Psycho-Babble Medication Thread 929182

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Atypical Depression versus Bipolar Depression

Posted by SLS on December 14, 2009, at 7:26:02

Atypical depression and bipolar depression look very similar. Anergia and reverse vegetative symptoms predominate (hypersomnia, hyperphagia, and leaden paralysis). However, mood-reactivity seems to be a feature specific to atypical depression, although it does not always manifest. This is still being debated. It may be that there is a great deal of misunderstanding between posting members of Psycho-Babble when an atypical compares themself to a bipolar and doesn't understand why the bipolar is not reactive to the same things that they are. Perhaps this includes psychotherapy and exercise.

Has anyone noted other differences between atypical and bipolar depressions?


- Scott

 

Re: Atypical Depression versus Bipolar Depression SLS

Posted by Phillipa on December 14, 2009, at 7:38:32

In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02

I always thought bipolar had different poles meaning high, normal, low all different lengths for different people. And the depression alone was just flat out depression. Phillipa

 

Re: Atypical Depression versus Bipolar Depression

Posted by uncouth on December 14, 2009, at 12:02:02

In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02

well I'm not sure what my official dx is but I feel that i've experienced both bipolar depression and atypical depression over the years. for me, bipolar depression is associated with more anguish, whereas atypical depression can be 'lived with' more readily. i think i worked for 2 years while dealing with atypical depression. i was far from 100% productive, but during a bipolar depression, I don't think I could have worked at all.

quite simply i think many bipolar depressions have a varying amount of 'mixed' states to them, so even if the body may be slow, some aspects of mind (rumination, guilt, self-consciousness, psychic pain) are running full blast.

 

Re: Atypical Depression versus Bipolar Depression SLS

Posted by Phidippus on December 14, 2009, at 15:05:14

In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02

Motor agitation seems to be a larger part of bipolar depression than atypical depression. Also, racing thoughts may present more often than in atypical depression.

P

 

Re: Atypical Depression versus Bipolar Depression

Posted by bleauberry on December 14, 2009, at 18:01:39

In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02

While I understand we as humans have an inborn need to understand and categorize things as best we can, I have not seen DX terminology serve a worthy purpose in the majority of pbabblers in guiding the journey to the proper medication.

More often the opposite happens. That is, for example, someone who has been DX'd with depression by 3 different doctors for the last 10 years tries a stimulant. Suddenly they are reborn...depresssion gone, social anxiety gone, focus returned, motivation returned, attention, energy...and walla, the DX is changed to ADD instead of depression. I mean, come on.

Obviously a cherry-picked example to make the point, and of course it can be debated from any angle with other examples, but you know what I mean. It can vary anywhere from subtle to dramatic from patient to patient.

DX terminology, I feel, is interesting but really doesn't serve a respectable clinical purpose. It makes doctors and patients feel better, that's about it. It satisfies their need to give something a name. I just don't see that it chooses the right meds very well.

At its very core it is flawed, because it immediately sends the patient on a narrow road of accepting a brain disease, when in fact no effort was made to rule-out other obvious causes of those exact same symptoms.

 

Re: Atypical Depression versus Bipolar Depression bleauberry

Posted by SLS on December 14, 2009, at 21:11:22

In reply to Re: Atypical Depression versus Bipolar Depression, posted by bleauberry on December 14, 2009, at 18:01:39

Diagnosis and categorization is critically important in identifying an illness so that an effective treatment can be effected. This is as true in the pursuit of healing in mental illness as it is in other illnesses. I don't think we should abandon this paradigm in building an approach toward treating depression more efficiently. We as humans become frustrated when our attempts at categorization and decision-making fail to provide the desired result. That does not mean that it is pointless to attempt to pusue the goal. Up until recently, empirical observation of behaviors has been the only tool we had available for trying to understand and treat mental illness. Although we are on the brink of being able to provide more exacting methods of diagnosis, it will be a few years yet before what emerges in the laboratory becomes available in the field. In the meantime, you use what you have. The description of illness presentation and treatment outcome is a valid tool to move us beyond blind trial-and-error. I don't think it is wise to throw away the principle of diagnosis just because we don't have it right yet. We simply need more information and understanding.

I do not believe that is productive to condemn everything for the sake of nothing. It would be more productive to offer suggestions of what can be done rather than to limit one's preoccupations to that which cannot. Refining and validating the descriptions of illness based upon clinical observation and psychometric testing is a good place to start when biological markers are unavailable.

If one could isolate a behavioral difference that would effectively differentiate between bipolar disorder and ADD, wouldn't it be humane to do so in order to choose an effective treatment? So, if the presence or absence of mood reactivity can help a physician choose between the use or non-use of lithium in a case of depression, wouldn't that also be humane? When the genomic differences between bipolar and unipolar depression are elucidated and measurable, will it not be humane to use that information to substantiate diagnosis and determine treatment algorithms?

What is inherently wrong with trying to get it right? I guess we are all doing the best that we can with what we have to work with. This is as true for the doctors as it is for the patients.

> DX terminology, I feel, is interesting but really doesn't serve a respectable clinical purpose.

I disagree.

If a doctor were to determine that a person complaining of depression were presenting with a TSH of 10.0 and elevated lymphocytes, would it be an irresponsible decision on his part to render a diagnosis of Hashimoto's Thyroiditis so that he could choose appropriate treatment? What is so flawed at its core about the concept of diagnosis?


- Scott

 

Re: Atypical Depression versus Bipolar Depression SLS

Posted by Phillipa on December 14, 2009, at 21:53:51

In reply to Re: Atypical Depression versus Bipolar Depression bleauberry, posted by SLS on December 14, 2009, at 21:11:22

Scott good point. Love Phillipa

 

Re: Atypical Depression versus Bipolar Depression Phidippus

Posted by delna on December 15, 2009, at 2:23:05

In reply to Re: Atypical Depression versus Bipolar Depression SLS, posted by Phidippus on December 14, 2009, at 15:05:14

> Motor agitation seems to be a larger part of bipolar depression than atypical depression. Also, racing thoughts may present more often than in atypical depression.
>
> P

P,
Racing thoughts and agitation during depression sounds more like a mixed state.

Tc
D

 

Re: Atypical Depression versus Bipolar Depression SLS

Posted by delna on December 15, 2009, at 2:34:25

In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02

> Atypical depression and bipolar depression look very similar. Anergia and reverse vegetative symptoms predominate (hypersomnia, hyperphagia, and leaden paralysis). However, mood-reactivity seems to be a feature specific to atypical depression, although it does not always manifest. This is still being debated. It may be that there is a great deal of misunderstanding between posting members of Psycho-Babble when an atypical compares themself to a bipolar and doesn't understand why the bipolar is not reactive to the same things that they are. Perhaps this includes psychotherapy and exercise.

Scott,
I am confused about the exact same thing. I have the 'anergia and reverse vegetative features' of atypical depression but definitely not the mood-reactivity. I too am wondering what makes bipolar depression distinctive (since I have bipolar disorder)
I also agree that an attempt to correctly identify and label can be very helpful. For example, it helps decide if you are a good candidate for ECT or not.

TC
D

 

Re: Atypical Depression versus Bipolar Depression

Posted by morganator on December 15, 2009, at 4:43:41

In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02

I am bipolar and have benefited from both therapy and exercise. I know others that are bipolar that benefit from both as well. It appears that you may be generalizing that bipolars to do not respond to these things, when in fact it is you that does not respond. I'm not trying to be harsh I am telling you how I see it. I just think you tend to believe that because it does not work for your bipolar depression it must not work on bipolar depression in general.

 

Re: Atypical Depression versus Bipolar Depression

Posted by morganator on December 15, 2009, at 5:08:05

In reply to Re: Atypical Depression versus Bipolar Depression Phidippus, posted by delna on December 15, 2009, at 2:23:05

I think bipolar depression often carries more anxiety with it. Isn't the main difference between being bipolar and suffering from atypical depression is simply that bipolars experience mania of some sort before and/or after their depression and atypical depressives do not? I know it can be confusing, especially when today someone who has not ever really experienced mania- mixed, hypomanic, or euphoric-can be diagnosed with bipolar. Maybe, in these cases, the diagnosis should have been atypical depression. Yes, this can get confusing.

 

Re: Atypical Depression versus Bipolar Depression delna

Posted by SLS on December 15, 2009, at 5:55:35

In reply to Re: Atypical Depression versus Bipolar Depression Phidippus, posted by delna on December 15, 2009, at 2:23:05

> > Motor agitation seems to be a larger part of bipolar depression than atypical depression. Also, racing thoughts may present more often than in atypical depression.
> >
> > P
>
> P,
> Racing thoughts and agitation during depression sounds more like a mixed state.
>
> Tc
> D

I agree. However, there are a few who propose that there exists a unipolar depression with racing thoughts. This presentation looks more like endogenous or psychotic depression than atypical deperession, though. This argues in favor of viewing the varying presentations of bipolar disorder as a spectrum.

Designing diagnostic paradigms is a work in progress with mental illness. Very little is set in stone. I think one must avoid thinking unidimensionally.


- Scott

 

Re: Atypical Depression versus Bipolar Depression morganator

Posted by SLS on December 15, 2009, at 6:03:02

In reply to Re: Atypical Depression versus Bipolar Depression, posted by morganator on December 15, 2009, at 4:43:41

> > Atypical depression and bipolar depression look very similar. Anergia and reverse vegetative symptoms predominate (hypersomnia, hyperphagia, and leaden paralysis). However, mood-reactivity seems to be a feature specific to atypical depression, although it does not always manifest. This is still being debated. It may be that there is a great deal of misunderstanding between posting members of Psycho-Babble when an atypical compares themself to a bipolar and doesn't understand why the bipolar is not reactive to the same things that they are. Perhaps this includes psychotherapy and exercise

> It appears that you may be generalizing that bipolars to do not respond to these things, when in fact it is you that does not respond. I'm not trying to be harsh I am telling you how I see it. I just think you tend to believe that because it does not work for your bipolar depression it must not work on bipolar depression in general.

Irony. Pot. Kettle. You know?

It was a proposition and not a definitive statement.

What symptoms or features of your illness suggests that you are bipolar?

What symptoms or features of your depression do you think might help one differentiate it from unipolar depression?


- Scott

 

Re: Atypical Depression versus Bipolar Depression

Posted by SLS on December 15, 2009, at 17:02:17

In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02

> Atypical depression and bipolar depression look very similar. Anergia and reverse vegetative symptoms predominate (hypersomnia, hyperphagia, and leaden paralysis).

I forgot about rejection sensitivity as being a symptom. After doing a bit of follow-up snooping, I found that some researchers believe that it is present in bipolar depression. There is still debate regarding mood reactivity.

I was hoping to get some more feedback from people with bipolar depression regarding the presence or absence of mood reactivity (If you are depressed and something nice happens, you feel better for a while).


- Scott

 

Re: Atypical Depression versus Bipolar Depression SLS

Posted by bleauberry on December 15, 2009, at 18:34:01

In reply to Re: Atypical Depression versus Bipolar Depression bleauberry, posted by SLS on December 14, 2009, at 21:11:22

Hi SLS,

Thanks for your response. I knew as I was writing it would push some of your buttons. :-) I know you well.

One problem you and I have is that we are often mistaken by each other in our interpretations of what we see in writing from one another. It is not the same as being face to face. You very often misinterpret things I say, or accidentally read things into what I say, or become overly defensive in a way that completely blots out huge chunks of things I said. I accidentally do the same with your posts. I

I have no doubt if we were in a living room together chatting and debating over snacks and tea, we would find we actually agree on just about everything, with minor nuances here and there.

As to your reply to my post, I pretty much agree with everything you said...while at the same time agreeing with everything I initially said. If that makes any sense. It is all the above together, not either-or.

Basically, I have not seen our DX terms be of much use. I'm sorry, I just haven't. Have you? I don't think so. Once in a while maybe. I agree with you, that does not mean throw it away or give up the whole idea. I am just saying, "keep it in perspective". Meanwhile, try to improve it.

But above all, use the diagnosis to ask, "why is this happening", before pulling out a prescription pad and completely ignoring why it is happening.

Your example of a diagnosis of depression with some bad thyroid numbers indicating hashimotos, well, the problem with that is that 8 of 10 of the doctors who gave that diagnosis of depression never would have even checked thyroid, and only half of those who actually did check it would have done a thorough enough check to uncover hashimotos. Most clinicians only look at TSH, a few at T3 and T4, but hardly any for the antibodies.

Here's my diagnosis:

1. Depression.
2. Double depression.
3. Dysthymia.
4. Depression with anxiety.
5. Bipolar depression.
6. Bipolar II.
7. Borderline Personality Disorder.
8. Anhedonia not depression.
9. Yuckiness of Lyme, not depression.

I mean, you can see why DX has not been helpful to me. Nine different doctors, nine different takes on it. Not one was in agreement with the other. Too much overlap. No clear boundary lines. One can look like another. They can mimic each other. They can change from week to week or month to month. Things are not stationary. Things are much too subjective, despite our best efforts to make them objective. I suspect I am not the only way that encounters this problem.

But it is still a worthwhile pursuit. I just think too much emphasis is placed on it at the expense of other more important issues.

 

Re: Atypical Depression versus Bipolar Depression

Posted by morganator on December 15, 2009, at 21:44:36

In reply to Re: Atypical Depression versus Bipolar Depression morganator, posted by SLS on December 15, 2009, at 6:03:02

That's funny, I see the pot-kettle thing. I also know that these things have not just helped me but a few other people I know suffering from bipolar and depression. This is one reason why I really believe exercise and therapy may be helpful for many sufferers, not all, but possibly a significant number. Anyway, I know this is not the topic.

>What symptoms or features of your illness suggests that you are bipolar?

>What symptoms or features of your depression do you think might help one differentiate it from unipolar depression?

I think answering the first should answer the second. I have had 3 periods of mixed states in my life, I am sure of this. The last mixed state was horrific and if it went on any longer I may have started to experience psychotic symptoms. It went on much much longer without being treated than it ever should have. I finally had to decide I was going to the hospital after not being able to find a psychiatrist who had the ability or balls to try to give me the right medication to bring me out of the episode. What symptoms did I experience during this last episode? I could not stop obsessing and regretting things I had done. I could not slow my mind down. I could not sleep for more than 3 hours a night. I was extremely agitated, depressed, and manic all at the same time. Actually, I was probably feeling the agitation and mania more than the depression. You could say that the racing thoughts, extreme fear, agitation, and mania were a manifestation manifested out of a very deep but fairly brief state of depression that came first.

Over the years I've been able to stay on an antidepressant alone and function at a fairly high level. But when I look back on my behavior during those I realize that I was hypomanic much of the time. I often engaged in risky sexual behavior and I at times acted like a raging lunatic(it was all in fun and entertained people around me but it was definitely indicative of a certain type of bipolar. Actually, most of the friends I grew up with and hung out with through the years were on the crazy wild side with very exuberant personalities, including my brother. None of them were bibolar. I tended to take it to the next level and was less in control of it). I had a ton of energy throughout the years and often could go without sleep easier than the average person. I would experience this even more sometimes when I was drinking heavily, believe it or not.

I have always had issues with depression and anxiety and they always coexisted. I remember in college when I was very depressed and obsessed with death I reacted to it by behaving in a more hyperactive manner and I would stay up very late(I know, everyone stays up late in college). No one would have ever guessed I was that depressed. I remember thinking about death and getting old at a very very young age. Not sure if this has anything to do with having a bipolar predisposition.

People who have unipolar depression simply experience the depression and maybe some anxiety. They do not have tons of energy, periods of hypomania or mixed mania, and they do not cycle in and out of depression in brief periods of time. Unipolar depressives are not likely to go around having unprotected sex like stray dogs in an alley.


 

Re: Atypical Depression versus Bipolar Depression SLS

Posted by morganator on December 15, 2009, at 21:52:34

In reply to Re: Atypical Depression versus Bipolar Depression, posted by SLS on December 15, 2009, at 17:02:17

If I am depressed and something good happens, at least in the past, I most certainly felt good about it. I could probably say that over the years I often needed good things to happen to feel good. While on Zoloft and feeling young and strong, I did not get depressed very severely. If I did feel depressed, I had to do something to make myself feel better. Going to the gym played a major role in constantly making me feel good :).

I have to say, I have been more on the hypomanic and anxiety side of bipolar than the depressed side, until just recently. My life has take a turn for the worst and I do not have the same things to feel good about that I believe protected me from this depression for so many years. If I could erase all the damage from the last 3 years, I would be a pretty damn happy bipolar right now.

 

Re: Atypical Depression versus Bipolar Depression bleauberry

Posted by morganator on December 15, 2009, at 22:00:03

In reply to Re: Atypical Depression versus Bipolar Depression SLS, posted by bleauberry on December 15, 2009, at 18:34:01

My recent dignosis has not only not helped me, but because of the time in my life and the way I was diagnosed, it has been detrimental to me in ways. Maybe I will elaborate later.

I do think that being diagnosed much sooner may have been very helpful. If I was diagnosed at the right time I may have made decisions as far as how I approached certain things differently. I do not think I would have taken myself of Zoloft 2 and a half years ago. I may have tried to drink less alcohol at times. I may have been more aware of my behavior and tried to modify it. So I think, Bleauberry, in some cases, a diagnosis can be very helpful. But I definitely see where you are coming from.

 

Re: Atypical Depression versus Bipolar Depression

Posted by kirbyw on December 16, 2009, at 0:05:11

In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02

In my most recent psychiatric consultation with Dr. Goldberg in New York, he found traits of bi-polar illness in both of my parents, based on their histories. But I have no manic states at all ever. I have had severe
"endogenous" depressive states, which have generally responded well to Parnate, but to no other AD's at all. Dr. Goldberg diagnosed me as having Atypical Depression, and recommended adding Lithium to my Parnate. When depressed I can sleep for 20 out of 24 hours, have ruminations, and a high degree of anxiety. When normal, that is not depressed, I am not manic but am "high functioning" in term of social relations, career etc. I have a Doctorate,and have had an interesting career. Generally I don't lose a job when i am severely depressed. I just go to work distracted, ruminating, and highly anxious but am able to keep it hidden from my peers. Its stressful. I get enough done, to avoid drawing attention to myself.

I also am always very sensitive to rejection, but extremely sensitive when more depressed. Both Dr. goldberg and Dr. Scheftner at Rush Medical Center in Chicago feel that there is a latent and 'invisible' bi-polar component to my depression. Both have recommended the Lithium.
I am having a tough time with Lithium because I already have a bladder problem with a urinary frequency problem, and I have the impression that Lithium is making this worse. So, temporarily, since I will be traveling over the holidays, I am limiting the Lithium to 300 mg per day, only in the morning. Will try again at 600 mg when I get back home.
Rick

 

Re: Atypical Depression versus Bipolar Depression kirbyw

Posted by morganator on December 16, 2009, at 1:56:57

In reply to Re: Atypical Depression versus Bipolar Depression, posted by kirbyw on December 16, 2009, at 0:05:11

If both of your parents were bipolar, it is likely that you did not have the best childhood. This could result in a lower self esteem, which may be one of the reasons for your issues with rejection. Have you ever addressed or thought about addressing this in therapy. Group psychodynamic therapy would most likely be best suited for addressing this issue. Also, any issues in childhood could have made whatever predisposition you have towards depression much much worse. I'm not saying that addressing these issues will solve anything, I'm just saying I may not hurt to consider looking into addressing them. These things just don't go away. They linger inside of us for the rest of our lives if not addressed in some way.

Sorry, maybe I should have just kept my thoughts to myself. I hope you are not offended.

 

Re: Atypical Depression versus Bipolar Depression kirbyw

Posted by SLS on December 16, 2009, at 6:42:12

In reply to Re: Atypical Depression versus Bipolar Depression, posted by kirbyw on December 16, 2009, at 0:05:11

Hi Rick.

Thanks for responding.

Good luck on your lithium treatment. In the past, Parnate was considered a particularly good drug to augment with lithium in unipolar depression, and one of the best treatments for bipolar disorder as well.

From what I have read, rejection sensitivity can manifest in both atypical and bipolar depressions. However, I am most interested in whether both types of depression share mood reactivity as a presenting feature or if it can be used as a symptom to differentiate between the two depressive subtypes.

Are there situations, events, or other experiences that can elicit a substantial improvement in your depression greater than 50%?


- Scott

 

Re: Atypical Depression versus Bipolar Depression bleauberry

Posted by SLS on December 16, 2009, at 6:53:14

In reply to Re: Atypical Depression versus Bipolar Depression SLS, posted by bleauberry on December 15, 2009, at 18:34:01

I think I understand better what you are trying to communicate.

I would agree that many, if not most, psychiatrists do not check for organic or other explanations for the symptoms they are presented with, even though the DSM is very specific to suggest that such a step be taken to diagnose major depressive disorder.

"D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)."

I don't think that the concept of diagnostics is irrelevant. It just might not be implemented properly.


- Scott

 

Re: Atypical Depression versus Bipolar Depression morganator

Posted by SLS on December 16, 2009, at 7:02:58

In reply to Re: Atypical Depression versus Bipolar Depression, posted by morganator on December 15, 2009, at 21:44:36

> People who have unipolar depression simply experience the depression and maybe some anxiety. They do not have tons of energy, periods of hypomania or mixed mania

Yes. But what differences are there between the depressive states of atypical depression and bipolar depression that would allow one to differentiate them? When a doctor is presented with a patient complaining of depression, it often occurs that they are looking at a case of bipolar disorder for which mania has not yet manifested. It would be ideal to be able to recognize such cases early and apply treatments that are more appropriate for bipolar disorder and that would not make the situation worse.

I think that this is really a critical issue.


- Scott

 

Re: Atypical Depression versus Bipolar Depression

Posted by bulldog2 on December 16, 2009, at 16:52:40

In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02

> Atypical depression and bipolar depression look very similar. Anergia and reverse vegetative symptoms predominate (hypersomnia, hyperphagia, and leaden paralysis). However, mood-reactivity seems to be a feature specific to atypical depression, although it does not always manifest. This is still being debated. It may be that there is a great deal of misunderstanding between posting members of Psycho-Babble when an atypical compares themself to a bipolar and doesn't understand why the bipolar is not reactive to the same things that they are. Perhaps this includes psychotherapy and exercise.
>
> Has anyone noted other differences between atypical and bipolar depressions?
>
>
> - Scott

Can one have both atypical depression coexisting with bipolar depression? In other words have explosive periods of reactive depression but also have separate periods of mania? If so how would that be treated?

 

Re: Atypical Depression versus Bipolar Depression

Posted by morganator on December 16, 2009, at 21:25:34

In reply to Re: Atypical Depression versus Bipolar Depression kirbyw, posted by SLS on December 16, 2009, at 6:42:12

I think mood reactivity is present in both bipolar and atypical depression. At least my friend and I both have experienced it pretty regularly. We both agree that we could be thrust out of feeling depressed fairly quickly and suddenly feel more on the hypomanic side in reaction to something good happening to us.


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