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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by pat c. on December 1, 2001, at 8:26:22
I'm thinking about taking Celexa, because I'm now getting "major" depression along with my "atypical" depression. This is called "double depression".
I'm taking Wellbutrin to help with the "major"
depression, and it helps, but it gives me GAD and anxiety attacks. Since I also suffer from atypical depression, I'm obviously very sensitive to stimulants like Wellbutrin. Neurontin and Klonopin help offset some of the anxiety caused by Wellbutrin.So, I'm thinking about Celexa. I've heard great things about it. I've tried all the other SSRIs and they all failed. Is Celexa just like the rest of the SSRI group?
Again, maybe it's time to take an SSRI at least to combat the "major" depression.
Any thoughts would be helpful.
Thanks.
Pat
Posted by JohnDoenut on December 1, 2001, at 10:59:19
In reply to Celexa vs. Wellbutrin, posted by pat c. on December 1, 2001, at 8:26:22
> I'm thinking about taking Celexa, because I'm now getting "major" depression along with my "atypical" depression. This is called "double depression".
What is atypical depression?
Also vs major?thanks.
Posted by Twain on December 1, 2001, at 20:55:23
In reply to Re: Celexa vs. Wellbutrin, posted by JohnDoenut on December 1, 2001, at 10:59:19
Hi,
Search for "atypical depression" and look for anything posted by Elizabeth. She really nails down the definition in one post but I can't find it.
I'm trying to figure out a way to search for posts by a particular person. Am I missing something?
Posted by KB on December 1, 2001, at 22:48:33
In reply to Celexa vs. Wellbutrin, posted by pat c. on December 1, 2001, at 8:26:22
I take both Celexa and Wellbutrin - I started out with Celexa, and felt better but had no energy, so I added Wellbutrin to balance it out. I tend towards more atypical symptoms, and didn't experience what you describe on Wellbutrin, but maybe because I was already taking Celexa.
Posted by Dr. Bob on December 2, 2001, at 0:13:38
In reply to Re: Celexa vs. Wellbutrin » JohnDoenut, posted by Twain on December 1, 2001, at 20:55:23
> I'm trying to figure out a way to search for posts by a particular person. Am I missing something?
No, unfortunately, it's a missing feature:
http://www.dr-bob.org/babble/admin/20010315/msgs/1008.html
You don't know Perl, by any chance, do you? :-)
Bob
PS: Any follow-ups regarding searching should be redirected to the above thread, thanks.
Posted by Twain on December 2, 2001, at 1:08:41
In reply to Re: search for posts by a particular person, posted by Dr. Bob on December 2, 2001, at 0:13:38
Hi Dr. Bob,
I don't know Perl.
This is a great site. I wish my doctor and pharmacist would visit psychobabble and find out what's really going on.
best wishes,
verne
Posted by pat c. on December 2, 2001, at 11:01:08
In reply to Re: Celexa vs. Wellbutrin, posted by JohnDoenut on December 1, 2001, at 10:59:19
Atypical depression is a mix of social phobia, chronic anxiety (panic)attacks, and depression. Oversleeping is a trait, and appetite is not an issue. But the most determining factor of atypical is mood reactivity. For example, if you think someone ignored you (rejection), you made a simple mistake, or stumbled over a word, you then blow that out of proportion and believe the world is coming to an end. You'll probably have an anxiety attack and follow-on depression with that. On the other hand, a postive event, like a compliment, a success or somebody showing a positive interest in you, can cheer you up immediately, and make you feel like nothing is wrong until you encounter another negative stimuli. Bottom line it's a rollor coaster of emotions. MAOIs (especially Nardil) have been most effective drug in this category, but you've got to deal with the side effects and the diet.
With major depression, there is no rollar coaster. Nothing can cheer you up. You don't care or think about eating. You always feel down, and seriously down. For me, I was in a black hole of sadness and misery. SSRIs supposedly work well on major. It depends on the person. Wellbutrin defintely gets you out of the black hole and pulls you out of the pit of depression. Neurontin will get you out of the pit, but it's not strong enough. I assume the trycylcics and MAOIs work on major as well.
Posted by Elizabeth on December 2, 2001, at 16:19:48
In reply to Difference btwn Atypical Major Depression » JohnDoenut, posted by pat c. on December 2, 2001, at 11:01:08
> Atypical depression is a mix of social phobia, chronic anxiety (panic)attacks, and depression.
No, it's not. Social phobia, generalized anxiety, and panic attacks can co-occur with atypical depression, but they aren't symptoms of atypical depression. They also are not specific to atypical depression; people with all types of depression can have anxiety, including full-blown anxiety disorders. Atypical depression is *not* defined as "depression with anxiety." Anxiety is not even part of the definition.
> Oversleeping is a trait, and appetite is not an issue.
Appetite is often a serious issue for people with atypical depression: they tend to overeat when depressed, instead of eating less.
> But the most determining factor of atypical is mood reactivity. For example, if you think someone ignored you (rejection), you made a simple mistake, or stumbled over a word, you then blow that out of proportion and believe the world is coming to an end.
Mood reactivity (being able to be cheered up from depression temporarily) and rejection sensitivity (which is what you're describing) are considered two different things, but both of them are features of atypical depression.
"Major depression" is a general term for any type of depression of a certain level of severity. People who have atypical depression may have "major depression with atypical features" or they may have "dysthymia with atypical features." Sometimes people with bipolar disorder have atypical depressions. Seasonal depression often has atypical features.
Major depression may or may not be mood-reactive. Most people with major depression have some degree of mood-reactivity. I think that people who are depressed often feel like nothing can cheer them up even if sometimes they can be cheered up, so (IMO) mood-reactivity is best assessed by observing the person rather than just asking them (self-reports can be misleading).
The symptoms you mentioned -- absense of mood-reactivity, not eating, feeling bad all the time -- are usually associated with "melancholic depression," not with major depression in general.
You didn't describe melancholic depression completely and I'm not saying that's necessarily what you have, but not everyone with major depression has completely nonreactive mood and appetite loss, for example. Again, major depression is not a qualitative subtype of depression.
"Atypical" and "melancholic" are not the only two types of depression, and most depressions probably don't fall under either category.
Tricylics do not work very well for atypical depression; ECT has not been studied much in atypical depression and has a reputation for being relatively ineffective. MAOIs are known to work well, and SSRIs and newer antidepressants also may work although it's not clear whether they work as well as MAOIs. (There is no evidence that Nardil works better than Parnate, or vice versa, in atypical depression.)
The antidepressants best known to work for melancholic depression are the tricyclics, Remeron, Effexor, and ECT. There is not much evidence regarding the use of MAOIs for melancholic depression, but what evidence exists is positive. There is some evidence that SSRIs do not work well for melancholic depression.
The reason why researchers come up with different categories like this is because they hope that the categories will prove helpful in predicting treatment response. If all you know about someone is that they have "major depression," you don't have enough information to predict what kind of antidepressants would be most likely to work for them (and therefore best to try first).
Here are a couple of web sites that discuss different types of depression:
http://www.mentalhealth.com/dis1/p21-md01.html (definition and description of major depressive disorder)
http://www.lorenbennett.org/atypical.htm ("atypical depression - pharmacotherapy response and diagnostic validity" - includes definition)
http://www.holisticonline.com/Remedies/Depression/dep_types_melancholic.htm ("depression with melancholic features" - good general description and list of symptoms)
http://www.postgradmed.com/issues/1996/07_96/mallakh.htm ("Clues to depression in primary care practice" - includes diagnostic criteria for melancholic features)
-elizabeth
Posted by pat c. on December 2, 2001, at 16:52:56
In reply to Re: atypical, major, etc. - comments » pat c., posted by Elizabeth on December 2, 2001, at 16:19:48
Whatever.
I've only been researching atypical depression
for 15 years, most of which time I've been
dealing with Fred Quitkin and his
team at NY Psychiatric (Columbia).I'm not as knowledgable about the other forms of depression.
Pat
Posted by Elizabeth on December 2, 2001, at 17:20:17
In reply to Re: atypical, major, etc. - comments » Elizabeth, posted by pat c. on December 2, 2001, at 16:52:56
Pat,
You might be interested to know that "atypical depression" used to be a vague term that was used to mean a lot of different things. Quitkin and some of his colleagues were largely responsible for the more precise, well-validated definition we have today (it actually dates back to before 1980; in that year, it was published in DSM-III).
Researching a subject over a long period of time can be very fruitful, of course, but one has to remember to make sure one's facts are accurate and up-to-date.
In what capacity have you been doing this research, BTW?
-elizabeth
Posted by JohnDoenut on December 3, 2001, at 4:35:57
In reply to Re: atypical, major, etc. - comments » pat c., posted by Elizabeth on December 2, 2001, at 17:20:17
Thanks for the info people.
Ill look at those websites!I wonder if you just put in the search not only keywords but the persons id if that will narrow down the posts it finds?! Worth a shot to try. I shall.
Posted by nightlight on December 3, 2001, at 8:04:01
In reply to Re: atypical, major, etc. - comments » pat c., posted by Elizabeth on December 2, 2001, at 16:19:48
Dear Elizabeth,Thanks for the interesting links! Tempts me to spend the morning perusing them, but I was a good girl, bookmarked instead, and now will try to make it to my 4 hr. a.m. shift at the store. (Big whoop, but I AM working).
Also, must bet my pre-schooler to to her 'work' by 9:15 so her 'perfect' teacher doesn't impose corporeal punishment upon me, the ADD, nerves-addled, depressive mom, who is often late (b/c I do dumb, distracting things like reading P-B in the a.m., when I shd. be getting ready).
Hope you are feelin' OK this Dec. Monday.
My dex has kicked in, so must rush, & maybe, I'll make it on time!
sincerely~nightlight
Posted by Bill L on December 3, 2001, at 9:28:07
In reply to Celexa vs. Wellbutrin, posted by pat c. on December 1, 2001, at 8:26:22
Celexa is not just like the others. The SSRI's are all different even though they all block serotonin reuptake (or atleast that's the theory). The only 2 prescription AD's I have taken are Pozac and Celexa. I currently take Celexa. Prozac made me too jittery. Celexa is more calming for me.
> I'm thinking about taking Celexa, because I'm now getting "major" depression along with my "atypical" depression. This is called "double depression".
>
> I'm taking Wellbutrin to help with the "major"
> depression, and it helps, but it gives me GAD and anxiety attacks. Since I also suffer from atypical depression, I'm obviously very sensitive to stimulants like Wellbutrin. Neurontin and Klonopin help offset some of the anxiety caused by Wellbutrin.
>
> So, I'm thinking about Celexa. I've heard great things about it. I've tried all the other SSRIs and they all failed. Is Celexa just like the rest of the SSRI group?
>
> Again, maybe it's time to take an SSRI at least to combat the "major" depression.
>
> Any thoughts would be helpful.
>
> Thanks.
>
> Pat
This is the end of the thread.
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