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mood disorders, ketoconazole, etc - Scott, Cecilia

Posted by Elizabeth on October 2, 2001, at 10:58:06

In reply to Re: DST in major depression Elizabeth, posted by SLS on October 2, 2001, at 8:59:22

Hi everyone.

> It sounds from what you`re saying that people with atypical depression are not too likely to respond to ketoconazole, is that correct?

Yes, that would seem to follow from what we know about it so far. People with atypical depression do seem to have some sort of HPA axis dysregulation, but it's different from the problems seen in "typical" depression (which, as we've seen, isn't so typical after all :-) ).

> Also Cruz says he takes it only once every 2 weeks, wouldn`t it be long gone from your system before 2 weeks?

I'm not sure what to make of this, but there certainly are some medications which can be taken in this way, for reasons other than
Some researchers have used dexamethasone, given for just a few days a month (or something like that), to achieve the same effect as you'd get from taking ketoconazole. I'm not sure what is achieved by Cruz's strategy, though; I would need to know the details of ketoconazole's pharmacodynamics and pharmacokinetics, which I don't.

> My pdoc has never suggested a DST suppression test, (of course, I`m in a HMO), what is the main purpose of this test?

It tests whether your cortisol level goes down following a single dose of the corticosteroid dexamethasone. If it doesn't, there's something odd going on. Alcoholism, anorexia nervosa, Cushing's syndrome, and some other things can also cause abnormal DST response (i.e., nonsupression).

> I'm a little confused. Do you feel the more restrictive criteria used in the bipolar studies of DST were invalid? How old are the studies? I guess I should do a search on Medline.

On the contrary. I think that in clinical trials, researchers adhere more firmly to diagnostic criteria than do clinicians in naturalistic settings. Although the DSM criteria aren't perfect by a long shot, they're the best we've got. So I think that findings about bipolar disorder may not apply to "soft" bipolar disorders which seem to have become extremely common in the last few years.

> My case profile is a little weird. I guess you know that by now.

If our case profiles weren't a little weird, we might not be here. :-}

> I forgot which doctor (witch-doctor) made the comment to me, but he said my condition was more similar to bipolar I than bipolar II. I think his main criterion was the severity of my manic episodes, even though they were all induced by exposures to medication.

That's interesting. Multiple full-blown manias, even if they only occur when you're on ADs, are a lot more suggestive of BP than are the "mixed hypomania" and things like that (these quasi-hypomanias seem to be pretty common reactions to ADs and, IMO, shouldn't be used to justify a dx of bipolar disorder).

> Parnate + desipramine = hypomania - > psychotic dysphoric mania

I never tried desipramine with MAOIs, although it would be a logical next step. I think I'm going to try something different, though: psychostimulants (which I didn't tolerate in combination with MAOIs).

> Nardil = protracted hypomania, mixed type

When Nardil pooped out on me, my depression didn't exactly return in its original state: instead of being strictly depressed, I got really irritable and excitable (in a bad way -- kind of reminded me of adolescence, only much more so). The possibility of mixed mania was brought up, but it was never confirmed and trials of Neurontin, Lamictal, and Depakote didn't help any.

> Nardil discontinuation = severe psychotic mania, dysphoric.

MAOI withdrawal symptoms, whatever you want to call them, *suck*. My experience was an exacerbation of the poop-out syndrome described above. After several *months* of this -- ouch -- I returned to my former depressed state.

> Some diagnostic schemes proposed for DSM V include this presentation as bipolar III.

That's what the doctors I talked to in Boston called it.

> I think another diagnostic subtype once proposed for bipolar disorder was one for which chronic depression is the only symptom.

I must be missing something: in what sense is that "bipolar?"

> Between ages 20 - 22, I displayed a remarkably regular 11-day cycle: 8 days of severe depression followed by 3 days of normothymia followed by 8 days of severe depression... etc. I was able to keep a social calendar around it. Unfortunately, Fieve's lithium did away with all of that.





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