![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by rjlockhart37 on March 11, 2016, at 20:16:09
ithe hours of 3-7pm are my depression periods.... espcially when im stressed to get things done and im in depressville land
caffeine didnt work, prozac this morning helped but maybe it's the zyprexa because if drink coffee with zyprexa it makes me sleepy, no matter how much caffeine, too much a nervous slump
i feel so much more better right now, it totally left on it's own, but i really would like to know the cause of the slump period, late afternoon trip to depressville......i feel so bland and boring, ughhhh it makes me want to do a recreational drug to get away from the yuk feeling
Posted by SLS on March 12, 2016, at 5:35:54
In reply to depression time periods (afternoon), posted by rjlockhart37 on March 11, 2016, at 20:16:09
> ithe hours of 3-7pm are my depression periods.... espcially when im stressed to get things done and im in depressville land
Is there any bipolarity in your case?
My worst period occurs between 1:00 PM and 4:30 PM.
Interesting. This is not typical. People are usually worse in the morning (melancholic) or worse in the evening (atypical).
- Scott
Posted by J Kelly on March 12, 2016, at 9:07:16
In reply to depression time periods (afternoon), posted by rjlockhart37 on March 11, 2016, at 20:16:09
> ithe hours of 3-7pm are my depression periods.... espcially when im stressed to get things done and im in depressville land
Could it be a result of when your medications are working? I know for me I'm better in the mornings as a result of Ritalin and caffeine.
Like you, mid day not so great. I feel the pressure to get things done. Its like pulling teeth.
With Zyprexa my evenings are okay (as long as I don't have to go out) because I know I can shut down and actually get a good nights sleep.
>
> caffeine didnt work, prozac this morning helped but maybe it's the zyprexa because if drink coffee with zyprexa it makes me sleepy, no matter how much caffeine, too much a nervous slump
>
> i feel so much more better right now, it totally left on it's own, but i really would like to know the cause of the slump period, late afternoon trip to depressville......i feel so bland and boring, ughhhh it makes me want to do a recreational drug to get away from the yuk feelingBoy do I know the yuk feeling. It makes me want to do an inventory of what's at my disposal as far as meds/alcohol/caffeine, etc.
Good luck teasing that out. You're not alone in your frustration.
Jade
Posted by porkpiehat on March 12, 2016, at 14:29:00
In reply to Re: depression time periods (afternoon) » rjlockhart37, posted by J Kelly on March 12, 2016, at 9:07:16
I'm terrible in the afternoons Also. I always blamed it on my lamictal but now I think that might be b*llsh*t. Sometimes it becomes frantic and depressed and then just SNAPS away and I'm happy and hyper around 6 or 7.
Scott why did you ask about bipolarity? would it come on in such a consistent pattern during the day?
Posted by SLS on March 12, 2016, at 16:44:03
In reply to Re: depression time periods (afternoon)))SLS » J Kelly, posted by porkpiehat on March 12, 2016, at 14:29:00
> I'm terrible in the afternoons Also. I always blamed it on my lamictal but now I think that might be b*llsh*t. Sometimes it becomes frantic and depressed and then just SNAPS away and I'm happy and hyper around 6 or 7.
>
> Scott why did you ask about bipolarity? would it come on in such a consistent pattern during the day?I don't know. I was just curious. I am trying to ascertain whether or not there are commonalities between people who have a midday slump.
Generally speaking, the literature indicates that bipolar depression is most similar to atypical depression. I might be wrong, but it seems to me that bipolar depression symptomatology appears like a hybridization between unipolar atypical and melancholic depressions. For instance, bipolar depression has a greater incidence of psychomotor retardation than does atypical depression. In this respect, it is more like melancholic depression. So, what I am wondering is if the pattern of diurnal variations follows a hybridization of melancholic (good at night) and atypical (good in the morning). This leaves the middle of the day as being the worst time for depression.
I really don't know. I just like to use Psycho-Babble as a source of empirical information. It makes for an interesting population to study. There are things to be learned here.
Is there any bipolarity with you?
- Scott
Posted by J Kelly on March 12, 2016, at 17:37:35
In reply to Re: depression time periods (afternoon)))SLS » J Kelly, posted by porkpiehat on March 12, 2016, at 14:29:00
> I'm terrible in the afternoons Also. I always blamed it on my lamictal but now I think that might be b*llsh*t.
For me its hard to tell what my "real" moods are throughout the day because of the meds I take.
Presently mornings are great. I wake up early, I'm feeling my Ritalin and caffeine and can get things done.
Midday/early eve kinda stinks cause my Ritalin is wearing off and I'm craving alcohol.
Late eve/nighttime is cool cause I can justify happy hour and look forward to a restful night sleep (thanks klonopin and Zyprexa)
Not a recipe for success by any means but its getting me by (barely).
I recently took a break from ALL meds and alcohol. During that period, mornings were horrible. I'd wake up scared and drenched in sweat. I didn't want to get out of bed. Midday was not any better and eve/nighttime was best because I knew nothing would be expected of me from family/work whatever, and I could just chill. I also stayed up wayyyy to late. Probably a product of my insomnia.
I've recently asked my pdoc to consider Lamictal for me. I think he will prescribe it the next time I see him. Do you do well on this med? May I ask why you take it?
> Sometimes it becomes frantic and depressed and then just SNAPS away and I'm happy and hyper around 6 or 7.
Sounds a little bi-polarish to me but I'm NO expert.
Jade
Posted by baseball55 on March 12, 2016, at 20:11:36
In reply to Re: depression time periods (afternoon)))SLS » porkpiehat, posted by SLS on March 12, 2016, at 16:44:03
Can you explain to me the differences between melancholic and atypical depression?
> > I'm terrible in the afternoons Also. I always blamed it on my lamictal but now I think that might be b*llsh*t. Sometimes it becomes frantic and depressed and then just SNAPS away and I'm happy and hyper around 6 or 7.
> >
> > Scott why did you ask about bipolarity? would it come on in such a consistent pattern during the day?
>
> I don't know. I was just curious. I am trying to ascertain whether or not there are commonalities between people who have a midday slump.
>
> Generally speaking, the literature indicates that bipolar depression is most similar to atypical depression. I might be wrong, but it seems to me that bipolar depression symptomatology appears like a hybridization between unipolar atypical and melancholic depressions. For instance, bipolar depression has a greater incidence of psychomotor retardation than does atypical depression. In this respect, it is more like melancholic depression. So, what I am wondering is if the pattern of diurnal variations follows a hybridization of melancholic (good at night) and atypical (good in the morning). This leaves the middle of the day as being the worst time for depression.
>
> I really don't know. I just like to use Psycho-Babble as a source of empirical information. It makes for an interesting population to study. There are things to be learned here.
>
> Is there any bipolarity with you?
>
>
> - Scott
Posted by SLS on March 13, 2016, at 6:44:32
In reply to Re: depression time periods (afternoon)))SLS » porkpiehat, posted by J Kelly on March 12, 2016, at 17:37:35
> Sounds a little bi-polarish to me but I'm NO expert.
Hopefully, your doctor can tease out bipolarity if it exists.
Your unmedicated diurnal pattern approximates that of melancholic depression rather than atypical depression. Melancholic depression responds well to tricyclics. My guess is that SNRIs would be of some help. However, bipolarity sometimes allows a TCA to produce a switch into mania. I think your idea of exploring Lamictal makes sense at this point. If you maintain a partial response to it, I would then look into adding Abilify. You can then think about adding antidepressants. Lamictal is not a very good antimanic drug, but Abilify should be. Since Abilify also confers antidepressant effects, you might not need a standard antidepressant. If you do, Abilify will hopefully protect you from a manic reaction.
You might consider adding N-acetylcysteine (NAC) now if you anticipate using Lamictal. NAC can take several months to work, but some researchers believe that it complements Lamictal for treating depression.
Do you have anxiety? Impulsive? Easily angered?
- Scott
Posted by SLS on March 13, 2016, at 7:12:21
In reply to Re: depression time periods (afternoon)))SLS » SLS, posted by baseball55 on March 12, 2016, at 20:11:36
> Can you explain to me the differences between melancholic and atypical depression?
First of all, it turns out that typical depression is atypical while atypical depression is typical. I'm having a bit of fun with words here, but originally, as defined clinically, the melancholic depression subtype was the one first described and considered to be typical. Later, it was recognized that another form of depression existed, so they called it atypical. It turns out that atypical depression represents the majority of cases.
There is always some debate as to where to draw the line between melancholic and atypical depression.
Here is a useful article:
https://www.psychologytoday.com/articles/200207/the-different-faces-depression
I'm sorry to wimp out this morning, but my energy level is pretty low right now.
- Scott
Posted by J Kelly on March 13, 2016, at 14:36:47
In reply to Re: depression time periods (afternoon)))SLS » J Kelly, posted by SLS on March 13, 2016, at 6:44:32
Hi Scott,
Not sure if this post was for me or porkpiehat.
Jade
> Hopefully, your doctor can tease out bipolarity if it exists.
>
> Your unmedicated diurnal pattern approximates that of melancholic depression rather than atypical depression. Melancholic depression responds well to tricyclics. My guess is that SNRIs would be of some help. However, bipolarity sometimes allows a TCA to produce a switch into mania. I think your idea of exploring Lamictal makes sense at this point. If you maintain a partial response to it, I would then look into adding Abilify. You can then think about adding antidepressants. Lamictal is not a very good antimanic drug, but Abilify should be. Since Abilify also confers antidepressant effects, you might not need a standard antidepressant. If you do, Abilify will hopefully protect you from a manic reaction.
>
> You might consider adding N-acetylcysteine (NAC) now if you anticipate using Lamictal. NAC can take several months to work, but some researchers believe that it complements Lamictal for treating depression.
>
> Do you have anxiety? Impulsive? Easily angered?
>
>
> - Scott
Posted by SLS on March 13, 2016, at 15:07:55
In reply to Re: depression time periods (afternoon)))SLS » SLS, posted by J Kelly on March 13, 2016, at 14:36:47
Sorry...
The original post was meant for » porkpiehat
>
>
> Hi Scott,
>
> Not sure if this post was for me or porkpiehat.
>
> Jade
>
>
> > Hopefully, your doctor can tease out bipolarity if it exists.
> >
> > Your unmedicated diurnal pattern approximates that of melancholic depression rather than atypical depression. Melancholic depression responds well to tricyclics. My guess is that SNRIs would be of some help. However, bipolarity sometimes allows a TCA to produce a switch into mania. I think your idea of exploring Lamictal makes sense at this point. If you maintain a partial response to it, I would then look into adding Abilify. You can then think about adding antidepressants. Lamictal is not a very good antimanic drug, but Abilify should be. Since Abilify also confers antidepressant effects, you might not need a standard antidepressant. If you do, Abilify will hopefully protect you from a manic reaction.
> >
> > You might consider adding N-acetylcysteine (NAC) now if you anticipate using Lamictal. NAC can take several months to work, but some researchers believe that it complements Lamictal for treating depression.
> >
> > Do you have anxiety? Impulsive? Easily angered?
> >
> >
> > - Scott
>
>
Posted by rjlockhart37 on March 15, 2016, at 0:42:17
In reply to Re: depression time periods (afternoon) » rjlockhart37, posted by SLS on March 12, 2016, at 5:35:54
i rerember when i was a kid, i would get really ... not depressed but feel wierd around late afternoon, but it went away, but for some reason during mid-late afternoon hours my body just ... gets slow, wants to like lay down, but i don't sleep like i used too......for a long time i was on xanax and it made me want to sleep, it's just it gets lagging during the day to keep up, then around 7pm i activate, and feel my dopamine levels rise
but it changes, there's been timems when 5pm is a big period to hang with friends and have a good time but if i just stay isolated, during those hours is when i get .... depresseed,
im on bipolar medications, but truthfully.....i don't believe im bipolar, i have ADHD with anxiety, and i've had to play along with these doctors over the years, but in a way the bipolar meds have stablized me, even though it's not indicated, i've noticed stablity from zyprexa and lamictal.....
there's alot of things that are in the way, but my nueros changed over the years, i changed in personality and the way i used to think
Posted by rjlockhart37 on March 15, 2016, at 0:55:59
In reply to Re: depression time periods (afternoon) » rjlockhart37, posted by J Kelly on March 12, 2016, at 9:07:16
zyprexa when i first started it, it made me zonnnnnned out, but things where peaceful, after years went by my body adapted to it's effects and began assuming being on zyprexa was normal day, but when it's discontinued after 3-4 days i will notice major effects of withdrawl, more energy and talkativeness but then mild hypomania with irrtibility
lamictal is just a stablizer i feel more clarity but sometimes a bit dulled out at times
prozac and nuvigil in the morning are what get me going, fluoxetine at 80mg i've noticed big improvement in mood, my doctor had told me fluoxtine at that dose can make you feel flat, and tired, but it worked for me....it's at maximum dose, but it's working, sometimes it's hard to tell but i don't get "serious" depressed anymore
Posted by SLS on March 15, 2016, at 6:42:11
In reply to Re: depression time periods (afternoon) » SLS, posted by rjlockhart37 on March 15, 2016, at 0:42:17
> there's alot of things that are in the way, but my nueros changed over the years, i changed in personality and the way i used to think
I see nothing but improvement in your personality and powers of reason. I think this is due to both treatment and personal growth independent of treatment.
- Scott
Posted by porkpiehat on March 16, 2016, at 14:08:02
In reply to Re: depression time periods » porkpiehat » J Kelly, posted by SLS on March 13, 2016, at 15:07:55
To answer this, yes, impulsive, anxiety, easily angered (seldom at once though)
More impulsive at higher doses of SSRI...at low or no dose SRRI it hits me around 2:30 every afternoon...distracted and racey, boundry issues, expansive
> Sorry...
>
> The original post was meant for » porkpiehat
>
>
> >
> >
> > Hi Scott,
> >
> > Not sure if this post was for me or porkpiehat.
> >
> > Jade
> >
> >
> > > Hopefully, your doctor can tease out bipolarity if it exists.
> > >
> > > Your unmedicated diurnal pattern approximates that of melancholic depression rather than atypical depression. Melancholic depression responds well to tricyclics. My guess is that SNRIs would be of some help. However, bipolarity sometimes allows a TCA to produce a switch into mania. I think your idea of exploring Lamictal makes sense at this point. If you maintain a partial response to it, I would then look into adding Abilify. You can then think about adding antidepressants. Lamictal is not a very good antimanic drug, but Abilify should be. Since Abilify also confers antidepressant effects, you might not need a standard antidepressant. If you do, Abilify will hopefully protect you from a manic reaction.
> > >
> > > You might consider adding N-acetylcysteine (NAC) now if you anticipate using Lamictal. NAC can take several months to work, but some researchers believe that it complements Lamictal for treating depression.
> > >
> > > Do you have anxiety? Impulsive? Easily angered?
> > >
> > >
> > > - Scott
> >
> >
>
>
Posted by SLS on March 16, 2016, at 15:38:52
In reply to Re: depression time periods, posted by porkpiehat on March 16, 2016, at 14:08:02
> To answer this, yes, impulsive, anxiety, easily angered (seldom at once though)
>
> More impulsive at higher doses of SSRI...at low or no dose SRRI it hits me around 2:30 every afternoon...distracted and racey, boundry issues, expansiveJust a few thoughts:
I think that you have the type of bipolar disorder that Trileptal would help treat. You might still need an antidepressant, but not a SSRI. I don't know why, but I don't see people having manic reactions to SNRIs as readily as they do to SSRIs.
In order to stay away from antidepressants, you can begin to think about combining Trileptal, Lamictal, and Abilify. If Abilify produces marked akathisia, Geodon might be a good replacement to help prevent mania and promote improvements in depression. You can also switch from Trileptal to lithium if necessary.
How are you doing?
- Scott
Posted by Horse on March 19, 2016, at 2:46:30
In reply to Re: depression time periods (afternoon) » SLS, posted by rjlockhart37 on March 15, 2016, at 0:42:17
> i rerember when i was a kid, i would get really ... not depressed but feel wierd around late afternoon, but it went away, but for some reason during mid-late afternoon hours my body just ... gets slow, wants to like lay down, but i don't sleep like i used too......for a long time i was on xanax and it made me want to sleep, it's just it gets lagging during the day to keep up, then around 7pm i activate, and feel my dopamine levels rise
I was going to suggest taking a nap or at least lie down and rest. Listen to music or podcast under headphones for distraction if you're not with friends.
>
> but it changes, there's been timems when 5pm is a big period to hang with friends and have a good time but if i just stay isolated, during those hours is when i get .... depresseed,
>
> im on bipolar medications, but truthfully.....i don't believe im bipolar, i have ADHD with anxiety, and i've had to play along with these doctors over the years, but in a way the bipolar meds have stablized me, even though it's not indicated, i've noticed stablity from zyprexa and lamictal.....I was think that it sounds like anxiety is a large part of your depression, and that your afternoon depression is a type of dysphoria. I don't know of course.
>
> there's alot of things that are in the way, but my nueros changed over the years, i changed in personality and the way i used to think
>
>
Posted by Horse on March 19, 2016, at 2:50:04
In reply to Re: depression time periods (afternoon)))SLS » baseball55, posted by SLS on March 13, 2016, at 7:12:21
> > Can you explain to me the differences between melancholic and atypical depression?
>
> First of all, it turns out that typical depression is atypical while atypical depression is typical. I'm having a bit of fun with words here, but originally, as defined clinically, the melancholic depression subtype was the one first described and considered to be typical. Later, it was recognized that another form of depression existed, so they called it atypical. It turns out that atypical depression represents the majority of cases.
>
> There is always some debate as to where to draw the line between melancholic and atypical depression.
>
> Here is a useful article:
>
> https://www.psychologytoday.com/articles/200207/the-different-faces-depression
>
> I'm sorry to wimp out this morning, but my energy level is pretty low right now.
>
>
> - Scott
That was a concise little article. I've exhibted all of those types of depression at some time or another.I hate mornings, but not as much as I used to. Mornings are horrible. Absolutely horrible. My hamilton score would be drastically different if my mornings and evening were compared.
Though I can feel a melancoly at sunset.
>
Posted by Chris O on March 21, 2016, at 14:53:19
In reply to depression time periods (afternoon), posted by rjlockhart37 on March 11, 2016, at 20:16:09
Interesting discussion topic.
My times of greatest anxiety are from night to early morning, from like, 8pm-4am, the times when I most need sleep. I surmise there is an increase in cortisol at these times due to my over-activated GAD-disordered"fight or flight" response.
Chris
Posted by B2chica on March 24, 2016, at 23:14:10
In reply to depression time periods (afternoon), posted by rjlockhart37 on March 11, 2016, at 20:16:09
some of my past doctors have completley written my comments about that off. because 'thats not the way it works'....
i think my worse times are typically between 1:30-2-ish till about 7 sometimes 8 at night. those times vary depending on medication but espeically the 2:00 time has been there pretty consistently...
i am very interested that you brought this up. i react so terribly to most meds, i just figured i had just one other 'anomoly' that messed up my being able to be properly medicated.
thank you for posting this.
b2
Posted by rjlockhart37 on March 31, 2016, at 0:35:22
In reply to Re: depression time periods (afternoon) » rjlockhart37, posted by Horse on March 19, 2016, at 2:46:30
alot of my depression, yes ... it is dyphoria, im not so depressed i can't get out of the bed, but i feel unpleasant, and irrtible at times.....and really it's because of enviormental factors, but htere's a saying that...internal practices of thinking and mood management is good to enhance how you feel during the day
i'll have energy but it's like yuk energy, i feel .... just not good at all
there's some things that happened in the past, including a person i live with, that ... caused some enviormental factors to cause that.....but it's not helpful to think about it, just makes me in a worst mood thinking about it
r
Posted by rjlockhart37 on March 31, 2016, at 0:37:45
In reply to Re: depression time periods (afternoon) » rjlockhart37, posted by Chris O on March 21, 2016, at 14:53:19
yea even when i was young, i seemed to get in bad mood at 5pm, but there's been many times where i've been a good mood, but that was because i was evovled with friends, and doing stuff.....but it seems when im isolated, or away from people, i get depressed around 3-7pm then at night my dopamine levels rise.......it's liek an internal clock i guess.....like nuerotransmitters have set times when they release
r
Posted by rjlockhart37 on March 31, 2016, at 0:40:55
In reply to Re: depression time periods (afternoon) » rjlockhart37, posted by B2chica on March 24, 2016, at 23:14:10
thanks for posting
i guess....maybe for some people there's an internal biorytham, something that tell the nuerotransmitters to lower and raise at certain timesbut that's not the cause with unipoler depression......i've had unipoler depression for years, then it seemed to jump to mood swings, i rather be moody than depressed all the time
Posted by alchemy on April 1, 2016, at 22:30:44
In reply to Re: depression time periods (afternoon), posted by rjlockhart37 on March 31, 2016, at 0:40:55
I was a rapid-cycler until the last couple years. I hit 40 and my body is falling apart but my mind seems a little more even, although depression still persists to some degree. I went through different phases of mood cycling, and I remember when my depression periods were in the afternoon.
You have probably already have tried this, but I noticed that I am sensitive to caffeine. After a couple of hours of ingesting caffeine, my mood drops and I become depressed. It took me a while to figure it out. Just a thought. (don't recommend cold turkey)
It also happened when I tried a certain snri.
I feel for you. Hang in there.
Posted by SLS on April 2, 2016, at 8:07:04
In reply to Re: depression time periods (afternoon), posted by alchemy on April 1, 2016, at 22:30:44
> You have probably already have tried this, but I noticed that I am sensitive to caffeine. After a couple of hours of ingesting caffeine, my mood drops and I become depressed.
Me, too. However, I still profit from very small doses of caffeine - maybe 1/8 cup or less of coffee. Then, I get a nice surge of energy that does not disappear so fast, and does not lead to worsened depression. I simply treat caffeine as a drug to be dosed carefully.
- Scott
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.