Posted by Elizabeth on November 19, 2001, at 17:36:44
In reply to Atypical a.d's make Endogenous depression worse?, posted by jay on November 15, 2001, at 0:59:18
> There is much talk about how the tricyclics somehow aren't good for "atypical" depression.
That's fairly well-established, yes.
> I think, though, that most folks have a number of symptoms that do somewhat indicate atypical depression, but also have many endogenous symptoms. (Irritability, anxiety, bouts of insomnia..etc.)
Irritability, anxiety, and some types of insomnia are common in many different presentations of depression, including "atypical depression," "melancholic depression" (the word "endogenous" isn't used much this way anymore because it can be very misleading), and depressions that fall into neither category.
Anxiety disorders are sometimes said to be more common in atypical depression, and some (notably, social phobia) may be connected specifically to atypical depression (the common feature in social anxiety and atypical depression being excessive interpersonal sensitivity), but anxiety in general occurs in a variety of types of depression.
The insomnia that is associated specifically with melancholic depression is called "terminal insomnia" or early-morning awakenings. Trouble getting to sleep at night is not a specific symptom of melancholic depression and is often a problem for people with atypical depression.
IMO, the most important distinctive feature of melancholic depression is the total absence of mood-reactivity.
> I also think the reverse of the first statement is true...and that meds for atypical depression can are little to no-good for endogenous depression symptoms, and maybe can make them worse, especially in the long run.
There doesn't seem to be any reason to suppose this. I have fairly clear-cut melancholic depression, and I was helped somewhat by several different MAOIs. Desipramine is about as effective as Parnate was; in fact, the main distinction that I notice is that while I never dreamed on Parnate, I have frequent intense dreams on desipramine.
Although MAOIs haven't been studied as much as they should be for melancholic depression, the existing research has generally been positive, as long as sufficient doses (e.g., 60 mg/day of phenelzine) were used. (Older studies tended to use lower doses; melancholic depression is almost invariably quite severe and unrelenting, so while 45 mg might be sufficient for atypical depression or dysthymia, it probably won't be adequate for melancholic depression.)
> From my little bit of experience (n=1..heh,) it seems the highly activating quality of the newer SRI/SNRI's seem to really complicate endogenous depressive symptoms.
The current thinking is that SSRIs are not very effective for melancholic depression. But there's no evidence that they're more effective than TCAs for atypical depression, either.
Effexor has been shown to be effective for melancholic depression.
> I think that is why many only attain partial relief from the newer a.d's. I've noticed that the tricyclics, in particular nortriptyline, help my depression and anxiety in a fairly different way than the newer meds.
I think you're getting too bogged down in classifications. Also, a disorder is much more than any one particular symptom of it. MAOIs can make some atypical depression symptoms (especially overeating) worse, but they are effective for the underlying conditions. All drugs have side effects; the side effects are not what treats the depression.
> Again, this is why I believe folks should consider (especially if you have had many problems with the newer a.d.'s..or they haven't helped.) a tricyclic.
True melancholic depression is actually pretty rare.
-elizabeth
poster:Elizabeth
thread:84318
URL: http://www.dr-bob.org/babble/20011113/msgs/84694.html