Okay Dr. Hive, mental illness or just too sensitive?

[Night Elf]

Someone suffering from depression, anxiety and paranoia. They are being seen by a psychiatrist for medication management and a therapist for counseling. Person also suffers from insomnia, usually waking up a half dozen times while sleeping. Person was just put on Ambien and it is making things a bit better because person is able to roll over and fall back asleep relatively easy. Person is tired all of the time. There is never a moment in their day/night where they are not tired, almost feeling drained. When they were a teenager, they were seen by a regular general physician for the fatigue who ran blood tests and found person was slightly anemic, but it was very slight. They put person on iron supplements and nothing else was done. Person stayed on them for several months then gave up because they didn't help. The fatigue stayed the same. That's medical background.

 

Person is highly sensitive and I mean over emotional nearly all of the time. Person cannot watch/read/discuss anything sad or intense because person can cry at the drop of a hat. Person cries easily anyway and has tears at least once every day, sometimes 3-4 times a day. The crying is usually triggered by something that makes the person feel overwhelmed. For example, person has had 3 part-time jobs and all were stressful to some degree. Person often had to excuse their self from work to go cry in the bathroom until they could pull themselves together and face work again. Person gets overwhelmed easily, like waiting on a bus and it not being on time causes stress which is overwhelming. Fighting back tears is an ongoing problem. 

 

Person gets very little enjoyment from things that used to bring joy. Person has few friends but they are busy a lot so person is alone a great deal of the time. Person gets in bed about 7:00 ready to go to sleep but tries to watch tv to stay awake at least until 9:00pm. Person has to wake early on weekdays and all of the sleep medication tried leaves person feeling groggy in the morning. Ambien has the same effect. So person's day starts off on a negative note.

 

What advice do you have for this person? What problems should be addressed and by what types of professionals?

[wonderchica]

Sounds like textbook depression, which you said has already been diagnosed. Are they on meds? If so, they likely need an adjustment.

[regentrude]

Sounds like depression. Person might need a different antidepressant, and psychotherapy. Is the therapist a good match? How long has therapy been going on? This is not an illness that has a quick fix.

 

I would strongly encourage exercise and sunlight.

Edited December 3, 2017 by regentrude

[regentrude]

Mental illness obviously (they've already been diagnosed) but fwiw, I'd tell the person who is tired all the time and making themselves stay up from 7pm to 9pm...to stop and just go to sleep at 7.

 

actually, depression symptoms get somewhat better through sleep deprivation. Excessive sleeping will not result in the person feeling more rested.

[Night Elf]

Mental illness obviously (they've already been diagnosed) but fwiw, I'd tell the person who is tired all the time and making themselves stay up from 7pm to 9pm...to stop and just go to sleep at 7.

 

When person falls asleep too early, they wake up too early. Person doesn't like being up before 7am and if person falls asleep too early, person can be up at 5:00am.

[Critterfixer]

Depression and chronic sleep deprivation. Has person been evaluated for the sleep disorder? That can't be making things any better.

[Night Elf]

But do they sleep WELL if they listen to their body for several weeks (say, a month) in a row and sleep 7-5??

 

What makes 5am too early?

 

Heck, even I think 5am is too early! I try to sleep at least until 6:30am. That's the latest I can get my dog to stay still in bed. 

 

The person I'm talking about has tried several sleeping aids including melatonin which also leaves person groggy in the morning. Person can fall asleep easily but wakes many times in the night. 

 

I never thought about a sleeping disorder. Where does one start the process to diagnose?

[Critterfixer]

Heck, even I think 5am is too early! I try to sleep at least until 6:30am. That's the latest I can get my dog to stay still in bed. 

 

The person I'm talking about has tried several sleeping aids including melatonin which also leaves person groggy in the morning. Person can fall asleep easily but wakes many times in the night. 

 

I never thought about a sleeping disorder. Where does one start the process to diagnose?

I'd see if they could get a referral for a sleep study.

[Greta]

Definitely sounds like depression and not merely being overly sensitive.  And this is just the opinion of a layperson, and not the medical advice of an expert, but since you asked for advice, mine would be to put this person on a vigorous exercise regimen and a very low arachidonic acid diet (see also this one for a follow-up).

 

 

ETA:  The sleep study is a great suggestion!

Edited December 3, 2017 by Greta

[Guest]

A lot of this person’s problems are similar to what mine were when suffering from depression, except I did not have insomnia. I guess I had hypersomnia, because I only wanted to sleep and I was always unhappy when it was time to get up and face the day. I cried every day. I had no fortitude. I had headaches every day. I wouldn’t beleive anyone cared about me, which made people who actually did care about me stop caring about me.

[wapiti]

I would wonder whether the medications were in need of adjustment or change.  I would be concerned about more medical issues behind it, but that gets complicated and controversial quickly.

[Lanny]

What diagnosis has the Psychiatrist made for this patient?  Does the patient have good rapport with the Therapist?  Is the patient honest with the Psychiatrist about the symptoms and complaints? Has the patient told the Psychiatrist all of the information that is in post #1? The Psychiatrist can look for Physical problems, along with the Mental problems and try to find the best medication(s) to treat the patient, if that's appropriate. 

[JFSinIL]

Perhaps a different doctor might try to tweak or alter meds. DS has gone through three psychiatrists to find one able to help him*. I would NEVER suggest that someone already diagnosed with mental illness is being "too sensitive".

 

* Depression, bipolar, insomnia, panic attacks. Currently the med that has helped best with panic attacks is causing not nausea, but an icky upper throat feeling that is leading to gagging and upchucking :-( yet he needs the med once or twice a week. Fun times. DS is on 5 or 6 meds, quite a cocktail, to be able to function.

Edited December 3, 2017 by JFSinIL

[Night Elf]

Okay, I'm turning off my computer for the night now. I'll check back tomorrow to see if anyone else has some thoughts. I'm just tired of seeing this person suffer so and accept it thinking it's normal. 

[Night Elf]

What diagnosis has the Psychiatrist made for this patient?  Does the patient have good rapport with the Therapist?  Is the patient honest with the Psychiatrist about the symptoms and complaints? Has the patient told the Psychiatrist all of the information that is in post #1? The Psychiatrist can look for Physical problems, along with the Mental problems and try to find the best medication(s) to treat the patient, if that's appropriate. 

 

Person was diagnosed by a different psychiatrist that is no longer accessible. The new psychiatrist is only going by what person has said. No new assessment has been done to my knowledge. The same medication regime was kept at first and tweaked a bit but I don't think it's enough. Person has not told doctor everything because person feels everything is normal and that if they go in with all these new thoughts that the doctor will think person is over reacting. Doctor feels depression is mild based on what person has told doctor. Doctor needs to be aware there is much more going on than person is saying. I'm in the process of encouraging person to be more forthcoming and not be afraid of what the doctor will think. But this is also why I asked here, because I don't know exactly what to say either. I only know this person has changed in the last couple of years, day by day and those who know this person have all noticed. Person was unaware of this until I told them. 

 

I appreciate all the replies so far.

[lavender's green]

Sounds like depression.

 

Sleep study, medication tweaks, and diet are all important to look at. In the meantime, exercise. Even just taking a brisk walk can do wonders. Bonus points if it's in an area where you can casually greet strangers. Simple connections with your fellow man are a great way to beat the isolation of depression.

 

I don't think it sounds like a good idea to spend two hours in bed trying to stay awake and then spend the rest of the night trying to fall asleep. Just seems like a great way to send mixed signals to your brain. Getting up at 5 am isn't the end of the world, especially if that's what your body wants to do. I know many people, some depressed, who get their best work done in the wee hours while the rest of the world is asleep.

[Ottakee]

First of all, honesty with the psychiatrist is key. If person will allow, it can be very helpful for a support person who knows the truth to go along with them and help explain exact symptoms to the doctor.

 

While multiple meds are often needed, I am leery of doctors that just add med after med instead of seeing if one of the other meds needs to be adjusted or if additional symptoms of side effects of a current med.

 

I would question a bipolar 2 or possibly something else considering the paranoia. Does psychiatrist know about this?

 

I would also ask the psychiatrist or primary care doctor to check blood work.... Basics, iron levels, thyroid, bit B and D levels, liver and kidney function, etc. As sometimes there are computing physical things that need yo be addressed.

[StephanieZ]

Heck, even I think 5am is too early! I try to sleep at least until 6:30am. That's the latest I can get my dog to stay still in bed. 

 

The person I'm talking about has tried several sleeping aids including melatonin which also leaves person groggy in the morning. Person can fall asleep easily but wakes many times in the night. 

 

I never thought about a sleeping disorder. Where does one start the process to diagnose?

 

Re: melatonin. It works very well for me . . . I found that 5-10 mg made me very hung over and groggy the next morning. But, once I figured out my ideal dosage (3mg), it helps me greatly in getting to sleep and then doesn't hang me over at all. Also, the chewables take effect much quicker which helps trigger a very sleepy temporary state when it's especially easy to go to sound sleep in a 30 min window when the melatonin is peaking. I add 2 tablets of benadryl at the same time, and this combo works as well for me as much more serious and dangerous drugs. 

 

I'm having my kid worked up for sleep disorders this week, and my understanding is that the PCP will refer us to a psychiatrist who would then order a sleep study (overnight), do a thorough history/questioning . . . and presumably other doctors or back to the PCP if there are more physical things that need addressing, or therapist for therapy if there is more of an emotional cause to the sleep disturbance . . . I'm not sure about these steps though, because I am literally a day away from beginning the first medical appointment. I definitely have confirmed that the diagnostic process is best begun with the primary care doc.

[Forget-Me-Not]

Has this person undergone a sleep study?

[Guest]

Person was diagnosed by a different psychiatrist that is no longer accessible. The new psychiatrist is only going by what person has said. No new assessment has been done to my knowledge. The same medication regime was kept at first and tweaked a bit but I don't think it's enough. Person has not told doctor everything because person feels everything is normal and that if they go in with all these new thoughts that the doctor will think person is over reacting. Doctor feels depression is mild based on what person has told doctor. Doctor needs to be aware there is much more going on than person is saying. I'm in the process of encouraging person to be more forthcoming and not be afraid of what the doctor will think. But this is also why I asked here, because I don't know exactly what to say either. I only know this person has changed in the last couple of years, day by day and those who know this person have all noticed. Person was unaware of this until I told them.

 

I appreciate all the replies so far.

This is what is difficult about depression: the depressed person often does not see it fully or at all except in retrospect. It’s hard to see it clearly when you are in the eye of the storm. Even harder if the person is young and doesn’t have a lot of life experience.

[matrips]

These are simplistic things, but all I’ve got :)

 

It might be okay to read (a physical book) for two hours in bed, but tv or computer or iPhone/pad is detrimental to sleep.

 

Second, I’ve had trouble staying asleep for years! It was just my normal and I didn’t think much about it, besides hating it. My dh recently did a sleep study and it triggered the idea for me to try some breathe right strips. I have slept through the night now for two weeks!!! It is awesome.

So yes, a sleep study may be very beneficial. It’s hard to function well without sleep.

[gardenmom5]

has person ever been evaluated by a functional medicine doctor or a naturopathic dr for thyroid (NOT tsh!!!), and adrenal function? (24 hr saliva test. NOT a blood test!)

 

those can often cause the symptoms from which person is suffering.

[Loesje22000]

Does the person exercise enough?

And with exercise I mean just ordinary walking, cycling nothing ‘special’.

 

If it is depression, a lot can improved by enough exercise.

 

According to this book:

https://www.amazon.com/Spark-exercise-improve-performance-brain-ebook/dp/B009S8HE2C/ref=sr_1_1?s=books&ie=UTF8&qid=1512288467&sr=1-1&keywords=Spark

A lot of mental health issues would improve if people were moving enough.

[JFSinIL]

has person ever been evaluated by a functional medicine doctor or a naturopathic dr for thyroid (NOT tsh!!!), and adrenal function? (24 hr saliva test. NOT a blood test!)

 

those can often cause the symptoms from which person is suffering.

Why is one test better than the other? Wondering, since DS has only ever had blood work done to check his thyroid.

[Lanny]

OP RE: Your comments in Post #18 responding to my questions.  IMO, if the person does not share 100% of the information you have     disclosed here, to the Psychiatrist, and also to the "Therapist",  the person is wasting time and money going to them.  They cannot possibly provide better help, if they are in the dark and think the patient has "Mild" depression and do not know all of the things you have disclosed in this thread.. 

[Sandwalker]

I would first suspect any medications he/she is on to be causing side effects, and talk to the doctor about them. With meds ruled out, I would suspect vitamin D deficiency.

 

To help the night waking, more cardio exercise throughout the week, and turn off all screens (or use a blue blocker app for the phone after 7pm). Meditation is the very best thing for sleep problems. If the person is male and over 30 and waking to urinate, I would suspect prostate issues. And in anyone waking to urinate several times at night I'd suspect diabetes, especially if they are thirsty too. Also if the person snores, could be sleep apnea, especially if he/she has a thick neck.

 

And of course could be depression, but if it were me, I'd like to rule out other physical causes before starting that whole medication train.

[Night Elf]

Thanks for the leads. I'll talk to Person and see what they they're willing to do. I had suggested a visit to the regular general physician for a checkup and possible blood work so I'll tell Person again that others are recommending the same thing. 

 

I totally understand if Person doesn't share everything then the professionals aren't working with the full story. The problem is that depression deceives. I actually have bipolar so have had my share of depressive moods and they didn't stand out to me as what was happening. I knew I felt bad but it was my normal feelings and I just thought it is what it is. I think that is what Person is going through. Person knows they feel bad but since they're on medication, they figure they're at the best they can get. This isn't true and what I'm trying to get Person to understand.

 

As for sleep, Person has no trouble falling asleep. It's staying asleep that's the problem. Person has also gone through periods of bad dreams which troubled Person because sleep was the one escape they had from their troubles. However, extremely good dreams also trouble Person. They wake up and realize it was all a dream and that they're back in the real world full of negativity and they cry, sometimes being unable to go back to sleep again. I get that watching tv isn't the best plan but this Person doesn't read. If Person isn't in the mood to watch something, they just listen to music and do something with their hands. Person is sleeping about 9pm to 7am but with lots of interrupted sleep. Ten hours seems to be the max though because if Person falls asleep earlier, then Person wakes early and Person doesn't want to be awake at that hour.

[SparklyUnicorn]

All the meds cause tiredness.  So that part is explainable.  They could be depressed as others said. 

 

This time of year can be tough for some people in general too.  My parents almost always had "episodes" around holiday times.

 

 

[Night Elf]

That’s super weird and not healthy at all. You’ve listed so many flags for depression and related conditions, I think some frank talks with the medical team and therapy team and some alterations in treatment are in order. They shouldn’t have to live like that. Even if they were sensitive and melodramatic as a personality type, this is wel beyond that IMO.

 

Thank you, I totally agree with you. Now let's see if I have any influence to get these problems resolved.

[Pronghorn]

Look into the connection between light exposure and sleep. I recommend lowbluelights.com.

[lavender's green]

Is this person under a lot of stress? Or maybe not a lot of stress, but the wrong type of stress for their personality? Placing inappropriate expectations on themselves? You wouldn't necessarily know from the outside.

 

I ask because while sleep, diet, exercise, medication, bloodwork, and coping skills are all extremely important, it may just be that they're in a bad situation and need to get free of that before those things will have any meaningful impact. We're more than just our bodies, and our bodies are not mere machines that can be fine-tuned with a tweak here and there.

 

What if they made a career change, took a sabbatical, a gap year if they're a student, changed their living situation...things like that.

 

I've had major depression and mild depression, and in both cases there were bodily issues that needed to be addressed, but at the same time, no amount of good diet and sleep were going to change the external factors or the internal constraints I was putting on myself. In one case I chose to change my environment, and that mostly cured me. Diet, vitamin D, and appropriate sleep and movement, got me the rest of the way there. The milder case I did everything possible from a physical standpoint, but we ultimately just had to wait for the whole family to mature (postpartum depression with lots of very young kids who weren't sleeping!). And I all-around just tend to place too-high expectations on myself, for no good reason. I addressed that from a spiritual point of view, plus general life experience. Others may choose to treat differently.

[JFSinIL]

don't know to delete a boo boo post

Edited December 3, 2017 by JFSinIL

[GoVanGogh]

Depending on age and gender, could be a hormone imbalance or perimenapause.

[KungFuPanda]

Do they get any exercise at all? It have have an effect on mood and quality of sleep.

[luuknam]

Like others said, a sleep study might be a good idea - there could be physical reasons like apnea that keep waking the person up. Other than that, I don't see why the person couldn't watch tv from 5 to 7am instead of from 7 to 9pm. Not that I think starting the day with two hours of tv is ideal - it'd be great if they could start the day with some exercise or something instead, but I don't really see a downside to switching tv time around, and there is the upside that research has shown that screens before bed make sleep worse. 

 

And, like others mentioned, have vitamin B, D, etc checked. 

[luuknam]

Oh, and in my experience, trazodone doesn't leave me tired in the morning (it's a fairly low dose, I think), but the best for sleeping through the night is klonopin... (I only use that as-needed either during the day or at night or not at all, so not very many nights, but it does deal very adequately with waking up from excessive stress/anxiety/etc).

[gardenmom5]

Why is one test better than the other? Wondering, since DS has only ever had blood work done to check his thyroid.

 

the most common thyroid test is tsh - that is a pituitary hormone. it's produced by the pituitary to tell the thyroid to make thyroid hormones. super high tsh (SUPER high) can be an indication there is something wrong with the pituitary itself.

the tests you want - are free t3, reverse t3, and free t4.  (totals are completely worthless)   t3 is the hormone that is actually used, - free because that tells you how much is available for your body to use.  t4 is a storage hormone and must be converted to t3 in order to be used.  people with thyroid issues can have problems converting.  it is not uncommon for t4 only patients to be left hypothyroid. (and . . . end up with a high reverse t3 - which causes a host of other problems )   I complained about how I felt - my dr didn't care.  When I confronted her on the tests she told me she ran - but didn't - she LIED to me.   I fired her.

 

cortisol is produced by the adrenals - which can often have issues along with thyroid issues.   the 24 hour saliva tests give four check points (very specific times of day) as a healthy cortisol level follows a distinct pattern throughout the day.   a blood test is once and done and doesnt' tell you how the body is actually using it.

[Forget-Me-Not]

Staying asleep problems can be a good reason for a sleep study. Bad sleep can exacerbate everything else, which I why I asked about a sleep study. Don’t rule it out. (I’m not saying it could be the CAUSE of it all, just that it can make it all worse).

[DesertBlossom]

See a primary that is in to nutrition.  Check the B12 and D and do something like 23andme to check for mutations in the methylation cycle. In the meantime, eliminate the enriched grain products and drop the processed carbs down to 2 a day.  

 

So I just happened upon some stuff related to a GI problem my DS had (he kind of outgrew) and about how nutritional deficiencies related to that problem (thanks to chronic diarrhea) have been linked to depression and mood disorders. So many things make sense now about DS! He probably should have been on some supplements to make up for it.

 

I think our gut health affects our overall health in ways science is only beginning to understand. I would start with a nutritional overhaul, IMO.

[Night Elf]

I truly appreciate all the advice and comments. I'm overwhelmed with where to start. I will be talking to Person this coming weekend. Person doesn't do well with discussing serious matters during the busy work week.