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Re: Terrible trouble getting up in morning Roslynn

Posted by SLS on September 14, 2022, at 19:35:29

In reply to Re: Terrible trouble getting up in morning SLS, posted by Roslynn on September 14, 2022, at 16:24:01

Hi, Roslynn

Based upon your diurnal rhythm, you qualify as the original "endogenous" / "melancholic" depression. Historically, tricyclic antidepressants were observed to be more effective for melancholic unipolar depression. Another hallmark symptom of more severe melancholic depression is psychomotor retardation.

1. Do you find yourself remaining motionless and staring into space for a minute or two (not rigid)?

2. Is it hard for you to get yourself to move in order to start a task - or even get off the couch to go to the bathroom?

3. Do you ever feel like you are posed like a statue without moving a muscle (not rigid)?

4. Do you feel stuck on the couch such that it takes a monumental effort to get yourself to move? Do you struggle to complete tasks because you suddenly "run out of gas" and begin into space?

5. Do you ever feel like you are moving in slow motion?

6. Do you have early-morning awakenings and feelings of doom or dread first thing in the morning?


If this fits your experience, then I would make sure that you try at least 2-3 tricyclics. I strongly advocate the use of low-dosage lithium treatment 300-600 mg/day. It goes well with many treatment combinations. I can't be without it. I tried to discontinue it about 4 months ago as an experiment to see if it was really a necessary component of my drug combination treatment. It was.


* I have bipolar depression, and its features look a lot like a hybrid of melancholic and atypical depression to me.

Keep trying. It's not fair, but keep trying anyway.

A thought just occurred to me. 30 years ago, a standard practice was to add lithium to a tricyclic or MAOI for TRD.

Another thought is to use thyroid hormone as an adjunct to tricyclics or perhaps Effexor.

If you do indeed have severe and stubborn endogenous / melancholic depression, I suggest that your angle of attack should be to combine TCA + lithium + Thyroid (T3 or T4). If your improvement is only partial, you can add methylphenidate or amphetamine. I favor amphetamine because it doesn't feel as harsh as methylphenidate.


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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