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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 29. Go back in thread:
Posted by sid on February 27, 2002, at 20:27:23
In reply to Atypical Depression, posted by Automated Lady on February 25, 2002, at 13:15:23
I recently read that MAOIs work best on atypical depression. I have to check other sources though... I had atypical depression too, so I want to know for sure.
Posted by Kat26 on February 27, 2002, at 22:54:00
In reply to Re: Atypical Depression » Automated Lady, posted by sid on February 27, 2002, at 20:27:23
From what I have read, both SSRIs and MAOIs work better for atypical depression than tricyclics.
Kat26
Posted by Elizabeth on February 28, 2002, at 2:13:48
In reply to Atypical Depression, posted by Automated Lady on February 25, 2002, at 13:15:23
Hi. I don't know if atypical depression is diagnosed outside the U.S. The only medications that are definitely known to be effective are MAO inhibitors. Tricyclics are not very effective and probably should be considered a last resort. ECT seems not to be very effective either. Newer antidepressants might work, but there's less evidence for them than there is for MAOIs. I've definitely heard of successes with SSRIs and Wellbutrin.
Seasonal depression often presents with atypical features. It's a good idea to try to determine whether you have a seasonal pattern, since seasonal depression often responds to light therapy.
"Atypical depression" is really a misnomer; it's very common, probably much more common than "classic" depression. Early-onset depression is more likely to be atypical, I think. On the other hand, I'm about your age and have childhood-onset depression, but I have "typical" symptoms. I think that's unusual, though.
-elizabeth
Posted by Sparkboy on March 1, 2002, at 1:07:43
In reply to Atypical Depression, posted by Automated Lady on February 25, 2002, at 13:15:23
> Just found out about atypical depression.... why have I never been told about this by any of the doctors or psychiatrists/counsellors I've seen? Can anyone else tell me about their experiences being diagnosed with this, or is it something they only recognise in the US?
>
> I've been struggling with depression since my teens (I'm now 24) and have never understood why it just wouldn't go away, why no medication really seemed to work, and why I was sleeping and eating so much when you're supposed to lose weight and not sleep when depressed (this was made worse because my mother suffered "classic" depression and I think expected mine to take the same course as hers).
>
> Anyone id, and what kind of medication has worked?
>
> ALHello. Yeah, this sounds like atypical depression. Younger onset and chronic, along with the more notorious symptoms you describe. I wouldn't waste time on re-uptake inhibitors (non-MAOIs). MAOIs defined atypical depression in the late '50s, when some doctors described the peculiarities of a group of patients who ONLY responded to an MAOI and not imipramine (tricyclic) or ECT. I found it interesting that the biology (a selective drug response) defined this illness rather than a subjective cataloging of symptoms. I think modern researchers muddy the definition of atypical depression by a seeming unawareness of the history.
Parnate was the only thing that ever worked for me. Nardil is also used. Marplan is another. Despite recent publicity, I don't think atypical depression is all that common. I struggled for years with useless meds, many doctors, and no definitive diagnosis, until I finally went to a university medical center, got a correct diagnosis, and treated with an MAOI.
--John
Posted by jsarirose on March 1, 2002, at 2:53:58
In reply to Re: Atypical Depression » Automated Lady, posted by Sparkboy on March 1, 2002, at 1:07:43
> > Just found out about atypical depression.... why have I never been told about this by any of the doctors or psychiatrists/counsellors I've seen? Can anyone else tell me about their experiences being diagnosed with this, or is it something they only recognise in the US?
> >
> > I've been struggling with depression since my teens (I'm now 24) and have never understood why it just wouldn't go away, why no medication really seemed to work, and why I was sleeping and eating so much when you're supposed to lose weight and not sleep when depressed (this was made worse because my mother suffered "classic" depression and I think expected mine to take the same course as hers).
> >
> > Anyone id, and what kind of medication has worked?
> >
> > AL
>
> Hello. Yeah, this sounds like atypical depression. Younger onset and chronic, along with the more notorious symptoms you describe. I wouldn't waste time on re-uptake inhibitors (non-MAOIs). MAOIs defined atypical depression in the late '50s, when some doctors described the peculiarities of a group of patients who ONLY responded to an MAOI and not imipramine (tricyclic) or ECT. I found it interesting that the biology (a selective drug response) defined this illness rather than a subjective cataloging of symptoms. I think modern researchers muddy the definition of atypical depression by a seeming unawareness of the history.
>
> Parnate was the only thing that ever worked for me. Nardil is also used. Marplan is another. Despite recent publicity, I don't think atypical depression is all that common. I struggled for years with useless meds, many doctors, and no definitive diagnosis, until I finally went to a university medical center, got a correct diagnosis, and treated with an MAOI.
>
> --JohnWow - I could have written that. I've had atypical depression for years (since 11 years old, now 34). Just started Parnate (my first MAO) this year. It really seems to be helping. Prozac did help for a year or so several years ago, but believe me I've been on almost every drug out there. I'm at 90mg of Parnate now and feeling much better. I know it's a high dose - but I've read a lot about atypical depression sometimes needing a higher dosage.
I'm starting to feel not quite as great lately, may have to tweak the dosage and/or add something to it though.
-Jessica
Posted by Sparkboy on March 1, 2002, at 23:10:08
In reply to Re: Atypical Depression, posted by jsarirose on March 1, 2002, at 2:53:58
It's terrible when you're that young because you really have no frame of reference for what normal is. I was always a little nervous and reserved, but it gradually got worse and when I hit teen years my nerves went completely haywire. I hid it for a long time. It was many years later and my first experience with Parnate that I realized that my "normal" is terrible. That level of anxiety should be experienced only by someone undergoing a bad life experience and not as a matter of course in day to day living. I think the oversleeping developed as an escape and to further short-circuit the system and dull some of the anxiety. Parnate showed me what normal can and should be. A calmness and warmth most people take for granted.
Unfortunately, it only worked for 3 months before I crashed off of it. Before that, I had relapses, where the anti-depressant effect would fade out for periods of time, like a radio station in the hills. Very strange, but I learned that most of my difficulties stem from a painful baseline emotion, and lack of pleasure. There is certainly no bad background to account for it. Retrials of Parnate failed even more quickly. My high dose was 60 mg/day. After the AD effect failed, side-effects intensified and higher doses were not possible. A specific response to Parnate makes me believe something is awry with the dopamine system because Parnate is a modified amphetamine molecule and very active on dopamine. I found no substitute and have had to settle for various meds to manage anxiety and sleep. Haven't been bothered with oversleeping or leaden fatigue for several years now, but anxiety and social phobia are still problems.
I read on here that gepirone, a new drug still in stage 3 trials, may help as many as 40% of atypicals. We can hope.
--John
Posted by Else on March 2, 2002, at 17:37:58
In reply to Re: Atypical Depression » Automated Lady, posted by Elizabeth on February 28, 2002, at 2:13:48
This link might be helpful:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10698808&dopt=AbstractApparently a study conducted at Columbia University indicated that fluoxetine was NOT more effective than imipramine for atypical depression, although it was better tolerated.
Posted by Automated Lady on March 4, 2002, at 7:31:30
In reply to Re: Atypical Depression » jsarirose, posted by Sparkboy on March 1, 2002, at 23:10:08
It's interesting what you said about Parnate because when I was in my mid-teens I discovered speed and it was my lifeline for about four years (until it all went horribly wrong..) but it was like it made me normal.
Posted by Sparkboy on March 4, 2002, at 23:16:57
In reply to Re: Atypical Depression - Sparkboy, posted by Automated Lady on March 4, 2002, at 7:31:30
> It's interesting what you said about Parnate because when I was in my mid-teens I discovered speed and it was my lifeline for about four years (until it all went horribly wrong..) but it was like it made me normal.
I never thought of anything like that in high school--way too social phobic, and just plain phobic. As far as speed, you must mean meth. I wonder how different that is from Dexedrine. I once had low dose Dexedrine prescribed as augmentation for Zoloft. I got very little of the expected lift, and after a couple of days got a real sour irritability. I've never had euphoriant feelings from any drug, and very little of the pleasantness from ordinary things like caffeine and alcohol, and so I've not been a substance abuser. When my Parnate was working, though, I drank a cup of coffee and finally realized why people like that stuff so much, other than taste. I think Parnate actually corrected the problem while it worked. I had high hopes for the dopamine re-uptake inhibitor amineptine, but it was banned in Europe, due to drug war idiocy. It helped people with retarded, anhedonic type depressions where nothing else would. Biopsychiatry.com talks about it under the section titled "the dopamine connection."
--John
Posted by Automated Lady on March 6, 2002, at 6:35:41
In reply to Re: Atypical Depression - Sparkboy » Automated Lady, posted by Sparkboy on March 4, 2002, at 23:16:57
Speed, in the UK, just means amphetamine sulphate - don't know if that's what you mean by meth? I can't get an NHS doctor who'd even consider mixing one med with another (too expensive). They don't even ask you any questions about what your specific symptoms are. I'm getting very tired of the whole thing. Just came off Efexor (which just made me sleep hours and hours and eat myself out of house and home) and now trying Celexa again, but not particularly hopeful about that either. Anyway...
Posted by Sparkboy on March 6, 2002, at 14:52:59
In reply to Re: Atypical Depression - Sparkboy » Sparkboy, posted by Automated Lady on March 6, 2002, at 6:35:41
> Speed, in the UK, just means amphetamine sulphate - don't know if that's what you mean by meth? I can't get an NHS doctor who'd even consider mixing one med with another (too expensive). They don't even ask you any questions about what your specific symptoms are. I'm getting very tired of the whole thing. Just came off Efexor (which just made me sleep hours and hours and eat myself out of house and home) and now trying Celexa again, but not particularly hopeful about that either. Anyway...
The form we have so much trouble with illicit manufacture in the US is called methamphetamine. It may be a more potent form, I don't know. I do recall that how a patient responds to a challenge dose of amphetamine is supposed to tell the doctor something about your likely response to AD medication.
Effexor was just ineffective for me. A worsening of classic atypical symptoms would lead me to dump Effexor too. If you've been diagnosed with atypical depression, I hope you'll give serious consideration to an MAO inhibitor. My experience is that most other meds are a waste of time. Amisulpride, an anti-psychotic drug you have over there, has pro-dopamine activity at low doses (50-150 mg/day). This is below the anti-psychotic dosage range. It has a reputation for helping anhedonia and dysthymia, a persistent low-grade depression. Such conditions have been likened to the "negative symptoms" (lack of ..) symptoms of schizophrenia.
--John
Posted by Sparkboy on March 6, 2002, at 15:36:03
In reply to Re: Atypical Depression » Automated Lady, posted by Elizabeth on February 28, 2002, at 2:13:48
Elizabeth, you've had much more access to text materials than I, and was wondering if you can suggest any textbooks or other publications with a discussion of atypical depression. I found a whole chapter I copied out of a book years ago, but that was published in 1989. Are there any more recents works that give insight into this frustrating disorder?
After Parnate quit working, I've been managing with low doses of various meds--moclobemide, Neurontin, Ativan--but the anxiety and social phobia have been to the point of disability. Any ideas? Lamictal sounds a little too scary, but I wonder if it could help something like this. Mostly I'd like to get back the Parnate-derived calmness and warmth that made me feel connected to people.
--John
Posted by jsarirose on March 6, 2002, at 19:29:06
In reply to Re: Atypical Depression » Elizabeth, posted by Sparkboy on March 6, 2002, at 15:36:03
> Elizabeth, you've had much more access to text materials than I, and was wondering if you can suggest any textbooks or other publications with a discussion of atypical depression. I found a whole chapter I copied out of a book years ago, but that was published in 1989. Are there any more recents works that give insight into this frustrating disorder?
>
> After Parnate quit working, I've been managing with low doses of various meds--moclobemide, Neurontin, Ativan--but the anxiety and social phobia have been to the point of disability. Any ideas? Lamictal sounds a little too scary, but I wonder if it could help something like this. Mostly I'd like to get back the Parnate-derived calmness and warmth that made me feel connected to people.
>
> --JohnYou shouldn't be scared by Lamictal. I tried it, it just didn't seem to do much for me. Although after I stopped I heard I could have gone much higher in dosage, I just didn't want to start the lengthy creeping up period again. You can go very high with it though (my friend takes a large dose) and neither of us have had any real side effects. There are much worse drugs out there - I tried Tegretol and that's one of the worst I've ever been on - and I've been on many, many different drugs. But then I know people that take that too without the side effects I had, maybe for those that it works for the side effects are minimal as they are getting something their body needs.
Anyway, if your doc suggests Lamictal, you may want to try it starting low and creeping up.
Posted by Sparkboy on March 7, 2002, at 16:39:07
In reply to Re: Atypical Depression, posted by jsarirose on March 6, 2002, at 19:29:06
> You shouldn't be scared by Lamictal. I tried it, it just didn't seem to do much for me. Although after I stopped I heard I could have gone much higher in dosage, I just didn't want to start the lengthy creeping up period again. You can go very high with it though (my friend takes a large dose) and neither of us have had any real side effects. There are much worse drugs out there - I tried Tegretol and that's one of the worst I've ever been on - and I've been on many, many different drugs. But then I know people that take that too without the side effects I had, maybe for those that it works for the side effects are minimal as they are getting something their body needs.
>
> Anyway, if your doc suggests Lamictal, you may want to try it starting low and creeping up.Thanks. I'm not too serious about trying it yet, but it's the only other thing I haven't tried.
Posted by Automated Lady on March 8, 2002, at 5:35:46
In reply to Re: Atypical Depression » Automated Lady, posted by Sparkboy on March 6, 2002, at 14:52:59
On MAOIs, I'm just a bit worried by what I've heard about their effect on cognitive ability and memory. I also saw my best friend on Chlorpromazine and was scared by the way it changed him (and I know MAOIs are related). Have you found problems like this?
Posted by jsarirose on March 8, 2002, at 14:41:28
In reply to Re: Atypical Depression » Sparkboy, posted by Automated Lady on March 8, 2002, at 5:35:46
> On MAOIs, I'm just a bit worried by what I've heard about their effect on cognitive ability and memory. I also saw my best friend on Chlorpromazine and was scared by the way it changed him (and I know MAOIs are related). Have you found problems like this?
I haven't found any problems and I take 90mg daily. I still drive and go about my daily activities as usual. The only time I don't feel well from it physically and mentally is when I forget to take a dose or take it very late. On a lower dose it didn't bother me, but now I notice if I'm a couple hours late with my first dose (I split my doses and take 50mg when I get up around noon, and another 40mg four hours later.) Like I said I sometimes forget the later dose for a while and I'm still okay, but if I forget the first dose then I feel a little dizzy, foggy, and generally unenergetic. Taking the dose and waiting a while makes me feel okay again. Since I moved to live by myself I've had a harder time making sure I wake up at around the same time each day and take it around the same time each day.
I do take Clonazepam (not Chlorpromazine) at a very low dose to help me sleep. Otherwise I really toss and turn if I don't take anything. I only take about .075mg of it a night. I'm still trying to find the right dose to not oversleep and still sleep soundly. People that take Clonazepam for it's real use (as a stabilizer) take a much higher dose and I can see how it might effect them mentally and physically. So far the only reaction I've had is if I take too much and then I'm just really tired. There are other meds out there to take for sleep too - I used to Trazadone which works great for me too.
I think the trick for me is staying steady with the amount of meds I take and the time I take them. (I seem to go through periods when I'm better and worse with this task.)
Hope that helps!
-Jessica
Posted by Sparkboy on March 8, 2002, at 17:24:23
In reply to Re: Atypical Depression » Sparkboy, posted by Automated Lady on March 8, 2002, at 5:35:46
> On MAOIs, I'm just a bit worried by what I've heard about their effect on cognitive ability and memory. I also saw my best friend on Chlorpromazine and was scared by the way it changed him (and I know MAOIs are related). Have you found problems like this?
When Parnate worked for me, I experienced cognitive clearing, improved memory, calmness, clarity and promptness in decision making, went to sleep without trouble and without oversleeping, and felt at peace with myself for the first time in years. Everyone reacts differently to these drugs, though, even with the same diagnosis. If Parnate doesn't work out, there's Nardil, Marplan, or Aurorix. Chlorpramazine is a phenothiazine anti-psychotic, chemically unrelated to MAO inhibitors. It was used for psychosis and schizophrenia, conditions unrelated to atypical depression.
--John
Posted by Automated Lady on March 10, 2002, at 17:46:54
In reply to Re: Atypical Depression » Automated Lady, posted by Sparkboy on March 8, 2002, at 17:24:23
Okay then.. and sorry to keep going on.. but what about weight gain? And how do you handle the diet?
Posted by jsarirose on March 10, 2002, at 21:27:21
In reply to Re: Atypical Depression » Sparkboy, posted by Automated Lady on March 10, 2002, at 17:46:54
> Okay then.. and sorry to keep going on.. but what about weight gain? And how do you handle the diet?
The reason my doctor put me on Parnate as opposed to Nardil or any other MAOI is specifically because it's not supposed to promote weight gain. I've actually lost some weight since I started Parnate. Nothing too dramatic, but I'm definitely not gaining anymore.
Like said though, Parnate is specifically supposed to be better for this particular side effect than the other MAOIs if weight gain is a concern of yours. For me, I'm already greatly overweight, so any weight gain is bad.
-Jessica
Posted by Automated Lady on March 11, 2002, at 12:11:43
In reply to Re: Atypical Depression, posted by jsarirose on March 10, 2002, at 21:27:21
Okay, thanks Jessica. What about other side effects? Are they really that much worse than SSRIs?
Posted by jsarirose on March 11, 2002, at 17:36:24
In reply to Re: Atypical Depression » jsarirose, posted by Automated Lady on March 11, 2002, at 12:11:43
> Okay, thanks Jessica. What about other side effects? Are they really that much worse than SSRIs?
Well, the worst is of course the diet restrictions that are the same for any MAOI. Other than that, I don't find the side effects any different than various SSRI's really. Every drug seems to have it's slight side effects and some are more tolerable than others. With Parnate, I get slightly dry mouth (but tolerable, not as bad as some drugs I've been on). I do have to take it at the same time every day or I start feeling bad. It's hard to describe bad, but physically I feel tired, shaky, and generally bad (sorry I can't be more descriptive). Because I take a higher than normal dose (90mg) I split it into two doses per day. It's just the first dose (50mg) that needs to be around the same time every day. I've varied the second dose (40mg) up to an hour or more (when I forget) and I still feel okay. Another side effect is that it makes it difficult to sleep. My doctor prescribed clorazepam for this (an anti-convulsant) and I take an extremely low dose (about .75mg/night) before I go to bed and sleep normally. No side effects from this med. And there are others that you can take to help sleep too.
The only other thing about Parnate (and I think all MAOIs) is that you need to watch your blood pressure. In general, it lowers your blood pressure and you don't want it too low. I get a reading every two weeks, standing and sitting. Once in a while I get dizzy when I stand quickly, especially if I was bending over. In general, I don't notice though. And I've never had a blood pressure problem in the past and it's still at an acceptable level. The paradox is, if you err with the diet your blood pressure can shoot way up and you can have extreme adverse effects. Your doctor will probably give you an emergency pill to counteract that effect or you have to call 911. I have had to take my pill before. I've heard people get different things prescribed, but my doctor gave me thorazine which lowers my blood pressure if necessary, but not so low that if I take it when I'm not elevated that it will harm me. I really should have a blood pressure cuff at home, but I don't yet. I've only had to take the thorazine once and it basically knocked me out and I just slept for a couple days. (Thorazine has a bad reputation, but it you aren't taking it on a regular basis it won't turn you into a walking mummy like the movies always portray.)
With Parnate, the books and company recommend a dose no higher than 60mg. However, more recent research has shown that people with treatment resistent depression (which I have) have had success with higher doses. Most information states you can go up to 130mg, although I've read of isolated cases where people go much higher. I wouldn't recommend going past the 130mg though. Since it only comes in 10mg increments, it's best to start with that anyway. And like I said, I take 90mg. I found 100mg makes me too dizzy.
Hope that helps. In general, it's really helped me. I don't quite feel perfectly normal, but it's helped more than anything else I've tried in years.
-Jessica
Posted by Sparkboy on March 12, 2002, at 0:39:59
In reply to Re: Atypical Depression » Sparkboy, posted by Automated Lady on March 10, 2002, at 17:46:54
> Okay then.. and sorry to keep going on.. but what about weight gain? And how do you handle the diet?
BTW, I haven't taken Parnate in quite a while (quit working). Parnate usually curbs appetite. The diet didn't bother me too much. All I had to cut out was pizza and cheese. Some people are more susceptible than others to a hypertensive reaction. I was never bothered. Warning signs include stiff neck and/or pounding headache. Follow the diet and you shouldn't have any trouble.
Posted by Automated Lady on March 12, 2002, at 12:43:19
In reply to Re: Atypical Depression, posted by Sparkboy on March 12, 2002, at 0:39:59
Posted by jsarirose on March 12, 2002, at 16:26:13
In reply to Thanks people! (nm), posted by Automated Lady on March 12, 2002, at 12:43:19
But wait, wordy-Jessica has one more thing to say! I can define "bad" a little better since I woke up about 2 1/2 hours later than usual (hence took first dose late). It makes me feel dizzy and not hungry yet I know I should take my pills and eat to feel better. I think the dizziness is what I couldn't put my finger on. I don't know why a med that lowers your blood pressure would make you feel dizzy when you miss a dose, but that's the perfect description.
-Jessica
Posted by luther on January 31, 2004, at 5:43:13
In reply to Atypical Depression, posted by Automated Lady on February 25, 2002, at 13:15:23
> Just found out about atypical depression.... why have I never been told about this by any of the doctors or psychiatrists/counsellors I've seen? Can anyone else tell me about their experiences being diagnosed with this, or is it something they only recognise in the US?
>
> I've been struggling with depression since my teens (I'm now 24) and have never understood why it just wouldn't go away, why no medication really seemed to work, and why I was sleeping and eating so much when you're supposed to lose weight and not sleep when depressed (this was made worse because my mother suffered "classic" depression and I think expected mine to take the same course as hers).
>
> Anyone id, and what kind of medication has worked?
>
> ALHi Lady,
I'm sorry to say most doctors are worthless and I wish I could write my own prescriptions. I was misdiagnosed with just depression even though all the symptoms I had written down and given to the doctor suggested Atypical Depression. I'm a graduate of Ball State University and as an Alumni I could check out books on psychology. After doing my own research I found I had Atypical Depression. Many disorders go along with it: Social Anxiety Disorder and Generalized Anxiety Disorder to name a few. I had all three and had to self diagnose myself and find out what medications to take as well. I found Nardil to work best for SSAD and Valium best for GAD and after I convinced my doctor of this, guess what? I felt better than I could ever remember since my symptoms kicked in at age 16. I am having problems with the new Gluten free Nardil, it stopped working cold turkey after 12 years of use. I have found on this site I'm not the only one with this problem. I'm looking into Marplan as I have tried Parnate in the past and found it far to stimulating, most likely due to my GAD. Has anyone had any experience with Marplan and how does it compare to Nardil, thank's.
Sincerely,
Luther
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