July 21, 2011

Midyear Checkup on Mood and Sleep: Both Fine, Thanks to Exercise, 5-HTP and Meditation

For many of us dealing with Parkinson's and aging, depression and insomnia top the list of our worries. I've struggled with both over the years, but neither bothers me today.

Observations as I continue my midyear health checkup:

Most of my life, I would tell you I wasn't bothered by depression. But I may be kidding myself, given my family history: a mother who was seriously disabled with depression most of her pre-medication life, and a sister who took her own life in her mid-30s. I suspect my brother and I took after my dad, who maintained an active and reasonably happy life -- in spite of the family problems -- until he died at age 83. Now that I'm 82, his "83" often comes to mind.

In my retired life, I began to experience brief spells of depression during my many extended visits to Nepal and the Indian subcontinent. I eventually realized those spells coincided with overuse of Tylenol PM for sleep issues on the road.

Nonetheless, that realization didn't stop this addiction-prone guy from continuing to use both Ambien and Tylenol PM while traveling. In June 2006, after returning from Nepal, I continued to use both to deal with jet lag. After a few days, I was hit with depression, insomnia, and panic attacks unlike anything I'd ever experienced. I spent that summer, which I now call The Summer from Hell, seeing a variety of doctors, shrinks, and sleep specialists.  I told them all I thought the  problem had its origins in the Ambien and Tylenol PM abuse. But they heard "depression," "panic attacks," and "insomnia" ... and reached for their prescription pads. I went through a half-dozen different prescribed meds, none of which helped. And my issues worsened.
One shrink, whose speciality was medication, decided we should shift to a holistic approach. I tried acupuncture, hypnosis, herbs. I even went to NYC to get a brain-wave reading that led to the making of a "brain wave music" disc specially designed for me. This therapy had been featured on the Today Show.

Nothing really helped, although my condition wasn't as severe as it was during pill extravaganza. The depression and panic attacks were gone, but I was stilled plagued by insomnia. Finally, I stumbled across The Insomnia Solution, a book that features meditation-like exercises... which began to work.
I was fine for a year or two. In fact, I was often surprised when I'd suddenly say to myself "I love my life!"

Then four or five years ago, I now realize, the depression that often accompanies Parkinson's arrived. But my Parkinson's was still undiagnosed, and the depression remained unacknowledged. Instead, I assumed the depression was just part of aging. I made plans to sell the house I love, abandon the neighborhood I love, and move into a senior home in the center of downtown DC. I shudder everytime I think how close I came.

Finally in September 2009, the Parkinson's was diagnosed and soon thereafter the depression was diagnosed and acknowledged. I got a prescription for the old-line antidepressant Elavil, which fixed the depression and the insomnia. But it also resulted in a weight gain of five pounds in about a month.

In January 2010, I switched to my present neurologist, Dr. Laxmi Bahroo, at nearby Georgetown Hospital. He immediately expressed concern about the cognitive side effects sometimes associated with Elavil. Since I fear dementia more than anything else, I bagged the Elavil.

During my Summer (and Fall) from Hell in 2006, I had briefly tried the over-the-counter serotonin booster 5-HTP. It seemed to work better than anything else during that summer's pharmaceutical grab bag. Dr. Bahroo was familiar with 5-HTP, and he suggested we give it a try.

Bingo! It worked. No depression. No insomnia. No constipation. The Elavil weight-gain disappeared. And I began experiencing unusual bouts of early morning inspiration. (I covered much of this territory in a recent post: http://bit.ly/ojxI0w.)

Insomnia became a real problem in 1998. Just as I was dozing off, my body would jerk sharply, and I'd be wide awake until 3 or 4am. This condition persisted for several years and was only alleviated when I used Tylenol PM, Ambien, or both.

By accident, I discovered I could get a good night's sleep on the living room couch. Periodically, I'd try going back to the bedroom, but always with the same negative results.

I wondered: why could I happily nap in bed during the afternoon if I couldn't sleep there through the night? Was the street light -- shining into the bedroom at night -- the problem? In November, 2006, I installed blackout blinds and immediately began sleeping well and pill-free in the bedroom. D'uh!
With the bedroom blinds and meditation, I had a couple years of good bedroom sleep. Then, insomnia began creeping back in as a partner to the emerging depression, both of them accompanying the forward march of the undiagnosed  Parkinson's.

The Parkinson's diagnosis and the move to  5-HTP took care of the insomnia just as it did the depression, although I sometimes had trouble getting back to sleep after my 3 or 4am bathroom break. But then I found that I could use this time for meditation. Later, I added a progressive muscle relaxation routine to the meditation. The two together have made getting back to sleep a snap. 

I also believe that maintaining a more regular schedule for meditation helps my sleep, mood, and general sense of well-being.

And, of course, underlying the good news on both depression and insomnia is my emphasis on getting plenty of exercise.

So I can happily report at midyear, 2011: I am plagued by neither depression nor insomnia.

But... a Caution on 5-HTP
Since 5-HP seemed to be a miracle supplement for me, I began raving about it. I even began blogging in part to tout 5-HTP to other Parkinsonians. I soon discovered that not everyone got the same results I did. In fact, to date, I know of no one else who has.

5-HTP can help individuals generally, and a case can be made that it may work especially for people experiencing Parkinson's dopamine depletion.

As with most meds, I started with the lowest available dose: in this case 50mg. I also monitor my blood pressure closely if I  increase the dosage. I found that if I increased my dosage to 150 mg, I'd approach euphoria, but I'd also experience scary blood pressure spikes.

I currently take 50mg of 5-HTP at bedtime and another 50mg with my 11am Sinemet. If my blood pressure escalates with my mood, I forgo the morning happy pill.

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