Posted by BarbaraCat on March 24, 2002, at 14:29:20
In reply to Multiple Layers of Depressive Symptoms » BarbaraCat, posted by fachad on March 24, 2002, at 3:41:38
Thanks, Fachad. I've heard of affective and somatic forms of depression before, but never made the connection as well as through reading your description. Here are some ideas to ponder. Do you think that this cycling between the affective and somatic forms is typical of 'depressive disorders'? When you go through the affective stage, acommpanied by tearfullness, are you also in the grip of an anxiety state?
I'm going to conjecture here, so hopefully you can stay with me and offer some comments. The opposite poles of somatic/affective seems to suggest that different neurochemicals come into play on an intermittant fluctuating basis. The anergic dysphoric phase suggests a lack of dopamine and/or NE. Theories state that there's a inverse relationship between serotonin and dopamine, so at the dysphoric times there is a disproportionate higher ratio of serotonin to the other more activating neurochems. That's probably why you'd feel much worse on an SSRI. Boosting the serotonin even more is going to create a minor serotonin syndrome, creating the body yucks worse inertia and generally awful feelings.
On the other hand, the affective stage suggests a lack of serotonin, thereby making dopamine more prominent, causing more lability and anxiety if one is so inclined. Of course, there's more involved here than just the three major players, but this flux in neurochemicals seems curious. Could it be affected and maintained by the meds we're taking? Perhaps SSRI's should be taken on a cyclical rather than constant basis to prevent the flat line effect which suggests that ooops! dopamine on the decline - better either cut back on the serotonin booster or take a pstim to prevent the see-sawing. Or, if dysphoric, just taking a pstim and then modifying as needed with an SSRI, as you are doing. I fortunately do not have chronic dysphoria, as you seem to, so my preference would be to take nothing until needed. Unfortunately, because my extremely severe episodes are mixed or all one or the other, I never know which way it's going to go and wouldn't have a clue as to how to tweak the med combo.
This fluctuating brain chemical bath idea has really grabbed my interest. If garden variety depression also typically has both affective and somatic elements, how different really is it than the bipolar disorders which may just be a matter of degrees. So perhaps this fluctuation property in itself needs to be looked at more closely. Are the mood stabilizers a big piece of the puzzle and perhaps even necessary if one is to 'get better'? Perhaps looking closer at balancing electro-chemical potential, resetting a magnetic/electrical switch (ECT, rTMS) makes more sense than manipulating chemicals which are always going to have a lag time in catching up to symptoms, and may even be contributing to and maintaining the whole dysfunction. I'm looking forward to the day when we all have a little portable brain zapper at home to align those little suckers as needed. - Barbara
poster:BarbaraCat
thread:99188
URL: http://www.dr-bob.org/babble/20020322/msgs/99886.html