I go to bed in a good mood… but wake up feeling depressed: Ask the GP DR MARTIN SCURR

Q: I go to bed in a completely normal state of mind, but wake up after sleeping in a deep depression or depressed mood. This usually disappears after two or three hours. This has been happening for many years. I've taken antidepressants regularly, but that never helped much. My general health is excellent.

Mrs N. E. Meah, Leicestershire.

A: I have no doubt that you have some form of depression. In fact, I have seen the exact pattern you describe before in one of my patients.

The striking mood change – the feeling of deep depression in the morning when you wake up from sleep – corresponds to a known biorhythm related to the body's production of the hormone cortisol.

Cortisol has many functions: its levels rise during stress or danger as part of our fight-or-flight response and it helps regulate blood pressure and inflammation, among other things.

There is a marked variation in the amount of cortisol the body produces during the day and night, with the lowest levels in the darkest hours just before dawn, but peaking around 9am, probably to get us going for the day.

We know very little about what exactly happens in the brain during depression. But we do know that chemical messengers are involved, and that the hypothalamus (a part of the brain involved in sending messages to stimulate cortisol production) is part of the picture.

It is important to point out that there is great diversity in the patterns of symptoms of depression.

For some, a depressed mood is overwhelming. Still others experience few mood disturbances, but instead report other so-called biological hallmarks of depression, including weight loss, exhaustion, sleep disturbances, poor memory, and loss of interest in things that were previously enjoyable.

Studies have even shown a slowdown in the rate at which fingernails and toenails grow. All this confirms that this condition can affect the entire body, and not just the mood.

You mention in your longer letter that your father had severe depression – and we know that depression can run in families.

My patient with similar symptoms responded to antidepressants, but your own doctor is undoubtedly best placed to help you find a suitable solution.

Q:I recently had surgery to remove a tumor at the junction of the duodenum, bile ducts and pancreas. I am cancer free, but I have to go to the toilet six times a day, pass a lot of gas and experience a lot of discomfort. Will I always live with this?

Tony Dean, via email.

A: The surgery you have undergone, known as the Whipple procedure, is complex and involves removing the head (the wide part) of the pancreas, as well as the first part of the small intestine, the gallbladder and the bile ducts (the small channels). that connect organs in the digestive system).

The main function of the pancreas is to secrete many of the enzymes needed to break down food. If not enough is produced, partially digested food continues to pass into the intestine, which can cause diarrhea, gas, bloating and pain.

That is why after this surgery, patients often have several bowel movements per day for several weeks, but the frequency gradually decreases.

For now, I suggest you focus on ensuring your gut continues to function as best as possible by improving the health of your microbiome – the community of microorganisms that play a crucial role in our health, including digestion.

Try adding fiber in the form of oats, fruit, vegetables and salad; If you increase your intake gradually over a few weeks, this should not make your bowel movements more frequent.

You might also consider taking a probiotic daily. These 'friendly' bacteria are found in fermented foods such as yoghurt, kefir or sauerkraut, and although they are readily available and relatively inexpensive, supplements are also available at health food stores.

Your bowel movements should become more or less normal within six to eight months after your surgery.

The weight you lost postoperatively should also regain.

If not, consult your doctor; You may have blood tests to check that you are not deficient in essential nutrients, and may be prescribed capsules to supplement the production of pancreatic enzymes.

In my eyes… Hope for migraine sufferers like me

For anyone who has never had migraines – I've had them for a long time – it's hard to describe how awful they can be.

It's not just the pain, there is also nausea, clumsiness, visual disturbance and (the predominant symptom) a feeling of despair and irritability when exposed to light or sound.

I recently went to a talk by a neurologist friend about innovations in migraine treatment – ​​the first breakthrough came in 1992 with drugs called triptans, which can stop symptoms – but they don't work for everyone.

But a new group of drugs, calcitonin gene-related peptide (CGRP) receptor antagonists, can actually prevent an attack. Currently, they are only available to patients who do not respond to or cannot tolerate other options.

My friend says patients claim the drugs have “changed their lives.” There will come a time when CGRP antagonists will be the first-line treatment. There is enlightenment on the horizon.

Write to Dr Scurr

Write to Dr. Scurr from Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk.

Dr. Scurr cannot enter into personal correspondence.

If you have health problems, consult your own doctor.