Ms. Western's first appointment: sudden sadness, exhaustion and craving for chocolate

Three weeks ago I met with a new patient, a woman in her 50s, whom I'll call Ms. Western.

She said she had had three episodes of uncontrollable crying and agitation over the past six months. She consulted her family physician who prescribed Zoloft, which "helped considerably." But Zoloft did not relieve her exhaustion, and her daily afternoon mood plummets. Due to the persistence of her problems, her family insisted she see a psychiatrist, so she contacted me and we arranged an appointment.

Ms. Western described her daily episodes as follows, "I suddenly lose my starch at 3:30 in the afternoon. I get limp and really tired. I crave chocolates. They give me a boost, a second wind. I call this my 'crave chocolate and tired syndrome.'"

I asked, "What do you mean by 'losing your starch?'" She answered, "That's a phrase mid-westerners use to describe a sudden fall in mood and loss of energy."

I added, "In the South, where I grew up, the sudden onset of depression and exhaustion is referred to as a 'sinking spell.' Other regional descriptions are 'My wheels fell off',' and 'My bucket's got a hole in it.'"

Undoubtedly there are many more phrases that are used to describe this widespread, frequent and troublesome experience. Fortunately such episodes are usually brief. Unfortunately, organized psychiatry has not directed much attention to this problem.

Then I said to Ms. Western, "Here is what I suspect causes you to 'lose your starch.' In almost all people, there are fluctuations in mood and energy during a 24-hour period. All of us have heard people describe themselves as 'a morning person' or 'a night owl.' They are referring to the time of day when they have the most energy and alertness.

"
But the daily swings in your mood and energy have become too wide. That may be caused by low blood sugar in the afternoon.

"Many of my patients — who have been troubled by "losing starch," "sinking spells," and "bucket's got a hole in it," — have benefited enormously from chromium. I think that's because chromium smoothes out fluctuations in blood sugar, which in turn elevates mood.

Therefore I said to Ms. Western, "I certainly think you should also take 500 micrograms a day of Chromax. Chromax is a special brand of chromium. And you should continue to take Zoloft. Please let me know if Chromax helps you."

I gave Ms. Western another appointment and also asked her to send me an email after she started taking Chromax, and tell me if she had any response to it.