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Re: Yo, AndrewB!

Posted by Scott L. Schofield on April 29, 2000, at 11:46:24

In reply to Yo, AndrewB!, posted by Ginny on April 29, 2000, at 10:03:02

> Just wondering. It may be a distinction without a difference to a depressed person, but I think it is a term of art to a psychiatrist with ramifacations as to prognosis and a course of treatment.


Dear Ginny,

I would first look at the diagnostic criteria posted by AndrewB. I am always admiring of his care for others and the accuracy and detail contained in his compositions.

There are constructive reasons for discriminating between the different types of depressions (presentations). They can be differentially responsive to treatments.

Melancholia is the term first used to describe depression. The term "endogenous" was later used to substitute for it. I think "endogenous" was chosen so as to put forth the idea that this depression seemed to be generated from within the body, and was not dependant upon what was happening outside of it. The term "unipolar" was later added to delineate it from "bipolar" (substituted for "manic-depression"). The majority of presentations of major depression (unipolar depression) is of the "endogenous" or "melancholic" type. Melancholic features were "typical" in diagnosed cases of unipolar depression. However, it became apparent that a minority percentage of cases were presenting with characteristics opposite to those of the majority. Vegetative symptoms were reversed. These depressions were "atypical".

Melancholic: unreactive; inability to respond stimuli.
Atypical: reactive; ability to respond to stimuli - smile, laugh

Melancholic: depression worse in morning
Atypical: depression worse in evening

Melancholic: insomnia; early morning awakening
Atypical: hypersomnia; sleeping too late

Melancholic: agitation
Atypical: anergia; lack of energy

Melancholic: anorexia or weight loss
Atypical: increased appetite or weight gain.

Melancholics have been shown to be more responsive to tricyclic antidepressants. Atypicals have been shown to be more responsive to MAO-inhibitors.

I really don't know enough about how these two types of depression respond to the other drugs. I'm sure someone does. If I have time, I will look into it. I think melancholic and psychotic depressions are more responsive to ECT.

I once met a SEVERELY depressed melancholic. She walked like an elderly woman and was as feeble. Her facial expression was fixed. It was excruciating to watch her fetch me a piece of paper-toweling. Each step taken was a monumental chore. I was horrified. She later committed suicide. I get the feeling that the great majority of depressed individuals participating on this board are atypicals. I may be wrong. If this is the case, though, I can certainly understand why.

- Scott




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