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Dr. Bob is Robert Hsiung, MD,
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Posted by River1924 on March 5, 2007, at 16:17:37
In reply to Re: Atypical depression » Ines, posted by FredPotter on March 5, 2007, at 13:47:01
Hi,
Those answers were helpful.
(Actually, I think the most important "symptom" is age of onset. One adapts to feelings during the more structured time of childhood and learns to live on top of them.)
My niece (who I mentioned in an earlier post) and I had/have a terrible time awakening. I've never been sure if that was part of my depression, some anxiety related psychological issue or (as it is called by the makers of provigil) excessive daytime sleepiness, or some circadian quirk.... but if I read you correctly, atypicals probably feel better earlier in the day.
I don't really have feeling in the morning because I have to work to stay awake. And I make a strong effort not to get too entangled in people's lives. I absorb their feelings. I used to catch others headaches.
So, if atypical depression is a true category of people.... maybe feeling better in the morning isn't important enough to kick me out of the camp.
Posted by River1924 on March 10, 2007, at 17:13:41
In reply to Re: Atypical depression, posted by Ines on March 2, 2007, at 8:01:15
I wrote this letter to John Davidson (UW-Madison (Wisconsin, USA.) He heads psychiatric research.
"I simply wish to raise an issue with the studies listed on your site. It seems as you are vetting out a large number of people with mental health problems. Atypical depression is the largest group of defined depressives. (Off the top of my head, I'd prefer conflicting contiguous ambiguous distressing mood states.) For example, I recall feeling depressed at age 11, and made a suicide attempt at 19. Many many people are in the same boat but your studies only allow those with no diagnosis and/or off meds. This favors those with melancholic or situational depression. I can't imagine anyone with my type of depression, which turns suicidal 10 days off an SSRI ever being in a placebo controlled medication study. How could someone with severe early onset depression not get some kind of diagnosis early on? This kind of depression is terminal. To use a "real" disease as an analogy, does skin cancer research recruit only those with mild squamous cell carcinoma or not allow those with skin cancer to participate? It seems as if the study models and precision have become more important than people with imprecise but serious non-psychotic mental illness."
Posted by Ines on March 18, 2007, at 4:53:41
In reply to Atypical depression vetted out of studies?, posted by River1924 on March 10, 2007, at 17:13:41
Hey River,
Just seen this- that's great! I hope they actually pay attention. I can't believe my GP won't even aknowledge that atypical depression exists- he waved it off and told me that that's irrelevant when choosing a treatment. It is so sad that there's huge numbers of us out there suffering and we just don't seem to get much focused help. I wonder if it is because there are less biological correlates with this type of depression, and it makes doctors think of it as either something the patients have control over or something that fits into the domain of psychologists rather than psychiatrists.
I'm still trying to find a psychiatrist who specialises in atypical depression, so we could try and get them as gust experts, but no luck so far...
Ines
Posted by FredPotter on March 18, 2007, at 7:03:52
In reply to Re: Atypical depression vetted out of studies? » River1924, posted by Ines on March 18, 2007, at 4:53:41
Ines well I'm not convinced that my GP recognises atypical depression either but my pharmacist does and he knows that MAOIs are best for it. Which is why I'm going through the throes of effexor withdrawal so I can start on Nardil after 7 days.
Atypical depression for me is pretty bad and goes hand-in-hand with anxiety. But being atypical doesn't mean I have any insight into it. Also anger against treatments that don't work and their apologists, and anger against people who's sum total of suffering is a sprained wrist or hayfever. A friend is recovering from a hip replacement and my! how the queue stretches up her path to her door! I'm there too as she needs practical help. But no-one comes to my door. How about you? The stigma has gone they say. I believe it's just not spoken out loud anymore.
Atypical for me also means sleeping too much, generally saved till the weekend when I can get my "natural" 12 hours. But that may have been Effexor, as now during withdrawal I either don't sleep at all or I dip in and out of shallow dreams in which I cry, to awaken with encrusted eyes. It also means sleepiness in the day and limbs and brain cells that feel like lead. I don't hyperphage though (why don't they say over-eat?)
Now what the hell was I talking about? Yes - atypical depression responds to MAOIs like Nardil and Parnate, though Moclobemide doesn't tend to work well. The downside of these is they cause anorgasmia and other sexual difficulty and you have to cut out all your favourite foods like pickled herring (?), broad pean pods (?) etc and weight gain can occur although I'm hoping the lift of the depression will lead to a more active lifestyle. One thing that (almost) annoys me is my ability to chirp up when conversing with people. This confirms to them there's nothing wrong with me.
I forget where we started now. All the best to you and let me know how you get on. Yes atypical depression constitutes 40% of all depression including bipolar tell your GP
best
Fred
Posted by Ines on March 19, 2007, at 17:57:58
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by FredPotter on March 18, 2007, at 7:03:52
Hey Fred,
You know reading your post is like reading something I wrote... I'm really glad you managed to get a prtespcription for Nardil- hope it works all the wonders for you. Keep us posted.
I too sleep a lot, but I seem to have dreams or nightmares constantly. I wake up feeling exhausted, very often drenched in sweat. Some days I feel like a robot, completely sleep deprived. And that's after hours and hours in bed. I'm so anxious I've cracked a few teeth by tooth grinding at night. I have so much mental clutter I can't seem to concentrate on anything properly, not even reading fiction, which I used to really enjoy. And I eat way too much. I've recently started thinking I must also have some ocd, I have some weird obsessive thoughts.
I spend a lot of time thinking I wish I'd never been born. And yet I perk up when I talk to people, I can actually be quite sociable and happy if I'm with people and I've had a few drinks, and can keep up a pretense of normality. Like you say, it confims to people there's nothing wrong. When I do need serious help, or time off work (fairly frequent these days) I feel like people think I'm just lazy. It infuriates me that even with people who ask how I am seem to genuinely care to know, I'll smile and say I'm fine, or doing much better thank you. I smile all the time, people comment on it! Just today my boss came to find out how I was after I've been off work for a few weeks, he's genuinely nice and wanted to know, and I had this idiotic grin and told him how much better I feel. Just before he stopped by I'd been in the loo crying, and wondering how much longer I'll have to endure this before something wroks, and thinking I really feel like I'm at my end's wit. But it's like a compulsion to pretend, I can't control it. And it really makes life harder in a way...
Anyway, I'll shut up. Didn't mean to completely unload on you there. Hopefully we'll all find the key that works one day. Best of luck to you with the Nardil, fingers crossed!
Ines
Posted by River1924 on March 20, 2007, at 0:01:46
In reply to Re: Atypical depression vetted out of studies? » FredPotter, posted by Ines on March 19, 2007, at 17:57:58
Hi,
Thanks for reading my previous posts and the comments.
I'm not sure how to respond to your post. I am much the same. (My niece who died recently was much more like you.... Crying in the toliet and feeling phoney seem to be more of a female experience.) When people ask me how are you, I feel like a fake if I say awful because at that moment, I usually don't. I think the right question with those with atypical depression is "How were you when you were alone ten minutes ago?" I can usually answer, I felt kinda down and was thinking of suicide. I understand the the ocd component. Without zoloft, I can kinda live with suicidal thoughts (which will appear) for a few days because they don't even seem like my ideas... slowly the ideas leak in and I feel swamped with sorrow. My emergency meds are stelazine and razadyne. Stelazine calms me down without making me sleepy. I can take it alone but, after a week, I feel kinda brain dead. The razadyne prevents that. Abilfy isn't sedating either. You might want to try it. It can make one feel tense and cause insomnia initially. I think if one is prone to suicidal thoughts, one needs an anti-psychotic to use for a month or two now and then. There is a connection between atypical depression and bipolar depression. Don't let youself treat your illness according to how you appear to others. It is serious. Even at my best, I test extremely depressed when my pdoc has me feel out a form. I can't imagine life any other way and most people don't really think there is much wrong with me. Perhaps, I should carry around the test and ask other people to take it. I'm sure they would be shocked at my answers. That's their problem.
Does any of this make sense? I hope so. River.
Posted by FredPotter on March 20, 2007, at 5:04:19
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by River1924 on March 20, 2007, at 0:01:46
Thanks Ines are you female? I have a dear (I thought) friend back in Wales where I used to live. He emailed a little while ago saying he'd always thought that there was nothing wrong with my mind but that often I didn't realise this. Well, so long as he's got it straight in his mind and is free from worrying about it. His daughter has had CFS for years. I could say something spiteful back in the same vein, but I won't.
River said, "How were you when you were alone ten minutes ago?" That's a good question. But it must be mystifying to friends to whom we appear normal. I even make people laugh. But it's not faked. I respond well to people.
Now that the Effexor withdrawal is nearly over I hope, I have felt pretty good today. Particularly lucid as a colleague said to me at work "considering you haven't slept properly for 5 days".
I'll let you know how Nardil works. I'm worried about getting fat(ter) and about all the nice foods and drinks I'll have to forego.
Thanks for your kind response
Fred
Posted by Ines on March 20, 2007, at 13:13:13
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by River1924 on March 20, 2007, at 0:01:46
Hi River and Fred,
I so agree with the 'how were you 10 minutes ago when you were alone' question!. Your posts got me thinking- I don't so much pretend that I'm feeling ok but rather I actually do feel ok at the moment I'm asked. It's so true and I'd never thought of it like that. I seem to perk up immediately when in company- unless it is someone I really trust; paradoxically, the contrary can happen then, i.e. feeling really low. It's almost like I have permission to feel bad then.
You know, it really helps to hear other people's similar experiences. It makes me feel less of an outsider... Thanks a lot for support.
River, I've thought of the bipolar connection- and the possibility that I'd respond well to mood stabilisers. So far I haven't responded to any to the AD medications I've tried- in fact, they've made it worse. I'm on the waiting list to see a psychiatrist and hopefully I'll get a proper diagnosis then, and proper help. Although the idea of being diagnosed is slightly scary as well: 'have-for-sure': atypical depression & binge eating disorder. Very probables: OCD, generalised anxiety disorder. Possibles: bipolar spectrum, even some borderline personality disorder traits. Yikes!
Just a few weeks ago I did a depression scale test on a not-so-bad day and tested extremely depressed as well. It actually shocked me: I was expecting moderately depressed or something along those lines. I'm down to very depressed now. The small victories!
Take care and keep well,
Ines
(Fred, yes I am female btw)
Posted by River1924 on March 21, 2007, at 0:34:24
In reply to Re: Atypical depression vetted out of studies?, posted by Ines on March 20, 2007, at 13:13:13
One of the big researchers in the US is Hagop Akiskal. I found this article which includes info about him and many of the probable diagnosis-es you mentioned. http://www.psycom.net/depression.central.lieber.html
I don't know what system they use in your country but I'd recommend bringing in several of those depression tests from various dates. It will show you are serious and that your "appearance" may not give him the full story. Tell him/her what you think you might have (bring your own info) but in the end, the diagnosis is secondary to treatment. If he/she wants to label you a gorilla, that's fine if the treatment is correct.
After my niece's suicide, I found this workbook for "mixed depression." The first few chapters helped her father understand her state of mind. The therapy is similar to cognitive behavioral but was developed for "borderliners" and those with eating disorders. "Depressed and Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression & Anxiety "
Posted by Ines on March 21, 2007, at 13:53:13
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by River1924 on March 21, 2007, at 0:34:24
River,
Thanks a lot for that post. I found that article by Akiskal very helpful, and reassuring re. treatment possibilities- and I'm going to try find that book to look through. I also really really liked your suggestion of taking depression test scores for different dates with me to an appoinment- I've found in the past that doctors don't seem to take my depression seriously. I'm always very matter of fact about my symptoms and don't get emotional when talking about it, (I also have an annoying tendency to smile at them- it's actually a nervous thing) and it just seems to make them think I'm just overstressed, in need of time off or something like that, and making too big a deal of it.
Thanks again. Take care,
Ines
Posted by FredPotter on March 21, 2007, at 17:55:57
In reply to Re: Atypical depression vetted out of studies? » River1924, posted by Ines on March 21, 2007, at 13:53:13
Ines there's a lot in your post. I want to reply at length but I'm supposed to be working right now. BTW River's idea of taking in test scores is a masterstroke as well as being good for measuring one's own progress
Later
Fred
Posted by FredPotter on March 22, 2007, at 0:12:02
In reply to Re: Atypical depression vetted out of studies? » River1924, posted by Ines on March 21, 2007, at 13:53:13
Ines I know. I was in a desperate anxiety crisis and had been taken to hospital, where they left me writhing with akathisia and periodic vomitting.
After several hours of this, 2 very attractive nurses came to talk to me. I can't help it, it'chemistry. One in particular was gorgeous and whenever I looked her way she smiled at me and she made me smile back. (She wasn't doing much of the interrogation.)
Eventually I smiled and said, "you keep smiling at me" then went back to writhing and saying things like, "what do you want, blood!?" I just wanted some valium or something. It was just me on different levels.
A friend of mine years ago was dying of stomach cancer but even at the end when she was vomitting every 2 minutes, her humour was irrepressible. To the point where we round the bed were laughing instead of looking suitably grave. That didn't prove she hadn't got cancer. She died about 2 weeks later. I'll never forget her
I read a story in Time magazine where a man's head was stuffed full of lung cancer. It had destroyed the brain. The family said to the surgeon after he died (not the surgeon I don't mean) that he came out of his coma, sat up stroked everybody, smiling and then collapsed and was dead. Even though there really was no brain left. "And I believed them", said the surgeon. Obviously the whole thing hangs on these 4 words.
I give these examples to show that with the kind of mental illness that doesn't show psychotic features, people usually have to take your word for it, or sometimes they don't.
During a voluntary hospitalisation some years ago (I hoped they might actually help me - silly me to think that - they just ignored me) a young girl with schizophrenia said, "There's nothing wrong with YOU is there?" Hitherto she'd taken me for a staff-member. In those days (1980) mental illness WAS schizophrenia. One of the patients told me to eat my dinner as I'd never feel better. I was feeling too anxious and sick to eat.
In a way (I THINK but perhaps not) I was suffering more than them.
"Whitewashed tombs do worms enfold", to quote the Bard.
Fred
Posted by Ines on March 22, 2007, at 7:35:42
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by FredPotter on March 22, 2007, at 0:12:02
Hey Fred,
Your post about the anxiety crisis and the nurses made me smirk (not that there is anything funny about the anxiety crisis obviously). My ex boyfriend was admitted into hospital at one point for major surgery. He too suffered from depression. Apparently the nurse that held his hand whilst they anaesthetised him had 'a lovely face and a kind smile'. He said he just sort of dosed off whilst her face became more and more distant and could've died 'a perfectly happy man'!
What is it with men and nurses?!
I might add this took place before we were going out, otherwise I would have been quite offended at his recounting of the story.. ;-)Hope the effexor withdrawal's getting more bearable.
Ines
Posted by TheMeanReds on March 22, 2007, at 13:18:43
In reply to Re: Men and nurses, posted by Ines on March 22, 2007, at 7:35:42
Yeah, like all of the sex-kitten nurse costumes for halloween. It seems like a very common fetish.
At least he wasnt dosing off to the heavenly, sexy & beautiful face of an older male doctor, and still describing the experience. =)
Posted by Ines on March 22, 2007, at 15:34:21
In reply to Re: Men and nurses, posted by TheMeanReds on March 22, 2007, at 13:18:43
Yes now that might have put me off! ;-)
Posted by FredPotter on March 22, 2007, at 16:00:24
In reply to Re: Men and nurses, posted by Ines on March 22, 2007, at 7:35:42
Thanks Ines I still have Effexor withdrawal symptoms even though I've started Nardil. Still I'm not going back now. I'm afraid they may be permanent, but let's hope not. I still have whooshing in my head on moving my eyes, I do go straight to sleep now though but wake at 1am not knowing who I am, what's outside the house or whether I live alone or with others. It takes a few minutes to work out. Maybe that's a Nardil side-effect.
My last post was to try and work out why atypical depressive types appear normal. It's genuine too and not just a brave front
Bye
Fred
Posted by FredPotter on March 22, 2007, at 16:03:38
In reply to Re: Men and nurses, posted by TheMeanReds on March 22, 2007, at 13:18:43
to be fair to me, they were not in nurses' uniforms and one stage up from nurses (charge nurses?). But gorgeous women in normal clothes
Posted by FredPotter on March 22, 2007, at 16:05:13
In reply to Re: Men and nurses » TheMeanReds, posted by Ines on March 22, 2007, at 15:34:21
You see we're not all rugby freaks (I used to have this notion that NZ was all male)
Posted by TheMeanReds on March 22, 2007, at 17:06:12
In reply to Re: Men and nurses » TheMeanReds, posted by FredPotter on March 22, 2007, at 16:03:38
Sorry, I only read the 'men and nurses' post by Ines. It caught my eye. I'm glad you had a pleasent experience with the other charge nurses though.
> to be fair to me, they were not in nurses' uniforms and one stage up from nurses (charge nurses?). But gorgeous women in normal clothes
Posted by TheMeanReds on March 22, 2007, at 17:14:01
In reply to Re: Men and nurses » FredPotter, posted by TheMeanReds on March 22, 2007, at 17:06:12
Oops, I forgot to add I have had a pleasent experience when I went under for and operation. I had a motherly figure type nurse, and she asked me little questions about where I grew up. Very calming, and made me smile before I was under. I felt very greatful because I was very nervous while in the pre-op waiting room all alone.
She actually inspired me very much to think of going into her type of work. I was out of high school and deciding about my major at the time. I never pursued it, but she will always be in my memories.
> Sorry, I only read the 'men and nurses' post by Ines. It caught my eye. I'm glad you had a pleasent experience with the other charge nurses though.
>
> > to be fair to me, they were not in nurses' uniforms and one stage up from nurses (charge nurses?). But gorgeous women in normal clothes
>
>
Posted by Phillipa on March 22, 2007, at 20:01:45
In reply to Re: Men and nurses, posted by TheMeanReds on March 22, 2007, at 17:14:01
You're very young and I didn't graduate from nursing school til 38 and always sat on my patients bed after asking permission to start an IV. Found always got it the first time that way as human touch is very calming. And Fred street clothes so a psych unit. My favorite are scrubs feels like you're in your pajamas. So comfortable. Love Phillipa
Posted by FredPotter on March 23, 2007, at 7:28:47
In reply to Re: Men and nurses, posted by TheMeanReds on March 22, 2007, at 17:14:01
I've experienced nurses like that. Worth their weight in gold, but severely underpaid
Posted by football on March 23, 2007, at 14:31:25
In reply to Re: Atypical depression is typical, posted by River1924 on March 2, 2007, at 1:45:58
It's actually fairly common with abilify.
Posted by stargazer on March 23, 2007, at 18:45:11
In reply to Re: Atypical depression is typical, posted by football on March 23, 2007, at 14:31:25
What is fairly common with abilify? I can't find the post you are referring to.
SG
Posted by River1924 on March 24, 2007, at 0:47:00
In reply to Re: Atypical depression vetted out of studies?, posted by Ines on March 20, 2007, at 13:13:13
J Clin Psychiatry. 2007;68 Suppl 3:25-9.
Treating depression with atypical features.
Stewart JW.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. [email protected]
Depression with atypical features was first recognized in a subset of patients with depression who preferentially responded to the monoamine oxidase inhibitor (MAOI) phenelzine, in contrast to patients with melancholic depression. This article reviews the history of approaches in treating depression with atypical features. Initial studies in the early 1980s focused on phenelzine, but an unfavorable adverse effect profile limits its clinical use. Despite such difficulties, phenelzine remains the gold standard in eliciting high response rates in nearly two thirds of patients with atypical depression. Searches for agents with improved safety profiles led to studies of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), chromium, and cognitive therapy approaches. Of these, TCAs showed inferior efficacy to MAOIs but also had cumbersome adverse effects. SSRIs have reported efficacy, but a lack of direct comparative studies limits clinical decision making. Cognitive strategies have shown promise, but demonstrating efficacy in comparison with an MAOI and placebo is limited to a single study. Despite advances in agents for melancholic depression, treatment for atypical depression remains dependent upon older agents for the greatest efficacy.
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