Why is it I wake up feeling depressed?

I GO to bed in a perfectly normal state of mind but, after sleep, wake in deep depression or a deflated mood. This usually clears after two or three hours. This has happened for many years. I have taken antidepressants periodically, which have never greatly helped. My general health is excellent.

IHAVE no doubt that you do have a form of depression. In fact, I have previously seen the exact pattern you describe in one of my patients.

The marked mood change — the sense of deep depression in the morning when you wake from sleep — matches a known biorhythm relating to the body’s production of the hormone cortisol.

Cortisol has many functions — levels rise with 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 how much cortisol the body produces throughout the day and night, with levels lowest in the darkest hours just before dawn, but peaking around 9am, probably to get us up and going for the day.

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

It’s important to point out that there is a great variety in the patterns of symptoms of depression.

For some, depressed mood is overwhelming.

Yet others experience little mood disorder but instead report other so-called biological features of depression, which can include weight loss, exhaustion, sleep disturbance, failing memory and loss of interest in things previously enjoyed.

Studies have even shown a slowing in how quickly fingernails and toenails grow. All of which confirms that this condition can affect the whole body, not solely mood.

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

My patient with similar symptoms responded to antidepressant medication, but your own doctor is undoubtedly best placed to help you to find a suitable solution. RECENTLY, I had an operation to remove a tumour at the junction of the duodenum, bile duct and pancreas. I am clear of cancer but I need to go to the loo up to six times a day, pass a lot of wind and feel a lot of discomfort. Will I always live with this?

The operation you had, 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 bile ducts (the tiny canals 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 it doesn’t produce enough, partially digested food will continue to pass into the bowel, which can cause diarrhoea, gas, bloating and pain.

That’s why after this surgery patients often have several bowel motions a day for some weeks — but the frequency does tend to gradually reduce.

For now, I suggest you focus on making sure your gut is otherwise functioning as well as it can by boosting the health of your microbiome — the community of microorganisms that plays a vital part in our health, including digestion.

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

You could also consider taking a daily probiotic. These ‘friendly’ bacteria are found in fermented foods such as yoghurt, kefir or sauerkraut, and while easily available and relatively inexpensive, there are also supplements available at health food shops.

Your bowel movements should more or less revert to normal within six to eight months of your operation.

You should also be regaining any weight lost post-operatively. If not, consult your GP; you may be given blood tests to check you’re not lacking in vital nutrients, and prescribed capsules to supplement your pancreatic enzyme production.