Medications like Lexapro (escitalopram) generally don’t have acute mood-lifting effects, where you’d feel a difference within hours of taking a pill. Rather, the pathways by which these drugs relieve depression result in changes to the central nervous system that take weeks to develop. I think what is more likely is that the change in your mood reflects a classic symptom of depression called diurnal mood variation, which basically means that mornings are the worst time of the day. What may be happening is that as the medication is starting to help, you are noticing its beneficial effects later in the day, when it is biologically easier to feel better. Changing when you take your medication probably won’t help speed things along, but if you do not get significantly better after a few more weeks, you may want to talk with your doctor about increasing the dose of escitalopram to 20 mg a day or considering another treatment option. Q2. Can nightmares or night terrors cause depression? I have bad dreams almost every night, and I wake up feeling very anxious and sad. I was recently diagnosed with depression and take Cipralex. I’ve been wondering if these dreams could have an impact on my mental health, or vice versa. — Miryelin Depression is often associated with an increase in dream, or rapid eye movement (REM), sleep, and often with dreams that have more negative themes. It is also the case that medications such as escitalopram (the generic name of Cipralex, which is sold as Lexapro in the United States) can be associated with an increase in the occurrence of bad dreams, the result of the tendency of these medications to “push back” dream sleep from the beginning of the night to the last few hours of sleep. Recurrent nightmares or night terrors are more characteristic of post-traumatic stress disorder and related conditions, which are also associated with an increased risk of depression. If this pattern of dreaming persists, please talk about it with your doctor. Perhaps a change in your treatment might be indicated. About one in 10 people get insomnia on bupropion, and usually this will get better over time and not get in the way of your recovery. If your insomnia persists, you should talk with your doctor about the pros and cons of the conventional sleeping pills, as well as other medications that may promote sleep but do not have the potential for being habit-forming. There is also another, drug-free approach involves improving your sleep hygiene and trying some fairly simple behavioral exercises. For example, don’t use your bed for anything other than sleep and sex. Go to bed at the same time each night. Eliminate alcohol, caffeine and nicotine. Exercise in the morning and try relaxation exercises in the evening. Ask your doctor for more ideas and see if this works for you. Q4. Can you give me some tips on how to handle all the horrible news I hear daily in regards to infants, babies, and children being harmed or killed? I am having such a hard time getting over these terrible stories. How can I let it go? — Jennifer, Ohio This is such a good question, Jennifer. We are so bombarded by stimulation in the form of television, Internet, radio, and word-of-mouth that it has become imperative that we learn what to pay attention to and what to shut out. I am not proposing a “head in the sand” approach, but our bodies and minds were not built to take in the amount and intensity of negative information that flows our way. Lousy, tragic, awful things do happen and remind us of our vulnerability; the trick is to figure out how to do the following: First, if you are watching or listening to the news and a tragic story about infants, babies, or children begins, change the channel immediately. Say to yourself something like, “I cannot help that child by listening to this story and will just get myself upset.” Then send out a prayer or good wish for the child and his or her family. Similarly, when others start to tell you such horror stories, politely and firmly say, “I do not want to hear this” and change the subject. If you are among a larger group of people when this happens and it’s too much to ask the speaker to stop, then quietly ask a friend or the person next to you to come and get you when the conversation switches to a more positive topic, and walk out of the room. You might think of this approach as deciding where to shine your flashlight in a dark room, focusing it on the things that you want to see. In other words, a person can only absorb so much: If you focus attention on tragic or negative events, then you have less attention to give to positive or triumphant events. Second, remind yourself that while truly awful things do happen, they are extremely rare. We hear about them only because they are so well publicized. Third, if you are not already doing this (which you may be since you are sensitive to relevant issues), invest some time in making a positive difference in the lives of children in need. Specifically, get involved in activities with children in which you will be able to see your direct positive impact. I hope that helps. Learn more in the Everyday Health Depression Center.
