you want to go hang out in doctors office waiting rooms to get exposed to something, well, almost.
Kate
Posted by pseudoname on November 3, 2005, at 22:02:07
In reply to Re: pdoc wondered about fever, posted by katekite1 on November 3, 2005, at 20:38:23
> Makes you want to go hang out in doctors office waiting rooms to get exposed to something
I remember from my grandmother's medical problems that conditions other than infection can trigger fever, so maybe there's another way.
I just read that in infection, the cytokines in linkadge's study are thought to *somehow* get a message to a regulator in the anterior hypothalamus. Perhaps they enter the brain by means unknown – OR they may activate something in the peripheral vagal nerve, which then gets the message through.
Maybe I should reconsider Vagal Nerve Stimulation.
(What we don't know about fever: http://jp.physoc.org/cgi/content/full/526/3/470)
And Kate, I completely forgot to ask my pdoc about the thyroid thing! Next time.
Posted by zeugma on November 5, 2005, at 6:45:44
In reply to Re: HEY check it out, posted by SLS on November 2, 2005, at 8:09:57
hi Scott.
Unfortunately, infections can also precipitate major depressive episodes.
They trigger all sorts of bad things for me too. I would experience severe depersonalization during episodes of fever as an adolescent. Flu makes me even more tired and my mood plummets.
>
> Many speculate that a chronic inflammatory process is involved with depression as it might also be with heart disease.
>
And fibromyalgia. narcolepsy is also conjectured to be triggered by an autoimmune process. OCD has been shown to occur in children after strep infections.> Linkadge's idea seems quite likely, though; that the suppression of REM sleep might have produced the antidepressant effect. That there was a REM rebound certainly supports this idea.
>
> This is a very interesting phenomenon. Maybe one of the cytokines acts as an antidepressant for some people, but not for others. I wonder if their choice of endotoxin contributed to the effect.
Some of the TCA's act on the cytokines, particularly amitriptyline and nortriptyline. I don't know if SSRI's act as strongly on the cytokine system. I do know that some neuroleptics act in the similar way to AMI and NOR. It is pure conjecture to attribute an AD effect to these actions. But it has been known that TCA's are useful in controlling rheumatoid arthritis, and the cytokine effect plausibly explains this.>
> Personally, I have never noticed an improvement in depression as the result of having an infection, but then again, I don't think I've ever had a true flu.
>
Flu makes me depressed. I was much more prone to infection before starting nortriptyline. Depression itself can have negative effects on the immune system, of course.-z
> Linkadge - you are a walking database of knowledge.
>
>
> - Scott
This is the end of the thread.
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