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Help w/ atypical depression? (my first post here)

Posted by Walfredo on December 24, 2009, at 4:03:22

Hi everyone,

Let me just say first that I have been a lurker here for a few months now after discovering a thread while googling "atypical depression". After my initial discovery, I have come back time and again to utilize the search forums function any time I have a question about anything depression/mental health or medication related, and I generally find I learn more from reading whatever comes up in the search results from discussions here than I could anywhere else on the web. I have to say, I am extremely impressed with both the knowledge and compassion expressed in this forum. It truly is an amazing resource; I only wish I had found this place sooner.

So, a brief personal background at the risk of turning this into an essay....

I am in my mid-twenties and have been struggling with "atypical depression" since at least my early to mid teens if not earlier (I use quotation marks because atypical depression is sort of my working diagnosis though I am not 100% certain of the diagnosis). I first sought help my first year in college when I was 18 but I was symptomatic for years before I realized that not everyone was "having as hard a time" as me. Anxiety was a major problem for me then especially pertaining to social situations and I was avoidant of social situations when I "felt bad". Nowadays, after aggressively going after my anxiety and largely conquering it by enacting some lifestyle changes along with CT (I now believe depression was my issue all along though anxiety largely brought me to see a pdoc), I would characterize my main symptoms as problems with energy/fatigue, concentration, memory, slowed thinking, and lack of real enjoyment in things I should enjoy. I am also very prone to oversleeping (hypersomnia is the the term I think) and overeating, and "mood reactivity" was a phenomenon I described to the first psychiatrist I ever saw but had a hard time describing the phenomenon, not knowing if such a thing even made sense in the context of psychology. Ironically, I never had even discussed "atypical depression" specifically with any of my doctors but stumbled across a link defining it while reading about MAOI's on wikipedia and it sounded just like me! I digress.

Up til now, I have tried virtually every SSRI/SNRI on the market (except Pristiq) with little to no positive effect EXCEPT FOR PAXIL CR. Paxil CR was like the fourth antidepressant I tried and within a few days of bumping up the dose to 25 mg (after several weeks at 12.5), it was like someone flipped a switch. I had a amazing sustainable improvement in my mood (and all major symptoms) way before the usual 2 week allotted time (after a couple of days I believe). So, I had a great run on Paxil CR (totally satisfied and content) for about a year until it "pooped out" at which point I decided to try to go alternative/antidepressant free for about 18 months but again became frustrated with lack of progress and starting going to see the psychiatrist again.

So most recently, I decided to try Paxil CR again and even went to 37.5 mgs to see if a dose increase might help. It didn't - though I did get like 1 excellent day when I went back down to 25 mg from the 37.5 (more on this in a bit). After too long of a second try with the Paxil CR, I researched MAOI's because a previous doctor had suggested Emsam to me. Well, due to the cost of Emsam, I ended up trying Nardil instead and only made it up to 60 mg before the side effects (namely insomnia and anorgasmia) because unbearable. At this point even though I wasn't at a max dose, I decided to cut bait and began seeing a new doctor who I discussed this with. She and I agreed there were other unexplored options with potentially more manageable side effects and we could try MAOI's down the road if need be.

So...(are you still reading? If so, hats off to you good people), I got off the Nardil, did my washout period, and she has me currently trying Abilify. I did two weeks at 2.5 mg and have been on 5 mg for about a week. No improvement and I'm starting to think I may feel a bit subtly worse (sometimes it's hard to tell with all the withdrawals and switching of meds) but definitely no improvement.

I am scheduled to see here the first week of the new year and assuming everything else remains the same, I am wondering where to go next. I read on here that sometimes Remeron is used for "Paxil poop-out" and interestingly my new doctor asked me specifically if I had tried it so that may be an option. I am also very intrigued by the supplement SAM-e and really want to give it a try as well (anyone know a good online source to buy it at reasonable cost and good quality???).

A few other interesting tidbits are:

Sleep deprivation totally helps my depression almost to the point of 100% remission or close to it. Have felt better on no sleep for as long as I can remember. Even when I couldn't sleep but 3 hrs per night on Nardil, I began to feel good although mixed in with the zombie-ness of being that sleep deprived. I thought the Nardil might be working but it turns out it was just the lack of sleep because the insomnia improved slightly, I slept more, and the mood improvement went away).

I already mentioned Paxil CR was great to me. Very early response upon going up to the 25 mg (which I have now read could possibly be indicative of bipolar II which I would have never even considered for myself until reading more about how subtle it can be on here. This is partly why I am hesitant to say I am definitely atypically depressed though it seems to be the most consistent with my history and symptoms.)

Finally, another phenomenon I have CONSISTENTLY experienced is that when I come off SSRI's, I feel better for like a day or two. Like consistently with almost all that I have tried from Zoloft to Prozac to Lexapro (and maybe even Cymbalta which I know is an SNRI). I have tried to find similar testaments on here but don't know what search terms to use for this phenomenon. It happened again when I went down from 37.5 mg to 25 mg in my second trial of Paxil CR after the initial "poop-out". A few days after the decrease, one day I woke up feeling good, wanting to go out and do stuff. Not manic (I dont think) or anything euphoric but feeling like I felt when I was a kid. Crazy. Just not depressed. And this has happened consistently across all or most of the SSRI's. Can anyone shed any light on this at all???

Well, that's all I have for now. I will check back in a day or so and see if anyone has responded. Any feedback or suggestions are welcome. I am determined to figure out something that works because I have had glimpses of how good life can be.

Best of luck to all of you in your quests to be well and a happy (as possible) holidays to you all.





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