Posted by petters on January 19, 2002, at 1:35:00
In reply to Mood-reactivity in atypical depression., posted by SLS on January 19, 2002, at 0:25:05
> Hi folks.
>
> Not doing so well...
>
> So, what else is new?
>
> I thought the study citation I included below was important to take a look at.
>
> I have often questioned the definition and characterization of "mood-reactivity". It has been a source of confusion in my attempts to accurately describe to clinicians (especially with the folks at Columbia Presbyterian) how I experience depression so that they may better evaluate my case. Hypersomnia and hyperphagia (both considered reverse-vegetative features), leaden-paralysis, and rejection-sensitivity have been consistent and defining features of my presentation. That I have been most responsive to MAO-inhibitors, particularly Nardil, would be corroborative with these features in characterizing my depression as being of the "atypical" type. However, I have never felt that the essential nature of my depressive state as I experience it has been qualitatively reactive to any environmental stimuli. I am most probably bipolar, as I have experienced manic reactions to antidepressants, although mania has never occured spontaneously (this presentation has been proposed to be included in the future DSM V diagnostic schema as Bipolar III). Based upon my experience, I would conclude that either:
>
> 1. Bipolar depression looks similar to atypical unipolar depression but lacks the mood-reactivity putatively intrinsic to atypical depression.
>
> 2. Mood-reactivity is not an essential characteristic of either illness.
>
>
> Gabitril looks interesting. I extend my appreciation to those who have shared their experiences with it, along with everyone else for their valuable presence here on PB.
>
>
> Always Yours,
>
> Scott
>
>
> -----------------------------------------------------
>
>
> Mood Reactivity Rejected As Symptom Of Depression Subtype
>
> Archives of General Psychiatry
>
> 01/16/2002 By Elda Hauschildt
>
> Mood reactivity may not be a valid component of the atypical features subtype of major depressive disorder.
>
> Four other symptoms of the subtype listed in the Diagnostic & Statistical Manual of Mental Disorders-IV (DSM-IV) are modestly associated with the subtype, United States researchers say. These include hypersomnia, hyperphagia, leaden paralysis and rejection sensitivity.
>
> Investigators from Brown University in Providence, Rhode Island suggest that mood reactivity should "perhaps be dropped from the diagnostic criteria set."
>
> They examined the five major atypical features using data on the first 579 psychiatric outpatients evaluated in the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project.
>
> Participants all had a current diagnosis of major depressive disorder. A total of 130 patients had atypical features and 449 did not.
>
> "Our most salient finding regards mood reactivity," the researchers explain. "Mood reactivity has been considered an essential component of the atypical features subtype; of the five atypical symptoms, it is the only one required to make the diagnosis.
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> "Consistent with other reports, we did not find any evidence to suggest that mood reactivity is associated with the atypical B symptoms."
>
> Investigators also point out that their correlation analyses revealed significant but modest associations for the other four atypical symptoms.
>
> "Although correlation coefficients of 0.09 to 0.10 account for only about 1 percent of the variance, the association between insomnia and decreased appetite was only slightly higher.
>
> "This suggests that this level of correlation may be clinically meaningful.
>
> "Our analyses lend support to the discriminant validity of the subtype because hyperphagia and hypersomnia were generally more closely related with the remaining atypical symptoms than were the non-atypical symptoms of decreased appetite and insomnia."
>
> They obtained detailed demographic and clinical information for each patient in semi-structured interviews. They then made a series of a priori hypotheses about how depressed patients with atypical features would differ from those without the features.
>
> Hypotheses were that depressed patients with atypical features would be more likely than non-atypical depressed patients to exhibit: female sex, younger age, longer episode duration, younger age at onset, amphetamine abuse or dependence, histrionic and avoidant personality disorders and higher rates of bipolarity, milder illness, greater comorbidity with panic attacks, agoraphobia, social phobia, hypochondriasis, bulimia, and body dysmorphic disorder.
>
> "Although many of the predicted hypotheses were substantiated, an equal number were not," investigators report.
>
> "Three of the most commonly cited validators of atypical depression were confirmed in our study: a preponderance of women, a younger age at onset, and a longer duration of illness.
>
> "Two other important validators were not confirmed. Depressed patients with atypical features were not younger and they were found to be more rather than less severely depressed."
>
> Archives of General Psychiatry, 2002; 59: 70-76.
Hi Scott...Very nice to hear from you. I´m very sorry for your suffering and pain in your current state. I hope for an remission in your current state as soon as possible.
By the way. Have you tried amantadine? I think you can get more mileage from your present meds by adding amantadine or ( bupropion, but I think, if I´m not remember wrong, that you already tried it without success)
Sorry, I don´t have more to come up with.
By the way. I am quite ok. I try to replace Remeron, because of reccurent infections.
My current mix: Effexor + Remeron + Lamictal + Litium. Result:Aproximately 80% recovery.
Any suggestion in replacing Remeron with?
I have nightmare from Efexor. Cyproheptadine, or..?Stay well, and take care.
Sincerely...//Petters
poster:petters
thread:90736
URL: http://www.dr-bob.org/babble/20020116/msgs/90740.html