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Suggest Treatment For Mood Swings, Laziness And Sleeplessness
Question: i go to bed to sleep around 10.30 in the night and wake up at 5.45 am usually. Since last 15-20 days , i wake up mid night around 3 - 4 am and than unable to sleep back. whole day i feel lazyness and sleepy. mood swings frequently. at times i am very energetic and at times not even want to move. body weight also fluctuate in the range of 500 gms to 1000 gms even twice in a week. no pressure or stress as such. by profession i am CA and following a very healthy lifestyle. i am an athlete and very particular in my routine. i am 42 now. my doctor prescribed me Tryptomer 10 mg in the night for 1 month. what should i do ?
Brief Answer:
This is depression
Detailed Answer:
hi, XXXXXXX thanks for your query.
These are the symptoms of depression and the sleep problem is early morning awakening particularly seen in biological or melanchlolic depression.
Typical symptoms are:
-Either of the following, occurring during the most severe period of the current episode:
1. Loss of pleasure in all, or almost all, activities
2. Lack of re activity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)
Three (or more) of the following:
1. Distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)
2. Depression regularly worse in the morning
3. Early morning awakening (at least 2 hours before usual time of awakening)
4. Marked psycho motor retardation or agitation
5. Significant anorexia or weight loss
6. Excessive or inappropriate guilt
Read this and tell me what you got from the list? it is important to make a diagnosis.
Don't take the drugs before proper diagnosis.
Revert to me with answers. I am waiting for the reply.
Wish you good health.
This is depression
Detailed Answer:
hi, XXXXXXX thanks for your query.
These are the symptoms of depression and the sleep problem is early morning awakening particularly seen in biological or melanchlolic depression.
Typical symptoms are:
-Either of the following, occurring during the most severe period of the current episode:
1. Loss of pleasure in all, or almost all, activities
2. Lack of re activity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)
Three (or more) of the following:
1. Distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)
2. Depression regularly worse in the morning
3. Early morning awakening (at least 2 hours before usual time of awakening)
4. Marked psycho motor retardation or agitation
5. Significant anorexia or weight loss
6. Excessive or inappropriate guilt
Read this and tell me what you got from the list? it is important to make a diagnosis.
Don't take the drugs before proper diagnosis.
Revert to me with answers. I am waiting for the reply.
Wish you good health.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thanks Doctor,
Well..i am feeling first 2 occurings as you mentioned . pointwise reply for the rest as as follow-
1. yes. (lost father in july this year)
2.well no...i feel good in the morning usually as i go to play / run/ zim. but as the day progresses , i start feeling lazyness, drousiness,lack of energy, lack of concentration etc.
3.yes .. since last few days.
4.do not understand the point
5.not significant weight loss ...but yes some loss is there which i can feel by fitting of my trouser i wear. My weight as of now is 68 kgs and height is 5.8ft. BMI is 24..
6.yes
Further, my HBa1c is 5.7 , B12 is 340 , BP normal, Cholestrol in normal range. hope i answered all your queries...
Well..i am feeling first 2 occurings as you mentioned . pointwise reply for the rest as as follow-
1. yes. (lost father in july this year)
2.well no...i feel good in the morning usually as i go to play / run/ zim. but as the day progresses , i start feeling lazyness, drousiness,lack of energy, lack of concentration etc.
3.yes .. since last few days.
4.do not understand the point
5.not significant weight loss ...but yes some loss is there which i can feel by fitting of my trouser i wear. My weight as of now is 68 kgs and height is 5.8ft. BMI is 24..
6.yes
Further, my HBa1c is 5.7 , B12 is 340 , BP normal, Cholestrol in normal range. hope i answered all your queries...
Brief Answer:
Might be suffering with melancholic depression or biological depression
Detailed Answer:
Hi, thanks for your answers. I appreciate your quick response.
So according to your answers, I came to the conclusion that you are suffering from a melancholic depression or biological depression. In this depression the vegetative symptoms like sleep disturbance, appetite change, weight loss, fatiguability, decrease sex desire etc. there should be predominance of guilt that should be excessive and inappropriate.
Psychomotor retardation means slowness in all activities and agitation means excessive involvement and restlessness in all activities.
Depression can be easily treated by proper antidepressant drugs. Initially when it is moderate to severe, we have to take drugs so that our mind will become responsive to psychotherapy or counselling. In your case the best drug would be desvenlafaxine [pristiq], it has some initial side effects, you will be informed about that by your prescribing psychiatrist. I usually give for 6 to 8 months in my patients or longer if the response is not enough. Drugs should not be stopped suddenly or without advice from a psychiatrist. You will have benefit within 15 to 20 days of starting the drugs. Initial dose of desvenlafaxine is 50 mg after dinner. Dose can be increased depending upon the improvement in symptoms.
Your B12 is in lower range. You should go through course of vitamin B12 injection. 5 to 6 injections of at least 1500 micrograms of vit B12 must be taken.
After that oral supplements should be continued. Other parameters are within normal range. [It is not necessary to take injections, you can have oral supplements only]
It is better to visit a psychiatrist and tell about your symptoms and ask for help. You can discuss about my opinion and suggestion with him and follow his advice.
hope I have answered your query. If you have further query then feel free to ask.
If you do not have further query then close the discussion and rate the answer.
Wish you good health.
Might be suffering with melancholic depression or biological depression
Detailed Answer:
Hi, thanks for your answers. I appreciate your quick response.
So according to your answers, I came to the conclusion that you are suffering from a melancholic depression or biological depression. In this depression the vegetative symptoms like sleep disturbance, appetite change, weight loss, fatiguability, decrease sex desire etc. there should be predominance of guilt that should be excessive and inappropriate.
Psychomotor retardation means slowness in all activities and agitation means excessive involvement and restlessness in all activities.
Depression can be easily treated by proper antidepressant drugs. Initially when it is moderate to severe, we have to take drugs so that our mind will become responsive to psychotherapy or counselling. In your case the best drug would be desvenlafaxine [pristiq], it has some initial side effects, you will be informed about that by your prescribing psychiatrist. I usually give for 6 to 8 months in my patients or longer if the response is not enough. Drugs should not be stopped suddenly or without advice from a psychiatrist. You will have benefit within 15 to 20 days of starting the drugs. Initial dose of desvenlafaxine is 50 mg after dinner. Dose can be increased depending upon the improvement in symptoms.
Your B12 is in lower range. You should go through course of vitamin B12 injection. 5 to 6 injections of at least 1500 micrograms of vit B12 must be taken.
After that oral supplements should be continued. Other parameters are within normal range. [It is not necessary to take injections, you can have oral supplements only]
It is better to visit a psychiatrist and tell about your symptoms and ask for help. You can discuss about my opinion and suggestion with him and follow his advice.
hope I have answered your query. If you have further query then feel free to ask.
If you do not have further query then close the discussion and rate the answer.
Wish you good health.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Answered by
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