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Re: atypical depression treatment? - jzp and noa

Posted by SLS on July 1, 2000, at 10:18:09

In reply to atypical depression treatment?, posted by jzp on June 30, 2000, at 4:18:24

> Last time I was in the hospital/being treated I was
> diagnosed as having Bipolar II, and was in a depressed
> mode. That was in November of 1998. I was given
> Depakote and Wellbutrin, and then Depakote and Zoloft,
> but my mood and energy level did not improve. I left
> school and lost my health insurance, so I went off all
> medication in November of 1999. It didn't make any
> difference; I was depressed on the medicine and off it.

> Now, I'm still depressed, but am in the process of
> resuming treatment for it. From everything that I have
> read, I fit all the qualifications of atypical depression:
> extreme rejection sensitivity, weight gain, lack of energy
> hypersomnia... It isn't so much that I just constantly
> feel sad and empty, it's more that any little thing is
> enough to make me feel terrible. Good things can
> often make me feel better (very) temporarily, but it
> invariably falls apart. Everything is overwhelming. I
> feel like I'm just one big exposed nerve-- everything
> affects me, everything hurts.

> I'm sorry it's taken me this long to get to the pertinent
> question: What kind of treatments have been helpful
> for those of you who also suffer from atypical
> depression?
>
> Thanks for any help that you can offer.
>
> -jzp


Hi there.

Do you know why you were diagnosed as being bipolar? The distinction between bipolar and unipolar is important as it determines the emphasis placed upon using mood stabilizers such as Depakote.

Have you ever been, or suspect that you may have been, manic or hypomanic? If so, how would you describe these manic states? How old were you when you first became ill? Any family history?

Atypical depression and bipolar depression look very similar.

You may indeed suffer from atypical unipolar depression. From your description, and in the absence of mania, this is probably the case. A thyroid examination is certainly something worth putting on your list, although I don't think thyroid abnormalities are as often associated with bipolar disorder as they are with unipolar disorders.

Noa - Is this true? Are thyroid abnormalities more common in atypical depression as opposed to melancholic (typical endogenous) depression? How much do thyroid tests cost?

I don't think either Provigil (modafinil) or adrafinil used alone is going to do it. Of course, I would not want to mistakingly persuade someone from choosing the right treatment for themselves, but I don't think these drugs belong at the top of your list. You may want to try adding one of these drugs to the antidepressants you are already taking at some point in the future. Adrafinil is not sold in the U.S., however, the two drugs may not be completely interchangeable. JohnL has responded better to adrafinil (added to the other antidepressants he is already taking). Others have had success with Provigil.

You have only mentioned two antidepressants. Did either of them help at all? Were they combined? What else have you tried? Have any drugs been partially effective?

It is becoming increasingly apparent that combinations of antidepressants are often required to acquire an adequate response.

MAO inhibitors must not be avoided if you have failed to respond to many different drugs. Nardil has been the drug traditionally chosen first for atypical depression. Years ago, it was thought that rejection-sensitivity was a symptom that Nardil was particularly well suited to treat. It is certainly effective in cases where social anxiety is present. Parnate is the MAOI usually thought of to treat bipolar depression and depressions in which having extremely low energy is a prominent feature. These associations do not represent rules, but rather trends. Either drug can work for either set of symptoms. Nardil is associated with greater weight gain than is Parnate. The other MAOI worth mentioning is Marplan.

Trial and error sucks. Sorry.

I recommend that you document which drugs you have tried and how you have responded to them. I would also recommend that you discuss your thoughts with your doctor. Thirdly, I recommend that you hang-out here for awhile to receive more replies so as to see what drugs other "real" people have had success with and how closely their symptoms match yours.

Mucho good luck.


- Scott

 

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