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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Jimmyboy on January 14, 2007, at 10:49:23
How much better does Atypical depression respond to MAOI's. Anyone had success on MAOI's but nothing else?How is it differant than regular depression? What exactly is mood reactivity? Could it resemble bipolar depression?
Posted by Phillipa on January 14, 2007, at 11:36:28
In reply to Atypical depression, posted by Jimmyboy on January 14, 2007, at 10:49:23
Isn't atypical depression a lot of sleeping and eating? love Phillipa minus the anxiety?
Posted by laima on January 14, 2007, at 12:39:07
In reply to Atypical depression, posted by Jimmyboy on January 14, 2007, at 10:49:23
If you google "atypical depression", a lot comes up. Yes, it's characterized roughly by oversleeping, oversleeping, and a lot of lethargy- as opposed to losing appetite and not sleeping. Mood reactivity is mood changing according to circumstances, ie good news bumps mood up a bit, bad news dunks it. Some depressions on the other hand don't budge even in the face of good news. I don't believe it has anything in particular in common with bipolar depression, but am not positive. I've read in a number of places that MAOIs are often the best thing for atypical depression.
>
> How much better does Atypical depression respond to MAOI's. Anyone had success on MAOI's but nothing else?
>
> How is it differant than regular depression? What exactly is mood reactivity? Could it resemble bipolar depression?
>
>
Posted by snapper on January 14, 2007, at 21:38:29
In reply to Re: Atypical depression » Jimmyboy, posted by laima on January 14, 2007, at 12:39:07
A lot of bipolars do seem to have a lot of atypical symptoms mixed in with thier mood disorder-- I personally don't beleive there are any cut and dry diagnoses to a lot of our illness(s) rather a whole lot of depressive and bipolar spectrum symptomology. Just my 2 cents
Snapper
Posted by jedi on January 15, 2007, at 1:53:12
In reply to Atypical depression, posted by Jimmyboy on January 14, 2007, at 10:49:23
> How much better does Atypical depression respond to MAOI's. Anyone had success on MAOI's but nothing else?
>
> How is it differant than regular depression? What exactly is mood reactivity? Could it resemble bipolar depression?Hi,
Currently, the SSRIs are going to be tried first for atypical depression. Many PDOCs will save the MAOIs for a last resort, or refuse to use them at all. However, after several med trials, if you are treatment resistant, I believe that Parnate, Nardil, or Marplan should be tried. Nardil is the only med that has worked for me (40+ combination med trials). Atypical depression is actually a misnomer. It is far more common than melancholic depression (characterized by the inability to find pleasure in positive things combined with physical agitation, insomnia, or decreased appetite).Mood reactivity is linked to atypical depression. It simply means that if something positive happens in your life, you can have a corresponding positive elevation in mood. People with severe melancholic depression will not have a positive mood reaction no matter what positive events happen in their life.
Some scientists believe that atypical depression does lie somewhere on the bipolar continuum. Probably closer to the bipolar II end of the spectrum.
JediStudy Abstract:
J Affect Disord. 2005 Feb;84(2-3):209-17.
Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II?
Akiskal HS, Benazzi F.
International Mood Center, University of California at San Diego, V.A. Hospital, 3350 La Jolla Village Dr. 116-A, La Jolla, San Diego, CA 92161, USA. hakiskal@ucsd.eduBACKGROUND: Although increasing data link atypical depression (AD) to the bipolar spectrum, controversies abound about the extent of the overlap. In particular, the Columbia group, which has pioneered in providing data on operational clarity and pharmacological specificity of atypical depressions, has nonetheless consistently avoided studying its discriminatory validity from bipolar II (BP-II). Accordingly, we undertook a full scale validation of such a link in a large clinical sample of BP-II and unipolar (UP) major depressive disorder (MDD). METHODS: Consecutive 348 BP-II and 254 MDD outpatients presenting with major depressive episodes (MDE) were interviewed off psychoactive drugs with a modified Structured Clinical Interview for DSM-IV, the structured Family History Screen and the Hypomania Interview Guide. We used the DSM-IV criteria for "atypical features" specifier. Depressive mixed state was defined as > or =3 concurrent hypomanic signs and symptoms during MDE. Bipolar validators were age at onset, high depressive recurrence, depressive mixed state and bipolar family history (types I and II). Univariate and multivariate logistic regression were used to examine associations and control for confounding variables. RESULTS: Frequency of AD was 43.0% in the combined BP-II and MDD sample. AD, versus non-AD, had significantly higher rates of BP-II. AD was significantly associated with all bipolar validators, among which family history was the most robust. A dose-response relationship was found between number of atypical symptoms during MDE and bipolar family history loading. The association between bipolar family history and number of atypical symptoms remained significant after controlling for the confounding effect of BP-II. Bipolar family history was strongly associated with the atypical symptoms of leaden paralysis and hypersomnia. CONCLUSION: These results confirm a strong link between AD and bipolar validators along psychopathologic and familial grounds. From a practical standpoint, AD is best viewed as a variant of BP-II. Clinicians confronted with MDE patients presenting with atypical features should strongly consider a BP-II diagnosis. In a more hypothetical vein, atypicality-or some associated features thereof-might serve as a nosologic bridge between UP and BP-II.
PMID: 15708418 [PubMed - indexed for MEDLINE]
Posted by laima on January 15, 2007, at 9:05:53
In reply to Re: Atypical depression, posted by jedi on January 15, 2007, at 1:53:12
If an SSRI works, easier and fabulous.
Posted by UgottaHaveHope on January 15, 2007, at 11:02:55
In reply to Re: Atypical depression, posted by jedi on January 15, 2007, at 1:53:12
Now what exactly is a melancholic depression? People who never are happy about anything? How is that treated or can it be? I might have it, Michael
Posted by Phillipa on January 15, 2007, at 17:35:27
In reply to Re: Qs about Melancholic depression - Jedi, posted by UgottaHaveHope on January 15, 2007, at 11:02:55
Me too Michael if it wasn't for the age difference I'd swear we were twins. But you're the courageous one the one who is not afraid of EMSAM. Love Phillipa
Posted by jedi on January 15, 2007, at 17:44:43
In reply to Re: Qs about Melancholic depression - Jedi, posted by UgottaHaveHope on January 15, 2007, at 11:02:55
> Now what exactly is a melancholic depression? People who never are happy about anything? How is that treated or can it be? I might have it, Michael
Hi,
Wikipedia, the online encyclopedia, uses the definition in DSM-IV to define melancholic depression as:"Melancholic Depression, or 'depression with melancholic features' is a subtype of depression characterized by the inability to find pleasure in positive things combined with physical agitation, insomnia, or decreased appetite. Roughly 10% of people with depression suffer from Melancholic Depression.
Diagnostic criteria (DSM-IV-TR)
The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines Depression with Melancholic Features as a subtype of depression characterized by:A. At least one of the following:
Loss of pleasure in all, or almost all, activities
Lack of mood reactivity to usually pleasurable stimuli (can't feel much better, even when something good happens)
B. At least three of the following:
Distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)
Depression is regularly worse in the morning
Early morning awakening (at least 2 hours before usual time of awakening)
Marked psychomotor retardation or agitation
Significant anorexia or weight loss
Excessive or inappropriate guilt"TCAs(tricyclic antidepressants) or TCA with an augmentation are probably the best treatment for melancholic depression.
Jedi
"J Affect Disord. 1996 Jun 20;39(1):1-6.
Pharmacotherapy for major depression with melancholic features: relative efficacy of tricyclic versus selective serotonin reuptake inhibitor antidepressants.
Perry PJ.
Department of Psychiatry, College of Medicine, University of Iowa, Iowa City 52242, USA.The effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) were contrasted in endogenous/melancholic depression. By reviewing Hamilton Depression Rating data from controlled trials, the data indicate that TCAs are consistently more effective than the SSRIs. Despite the wide use of SSRIs in the treatment of depression, it seems reasonable that clinicians subtype their depressed patients and treat melancholic patients first with a course of TCAs. For melancholic patients who have not responded to a SSRI, pharmacotherapeutic alternatives include (1) a TCA alone; (2) TCA augmentation of the SSRI, or (3) lithium augmentation of the SSRI.
PMID: 8835647 [PubMed - indexed for MEDLINE]"
Posted by Phillipa on January 15, 2007, at 19:10:45
In reply to Re: Qs about Melancholic depression - Jedi, posted by jedi on January 15, 2007, at 17:44:43
Pretty much fits. So EMSAM wouldn't help? Love Phillipa
This is the end of the thread.
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