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Re: Atypical Depression or BiPolar II?

Posted by JohnL on June 27, 1999, at 4:49:09

In reply to Re: Atypical Depression or BiPolar II?, posted by Erin on June 26, 1999, at 22:30:42

Erin, first an apology to all for my bad choice of words, "'s the inevitable fall that kills you." That's terrible. Sorry for poor choice of words. Didn't realize it until I reread it. Was actually trying to be a bit humorous, but it doesn't come across that way at all.

OK, in a book on Dysthymia, Hagog Akiskal (a respected guru) writes, "A more specific meaning of atypicality refers to reverse vegetative signs (i.e., evening worsening, initial insomnia, tendency to hypersomnolence, fatigue...". Also, "...bipolar, especialy bipolar II, depression often presents with atypical sympomatology...such atypical presentations...have been shown to precede bipolar illness." He also goes on to say that atypical is often just a term used to describe symptoms that deviate from a more classical straight forward depression. Also, atypical and bipolar etc do not refer to distinct affective disorders but represent alternative phases in an ongoing disorder. Another paragraph describes atypical as mood worse in evening, insomnia, tendency to oversleep and overeat, irritability, daytime fatigue. He specifically says there is some evidence of MAOIs being appropriate for atypical. However, if it is a bipolar phase (sounds that way to me) (hypomania mixed with irritation = mixed state), he says ADs can often confuse the situation and make it worse. In those cases, mood stabilizers are warranted.

The more I learn though, the more confusing it all seems. There are so many gray areas, not well-defined black and white. In other countries they typically treat patients with mood stabilizers where we treat the same symptoms in USA with ADs.

I've noticed Ad's tend to stabilize mood in me, like you. Don't know why. They haven't helped depression much in me, but do stabilize.But the mood stabilizer drugs are probably more appropriate. They can relieve the depressive spectrum in addition to toning down any mixed mania. Right now though it seems a couple real good nights sleep would be very helpful to you.

Can anyone suggest a good short term sleep med while waiting for a doc appointment weeks away? Take care Erin, stay in touch. JohnL.




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