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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by blueberry on April 4, 2006, at 20:57:51
Here's the pattern:
3:00am begins a slow gradual adrenal-type rush, where I wake at 5:00 with fear, paranoia, anxiety, butterflies, restlessness, and almost complete inability to cope, almost insane-like.
9:00am it all fades away at this time and is replaced by a strong depression that feels a lot like the flu in the body and the brain.
8:00pm the depression lifts somewhat and there is no anxiety, fear, all that stuff, at all.
10:00pm go to bed.
3:00am it starts all over. Xanax or lunesta helps me sleep through some of it, but the longer I sleep, the worse it is when I wake up.
What is this? It's been going on for 15 months! Antidepressants or depakote tamed the pattern but the pattern still remains. No meds right now.
Sometimes I think maybe this is a weird form of bipolar that has a solid predictable pattern that repeats day after day...beginning with mixed dysphoric anxiety paranoia type mania changing to depressio and then mellowing out in the evening. Never heard of cycling like that.
I want to go in the hospital and at least be hooked up to a bunch of stuff and monitored for a 24 hour cycle so they tell me what happens at 3:00am that starts it all. And then what happens at 9:00am. And then at 8:00pm. What is changing?
But what kind of tests? What to look for? Do I just walk in? Do I need my doctor to agree and set it up? I'm so frustrated and near the end of my rope that it has been going on so long, is terribly incapacitating, and no one is doing anything about it except suggesting ADs, mood stabilizers, and benzos. I understand those can diminish my symptoms, but I'm telling you this isn't psychiatric. What the heck is it?
I need some tests. But what? Thryoid is normal. Cortisol is very low (but doesn't explain the abrupt changes at specific times of the day because the cortisol curve is smooth and properly shaped). Toxic metals test shows elevated levels above normal for mercury and lead. Hard to see how any of these things though would cause such defined patterns.
Posted by SLS on April 4, 2006, at 21:32:11
In reply to What kinds of tests for this?, posted by blueberry on April 4, 2006, at 20:57:51
Hi.
Didn't you once say that you were hypocortisolemic?
I don't know enough about endocrinology to be able to suggest an explanation. What cortisol tests have you had performed? Ever had a DST (dexamethasone suppression test)? ACTH? CRH?
If one were to be focused on psychiatric illnesses only, it seems to me that your pattern follows a classic endogenous depression. This would be treated using a tricyclic antidepressant.
If you are hypocortisolemic, perhaps you have reached a point of adrenal exhaustion as a result of the chronic HPA axis hyperactivity that endogenous depression can produce. It would be unusual, though. Hypocortisolemia is more common in atypical depression.
- Scott
Posted by blueberry on April 5, 2006, at 6:06:18
In reply to Re: What kinds of tests for this? » blueberry, posted by SLS on April 4, 2006, at 21:32:11
Scott, no I haven't had any of the suppression tests. Just the 4 times a day saliva cortisol/dhea test. Cortisol curve looked good, but the entire curve was way below normal.
Yeah I had thought about nortriptyline. With very low blood pressure already, and I just can't stand that dry mouth and drugged fogginess, I doubt I could handle it even in small doses. It is a distant maybe though.
I think I need either a neurologist or an endocrinologist. Have them throroughly check me out in detail. At least then if everything looked ok, I would know that this is indeed psychiatric. My gut instincts just tell me this is physical but manifesting itself in psychiatric ways. I could be wrong. I just want to find out. My old doctor and my current doctor both seem very reluctant to pass me off to someone, they just want to throw more drugs at me or say it is going to take many months to slowly recover, and neither one of them is offering a diagnosis. So much time passes and nothing is done. They complain that I don't do what they say...for example start lamictal, take 5htp, take depakote, take clonazepam or xanax...I mean, they aren't even clear about what I should take or why. And exactly how does one find a different doctor when the current ones won't even refer one? Yellow pages? Man.
Years ago I sent a batch of letters shotgun style to psychiatrists in the yellow pages, explaining my situation and asking if they would be interested. Out of 30 letters I got 6 interested responses. Well, a couple weeks ago I sent out 40 letters...zero responses.
Posted by ed_uk on April 5, 2006, at 14:32:55
In reply to Re: What kinds of tests for this? » SLS, posted by blueberry on April 5, 2006, at 6:06:18
So have you ever tried a TCA? How did you find it?
Ed
Posted by Racer on April 6, 2006, at 1:56:29
In reply to Re: What kinds of tests for this? » SLS, posted by blueberry on April 5, 2006, at 6:06:18
>
> Yeah I had thought about nortriptyline. With very low blood pressure already, and I just can't stand that dry mouth and drugged fogginess, I doubt I could handle it even in small doses. It is a distant maybe though.
>I took nortriptyline successfully, it was the only TCA I could tolerate. My BP ranges from about 95/65 to 85/52, so any lowering is a big deal for me. ALL of the other TCAs provided me with unexpected close up views of the ground, including desipramine. (Which is too bad, because I'd have liked to be able to give that a better try.) If you are hoping to find something helpful, do consider trying it.
Good luck.
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