Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

Sunday, 30 December 2012

Paroxetine & Overtraining Syndrome

I guess they were right when they said Paroxetine would cure depression. Maybe not so much actually taking the pills, but looking at them. Contemplating.
Dormant Paroxetine

Weight gain, insomnia, nightmares, "sexual dysfunction" (what exactly does that mean, anyway? - I don't want to find out). I mean come on - it's for people who are depressed to begin with!

In order to avoid putting them in my mouth, I wonder why I have had the recurring episodes of depression. Depression is a relatively new thing for me (since Mattias' birth) and it comes and goes in brief but intense waves. People who grew up with me (Sarah?? - are you there :o)) would have described me as happy and energetic. And I was. And am?

Two weeks ago, I went to the doctor and scored as having a moderate depression on what I believe was called the Hamilton Score - but it's different than the one I find online. I could not stop crying. I had again run the 200 meter intervals that day. I almost threw my iPod Shuffle in the woods on the way home because the music sounded like shit. Cry cry cry. A week later, I went to take the test again (this is required for an official diagnosis) and I was far from depressed. I was embarrassed I had felt so hopeless.

It was following along with Geoff Roes' blog that finally (I think) gave me the answer: Overtraining Syndrome. I can hardly believe I hadn't considered it or had someone suggest it to me. Maybe I thought it was a term made up by non athletes who just didn't "get it". But I have come to realize that if you take training seriously, you should take overtraining even more seriously.

If anything, I had thought Overtraining Syndrome would simply mean you were tired and couldn't perform at your previous level. But most often, the first symptom is depression. And insomnia (estimated to be present in 90% with overtraining syndrome) goes right along with it. Add to this anorexia, and you have the trifecta of Overtraining Syndrome. It seems to originate in overworked muscles that aren't allowed to rest raising cortisol levels and this affecting brain tryptophan and serotonin levels - causing the viscious cycle of insomnia, anorexia and depression listed above, which of course will negatively impact training and things can spiral from there.

Signs that you may have it include an increased resting heart rate and slower return to resting heart rate (I haven't noticed a difference). Cervical lymph nodes also tend to be enlarged as well (you may recall I had mentioned the enlarged lymph nodes in my neck in a recent post). Susceptibility to infection is also mentioned, but not something I personally have experienced. Finally, injuries that heal very slowly (check) if at all.

Here is an article from the British Medical Journal, which I found very helpful:

The thing that I can't explain is that, in the face of this, I had a dynamite training week. Although for me Christmas meant more calories and more sleep. Plus Ole has had me doing somewhat less intense sessions (I have read 6 min. repeated intervals have the greatest chance of causing overtraining syndrome of anything -and I used to do those every single week). Plus I'm not racing every other weekend like before. More is indeed not more. My mantra is that I need to enter every session feeling fresh and energetic. And I am getting there.

Here my latest training log which I sent Ole. Pretty sure you can get the gist despite the Danish. I'll translate in a few spots.

Lør - 10km på 46.50 udenfor (outside)
Søn- Skodsborg Marathon på trails i Dyrehaven - 37 km på 3.15 og havde masse af overskud og det føltes bare rigtig godt. (der var godt nok mange, som var forvirret over, jeg ikke løb en hel marathon - men jeg var hurtig at meddele, det var din skyld :o)).
Man- spinning
Tirs: 2 + 1.5 + 1 km (genial træning, synes jeg!) - 7.42; 5.45; 3.42 (!). Det var på løbebånd (treadmill) 0,5%. +  mave, baller, lår
Ons: 10km på 46.18 udenfor (igen, føltes nemt og godt) + Bikram Yoga
Tors: 4 x 1 km på banen (the track) (udenfor) gik MEGET bedre end sidste uge: 3.57, 3.54, 3.53, 3.55. Tror nemlig det hjælp at jeg varmede op med (warmed up with) 2 x 200 meter intervaller så hurtigt som muligt. 
Fre: spinning + mave, baller, lår

At this point, my right foot started bothering me because my shoe could not be tied tight enough anymore. I bought some new shoes at Fysium here in Næstved. I adore both the shoes and the store! They look just like my old shoes but logarithmically more comfortable. Wow. I have no idea what that means, but it sounds about as comfortable as they are.

New shoes on bubbleope on radiator = fire hazard

Right now I'm in the middle of an "ultra" training weekend for the Bandera 100k in two weeks:
yesterday: 32 km with SR
today: 28 km
tomorrow: 30 km (? with Annette?)
all on trails in (ok, near) our own back yard.

Running Songs of the Day: (witness taking pleasure in things I normally love)
1. When I See You by Magic Touch & Sapphire Slows
2. Breezeblocks by Alt-J

Finally - for those not friends with me on Facebook yet (or for those who stopped being my friend when I came out as pro gun control), some Christmas pics:

Does this look like a child who was so ill he would keep his parents up all night? Well, it should!  (he's all better,  and we are so relieved)


cherelli said...

Interesting; i have found in the past that my first signs of overtraining are irritability and a kind of negative obsession with making sure I complete every workout, ignoring my body...depression makes sense though as it would tie in with these feelings...? SO, from your post you have realised you are likely overtrained (if it has been since Matthias birth does this maybe imply your body needed a little more recovery time from this event?) - what was your compensation for this apart from having an easier week last week(leading into some big miles this week)? After Bandera will Ole make you take a serious recovery week? Are there any dietary issues that could help (eg iron, B12, Cal/Mag recovery, B complex)? Lots of questions I know, just wondering if you will be able to identify overtraining in the future/be able/willing to stave it off in the future rather than push through; recovery is such a huge part of the body's adaptation to stress. Anyway, i hope the depression bouts subside as you pay more attention to the OT possibility - good luck for the Bandera 100!!

Fast Bastard - World's Fastest Hematologist said...

I am skeptical of the hormonal changes. The article in BJSM mentioned no hard data to support this claim.

Whenever you mention cortisol, there is bound to be a lot of selection bias, as cortisol is always measured in people with strange symptoms, and rarely in people with well-defined disease.

I bet you could take any athlete who thinks he/she is overtrained and find an elevated cortisol level. Stress of any kind brings this on.

Of course, some people talk about "adrenal fatigue", ie. relatively inadequate cortisol levels. I am equally skeptical.

Like Cherelli says, it would make a lot of sense to get certain labs done (TSH, iron studies, B12 and throw in a CBC with your history of severe anemia) and supplement as needed.

sea legs girl said...

Fast Bastard & Cherelli, I agree with doing lab tests. I have been to the doctor twice and he refused to order any. But I finally did get the celiac labs drawn (ordered by my old doctor) - results pending!

Jill Homer said...

I'm sorry to hear you're battling depression. I've been hearing from a lot of my own friends about overtraining syndrome since Geoff diagnosed himself on his blog. The thing with Geoff's case is that he hasn't been completely open about the depth of his symptoms on his blog. There were days when he couldn't get out of bed, couldn't eat. He was tested for just about everything imaginable and couldn't find an answer, wanted to find an answer, and this seems to be what he's settled on. I haven't talked to him directly since he started making more improvements, but I remain skeptical that his case is as simple as overtraining or the equally vague "adrenal fatigue."

Still, I of course am not a medical professional, and you are. Hope you can find some answers soon.

SteveQ said...

Well, if there's three things I know it's depression, overtraining and the difference between them. The standard terms for overtraining begin with the Blahs, then the Plods and then onto the Superplods, which range from apathetic disinclination to me thinking about which cliff to throw myself off of after quitting 1/4 the way through Lean Horse. There's not enough space here to discuss it.

And if there's 4 things I know, you can include sexual dysfunction.

Olga said...

First of, nobody (or almost nobody) mentioned to you about overtraining because it's pretty useless - you'd brush it off and keep on going, thinking, exactly, what do we know, you've always exercised/trained like that and more, and/or you can't live without it even if you admit.
Now, to Rasmus' "I don't believe unless I see 100 tests" - not every disease is diagnosed with tests (depression, for example, can't be done in labs, even if you answer a 1000 questions and form-fit them into an answer of a syndrome). Even though cortisol level can be up with any stress (or down for about 50 other reasons), it doesn't mean adrenal fatigue does not exist. It's kind of a combination, and kind of personal to each.
Now, for Geoff, I agree with Jill that his diagnosis is not that simple. And yes, we don't know the full picture either, he is in public eye and may not want to share, not ready yet, and simply has no clue or too depressed to talk about it (or just a guy thing). Doesn't matter. I think he's got something deeper than "I raced and trained for 4 years hard" - we have a few dozen of those at his level, and another hundreds at a level below (what doesn't mean they raced and trained any less hard). Regardless of him submitting to all possible tests, there is something more, and as a medical professional I'd love to learn about in details more - and as a human being I'd love for him to fight it back and overcome.
Now, back to Tracy, I hope you recover enough to run well here, in TX - and then be smart enough to step back for a bit before ramping up.
But at the end of the day, it'll be your decision.
I know which one I am making:)
See you soon!

SteveQ said...

btw, just finished reading Scott Jurek's book. Found myself remarking "hey, I know that guy!" several times and found it most interesting how everyone thinks he's laidback, but is super-competitive.

sea legs girl said...

Jill, thank you so much for your comment and concern! I am continually impressed by your empathy when you have so much going on in your own life!

What Geoff is going through seems to be many magnitudes worse (and just different) than what I have experienced. He has done many ultra runners a huge favor by bringing this subject into the spotlight, whether or not it fully explains his symptoms.

Yes, I am a medical professional, but one of the most important lessons I have learned since med school is just because a disease or syndrome is not yet correctly defined or is vague does not mean it doesn't exist. Especially in the field of ultra/endurace athletics where so much of what people are going through is new. The only way we can learn is by discussing openly it seems!

sea legs girl said...

Olga- agreed. Thanks so much for your insight. One day there may be simple tests for the many different types of depression - and specific treatments. Won't that be great! For now, we fumble along, finding what works for each individual. It is only good medicine though to be sure no simple cause of depression can be found - and basic lab tests can help with this. This coming from one of the most "minimalist" doctors you'll ever meeet.

So much looking forward to seeing you again in person in Texas!

Jacqueline said...

Toward the end of any training cycle, I would say I definitely suffer from some overtraining -- mainly with feeling really stressed out and having terrible insomnia.

The pictures of your kids are wonderful. Happy new year!

Jacqueline said...

I also just wanted to add: I think one thing to be careful of with overtraining issues are that "overtraining" is so subjective. For one person maybe it's more than 50 miles a week, for another, maybe that doesn't happen for another 40 miles, or maybe it happens at 20 miles, you know? I think that is why it can be tricky.

Jill Homer said...

Thanks! The concept of overtraining is interesting to me as well, and you're right that a lot of new ground is being broken in this area of human performance right now, especially at the top levels. Even in my own lower end, relatively unfocused efforts, I've had some low points this past year, sometimes whole weeks where I felt like a shadow of myself. It was strange, almost as though I'd fallen completely out of shape, struggling to bike slowly for two hours or run four miles. Then, a week later, I'd bounce back as if nothing had happened. Still, with Geoff, his symptoms seemed to indicate a neurological disorder — things like partial paralysis, extreme weakness, intense headaches, neck pain, tingling. Honestly, not the kind of symptoms most would associate with overtraining. But I think he did rule out most of the obvious conditions (MS, Lyme, mercury poisoning, stroke), so he's still looking. I don't think he minds these details being out, he just doesn't feel the need to get into the depth of it in his writings. And because he hasn't, his blogs read (to me at least) like he's just kinda tired and not running well. And now I hear from mutual friends and acquaintances along the lines, "you run too much, too. See what happens." No, it's much more complicated than that.

You're right that it's good to be having this discussion. My main point is that I think it's a little dangerous to base important decisions on the vague details of someone else's experience. But with any health setback, it's important to consider all the possible causes to find an answer.