Posted by Tomatheus on July 5, 2006, at 16:44:38
In reply to The Bipolar II Oracle Speaks » HEART~, posted by Ripley Snell on July 5, 2006, at 7:44:42
Ripley Snell,
See below for my responses...
Tomatheus
> No one, duh, noticed that a lot of the symptoms of "unipolar" depression were at either ends of a scale: eating too much/eating nothing; sleeping too much/not sleeping; anxious and restless/psychomotor retardation. So then they came up with all this stuff about "atypical" and "melancholic" depression--which, it turns out, is mostly beside the point.
No, this is not mostly beside the point. Research studies done during the 1970s and 1980s consistently found that "melancholic" depressives tended to respond best to the tricyclics, and "atypical" depressives tended to respond best to the MAOIs of the time, the "old" Nardil and the "old" Parnate -- both of which no longer exist.
> Then light dawned on the Marbleheads, and people realized, wait! It's not "agitated depression"--it's a form of bipolar where the mania isn't quite as pronounced.Do you really think that these "marbleheads" just so happened to "realize" that all of these "softer" forms of bipolarity exist shortly after the introduction of the SSRIs? Don't you think that maybe -- just maybe -- these agitated and/or atypical depressives might not have exhibited any clear signs of hypomania until relatively recently because the TCAs (with their antimuscarinic/antihistamine properties) and the MAOIs (the most efficacious meds for atypical/anxious depressives) never induced hypomania in these individuals as at least some of the SSRIs/SSNRIs do now?
I think that it would be more accurate to say that the light dawned on the big pharmaceutical companies that they can profit a hell of a lot more from these "agitated" or "atypical" depressives if they could convince these individuals that they're actually bipolar and really need two, three, or more medications (preferably newer ones with patents that had yet to expire) instead of just one older unprofitable MAOI. Have you ever noticed that most (if not all) of the published studies advocating the over-diagnosis of bipolar II are funded by not just one, but several pharmaceutical companies? And doesn't it seem just a little conveeeeenient that the two medications that were always shown to be highly effective in the treatment of atypical and anxious depression (as monotherapy, no less) no longer work as well as they used to (and cause more side effects than they used to) in many patients now that they're no longer profitable?
Now that the term "antidepressant" is almost always used to refer to an SSRI, SSNRI, or perhaps Wellbutrin, it is no surprise that all of these so-called "soft" bipolars are responding more favorably to mood stabilizers than they are to "antidepressants." However, I think that all of us can agree that atypical/anxious depressives are no more "bipolar" than they were 20 years ago. In other words, the patients themselves haven't changed. It's the treatments that have changed. And for a majority of atypical, anxious, and/or "non-endogenous/neurotic" depressives (which is essentially what dysthymics used to be called), I think that the treatments have changed for the worse.
But then again, what do I know? I'm not a psychiatrist or a researcher, just a stupid patient.
poster:Tomatheus
thread:664021
URL: http://www.dr-bob.org/babble/20060701/msgs/664243.html