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Re: Dysthymia -- Elizabeth/John

Posted by JD on June 8, 1999, at 8:02:34

In reply to Re: Dysthymia Book, posted by John on June 5, 1999, at 14:34:53

Thanks for the tip, folks--I will have to check the book out... I'm assuming it features much of the stuff that's been floating around lately (on this site and off) about early-onset mood problems, "soft" bipolar signs, etc... The more I consider it, the more I feel sort of like a textbook example of these issues: very early onset in childhood, atypical symptoms, mood reactivity and widely varying social impairment for as long as I can remember (sometimes just fine, most often not). As with John I've had a few major depressions thrown in, but these days mostly range between 95% dysthymia and 5% euthymia to mild hypomania. Needless to say, I try to take advantage of that 5%, but it's largely unpredictable and all too brief! All of which probably makes me sound like a great candidate for an MAOI, which in fact will probably be my next stop. (Given my ridiculous hypersensitivity to meds, though, especially serotonergic and/or dopaminergic ones, these are hardly a sure bet. I've tried mood stabilizers and have personally found them unhelpful.) In my experience, doctors are at a loss over what to do with "complicated" patients--as with you John, I usually feel like I'm writing my own prescriptions, which doesn't inspire great confidence in the profession after a while. BTW, I'm curious that you'd "go international" to get moclobemide before say Nardil, Parnate, or Marplan--I know it's technically a "safe" MAOI, but I believe it's only MAO-A inhibiting and generally not as impressive in refractory cases as the old-line irreversible ones. But hey, within certain limits of course, my motto has basically become "Try everything"--It can only increase your odds of finding something that works.

> > I've been reading a book, _Dysthymia and the Spectrum of Chronic Depressions_, that I wholeheartedly recommend. It goes into all the different forms that chronic depression can take - sometimes it manifests as life-long low energy and disinterest, other times as chronic rejection-sensitivity and irritability. Dysthymics usually don't show the prominent "vegetative" (somatic) symptoms that you see in major depression, though I think that chronic sleep problems are probably common.
> >
> > Usually there's at least some degree of mood reactivity (ability to be cheered up when good things happen) in chronic depression, whereas total anhedonia is the main defining feature of melancholia. FWIW, the other symptoms and associated features of melancholic depression (besides the general features of major depression that we all know and love :-P) are: waking up early in the morning ("terminal" insomnia - a rather scary-sounding name!), loss of appetite,
> > guilt (culture-bound?) or self-reproach, feeling worst first thing in the morning, and psychomotor changes (appearing slowed-down or agitated). It responds well to tricyclics and ECT, possibly not as well to SSRIs (although I wonder if high-dose SSRIs have been tested).
> >
> Dysthymia and the Spectrum of Chronic Depression is indeed an interesting book, though I find I have to re-read parts to understand and abosrb. I don't think I fit any particular diagnosis, which is pretty much what the book says anyway, that they are kind of mixed and ever-changing states. I've been to that hellhole of deep suicidal psychotic depression, and maybe 4 days a year actually feel wonderful, perhaps too wonderful, but most often am just totally anhedonic without many other depressive symptoms. I would pay a million $$$ to have joy/interest/pleasure. Others take those feelings for granted. Anyway, according to the book, a mood stabilzer seems warranted, perhaps one of the newer ones that are claimed to have marked antidepressent properties, and I'm still leaning toward MAOI. I live 4 hours from Canada and may go there to get some Moclobemide. We'll see. Would be nice to have a good doc, like the ones I read about here, to lead me on this journey, but they don't exist around here. I'm kinda on my own, and maybe off to Canada for a day. Any doc I see is fairly perplexed and perfectly willing to write a prescrip for whatever I want. Gotta take care of myself I guess. Hey, I rambling. Nice to hear from you. I'll look for your postings which are always interesting. John.




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