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Re: Brain Signature for Melancholia Identified » SLS

Posted by Robert_Burton_1621 on February 21, 2015, at 13:45:13

In reply to Re: Brain Signature for Melancholia Identified » Robert_Burton_1621, posted by SLS on February 21, 2015, at 7:51:55

> As per my personal experience, I think bipolar depression may be a hybrid between atypical and melancholic depressions.>

Scott, that's interesting. I note you restrict your speculation about potential hybridity to the depressive phases of bipolar disorder, rather than bipolar disorder generally. I understand that the profoundly anergic depressive phases of bipolar are melancholic; in what respects, in your experience, do you associate some of the symptoms with atypicality? Do you refer to the atypical symptoms of hypersomnolence and hyperphagia?

The other key symptom of atypical depression is reactivity. I have never quite grasped precisely what is involved in this notion. Does it involve mere signs of behavioural reactivity to stimuli or does it require a capacity to derive positive hedonic feedback from such stimuli, if only episodically? If the former, I think it would be difficult to distinguish such behavioural indicia from the capacity merely to *simulate*, mechanically, a degree of seemingly "active" response to direct stimuli. Melancholic depressives do, unless they are in the deepest catatonic state, sometimes have the capacity to perform "mechanical" actions, especially if others are reliant on them or other duties demand a degree of active engagement of them, and may be said, to this extent, to demonstrate "reactivity". If so, what is the clinical role which "reactivity" plays in distinguishing atypicality from melancholia?

> I saw the most severe melancholic depression in a woman who was visiting her mother who lived down he block. It was excruciating to witness the magnitude of psychomotor retardation she displayed. It was like watching slow-motion. She committed suicide soon afterwards.>

This is a harrowing story, and confirms the uttery dehumanising effect of severe psychomotor retardation in melancholia. Apart from being biological systems, we are also meaning-making creatures; and our capacity to apprehend and express our being *as* human presupposes to a great degree, I think, the subtle, imperceptible, connective functionality which links volition, intention, and action (I would count "thinking" as an action): which constitutes, in short, the preconditions to our agency. The profoundly fragmenting and nauseating alienation which psychomotor retardation induces between the body conceived under the aspect of biological object and our *self* as active agent can be unbearable.


> ------------------------------------------

> > http://newsroom.unsw.edu.au/news/health/disruption-brain-signals-sheds-new-light-melancholic-depression

> > For anyone interested in the nosology of depressions and, in particular, the bearing which progress in nosology may have on the classifications authorised by DSM-5, Professor Gordon Parker and his team have just published research which is claimed to isolate (for the first time) an empirically identifiable form of neurobiological dysfunction which is specific to melancholic depression.

> > "Disrupted Effective Connectivity of Cortical Systems Supporting Attention and Interoception in Melancholia" (JAMA Psychiatry, 18 Feb 2015):

> > http://archpsyc.jamanetwork.com/article.aspx?articleid=2119327

> > Part of the resistance to reform of the DSM-5 typologies rests on scepticism as to whether melancholia is a distinct biological form of depression which ought be distinguished clinically from non-melancholic kinds.

> > The results of this recent research may have the effect of rendering such scepticism less presumptively cogent than it has hitherto been.

> > "Issues for DSM-5: Whither Melancholia? The Case for Its Classification as a Distinct Mood Disorder" Am J Psychiatry (2010) 167 (7):

> > http://www.ncbi.nlm.nih.gov/pubmed/20595426

> > What do interested people here think about the plausibility and desirability of classifying melancholia as a distinct nosological type and the consequences such classification may have on diagnosis, treatment, and in particular medication "algorithms"?

> > Professor Parker has been engaged in the broader project of melancholia research for decades. His important edited collection of papers on the topic can be partly read on google books:

> > "Melancholia: A Disorder of Movement and Mood
A Phenomenological and Neurobiological Review", Cambridge UP, 1996

> > https://books.google.com.au/books?id=aQYJbOT4PCUC&printsec=frontcover&dq=Melancholia:+A+Disorder+of+Movement+and+Mood&hl=en&sa=X&ei=bUboVOaEEYrg8gWnsIDwAg&ved=0CB4Q6AEwAA#v=onepage&q=Melancholia%3A%20A%20Disorder%20of%20Movement%20and%20Mood&f=false
> >



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