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Re: Atypical depression options

Posted by Elizabeth on March 9, 1999, at 23:43:09

In reply to Re: Atypical depression options, posted by Jim on March 8, 1999, at 9:43:31

Jim, you left out two salient features of atypical depression: chronic interpersonal sensitivity (not just while depressed, but as a trait throughout life), and feelings of extreme lethargy (especially feelings of "heaviness").

A tricyclic like imipramine, nortriptyline, or desipramine may be worth trying, but be aware that atypical depression was defined as the result of studies of patients who failed to respond to tricyclics but did respond to MAOIs.

I believe that Anita has already tried anticonvulsants. I think the idea of trying the other new antidepressants is reasonable. Another possibility is the many drugs that are available in Europe (France especially) but not here. (I don't mean moclobemide: general clinical experience seems to be that moclobemide is not a substitute for Nardil or Parnate in atypical or refractory depression.) One thing to consider would be the other MAOI, Marplan. I've heard *rumors* that it's now used here again, and it is still used in the U.K. for sure.

And of course, there are always Buprenex and Tramadol. :-)

I haven't heard much good about naltrexone as an antidepressant itself, only for jump-starting ADs that have stopped working. Specifically, the people I know (doctors and patients) who use it (for self-injurious behavior and alcoholism mostly) say that it causes "dysphoria."





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