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Re: atypical depression: Annie

Posted by Scott L. Schofield on November 9, 1999, at 10:21:55

In reply to Re: atypical depression: Annie, posted by Elizabeth on November 9, 1999, at 7:11:09

> I think that docs who diagnose anyone with mood-reactive or atypical depression as bipolar II (and I seem to keep hearing of instances of this) are probably doing more harm than good. Atypical depression has been well documented, and the proper treatment for it is antidepressants (strong evidence for MAOIs, moderate support for SSRIs), not mood stabilizers. <


I'm not a big proponent of using drugs that don't work.

Unfortunately, medicine has not yet reached the point where choosing a drug that will work can be determined by some sort of objective test. I know I can't. I know my doctor can't. And I also know that Robert Post can't. Doctors can, however, make an educated guess based upon some of the empirical evidence gleaned from statistics.

From what little I know, Elizabeth's suggestion to try an MAO-inhibitor seems like a good one. The ones most commonly used in the U.S. are Parnate and Nardil. Another MAO-I, Marplan, was recently reintroduced. The old rule-of-thumb was to consider Parnate as a first choice for bipolar depression and Nardil for atypical unipolar depression, particularly if there also exists some social-phobia, panic-attacks, or obsessive-compulsive characteristics. Again, there are no hard rules to adhere to because there are many instances where the reverse is true.

One thing worth mentioning is that low-dose lithium in combination with an antidepressant has been used with some success at treating unipolar depressives. The range of dosages used was between 300 - 600 mg/day. 450 seemed to be the sweet-spot.

There's a bunch more strategies to try.* Hopefully, both you and I will find one that works. Keep researching. Our doctors can use all the help they can get.

* I tend to be more optimistic when it comes to other people's plights than I do for my own. Does anyone else experience this?

- Scott




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