222 replies to this topic

[fishinghat]

Some times Omega 3 helps. Are you taking that?

[invalidusername]

I'm a vegetarian! I looked into some substitute, but I don't think it will work the same.

 

Happy to say that I managed work today. Still dizzy at times, but just took it slow.

[fishinghat]

Gotcha.

[invalidusername]

Having difficulty knowing whether my depression is bought about by withdrawal, or whether it is just "me". 

 

Last night, around 8pm, it just hit me like a wave in the stomach. A feeling of intense hopelessness. This coincided with my time to take Citalopram, and within 2 hours I was absolutely fine. 

 

Really not sure what to make if it all...?

[fishinghat]

Withdrawal. Citalopram brought the serotonin back under control. Remind me IUN, what dose of Cymbalta and Citalopram are you currently on and how long have you been at that dosage.

I would also like to express my appreciation for all the advice and support you give new members. You are a tremendous help. Thanks.

[invalidusername]

After being on 60 Dulox and 10 Cital for 3 months, I went to 30/10 for 3 weeks, then 20/20 for 12 days, and this is where I am currently. I have 28 Dulox capsules of 112 beads (20mg) down to 0 ready for when I want to move forward...

 

Remembering that by splitting the dose, I will not be getting the "full whack" of the combination of the two, of course. I forget this. I split the dose just over 2 weeks ago when you advised, which cured my stomach issues.

 

I am only too happy to help where I can. I am sure the man upstairs put you in place when I needed this information and seeing how this helps me, I can but only follow in the same way as best I can.

[fishinghat]

Hopefully in another 2 or 3 weeks you will stabilize again.

I know what you mean. When I was going through my nasty withdrawal I asked "God why me?". When it was over I thought "Never mind", "Know I know what you had in mind God." Been glad I stayed ever since.

[invalidusername]

Faith can often be tested, but there are many reasons for these things that we are just not meant to understand at the time.But some days it sure can be tough...

 

Just finished work and had my Citalopram and a similar day. It seems like the depression is there waiting to take advantage of the slightest slip, the wrong thought and it'll be "here's my chance... you're gonna be depressed now!". It is such a struggle to keep trying to reassure yourself that it is the pills.

 

On that thought, do you also think there is anything to be gained by switching the Cit back to the morning as it is already the higher dose?

 

And just to clarify in what you are saying, would you advise I remain where I am on the 20/20 split for another couple of weeks, or go ahead with the 4 beads per day already?

 

Do you also think there is anything to be gained by switching the Cit back to the morning as it is already the higher dose? 

[fishinghat]

"Do you also think there is anything to be gained by switching the Cit back to the morning as it is already the higher dose?"

It will just switch the time that the depression hits. That means it will hit in the early morning hours just before the Cit is due. Maybe you can be lucky and sleep through it.

"And just to clarify in what you are saying, would you advise I remain where I am on the 20/20 split for another couple of weeks, or go ahead with the 4 beads per day already?"

You need to stay on the 20/20 until fairly stable and then it would be time to consider the 4 bead drop per day routine. You might need to start the drop sooner though if you are going to risk running out of medicine.

[invalidusername]

Morning can be very touch and go as serotonin is at lowest in the morning. I am just thinking that 20mg of the Dulox will hardly be touching me now in terms of any benefit, so struggling on that through the day might become a problem.

 

For now I will remain on present dose and take it from there. I think I need to at least stabilize before any more juggling. Last thing I need to do at the moment is to further complicate things. 

[invalidusername]

Had another seizure yesterday shortly after writing the above. Bit worrying.

 

I decided to switch am/pm, but maintaining doses of course. I took half dose of Cit last night to see me through the 12 hours, and then the usual 20mg this morning, but no Dulox as we know what mixing them does to me! So I will be going through the rest of today on next to no Dulox... wish me luck!

 

Will see how this switch goes before going ahead with the bead count.

[invalidusername]

Fishinghat (or anyone else!) - a little advice if you would...

 

After four days of switching times of meds, I have found that the fatigue and dizzy spells occur towards the evening, and they have got easier. However, the last couple of mornings I am having very strange and disturbing feelings. A mix of depression and anxiety, not too bad but enough to make me feel very uneasy. I seem to react badly to just about any thought I have - good or bad - as soon as I wake. Dreams are not disturbing and perfectly normal. Very odd. Difficult to describe, but still sets up me up badly for the day ahead. I think it may be my anxiety playing up as it appeared yesterday evening for no reason, and should something small come to mind, it hits worse that before.

 

Really not sure if this is due to switching, whether I should have done it, and if it still needs time to level out? Any suggestions at all?

 

I am nocturnal, so I sleep at 4am, wake around 11am and have my 20mg Citalopram, then take my Dulox around 8pm, sleep again 4am....

[fishinghat]

:I am nocturnal, so I sleep at 4am, wake around 11am and have my 20mg Citalopram, then take my Dulox around 8pm, sleep again 4am...."

I think this is mostly an adjustment to the change in schedule BUT I dis notice it was 9 hours between Cit and Dulox but 15 hours between Dulox and Cit. That is not a stable dosing schedule. I would suggest changing the Dulox to 11 PM.

Also that is an unhealthy sleep cycle especially for someone dealing with depression/serotonin. Melatonin levels begin to rise with sunset and peak just before dawn. Serotonin is the lowest just before dawn and rises rapidly thereafter. By being a sleep during those early morning hours (7 am to 11 am you are not using any of that serotonin and it may be contributing to some of the symptoms when you awaken. Have you always had this type of cycle?

[gail]

Hello Scrat,

Don't worry, I won't steal your nut. I have no explanation for that. Just know that it's a nearly contant thing since Cymbalta. Nearly 4 to 5 years back. That feeling, which you described perfectly, usually eases off after one hour or so.

I used to take 1 gram of Ativan, worked well, I got used to it, doesn't work Anymore. And let me tell you that it's real unpleasant as you experienced it.

What I do is prepare coffee (decaf), take out my writing book and write, first thing I know is that I'm not longer writing about this and have skipped to another more pleasant subject. This morning was about gratitude for this and that. I often wake up crying, for nothing.

Love from Sid, hold your nut strongly as I know that Fishinghat loves them. I think!

[fishinghat]

I am a bit of a squirrel myself as I have eaten acorn flour, the nuts and acorn starch.

[invalidusername]

Thanks for replies!

 

Fishinghat - I am with you on the nocturnal schedule, and I have been told it can contribute to symptoms. It is delayed sleep phase disorder and I developed it about 15 years ago, so it is pretty stuck. Any attempt to change to a "normal" routine finds me getting very tired and lethargic. It is all documented somewhere... and students are more prone to it. 

 

I didn't pay much mind to the Dulox as I thought I would be asleep that I would not notice it, but I forget the effect on the morning. I took it at the point the physical withdrawal symptoms started to occur, hoping that they would abate quicker. I was worried that eventually I would need to switch back to Citalopram in the morning (or I assumed as this is what I was doing before Dulox), and doing this towards the end of the taper would only be more difficult. Again - too many questions! I do tend to overthink....

 

Gail-scrat - the feeling does ease off yes, but leaves an aftermath that feeds the anxiety and depression. I have been coping very well with anxiety for some time now, and its the depression being the biggest problem. It is very worrying to see anxiety creeping back in. Really trying to keep telling myself that it is the withdrawal and it will go. I have a problem with control, and it is things like this that steal my control and make my symptoms worse. It was easier when I could see the reason for symptoms intensifying (life circumstances, stress etc). I at least felt some control, and that it could be explained away...

 

I like your approach. Writing is a good distraction, and gratitude is something we all need to consider. Look inwards as well as outwards to find the small positives.

 

Much hugs - and feel free to share my nut anytime

[invalidusername]

What I am finding the most difficult is again, this "marathon" of constant swings of mood and never quite reaching the better times because the mood doesn't stay there long enough for confidence to return. 

 

I have had a year of strings of good and bad days, so the confidence is there in so much that I can expect the good to return for some relief, but for the last few weeks, I have had no downtime, no respite. I know all on the forum have similar, but I just need to vent. I am so tired, angry and arrrghhhhhhh!!!

[fishinghat]

This is a time to be kind to yourself. Do something that brings you pleasure.

[invalidusername]

Finished work - time for bath, book and favourite veggie pie for dinner then.

 

Still haven't taken my Dulox - getting tougher by the hour, but I'm holding out for the 12th hour.

[fishinghat]

It will take you a couple days to adjust.

 

Hey IUN, what do you do from dark to 11 PM? Does it involve bright lights like a hd tv, using a 75 watt light, bright screen on a pad or notebook, etc?

[invalidusername]

I try not to spend too long on the laptop, but is sometimes needed as I am studying by distance. But I do a lot of reading which calms me a lot, bit of meditation most evenings. Also got daylight LED bulbs, for what they might help.

[fishinghat]

The recommendation is to use 25 watt or less lighting after dark to optimize melatonin levels and minimize serotonin levels.  That is around 250 lumens. Anything above 500 lumens is considered detrimental to getting to sleep.

[invalidusername]

Interesting... so minimize serotonin levels such that one stores those levels up?

 

I generally have a single lamp (and a saltrock lamp) on around this time, but I am not too sure of the bulb wattage.

 

Once told that the "daylight" bulbs simulate more day time and thus produce more overall happiness. We even have a place down the street that charges an hourly rate for sitting in a room with a load of these lights. Personally, I have better things to do  

[fishinghat]

With the setting of the sun serotonin is changed over to melatonin. So as darkness proceeds the amount of serotonin decreases and the amount of melatonin increases. The opposite is true in the morning and with the rising sun serotonin production continues but with the increasing light levels it is not converted to melatonin. This we get sleepy in the evenings as the level of melatonin rises and begin to awaken in the morning as the levels of serotonin increases.

 

Many people black out their bedroom windows so they can go to sleep easier and stay asleep longer. I have a document called How to Sleep Better that was given to me by my first therapist. Have I posted that for you earlier?

[invalidusername]

Not seen this document... but it sounds like interesting reading. I am aware that there is a lot of talk about Seasonal Affective Disorder now - but not quite sure how this all works. Would be good to do what I can to help the cause of depression. I don't full understand the role of both, and the link between serotonin and melatonin. 

 

My anxiety isn't so bad today, but depression has come back - this is stemming from not being able to maintain the good as I have said before. I am grateful of course not to have had any really bad days for a while, but being mediocre for some time makes it feel there is no progress, and this inevitably serves to drive me backwards. Its very frustrating. Seems I can't win. 

 

I can see that the withdrawal is doing it, by it worries me that once it has been around too long, it will become the norm....

[fishinghat]

"...Seasonal Affective Disorder now - but not quite sure how this all works."

It is based on the same relationship I mentioned between serotonin and melatonin.

During winter months it is more cloudy than summer and the days are shorter. This causes more serotonin to be converted to melatonin. For most people this may cause some laziness, lack of ambition, etc but for a few who naturally produce lower levels of serotonin this can lead to depression. With the shorter days and longer nights the low levels of serotonin can take away all motivation and interest in life and lead to Seasonal Defect Disorder (SAD). This type is called fall and winter SAD.

Although rare, some people naturally generate more serotonin than most and in the summer when the days are longer and brighter their serotonin becomes excessive. This leads to anxiety, restlessness and agitation. This type is called spring and summer SAD.

I will post the sleeping document in a minute.

[fishinghat]

                                                                       How to Sleep Better
Tips for Getting a Good Night’s Sleep

Tip 1: Keep a regular sleep schedule
Getting back in sync with your body’s natural sleep–wake cycle—your circadian rhythm (daily rhythm)—is one of the most important strategies for achieving good sleep. If you keep a regular sleep schedule, going to bed and getting up at the same time each day, you will feel much more refreshed and energized than if you sleep the same number of hours at different times. This holds true even if you alter your sleep schedule by only an hour or two. Consistency is important.

Set a regular bedtime. Go to bed at the same time every night. Try not to break this routine on weekends when it may be tempting to stay up late. No more than 15 minutes earlier or later each day.

Wake up at the same time every day. If you’re getting enough sleep, you should wake up naturally without an alarm. If you need an alarm clock to wake up on time, you may need to set an earlier bedtime. As with your bedtime, try to maintain your regular wake–time even on weekends.

Nap to make up for lost sleep. If you need to make up for a few lost hours, use a daytime nap rather than sleeping late. DO NOT NAP MORE THAN 1 HOUR PER DAY as it may affect your evenings sleep. DO NOT NAP AFTER 5 PM. The best time to nap is early afternoon.

Fight after–dinner drowsiness. If you find yourself getting sleepy way before your bedtime, get off the couch and do something mildly stimulating to avoid falling asleep, such as washing the dishes, calling a friend, or getting clothes ready for the next day. If you give in to the drowsiness, you may will usually wake up later in the night and have trouble getting back to sleep.

Tip 2: Naturally regulate your sleep-wake cycle

Melatonin is your naturally produced hormone that regulates your sleep. Melatonin production is controlled by light exposure. Your brain will secrete more in the evening, as it becomes darker, Conversely, during the day your brain detects increasing light levels and begins producing serotonin, which causes one to wake and be alert.

Spending long days in an office away from natural light, for example, can impact your daytime wakefulness and make your brain sleepy. Then bright lights at night—especially from hours spent in front of the TV or computer screen—can suppress your body’s production of melatonin and make it harder to sleep. However, there are ways for you to naturally regulate your sleep-wake cycle, boost your body’s production of melatonin, and keep your brain on a healthy schedule.

Increase light exposure during the day
Remove your sunglasses in the morning and let light onto your face.
Spend more time outside during daylight. Try to take your work breaks outside in sunlight, exercise outside, or walk your dog during the day instead of at night.

Let as much light into your home/workspace as possible. Keep curtains and blinds open during the day.

Boost melatonin production at night
Turn off your television and computer. Many people use the television to fall asleep or relax at the end of the day. Not only does the light suppress melatonin production, but television can actually stimulate the mind, rather than relaxing it. Try listening to music or audio books instead, or practicing relaxation. If your favorite TV show is on late at night, record it for viewing earlier in the day.
Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a bedside lamp.

Change your light bulbs. Avoid bright lights before bed, after 7 PM do not use a light greater than 25 watts. Reduce light exposure by significantly reducing the brightness on your TV or electronic device.

When it’s time to sleep, make sure the room is dark. The darker it is, the better you’ll sleep. Cover electrical displays, use heavy curtains or shades to block light from windows, or try an eye mask to cover your eyes. Most patients with chronic problems blacken their bedrooms entirely. Do not use nightlights if it can be done safely. Block all windows in the bedroom so light can not enter.
See... https://www.ncbi.nlm...n00057-0027.pdffor details

Tip 3: Create a relaxing bedtime routine
If you make a consistent effort to relax and unwind before bed, you will sleep easier and more deeply. A peaceful bedtime routine sends a powerful signal to your brain that it’s time to wind down and let go of the day’s stresses.

Keep noise down. If you can’t avoid or eliminate noise from barking dogs, loud neighbors, city traffic, or other people in your household, try masking it with a fan, recordings of soothing sounds, or white noise. You can buy a special sound machine or generate your own white noise by setting your radio between stations. Earplugs may also help. Sound machines can be purchased at local department stores.

Keep your room cool. The temperature of your bedroom also affects sleep. Most people sleep best in a slightly cool room. A bedroom that is too hot or too cold can interfere with quality sleep.

Make sure your bed is comfortable. You should have enough room to stretch and turn comfortably. If you often wake up with a sore back or an aching neck, you may need to invest in a new mattress or a try a different pillow. Experiment with different levels of mattress firmness, foam or egg crate toppers, and pillows that provide more support.


Relaxing bedtime rituals to try...
Read a book or magazine by a soft light
Take a warm bath
Listen to soft music
Do some easy stretches
Wind down with a favorite hobby
Listen to books on tape
Make simple preparations for the next day
DO NOT exercise or do any significant physical activity after 6 PM. Anything considered work (laundry, dishes, etc) must be avoided after 6 PM.

Tip 4: Eat right and get regular exercise
Your daytime eating and exercise habits play a role in how well you sleep. It’s particularly important to watch what you put in your body in the hours leading up to your bedtime.

Stay away from big meals at night. Try to make dinnertime earlier in the evening, and avoid heavy, rich foods within two hours of bed. Fatty foods take a lot of work for your stomach to digest and may keep you up. Also be cautious when it comes to spicy or acidic foods in the evening, as they can cause stomach trouble and heartburn.

Avoid alcohol before bed. Many people think that a nightcap before bed will help them sleep. While it may make you fall asleep faster, alcohol reduces your sleep quality, waking you up later in the night. To avoid this effect, so stay away from alcohol in the hours before bed.

Eliminate caffeine. You might be surprised to know that caffeine can cause sleep problems up to ten to twelve hours after drinking it! No chocolate, most teas, coffee.

Avoid drinking too many liquids in the evening. Drinking lots of water, juice, tea, or other fluids may result in frequent bathroom trips throughout the night. Caffeinated drinks, which act as diuretics, only make things worse.

Quit smoking. Smoking causes sleep troubles in numerous ways. Nicotine is a stimulant, which disrupts sleep. Additionally, smokers actually experience nicotine withdrawal as the night progresses, making it hard to sleep.

Eliminate stimulants. No sugars, salty food or MSG. Sugar is a stimulant which can increase blood pressure and pulse. It can take significant time to process this material and slow down your metabolism. Salts like table salt and MSG provide sodium which is used by the body to help carry electrical system in our bodies. This can also increase heart rates and metabolism for several hours.

If you’re hungry at bedtime
For some people, a light snack before bed can help promote sleep. When you pair tryptophan–containing foods with carbohydrates, it may help calm the brain and allow you to sleep better. For others, eating before bed can lead to indigestion and make sleeping more difficult. Experiment with your food habits to determine your optimum evening meals and snacks. If you need a bedtime snack, try:
A small bowl of whole–grain, low–sugar cereal
Granola with low–fat milk or yogurt
A banana (not sugary fruits)

You’ll also sleep more deeply if you exercise regularly. As little as twenty to thirty minutes of daily activity helps. And you don’t need to do all thirty minutes in one session. You can break it up into five minutes here, ten minutes there, and still get the benefits. Try a brisk walk, a bicycle ride, or even gardening or housework. Serious exercise, even small amounts, must be done before 6 PM.

Some people prefer to schedule exercise in the morning or early afternoon as exercising too late in the day can stimulate the body, raising its temperature.

Tip 5: Get anxiety and stress in check
Do you find yourself unable to sleep or waking up night after night? Residual stress, worry, and anger from your day can make it very difficult to sleep well. When you wake up or can’t get to sleep, take note of what seems to be the recurring theme. That will help you figure out what you need to do to get your stress and anger under control during the day:

If you can’t stop yourself from worrying, especially about things outside your control, you need to learn how to manage your thoughts. When trying to go to sleep it is essential not to think about work, money, your family’s problems or other stressful subjects. These are very detrimental to sleep. Do not think about exciting subjects (a vacation, your favorite hobbies, etc.). Instead pick something mundane (boring). Pick a subject like weeding you garden, cleaning your car, etc. It will be difficult to stay focused on these boring subjects at first but it will become easier with time and practice.

If the stress of managing work, family, or school is keeping you awake, you need help with stress management. By learning how to manage your time effectively, handle stress in a productive way, and maintain a calm, positive outlook, you’ll be able to sleep better at night.

Relaxation techniques for better sleep
Deep breathing. Close your eyes—and try taking deep, slow breaths—making each breath even deeper than the last.
Progressive muscle relaxation. Starting at your toes, tense all the muscles as tightly as you can, then completely relax. Work your way up from your feet to the top of your head.
Visualizing a peaceful, restful place. Close your eyes and imagine a place or activity that is calming and peaceful for you. Concentrate on how relaxed this place or activity makes you feel.

Tip 6: Ways to get back to sleep
It’s normal to wake briefly during the night. In fact, a good sleeper won’t even remember it. But if you’re waking up during the night and having trouble falling back asleep, the following tips may help.

Stay out of your head. Hard as it may be, try not to stress over the fact that you’re awake or your inability to fall asleep again, because that very stress and anxiety encourages your body to stay awake.

Make relaxation your goal, not sleep. If you are finding it hard to fall back asleep, try a relaxation technique such as visualization (focus your eyes on something in the room), deep breathing, or meditation, which can be done without even getting out of bed. Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body.

Stretching. If you wake during the night do NOT fight it or panic. If you can not go to sleep in 10 to 15 minutes, get up, wake 20 or 30 feet, stretch (touch your toes or stretch your arms), walk back to bed and lay back down again. Each time you stretch and lay down your body will produce a small amount of endorphins which help the body relax.

Postpone worrying and brainstorming. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when you are fresh and it will be easier to resolve. Similarly, if a brainstorm or great idea is keeping you awake, make a note of it on paper and fall back to sleep knowing you’ll be much more productive and creative after a good night’s rest.

[fishinghat]

I just have to day. I have these documents saved on my computer in a very readable and organized way. BUT when I post this forum removes all bold letters, sentence breaks and spacing. I then have to correct these changes and when I post it again only half the changes appear. Urgghh.

 

Sorry, just a little venting.

[invalidusername]

I really appreciate you taking the time to post this for me. I will print off later and read - I always prefer to read from paper than screen where I can.

 

The info you gave about both SAD disorders is very interesting. I didn't even know it could go the other way. Although when I had my days of 60mg Dulox and 10mg Cit, my good days were at the point that I got restless and irritable, so the very hot weather and long days could well have been a factor there.

 

But all these snippets of information are great. And even though I have had issues worthy of complaint to the local mental health service, I am finding that I don't want to hear what they say about my treatment as I'd much rather follow the voice of the masses here on the forum. People here clearly have more information about what I need.

 

Is there any way we can put a permalink for these documents online? Would save you a lot of hassle!

[invalidusername]

I have re-formatted and saved as a pdf - let's see if this works;

 

https://www.dropbox....Better.pdf?dl=0

 

Feel free to use this link FH - I can leave the file in place for the foreseeable...