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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Walfredo on March 2, 2010, at 16:28:01
Count me in the boat where if I go a night without sleeping, the next morning I don't want to go to bed because my depression is in remission and I want to enjoy it. Verbal facility is improved ten-fold. I actually feel the way I want to feel. You know, the whole nine yards.
When I tried Nardil (never actually making it to a target dose of 90 mg - I stopped at 60 mg b/c the side effects were so harsh), it gave me SEVERE insomnia. For several weeks I could only sleep like 3-6 hours while usually waking up 3 hrs in. At one point, I didn't sleep for like 2.5 days. Ironically though, at this point, despite feeling like a bit of a zombie, underlying being genuinely tired, I actually felt emotions and experienced moods/ways of feeling that I remember from like childhood, way pre-depression. And, I am 99% sure it was the severe sleep deprivation (not the Nardil) because after those few days of zero sleep, I finally was able to sleep again (I guess this side effect subsided), and of course the mood improvement vanished after I started sleeping again.
So, I have been reading up some on sleep deprivation, and it seems my experience is not that rare based on some articles I have found doing basic google searches. However, nothing I have read seems to implicate what mechanism is involved biologically that seems to result in the mood improvement or how to apply this phenomenon in treating depression.
So, I was hoping to get a discussion going, hoping some of you real savvy posters might have some idea or theory as to why this happens and possibly even some pharmacological applications if I'm lucky.
I'm especially interested in any ideas involving acetylcholine as I am starting to suspect that this under-discussed neurotransmitter's over expression might be a key to my depression (for several reasons which I won't delve into unless someone is curious or wants to hear more in depth).
So, fire away with experiences, theories, or any other comments. I'm curious to hear some of you veteran's takes on this phenomenon.
Posted by linkadge on March 2, 2010, at 18:54:12
In reply to How does sleep deprivation alleviate depression?, posted by Walfredo on March 2, 2010, at 16:28:01
Sleep deprivation causes all sorts of wierd and wonderful biochemical alterations. Serotonin, dopamine, acetycholine, neuropeptides and hormones...you name it.
It tends to decrease overactive limbic neurotransmission, but increase overall cortical neurotransmission. Lack of sleep can easily cause a bipolar to switch from depression to mania.
The theraputic effects are somewhat temporary. Go to sleep and the body snatchers will get you. Some have tried (with some sucess) to combine theraputic sleep deprivation with certain agents to prolong the effect.
Sleep deprivation + pindolol + lithium has been well studied. The rational is that it reduces the feedback inhibition on serotonergic functioning.
Its a mystery, but very interesting one. Horrible nasty miserable depression can resolve in one evening. Makes you wonder what all the wait with AD's is for - or if its even necessary.
Linkadge
Posted by Walfredo on March 2, 2010, at 23:04:46
In reply to Re: How does sleep deprivation alleviate depression?, posted by linkadge on March 2, 2010, at 18:54:12
thanks for the thoughts linkadge. I really is amazing that something as simple as sleep deprivation can basically "cure" me until I sleep again, yet eight years of seeing pdoc's on and off and I still can't figure out a pharmacological treatment plan that works.
It's gotta be something so simple...some mechanism these med's don't touch...I guess. Who knows....
Posted by CrAzYmEd on March 3, 2010, at 4:55:04
In reply to Re: How does sleep deprivation alleviate depression?, posted by Walfredo on March 2, 2010, at 23:04:46
Sleep deprivation effectivly reduces my social anxiety alot.
Posted by Walfredo on March 22, 2010, at 0:52:00
In reply to Re: How does sleep deprivation alleviate depression?, posted by CrAzYmEd on March 3, 2010, at 4:55:04
please?
Posted by john morgan on March 24, 2010, at 18:11:35
In reply to Anyone got anything to add?, posted by Walfredo on March 22, 2010, at 0:52:00
I am a 50 year old male and have suffered from moderate unipolar depression and anxiety since my major depressive episode two years ago which put me in the hospital for 8 days. I have taken Mirtazapine to help me sleep for the last two years. I tried a few courses of antidepressants with only a partial response - I am off them now. My depression is the melancholic kind - much worse in the morning. Lately, the Mirtazapine hasn't been working as well and the last two nights I only got about 3-4 hours of sleep instead of my usual Mirtazapine-induced 7-8 hours. I actually feel better today than I have in months. I have researched this and found this is no accident. This phenomena needs to be researched exhaustively for it is truly the only real relief I have felt in two years. - John in Albuquerque
Posted by SLS on March 24, 2010, at 19:39:37
In reply to My sleep deprevation endorsement, posted by john morgan on March 24, 2010, at 18:11:35
Hi.
> I only got about 3-4 hours of sleep instead of my usual Mirtazapine-induced 7-8 hours. I actually feel better today than I have in months.
I recall a doctor at the NIH telling me that there was a positive association between an antidepressant response to sleep deprivation and a therapeutic response to Wellbutrin. Unfortunately, I don't fit this pattern. I respond to sleep deprivation, but Wellbutrin worsens my depression.
- Scott
Posted by john morgan on March 25, 2010, at 13:51:14
In reply to Re: My sleep deprevation endorsement, posted by SLS on March 24, 2010, at 19:39:37
I'm sure you might of seen this:
http://www.medicinenet.com/script/main/art.asp?articlekey=50800
An experiment in Germany where they introduced sleep deprivation into a group of depressed patients and then gradually brought them back into a nightly sleep routine with positive results. The article suggests TSH has something to do with it.
Posted by john morgan on March 25, 2010, at 14:59:36
In reply to Re: My sleep deprevation endorsement, posted by john morgan on March 25, 2010, at 13:51:14
Also:
http://www.ncbi.nlm.nih.gov/pubmed/11146761?dopt=Abstract
Posted by evenintherain on April 7, 2010, at 20:45:57
In reply to Re: My sleep deprevation endorsement, posted by john morgan on March 25, 2010, at 13:51:14
there's an opinion piece about this in the NY Times today: http://opinionator.blogs.nytimes.com/2010/04/07/in-sleepless-nights-a-hope-for-treating-depression/?emc=eta1
Posted by shalhevet on April 8, 2010, at 2:24:10
In reply to Re: My sleep deprevation endorsement, posted by evenintherain on April 7, 2010, at 20:45:57
I left this comment over in the NYT post:
Wow, so many negative comments about this article. I thought it was cool. I'm taking an antidepressant that suppresses REM sleep (Parnate, an MAOI, for refractory depression), and I've never responded so profoundly to a medication before. I've never thought to make any connection between the two (the incredibleness of Parnate, and REM), though. Parnate for me causes both insomnia and intense daytime hypersomnolence, and they feel independent of each other, and my afternoon naps feel so resorative that I've wondered if it's a REM rebound. (Who knows?)Unfortunately, for now this means being on a merry-go-round of stimulants and sedatives, which are bandaids until something better comes along. Too bad Xyrem is so exorbitantly expensive and difficult to obtain (I mean, wow, I've tried $$Provigil, but Xyrem is $$$$ and Serious Business! I'll stick with cheap old Dexedrine). It's meant for narcolepsy, but it's an interesting drug and I wonder how it would affect people with depression who have psychomotor slowing and residual hypersomnolence during the day, but also insomnia or shifted biorhythms altogether. (I also wonder how many narcoleptics with depression find their depressive symptoms abate as their sleeping patterns are corrected)
Night night NYT!
This is the end of the thread.
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