Posted by SLS on June 2, 2006, at 8:17:26
In reply to Re: MAOIs not good for BPII? » CEK, posted by jedi on June 1, 2006, at 17:27:19
> > > That's basically what my pdoc says. I mentioned to him a couple of weeks ago that I had all of the symptoms of borderline personality disorder and he looked like he wanted to slap me. He told me what you just said and told me that we were going to stick with trying to treat me as bipolar 2 with mixed states and major depression. Oh yeah with GAD and obsessional features. He won't try me on any more AD's. He said they weren't good for my bipolar. I've never even tried an MAOI. None of my doctors have ever even mentioned trying one, yet nothing yet has been able to break through this wall of depression. He said all we've got to work with now is the mood stablizers and benzos. I'm on Lamictal and Klonopin now and am going to see how it goes. The only thing I don't understand is that he says that Klonopin is not depressing, yet other pdocs and most of everyone here on babble say it is. I've decided to try to do without it and see if the Lamictal alone helps. I seem to trust y'all's opinions on Klonopin than I do his. And with my depression there is no elevation in mood to possitive life events. It's all gloom and doom even if daisys are sprouting out of everyones butts in my house. There is no break in it.
>
> Hi,
> There is a school of thought that the definition of atypical depression in the DSM-IV is too complex and difficult to diagnose. The definition can be simplified to just major depression with oversleeping and overeating. If your trial of Lamictal does not work, find a MD that will prescribe a MAOI. Nardil is the only med out of about 35 different combinations that has worked on my major atypical depression. Sounds to me like your current PDOC would really freak out at this suggestion.
> Good Luck,
> Jedi
> PS I am one of the people for which clonazepam is not depressing. When combined with Nardil it is simply the best medication for my social anxiety.
>
> Eur Arch Psychiatry Clin Neurosci. 2002 Dec;252(6):288-93.
> Can only reversed vegetative symptoms define atypical depression?
> Benazzi F.
> Outpatient Psychiatry Center, Ravenna and Forli, Italy.
>
> BACKGROUND: The definition of atypical depression (AD) has recently seen a rebirth of studies, as the evidence supporting the current DSM-IV atypical features criteria is weak. Study aim was to compare a definition of AD requiring only oversleeping and overeating (reversed vegetative symptoms) to the DSM-IV AD definition (always requiring mood reactivity, plus overeating/weight gain, oversleeping, leaden paralysis, and interpersonal sensitivity [at least 2]). METHODS: Consecutive 202 major depressive disorder (MDD) and 281 bipolar II outpatients were interviewed, during a major depressive episode (MDE), with the Structured Clinical Interview for DSM-IV. The DSM-IV criteria for AD were compared to a new AD definition based only on oversleeping and overeating, which was the one often used in community studies. Associations were tested by univariate logistic regression. RESULTS: The frequency of DSM-IV AD was 42.8 %, and that of the new AD definition was 38.7 %. DSM-IV AD, and the new AD definition, had almost all the same significant associations: bipolar II, female gender, lower age, lower age of onset, axis I comorbidity, depressive mixed state, MDE symptoms lasting more than 2 years, and bipolar family history. DSM-IV AD was present in 86 % of the new AD definition sample. The new definition of AD was significantly associated with all the other DSM-IV AD symptoms not included in it. The new AD definition was strongly associated with DSM-IV AD (odds ratio = 17.8), and had sensitivity = 77.7 %, specificity = 90.5 %, positive predictive value = 86.1 %, negative predictive value = 84.4 %, and ROC area curve = 0.85, for predicting DSM-IV AD. CONCLUSIONS: Results support a simpler definition of AD, requiring only oversleeping and overeating, and support the similar AD definition previously used in community studies. This definition is easier and quicker to assess by clinicians than the DSM-IV definition (mood reactivity and interpersonal sensitivity are more difficult to assess). Some pharmacological studies support this new AD definition (by showing better response to MAOI than to TCA, as shown in DSM-IV AD).
>
> PMID: 12563537 [PubMed - indexed for MEDLINE]
The problem with this approach is that bipolar depression looks a lot like atypical depression. Usually, it is anergic and produces a reversed vegetative symptomology - over eating and over sleeping. A misdiagnosis here might result in an exacerbation of the illness if mood stabilizers are not employed.
- Scott
poster:SLS
thread:650793
URL: http://www.dr-bob.org/babble/20060530/msgs/651818.html