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Re: difference bet no 'future' and wanting to die?

Posted by JohnL on December 15, 1999, at 3:51:37

In reply to difference bet no 'future' and wanting to die?, posted by jane on December 14, 1999, at 19:16:13

Hi Jane. You sound like me. And probably thousands of other people battling the beast. I know exactly how you feel. I know it doesn't help much, but you are far from being alone. I do not think your situation has much to do with getting your act together, but that substantial residual depressive symptoms are impeding the ability to get one's act together. Your symptoms sound like textbook depression of the dysthymic melancholic subtype. Able to function, but no spark, no joy.

Not knowing what drugs you take right now, it's worth mentioning that the SSRIs are often disappointing in your kind of depression. I've seen a lot of research studies on TCAs compared to SSRIs in melancholic depression. If the goal is 50% improvement, they are equally effective. However, if the goal is a Hamilton score of 10 or less, the TCAs are 70%-86% effective where the SSRIs are only 10%-30% effective. I believe Effexor is also considered to be more suitable for melancholics than SSRIs. So if your cocktail doesn't have a TCA component, you might want to see a doc about that. Nortriptyline or Desipramine are probably the best choices due to their relatively milder side effects compared to other TCAs. And since you don't have insurance, the TCAs are a lot cheaper as well.

Zoloft according to the literature has the most effect on melancholia compared to other SSRIs due to its 'relatively' stronger action on dopamine. But overall it's hard to find anything more convincing than TCAs for melancholic subtypes. This is all based on the assumption that I am interpreting your symptoms correctly as melancholic dysthymia. You sound exactly like me, and that is my diagnosis. Sometimes I have severe epidsodes, and then it is called double depression. When I read the symptoms of melancholic subtypes, it fits me like a glove. Fits you pretty well too. So in the confusion of messing with the cocktail, I just wanted to put in a vote for the TCAs. They are generally better suited for your symptoms than SSRIs. Correct approach would be TCA alone, TCA agumentation of an SSRI, or Lithium augmentation of SSRI or TCA.




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