Posted by BobGoldman on March 16, 2001, at 17:19:54
In a message dated 3/12/01 12:03:33 AM, Psycdocal@aol.com writes:
< < This patient may be manifesting a relatively rare subtype of unipolar
atypical depression known as abulia, or abulic depression. The cardinal
symptoms of this disorder are the six A's - apathy, anergia, amotivation,
avolia ( lack of will power ), anhedonia and affective blunting. Patients
rarely complain of feeling depressed per se, but rather they manifest an
affective syndrome comprising mainly negative symptoms ( not unlike the
negative syptoms of schizophrenia ). The good news is that this condition is
responsive to combination treatment using a tricyclic antidepressant and an
SSRI. I usually give 50 to 100 mg of desipramine or nortriptyline in the
morning and 20 to 40 mg fluoxetine at bedtime. The symptoms should resolve
within two or three weeks. For some unknown reason, the combined therapy is
effective whereas use of a single agent which affects multiple
neurotransmitters usually is not. > >< < look up abulia/ abulic depression in Friedman and Kaplan's
Comprehensive Texbook of Psychiatry. It is an old concept, not readily
recognized by most psychiatrists today, and not taught in most residency
programs. As a tertiary consultant for patients with refractory depression,
I probably encounter it more than most practitioners. It is rare, probably
comprising less than 1 % of those presenting with clinical depression.
Nothing else except the drug combination I suggested previously seems to be
effective for these patients, at least in my hands.look up abulia/ abulic depression in Friedman and Kaplan's Comprehensive Texbook of Psychiatry. It is an old concept, not readily recognized by most psychiatrists today, and not taught in most residency
programs. As a tertiary consultant for patients with refractory depression,
I probably encounter it more than most practitioners. It is rare, probably
comprising less than 1 % of those presenting with clinical depression.
Nothing else except the drug combination I suggested previously seems to be
effective for these patients, at least in my hands. > > A.L. LieberDoes anyone else know about this and why treatment works? My pt exhibits exactly the above sxs.
Know any other references? Given the mystery of what makes the drug combination work, how would you suggest adjusting pt's currently ineffective 600 mg venlafexin, 40 mg fluoxetine, 1200mg gabapentin, 200 mg quetiapine and 35 mg dexedrine to try to get the combo effect?
BobGoldman
poster:BobGoldman
thread:56694
URL: http://www.dr-bob.org/babble/20010310/msgs/56694.html