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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3704 to 3728 of 8406. Go back in thread:
Posted by Bela on July 28, 2003, at 12:04:57
In reply to Re: Lexapro and dirurnal variation, posted by JaneB on July 28, 2003, at 11:25:39
JaneB,
The term diurnal variation typically refers to some kind of 24 hour cycle or periodicity. I have run across it in the psychiatric literature in reference to daily mood cycles, and my own psychiatrist also mentioned used the term. I am not sure about the headaches, but that is not a problem for me.
> > I have a question for Lexapro users and those that who have experienced the poop-out syndrome with other SSRIs. Over the years of experiencing the SSRI merry-go-round, the main depression symptom I experience when they all quit working, was diurnal variation (DV). DV involves no motivation in the morning, dragging the butt out of bed, etc., with improvement as the day progresses. At present, the Lexapro is working for me and basically eliminated the DV, but I am not optimistic about it working forever. For any of you that have experienced DV, do you have suggestions for psychotherapeutic coping mechanisms? Do any of you know what happens during the night to cause the cycle to repeat itself the next day?
> > Bela
> >
> Where did you find this term? Do you know what causes 4 am headaches? Every day. They go away without meds sometimes. Is this a symptom of a mood disorder?
> JaneB
>
Posted by Capri on July 28, 2003, at 13:12:37
In reply to re: Sun sensitivity, posted by lil' jimi on July 27, 2003, at 17:37:03
Posted by Peter S. on July 28, 2003, at 13:30:49
In reply to Re: Lexapro and dirurnal variation » JaneB, posted by Bela on July 28, 2003, at 12:04:57
I've been on Lexapro for about 7 weeks with not a lot of benefit. I increased to 20 mg last week and noticed a slight increase in mood, but now it seems to be dissipating. I'm wondering if others have gone beyond 20mg and whether this has worked.My pdoc has talked about examples of people not responding fully to Prozac until they got up to 80mg. Maybe Lex has the same effect- I've seen research that indicates that there isn't a whole lot of difference between 10 and 20mg, but it's such a new drug and there are so many individual differences about how people respond to meds.
Thanks for any responses!
Peter
Posted by JaneB on July 28, 2003, at 13:38:34
In reply to Re: Lexapro and dirurnal variation » JaneB, posted by Bela on July 28, 2003, at 12:04:57
> > > I have a question for Lexapro users and those that who have experienced the poop-out syndrome with other SSRIs. Over the years of experiencing the SSRI merry-go-round, the main depression symptom I experience when they all quit working, was diurnal variation (DV). DV involves no motivation in the morning, dragging the butt out of bed, etc., with improvement as the day progresses. At present, the Lexapro is working for me and basically eliminated the DV, but I am not optimistic about it working forever. For any of you that have experienced DV, do you have suggestions for psychotherapeutic coping mechanisms? Do any of you know what happens during the night to cause the cycle to repeat itself the next day?
> > > BelaBela
Do you dread going to bed because the good feelings you experience by nightfall will be gone when you wake up only to return when it is about time to go back to bed. And no method of changing time of med dosing works.
I don't have answers for you but it I anxiously await the "experts" answers (if there are any.)I also tried Lex and side effects outweighed the benefits. I now only take clonazepam without any antidepressant. I have less DV without any AD. But I have only been off Ad's since March. Time will tell.
JaneB
PS Lexapro made me want to drag my butt back into bed by early afternoon! If I got out of the house I was fine. But stay home and couldn't resist the nap. Possibly because Lex seemed to activate me during sleep at night too much.
Posted by arrianna on July 28, 2003, at 14:09:51
In reply to re: Back at ya!, posted by trucker on July 28, 2003, at 10:57:27
Hey Trucker-
This isn't "med" related, so I hope I don't get in trouble. But, I just saw that you were leaving for Minnesota tonight, and I'm from Minnesota: Twin Cities area. Where are you from? Anyways, it's a great day to be in Minnesota today: a beautiful, sunny, and warm summer day here! Enjoy your trip! Arrianna
Posted by Bela on July 28, 2003, at 14:33:11
In reply to Re: Lexapro and dirurnal variation » Bela, posted by JaneB on July 28, 2003, at 13:38:34
JaneB,
My experience fits very closely to yours. When DV is a problem, I dread going to bed because of what I know I will feel like in the morning. Also, if I stay around the house, the bed is like a huge magnet sucking me in. No motivation.You made one comment which REALLY interests me. I never experiencing diurnal variation until I started taking ADs. Before ADs, I used to absolutely love the mornings. I would be interested in knowing how you took yourself off them; the few times I have tried it have resulted in horrible relapses.
Bela
Posted by lil' jimi on July 28, 2003, at 14:35:31
In reply to Hi Jim....How are you? (nm) » lil' jimi, posted by Capri on July 28, 2003, at 13:12:37
Posted by Rich B on July 28, 2003, at 15:12:19
In reply to Re: Lexapro Withdrawal Dizziness » arrianna, posted by micheke on July 27, 2003, at 21:01:32
Micheke, Well, I went back to a quarter of a pill on Thursday-Sunday and I had a great weekend. The getaway weekend with my friends went well and I felt fine. Now it’s time to get back to work. I was going to stop it totally again today, but I am not. What I am going to do is to take less than a quarter of a pill for a while. I take a quarter of a pill (5mg) then slice bits of it off with a knife. I will do this for a week or so before I try to stop all together. I decided to do that because I was thinking that I was in for another miserable week and I was dreading it. Maybe this will work out better. How are you doing? You have been off it totally for a while now, right? How many days?
Rich
Posted by JaneB on July 28, 2003, at 15:15:12
In reply to Re: Lexapro and dirurnal variation » JaneB, posted by Bela on July 28, 2003, at 14:33:11
> JaneB,
> My experience fits very closely to yours. When DV is a problem, I dread going to bed because of what I know I will feel like in the morning. Also, if I stay around the house, the bed is like a huge magnet sucking me in. No motivation.
>
> You made one comment which REALLY interests me. I never experiencing diurnal variation until I started taking ADs. Before ADs, I used to absolutely love the mornings. I would be interested in knowing how you took yourself off them; the few times I have tried it have resulted in horrible relapses.
> BelaI took myself off ADs by accident in a way. I got stuck in the March snowstorm, stranded in Denver airport with no access to suitcases. All meds (Lexapro) in suitcase except clonazepam. I slept fine and woke up feeling better and just never took any more. All the side effects which I was attributing to depression went away. But I kept taking clonazepam. In the past I had times when I was fed up with meds and stopped gradually but I always included the clonazepam in the decrease and had trouble. This time no trouble. So I have concluded that the pdoc who wanted to eliminate clonazepam and thought that Celexa, Wellbutrin, Lexapro, etc. would eliminate anxiety, night time terrors, etc. if I had adequate SSRI dose was mistaken. Clonazepam works. Just .5 mg. With the AD's I would have to increase the clonazepam just to counteract the anxiety produced by the SSRI. Why would a dr. want to eliminate what works and is inexpensive (clonazepam) and replace it with what does not work (SSRI)and is very expensive?
However, a major KEY has been the elimination of extreme stress. For years I was on stress overload. Are you on stress overload? I recognize I may need to go back on an AD if stress level skyrocketed again.
JaneB
PS This is a long story in a nutshell.
By the way, another thread questions the use of benzos for OCD. Since a child I have had mild OCD which includes simple counting in my mind. That's all. It is gone.
Also, I do avoid triggers for depression--rape movies, too much news about clergy abuse, etc.Also, my previous pdoc, before I moved, highly recommended the clonazepam as long term treatment and caution about AD's because they produced mild cycling. I value his opinion and overcame the stigma of benzo use.
Do you have any cycling? EX. Maybe 4 days of DV and than 4 days without? Very subtle but definite if charted. Days when you say, "Why can't I wake up every day feeling good like today?"
Posted by lil' jimi on July 28, 2003, at 15:22:09
In reply to re: Hi Capri! i'm fine! .... how are You? (nm) » Capri, posted by lil' jimi on July 28, 2003, at 14:35:31
Michael provided this great link over on the main pBab board and i thought i'd repeat it here for all our brothers and sisters in Lexapro-land.
he posted:
Must Read!
Posted by Ame Sans Vie on July 27, 2003, at 19:44:49This site contains what appears to be the complete online text of the book "Mind Boosters: A Guide to Natural Supplements That Enhance Your Mind, Memory, and Mood" by Ray Sahelian, M.D. This is a definite must-read for anyone interested in nutritional and herbal supplementation.
... I thank Michael ... thanks!
~ jim
Posted by Bela on July 28, 2003, at 15:39:33
In reply to Re: Lexapro and dirurnal variation, posted by JaneB on July 28, 2003, at 15:15:12
> > JaneB,
> > My experience fits very closely to yours. When DV is a problem, I dread going to bed because of what I know I will feel like in the morning. Also, if I stay around the house, the bed is like a huge magnet sucking me in. No motivation.
> >
> > You made one comment which REALLY interests me. I never experiencing diurnal variation until I started taking ADs. Before ADs, I used to absolutely love the mornings. I would be interested in knowing how you took yourself off them; the few times I have tried it have resulted in horrible relapses.
> > Bela
>
> I took myself off ADs by accident in a way. I got stuck in the March snowstorm, stranded in Denver airport with no access to suitcases. All meds (Lexapro) in suitcase except clonazepam. I slept fine and woke up feeling better and just never took any more. All the side effects which I was attributing to depression went away. But I kept taking clonazepam. In the past I had times when I was fed up with meds and stopped gradually but I always included the clonazepam in the decrease and had trouble. This time no trouble. So I have concluded that the pdoc who wanted to eliminate clonazepam and thought that Celexa, Wellbutrin, Lexapro, etc. would eliminate anxiety, night time terrors, etc. if I had adequate SSRI dose was mistaken. Clonazepam works. Just .5 mg. With the AD's I would have to increase the clonazepam just to counteract the anxiety produced by the SSRI. Why would a dr. want to eliminate what works and is inexpensive (clonazepam) and replace it with what does not work (SSRI)and is very expensive?
>
> However, a major KEY has been the elimination of extreme stress. For years I was on stress overload. Are you on stress overload? I recognize I may need to go back on an AD if stress level skyrocketed again.
> JaneB
> PS This is a long story in a nutshell.
> By the way, another thread questions the use of benzos for OCD. Since a child I have had mild OCD which includes simple counting in my mind. That's all. It is gone.
> Also, I do avoid triggers for depression--rape movies, too much news about clergy abuse, etc.
>
> Also, my previous pdoc, before I moved, highly recommended the clonazepam as long term treatment and caution about AD's because they produced mild cycling. I value his opinion and overcame the stigma of benzo use.
>
> Do you have any cycling? EX. Maybe 4 days of DV and than 4 days without? Very subtle but definite if charted. Days when you say, "Why can't I wake up every day feeling good like today?"
>JaneB:
In answer to your question about stress: no, I am definitely not on stress overload, and never really have been. I have taken clonazpam for periods before, but was fearful of the habituation, so I quit. Anxiety was also NEVER a problem for me until I started with the ADs.I don't have OCD except in regards to obsessive thought patterns. Very annoying.
I do have mood cycles that overlay the daily cycles, just as you described. I can feel fabulous for days, and for no apparent reason, wake up the next morning and feel like the sky has fallen. This has happened to me on wonderful, relaxing vacations! The reverse has happened, but usually not as abruptly.
Bela
Posted by JaneB on July 28, 2003, at 16:36:16
In reply to Re: Lexapro and dirurnal variation, posted by Bela on July 28, 2003, at 15:39:33
> JaneB:
> In answer to your question about stress: no, I am definitely not on stress overload, and never really have been. I have taken clonazpam for periods before, but was fearful of the habituation, so I quit. Anxiety was also NEVER a problem for me until I started with the ADs.
>
> I don't have OCD except in regards to obsessive thought patterns. Very annoying.
>
> I do have mood cycles that overlay the daily cycles, just as you described. I can feel fabulous for days, and for no apparent reason, wake up the next morning and feel like the sky has fallen. This has happened to me on wonderful, relaxing vacations! The reverse has happened, but usually not as abruptly.
> Bela
>
>
I can relate so well.
Have you ever tried a mood stabilizer?
JaneB
Posted by Bela on July 28, 2003, at 16:53:46
In reply to Re: Lexapro and dirurnal variation » Bela, posted by JaneB on July 28, 2003, at 16:36:16
> > JaneB:
> > In answer to your question about stress: no, I am definitely not on stress overload, and never really have been. I have taken clonazpam for periods before, but was fearful of the habituation, so I quit. Anxiety was also NEVER a problem for me until I started with the ADs.
> >
> > I don't have OCD except in regards to obsessive thought patterns. Very annoying.
> >
> > I do have mood cycles that overlay the daily cycles, just as you described. I can feel fabulous for days, and for no apparent reason, wake up the next morning and feel like the sky has fallen. This has happened to me on wonderful, relaxing vacations! The reverse has happened, but usually not as abruptly.
> > Bela
> >
> >
> I can relate so well.
> Have you ever tried a mood stabilizer?
> JaneB
>JaneB,
I have tried both Lithobid (Lithium) and Lamictal. I hated Lithium. I am currently taking the Lamictal. It may eliminate deep depression, but it doesn't seem to affect the more subtle DV. I wonder, as you suggest, perhaps the AD is causing the DV.Can anyone else out there in "Psycho-Babble Land" contribute to this dialogue between JaneB me?
Bela
Posted by micheke on July 28, 2003, at 17:02:14
In reply to Re: Lexapro Withdrawal Dizziness, posted by Rich B on July 28, 2003, at 15:12:19
Rich:
Glad to hear that the vacation was great! How did everything go with your lady friend?
I think you have the right idea about the tapering. Unfortunately, after a few days I was not able to stay off it completely. I was feeling pretty bummed about having to start again but I try to tell myself that I just have to taper slower. I went back to 5mg then down to 2.5mg. I haven't bothered to consult my doc because the only thing she can tell me is that she doesn't know why I'm even experiencing withdrawal. Funny, huh? I get more information from this site. Anyway, I will stay on 2.5mg for this week until Friday when my fiance comes back from his business trip. I am having the same problem where I start to dread trying to go off completely. I can deal with everything except the extreme dizziness. So, I have decided that I will then start chopping pieces off until I can't chop anymore. I'm wishing us both luck!
-MicheleHas anybody gone through this before that can give us an idea of how long the withdrawal lasts??
Posted by SLS on July 28, 2003, at 17:04:16
In reply to Lexapro and dirurnal variation, posted by Bela on July 28, 2003, at 10:05:00
> DV involves no motivation in the morning, dragging the butt out of bed, etc., with improvement as the day progresses.
Hi.
The pattern you describe is considered typical of endogenous depression, sometimes known as melancholic or "typical" depression. Have you ever tried imipramine or any other tricyclic? They are sometimes very effective for that kind of depression. What about Effexor?
- Scott
Posted by Bela on July 28, 2003, at 17:24:07
In reply to Re: Lexapro and dirurnal variation » Bela, posted by SLS on July 28, 2003, at 17:04:16
> > DV involves no motivation in the morning, dragging the butt out of bed, etc., with improvement as the day progresses.
>
> Hi.
>
> The pattern you describe is considered typical of endogenous depression, sometimes known as melancholic or "typical" depression. Have you ever tried imipramine or any other tricyclic? They are sometimes very effective for that kind of depression. What about Effexor?
>
>
> - ScottScott,
No,to both of your questions. You are the first, obviously knowledgeable, person who has ever mentioned the term endogenous, melancholic, or "typical" depression to me. I will look into both your suggestions. Thanks.
Bela
Posted by pasdenom on July 28, 2003, at 18:19:08
In reply to Lexapro to 30mg or higher anyone?, posted by Peter S. on July 28, 2003, at 13:30:49
>
> I've been on Lexapro for about 7 weeks with not a lot of benefit. I increased to 20 mg last week and noticed a slight increase in mood, but now it seems to be dissipating. I'm wondering if others have gone beyond 20mg and whether this has worked.
>
> My pdoc has talked about examples of people not responding fully to Prozac until they got up to 80mg. Maybe Lex has the same effect- I've seen research that indicates that there isn't a whole lot of difference between 10 and 20mg, but it's such a new drug and there are so many individual differences about how people respond to meds.
>
> Thanks for any responses!
>
> Peter
>
>
>
> Hi Peter,
I am on Lexapro 30 mg and it did take this dosage to bring me out of my depression.
I am also on Effexor XR 140 mg and Lamictal 100mg.
I hope everything works out for you.
Posted by gamble on July 28, 2003, at 20:19:36
In reply to Anyone switched to Lexapro? « ggrrl, posted by Dr. Bob on June 11, 2002, at 7:52:48
I have been on Lexapro going on the 4th week and the light switch just came on 3 days ago but I still have the side effect of diarrhea. Does anyone else have the same problem. It's interesting because I don't have all of the other side effects that I did with Paxil and Zoloft. I have also been off of Xanax for the past 2 weeks because of the ability of Lexapro to wane my anxiety. Very interesting posting board. Good luck to all who need the help!
Posted by Capri on July 28, 2003, at 21:17:57
In reply to re: Hi Capri! i'm fine! .... how are You? (nm) » Capri, posted by lil' jimi on July 28, 2003, at 14:35:31
Hi Jim,
I'm hanging in there. I just came back from vacation. Just did a local thing this year.
I just increased my Lex to 7.5 mg. Trying to give this med a chance. Not sure if it's working or not. Really tired in the a.m. and headache since I increased it. I know though those SE's will go away. Had some anxiety on vacation so I can't say this medication is totally working.
I've been on this board daily (I think sometimes that could be a bad thing being I start to think I will get other people's SE's). I see you post often...check in on me once in awhile would ya (ha!)
Be good,
Capri
Posted by oldhand on July 28, 2003, at 21:35:29
In reply to Re: Lexapro and dirurnal variation, posted by JaneB on July 28, 2003, at 11:25:39
Just a thought on the 4 am headaches. Try drinking some water. A grade-school teacher friend of mine told me a long time ago that when her students complain of headaches she sends them to the drinking fountain. Especially after recess when they have been playing and may be dehydrated. I personally keep water by my bed at all times. I have been thirsty on the Lexapro (20mg) and consume alot of water.
As for DV, can't help there as this is the first I've heard of it.
Best wishes for peace for our hearts and minds.
Posted by lil' jimi on July 28, 2003, at 21:47:19
In reply to re: Hi Capri! i'm fine! .... how are You? » lil' jimi, posted by Capri on July 28, 2003, at 21:17:57
hi Capri!
it's good to check in with each other .... thanks
... i read your posts and the replies too .. ...and i went on vacation weekend before last ... ... we're supposed to go to relax, you know? but it can be so much stress ... ...
the standard suggestion is to try to adjust when you take your lex to compensate for when it makes you tired ... i used to always get tired in the afternoons ...
... ... remember to drink lots of water for your headache prevention ... and vitamins ... try to relax and don't take the pBabb too seriously ... ... it can be relief and comfort, but it can be its own kind of stress too .. ... .. i was almost starting to have withdrawals !! ... HA!
glad you're hanging in there ... ... how long have you been at 7.5 ?
thanks for keeping in touch ... and, of course, ...
... (glad you met my friend, Wayne, too!) ...
... TAKE CARE !!!~ jim
Posted by Dr. Bob on July 28, 2003, at 21:55:14
In reply to re: Back at ya!, posted by arrianna on July 28, 2003, at 14:09:51
> This isn't "med" related, so I hope I don't get in trouble.
You're not in trouble, but since this isn't medication oriented, I'd like follow-ups to be redirected to Psycho-Social-Babble. Here's a link:
http://www.dr-bob.org/babble/social/20030727/msgs/246326.html
Bob
Posted by lil' jimi on July 28, 2003, at 22:00:27
In reply to side effects, posted by gamble on July 28, 2003, at 20:19:36
hi gamble,
glad to have you sharing your post with us ... thanks.
diarrhea is a rough SE to endure ... got to watch out for dehydration ... i believe lexapro alone increases your risk for dehydration, diarrhea is another major risk .... .... so drink LOTS of water, and electrolyte replacing fluids ... push fluids and avoid caffeinated-beverages, or at least drink twice as much water as cola/tea/coffee to replace water loss from their diruetic effects ...hang in there and keep us up-to-date ...
TAKE CARE !!
~ jim
Posted by jrbecker on July 28, 2003, at 23:18:20
In reply to Lexapro and dirurnal variation, posted by Bela on July 28, 2003, at 10:05:00
> I have a question for Lexapro users and those that who have experienced the poop-out syndrome with other SSRIs. Over the years of experiencing the SSRI merry-go-round, the main depression symptom I experience when they all quit working, was diurnal variation (DV). DV involves no motivation in the morning, dragging the butt out of bed, etc., with improvement as the day progresses. At present, the Lexapro is working for me and basically eliminated the DV, but I am not optimistic about it working forever. For any of you that have experienced DV, do you have suggestions for psychotherapeutic coping mechanisms? Do any of you know what happens during the night to cause the cycle to repeat itself the next day?
> Bela
>diurnal variation is also a major symptom of my [atypical] depression. My body's natural clock wants me to sleep til noon and stay up past 2am. And taking antidepressants only exacerbates the daytime sleepiness.
The best tips I can give (besides finding the best AD that won't sedate you) are:
1.Take a sleep agent at night if you aren't on one already. Whether it's Ambien, a regular benzo, or something stronger like trazodone, find something that will get you a good night's rest. In some of us, this is just not possible while taking an AD montherapeutically. In my case, even though I'm tired all day, I still won't get a good night's rest -- this is a symptom of the daily phase shift most depressive sufferers exhibit as well the insomnia from the AD. Take a good look at your sleep efficiency: if you can sleep through the night, but sometimes toss and turn and wake-up intermittently, your sleep pattern might be dysfunctional and could probably be made a lot more efficient by the addition of a sleep aid. For a lot of depressed people, this realization isn't always an apparent one, and remains the missing link to getting over a good deal of the daytime sleepiness.
Equally important, make sure that your sleep agent doesn't have too much overhang sedation the next day. Finding the right one for you is the tricky part. A dose of Ambien and some short-acting xanax were a good combo for me (the ambien on its own didn't keep me asleep the whole night). But something like klonopin left me too tired the next day. There is a new sleep med, much like Ambien, but much more potent and with a longer half-life, called Estorra, that is due out near the beginning of '04. There was a lot of great data to show that this will be a better drug -- with no daytime overhang. I suggest you check it out when it surfaces on the market.
2. Take the AD at night if you can. I found that when taking Lexapro, this was possible. The catch-22 is that you might have to take more sleep agent to compensate.
3. Exercise at the peak of your daily schedule. This would be around mid-afternoon for someone's normal sleep-wake cycle. This will definitely put you to sleep earlier and also shift your clock to be arouse earlier in the morning. A more reliable option is that you can try exercising vigorously right as you get up in the morning for more than a half hour. As much as the idea of running right as you first get up strikes you as pleasant, it might just be worth it if it actually keeps you energized the rest of the day.
4. Try B12. Important: make sure it is Methylcobalamin form - this is really the only form that crosses the BBB efficiently. Some people find it to help moderately (for me it probably gives me a 10% overall boost). It helps maintain energy during the early part of the day and helps with getting to bed by inducing the a timely release of melatonin earlier in the evening.
5. Tried light therapy? Take advantage of the summer weather and get as much light as you can throughout the early part of the day.
In the darker/colder months, get outside around noon and catch the sun at its zenith -- take a walk or something. This will help wake you up.Good luck
Posted by Donia on July 29, 2003, at 0:24:16
In reply to Re: Lexapro and dirurnal variation, posted by Bela on July 28, 2003, at 15:39:33
I was on xanax for a while when first starting zoloft. My doctor does not think long term benzo use is a good treatment. Do doctors treat with long term use of benzo? Do you become addicted and just need more and more? I will admit the xanax has made me feel better than zoloft or lexapro, but I am afraid of the long term use of them?
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