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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by bissie66 on May 22, 2008, at 14:29:30
Has anyone noticed depression/anxiety symptoms that come on in the morning and then completely subside around noon (or some variation). It's like my meds kick in later in the day or something.
I am also hypothyroid and lately needed to increase my meds. I've wondered if that could have anything to do with feeling a little anxious/ruminating thoughts in the a.m. It's almost like I'm feeling like my A.D. is fading out but then in the afternoon I'm fine. Weird!
Posted by Phillipa on May 22, 2008, at 16:30:10
In reply to time of day of symptoms, posted by bissie66 on May 22, 2008, at 14:29:30
Feeling worse in the morning is a type of depression not sure of the type. I too have hypothyroidism and changed doses of meds but have no idea what the results of last blood test was. Hypothyroidism can cause the same symptoms as depression lots of forum on thyroid. Good luck. Love Phillipa
Posted by bissie66 on May 22, 2008, at 16:57:43
In reply to Re: time of day of symptoms » bissie66, posted by Phillipa on May 22, 2008, at 16:30:10
Posted by chiron on May 22, 2008, at 18:44:00
In reply to time of day of symptoms, posted by bissie66 on May 22, 2008, at 14:29:30
Yip, I would keep reminding myself that it will get better as the day goes on.
Posted by bleauberry on May 24, 2008, at 13:14:08
In reply to time of day of symptoms, posted by bissie66 on May 22, 2008, at 14:29:30
The pattern of cortisol fluctuation from the adrenal glands profoundly affects how the meds work, or don't work. During my last year on prozac+zprexa, and then replaced with lexapro and then zoloft, it was weird but I was a bit under the weather but basically ok in morning, took a rough dive in the afternoon, and then in the evening I felt absolutely perfectly fine. An adrenal stress index test, which shows the cortisol curve, matched my mood patterns exactly.
The adrenals are closely intertwined with thyroid also. So if you have thyroid issues, adrenal issues could be expected.
Unfortunately treating daily pattern hormonal imbalances is not well understood and tricky to do. Patients at Yahoo forums know the most about it, as far as I have seen.
You could take a look at the dosing times of your thyroid meds and tinker with those to see if the pattern can be manipulated. Change the time of day, take more frequent doses (but same total daily dose), and stuff like that. If hypothyroid, there could very well be hypoadrenal too. As one went bad first, the other followed in an attempt to maintain equilibrium. If there is hypoadrenalism, the two natural treatments are licorice root or adrenal cortex extract, sometimes both, but the real fix is 5mg-20mg daily of hydrocortisone.
Posted by bissie66 on May 28, 2008, at 13:07:11
In reply to Re: time of day of symptoms, posted by bleauberry on May 24, 2008, at 13:14:08
Thanks so much for taking the time to respond with such informative and helpful stuff! You're awesome!
Posted by Crotale on June 1, 2008, at 11:24:48
In reply to time of day of symptoms, posted by bissie66 on May 22, 2008, at 14:29:30
Hi there...
I typically feel worst in the morning. My mood gradually improves over the course of the day.
Mood that is worst in the morning can be a symptom of what is called major depression with melancholia or melancholic features. Other symptoms include insomnia (especially awakening early in the morning), decreased appetite, anhedonia (inability to enjoy activities that used to give you pleasure), and inability to be cheered up even temporarily by things that ordinarily might be expected to make you feel better.
On the other hand, feeling worse in the AM could be a symptom of your hypothyroidism, or a side effect of your hypothyroid meds (hormones, I presume?) -- I don't know enough about that to be able to say.
Posted by Phillipa on June 1, 2008, at 19:15:32
In reply to Re: time of day of symptoms » bissie66, posted by Crotale on June 1, 2008, at 11:24:48
Same here hypothyroid meds in am empty stomach and feel worse in early part of day. Phillipa ps any suggestions?
Posted by BGB on June 1, 2008, at 23:20:46
In reply to Re: time of day of symptoms » bissie66, posted by Crotale on June 1, 2008, at 11:24:48
Mornings have always been an absolute hell for me, depression wise. I'm bipolar I in a super-depressive phase right now.
Posted by bissie66 on June 2, 2008, at 8:22:29
In reply to Re: time of day of symptoms » bissie66, posted by Crotale on June 1, 2008, at 11:24:48
yep, all of that happens to me when i have a relapse of depression. it's really strange, one day i just LOST my appetite, it was just gone. i could go almost the whole day without eating, and then i'd eat just a little bit. and then i noticed i'd watch my family playing badminton, instead of joining in. this is an activity i used to LOVE to do with them. and then, i couldn't wait to go to bed at night in order to end the day. normally i stay up late because i enjoy watching netflix with my husband. i enjoy this time with him after our daughter goes to bed. not anymore.
anyway, thanks a lot for pointing this out. it helps not to feel alone. meds poop out on me really quickly unfortunately. the good news is my pdoc has a new plan for me. he says a couple of his bipolar patients are like this and he is recycling A/Ds that works for us. luckily, they work again after taking a couple months off of them.
Posted by bissie66 on June 2, 2008, at 8:28:27
In reply to Re: time of day of symptoms, posted by BGB on June 1, 2008, at 23:20:46
> Mornings have always been an absolute hell for me, depression wise. I'm bipolar I in a super-depressive phase right now.
I feel for you. I'm bipolar too and definitely have more depressions than up periods. I hope it gets better. Do you take an A/D?
Posted by BGB on June 2, 2008, at 8:51:42
In reply to Re: time of day of symptoms » BGB, posted by bissie66 on June 2, 2008, at 8:28:27
> I feel for you. I'm bipolar too and definitely have more depressions than up periods. I hope it gets better. Do you take an A/D?
No, I'm taking 3 A/D's right now. =(
Just in case you were wondering, here's the hot mess I am taking right now...
Remeron 60mg
Cymbalta 120mg
Wellbutrin SR 600mg
Trileptal 1200mg
Lamictal 200mg
Diazepam 5-10mg PRN
Cytomel 50mcg (to augment AD's)
Propranolol 60-120mg (to control tremors)
Trazodone 150mg PRN (for sleep)Best of luck to you. Let us know if you find something that works!!!
Posted by bissie66 on June 3, 2008, at 9:56:07
In reply to Re: time of day of symptoms » bissie66, posted by BGB on June 2, 2008, at 8:51:42
Thanks for sharing your current cocktail. I'm defintiely interested, always. I was taking 3 AD's too, until a couple days ago -- Remeron, Cymbalta, and Zoloft. I just dropped the Zoloft b.c. I'm pretty sure it pooped out. That one quits on me super-fast. Now I'm on Pristiq and Remeron but I'm thinking of taking a break on the Remeron b.c. Remeron+SNRI combo (aka California Rocket Fuel) usually works 2 month (and I've hit that point) and if I take a break it works again.
I also take lithium and lamictal for bipolar and levoxyl for hypothyroidism. Plus seroquel if things get really bad.
Sometimes I feel like dumping the whole mess down the toilet and meditating under a tree. But, life must go on. Hang in there.
Posted by blueboy on June 6, 2008, at 10:55:42
In reply to time of day of symptoms, posted by bissie66 on May 22, 2008, at 14:29:30
> Has anyone noticed depression/anxiety symptoms that come on in the morning and then completely subside around noon (or some variation). It's like my meds kick in later in the day or something.
>I was like that in my younger days. Now I'm just the opposite. Mornings are my best time. I get severely depressed or else mixed in the afternoon, then the evenings get better.
I'm Bipolar II with normal thyroid. This isn't med related. It might be sleep related, as I have bad insomnia.
Posted by bissie66 on June 6, 2008, at 11:01:58
In reply to Re: time of day of symptoms, posted by blueboy on June 6, 2008, at 10:55:42
> > Has anyone noticed depression/anxiety symptoms that come on in the morning and then completely subside around noon (or some variation). It's like my meds kick in later in the day or something.
> >
>
> I was like that in my younger days. Now I'm just the opposite. Mornings are my best time. I get severely depressed or else mixed in the afternoon, then the evenings get better.
>
> I'm Bipolar II with normal thyroid. This isn't med related. It might be sleep related, as I have bad insomnia.I have been that way too and am more so now that I'm older (41). In fact that has been going on this week. This morning my husband commented that I was in a good mood. I said yes, but it's morning. He knew what I meant, all too well.
Posted by yxibow on June 6, 2008, at 23:02:07
In reply to Re: time of day of symptoms, posted by bissie66 on June 6, 2008, at 11:01:58
It has varied -- I have a complex somatiform condition (anxiety manifesting in real bodily functions, mostly heightened visual and some auditory senses) plus accompanied depression and some possible sleep disorder.
Decompensation can occur at any point of the day, due to panic -- but in general the disorder has, once I'm fully awake after having experienced sleep issues typically (and all of this is 24/7), the best point in the day is late morning through about 6-8pm.
Then things tend to slide, possibly with a perk around midnight but in general day has always varyingly been better than night.
Posted by blueboy on June 9, 2008, at 6:52:41
In reply to time of day of symptoms, posted by bissie66 on May 22, 2008, at 14:29:30
I was writing an article on cortisol yesterday and thought maybe a comment on it might be interesting in this context.
Cortisol is similar to adrenaline, and is in fact manufactured in the adrenal glands, but acts more as a daily regulator than as an emergency source of energy. It is longer lasting and slower acting than adrenaline. High levels tend to break down fat and keep blood sugar high, and keep us alert.
It lowers immunity (think "cortisone", a substance that imitates cortisol and is used to reduce auto-immune disfunction) and is harmful in a number of ways when stress keeps cortisol levels high for too long. Low cortisol periods are needed for the body to repair itself: build bone and muscle, fight off disease, and who knows what all.
Anyway, normal cortisol fluctuation may be useful to keep in mind when you are trying to figure out what's going on with your mood and energy level at a particular time of day. Assuming a full night's sleep (@ 7-8 hours), levels are usually lowest about 3-5 hours after you go to sleep. They start to rise before you wake up and max out in midmorning. Then they slowly decline.
Stress causes some degree of cortisol release, similar to adrenaline but longer-lasting. It seems likely, to me, that this is partly responsible for some of the bad effects of long-term stress, especially the tendency to catch colds.
That's all I really know. It's obvious to me that I have a less active period after lunch and a more active period starting around 7 pm, but I don't know what causes this, whether my cortisol doesn't decrease in a straight line or whether other energy regulatory functions.
Also, maybe this is why I sleep better after I get a lot of exercise -- my body needs to repair itself and so something in my brain signals the adrenal gland to hold off on the cortisol a bit longer.
Posted by yxibow on June 10, 2008, at 3:01:02
In reply to Re: time of day of symptoms - Cortisol, posted by blueboy on June 9, 2008, at 6:52:41
To bring a tangent, I have had a normal (urine) cortisol test, which is the typical way of doing it, a full 24h test. There are blood tests but they aren't as reliable as far as I know, even if given twice because of the rather large fluctuation.
This is the end of the thread.
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