![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Questionmark on April 18, 2003, at 0:56:08
i've read alot of stuff about atypical depression and what meds can be better for it (e.g., MAOIs esp Nardil), but i rarely see much on melancholic-type depression. i do find that the differences overlap so much that the distinction is kind of a stupid one, er, ambiguous one, for the most part, but nevertheless there seems to be some validity to it/them. i still don't really understand the differences that much besides the technical/offical stuff they list in the DSM-IV.
i think i definitely have melancholic depression and some aspects of atypical as well-- so i guess i have what would be called "mixed." Anyway my question in all of this is-- what meds are especially helpful for melancholic depression (that would be good for atypical as well hopefully)? i read that TCAs can be good, and that SSRIs can be also-- some articles say TCAs are better some say they are about equal. But i haven't been able to come across anything regarding MAOIs or other antidepressants. Does anyone know or have any experience with what might be helpful. Do you think Parnate would be good? Any help would be most appreciated.
Posted by Questionmark on April 18, 2003, at 1:47:50
In reply to Melancholic depression, posted by Questionmark on April 18, 2003, at 0:56:08
A doctor's description of melancholic
depression that i found online (sorry i can't remember the source):
"In melancholic depression, patients seem almost
hyper-aroused; they feel very anxious. The anxiety is
most often about themselves. They often feel they're
not good enough, that they really are deficient human
beings, that it would be hard for someone to love a
person like them and that this is the way they will be
for the rest of their lives — so they have no hope for
the future.
When this is very severe, I don't think that a person
could feel more pain or any worse. The melancholic
depression is also associated with physiological
changes. Folks have insomnia and most often
early-morning awakening; their appetite is decreased;
they generally feel worse in the morning and the
depression improves slightly as the day goes on.
They lose interest in sexual activity; they lose
concentration; and, to a certain extent, all they
think about is how bad they feel. No matter how many
thoughts they have about making it better, they often
really can't arrive at any conclusion at all. They
think it is going to last forever."Except for the early-morning awakening and one other thing, i think that describes me extremely well. Anyone else feel this?
Here's another description i liked, from holistic-online.com:
"Sufferers of depression with melancholic features withdraw into a dense cocoon of misery that nothing can penetrate. Nothing seem to make them happy. Even the most joyful events in life seem empty and have no meaning to them.
The victims of this depression are frigid and have lost the capacity to experience pleasure.
Other symptoms include the disappearance of appetite, severe weight loss, and a terrible problem getting any sleep."
"Here is a typical scenario:
You wake up at 3 A.M. feeling absolutely rotten, desperate, and agitated. You turn on TV but can't watch, pick up a book but can't read, try soothing music but feel irritated by it. You return to bed-but toss, turn, and fret in the endless hours before dawn. As the sun rises, you begin pacing around the apartment but feel no relief or comfort and finally go back to bed. You feel worthless wasting time in bed but you are too washed out to get up.
Your mind is filled with self-criticism, ruminations, catastrophization, and worries.
As the day progresses, you feel a bit better. By late afternoon you are relieved enough to eat a light meal and get dressed. The evening is not fun, but it is not an agitated torture. By 3 A.M. the next morning, however, you are back in the lowest circle of hell."
Posted by mmcasey on April 18, 2003, at 13:27:17
In reply to Re: Melancholic depression, posted by Questionmark on April 18, 2003, at 1:47:50
"You turn on TV but can't watch, pick up a book but can't read, try soothing music but feel irritated by it."
Oh my God! Those descriptions that you put up totally resonated with me, but the part that grabbed me the most was the above quote! That is an exact problem that I've been having for the past few months. I have been depressed for years, with not much treatment success, but I think that the melancholic features of my depression have recently (over the past 4 or so months) really kicked into high gear. Most of the symptoms do fit me, too, except for a few like the early morning waking and severe weight loss. It is the agitation that is getting me... I think another term for it is "agitated depression". I do, however, also feel that I have some symptoms of the atypical depression, mainly the ability to sometimes feel better in response to a positive event (although I certainly can't count on it!).
Anyways, I don't know about treatment - nothing has worked for me - but what I am on now is paxil 40mg, risperdal 1mg, and just started desipramine at a low dose.
Good luck. I know how much it totally SUCKS!!!!!
Posted by falconman on April 18, 2003, at 18:30:29
In reply to Melancholic depression, posted by Questionmark on April 18, 2003, at 0:56:08
> i've read alot of stuff about atypical depression and what meds can be better for it (e.g., MAOIs esp Nardil), but i rarely see much on melancholic-type depression. i do find that the differences overlap so much that the distinction is kind of a stupid one, er, ambiguous one, for the most part, but nevertheless there seems to be some validity to it/them. i still don't really understand the differences that much besides the technical/offical stuff they list in the DSM-IV.
> i think i definitely have melancholic depression and some aspects of atypical as well-- so i guess i have what would be called "mixed." Anyway my question in all of this is-- what meds are especially helpful for melancholic depression (that would be good for atypical as well hopefully)? i read that TCAs can be good, and that SSRIs can be also-- some articles say TCAs are better some say they are about equal. But i haven't been able to come across anything regarding MAOIs or other antidepressants. Does anyone know or have any experience with what might be helpful. Do you think Parnate would be good? Any help would be most appreciated.Hi,
augmenting an AD with an atypical AP seems to be especially effective for melancholic. This article might help. www.psychiatrictimes.com/p021069.htmlPeace
Mark
Posted by Questionmark on April 18, 2003, at 20:00:34
In reply to Re: Melancholic depression, posted by falconman on April 18, 2003, at 18:30:29
mmcasey, thanks for your response. That's interesting. Too bad though. It is terrible, huh?
> "augmenting an AD with an atypical AP seems to be especially effective for melancholic. This article might help. www.psychiatrictimes.com/p021069.html"
Thanks for that article Mark (falconman). i tried 1mg Risperdal when i was on Paxil and it did not help at all though. i duno. Thanks though.
Posted by falconman on April 18, 2003, at 20:17:37
In reply to Re: Melancholic depression, posted by Questionmark on April 18, 2003, at 20:00:34
It is terrible, huh?Yeah whatever it is, its f***ing destroying me
Peace
Mark
Posted by cybercafe on April 18, 2003, at 23:26:12
In reply to Melancholic depression, posted by Questionmark on April 18, 2003, at 0:56:08
melancholic depression involves no mood reactivity, insomnia, hypophagia, less rejection sensitivity
i believe the most effect treatment is thought to be TCAs
> i've read alot of stuff about atypical depression and what meds can be better for it (e.g., MAOIs esp Nardil), but i rarely see much on melancholic-type depression. i do find that the differences overlap so much that the distinction is kind of a stupid one, er, ambiguous one, for the most part, but nevertheless there seems to be some validity to it/them. i still don't really understand the differences that much besides the technical/offical stuff they list in the DSM-IV.
> i think i definitely have melancholic depression and some aspects of atypical as well-- so i guess i have what would be called "mixed." Anyway my question in all of this is-- what meds are especially helpful for melancholic depression (that would be good for atypical as well hopefully)? i read that TCAs can be good, and that SSRIs can be also-- some articles say TCAs are better some say they are about equal. But i haven't been able to come across anything regarding MAOIs or other antidepressants. Does anyone know or have any experience with what might be helpful. Do you think Parnate would be good? Any help would be most appreciated.
Posted by Viridis on April 19, 2003, at 3:46:12
In reply to Re: Melancholic depression, posted by Questionmark on April 18, 2003, at 1:47:50
Those descriptions almost perfectly capture the worst kind of depression that I experience, right down to the insomnia, lack of appetite, obsession with exaggerated problems, most severe in the morning, improving a bit later in the day etc. I had thought that "melancholic" depression connoted sadness, primarily, but that summary is dead on. I've experienced regular episodes of that state since I was a child, and have only found relief in the last couple of years .
Benzos have pretty much eliminated that kind of depression for me, and stimulants further improve things. "Real" antidepressants that I've tried make everything worse, alhough I haven't tried the whole spectrum by any means -- mainly SSRIs/SNRIs. I'm pretty happy with my current mix (Klonopin/Xanax/Adderall/Neurontin); even if it's somewhat nonstandard, at least I have no side effects, and it works.
Posted by BrittPark on April 20, 2003, at 12:36:08
In reply to Melancholic depression, posted by Questionmark on April 18, 2003, at 0:56:08
My depressions have always been text book melancholic. The medication combo that has worked best for me in accute phases is imipramine and xanax. After years of recurrent depression I take imipramine prophylactically and add xanax to get through breakthrough episodes. YMMV.
There is clinical lore that TCAs are somewhat better than other classes of ADs for melancholic depression. I don't know how much research there is to back that up.
Feel Better
Britt
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.