Posted by Adam on November 11, 2001, at 18:34:07
In reply to Re: Atypical Depression Actually Very Typical » Adam, posted by Elizabeth on November 8, 2001, at 20:55:23
Well, you may know best. From my own experience (I know: n=1 is not terribly reliable, but a p-doc I am familiar with non-professionally has corroborated some of my suspicions), the melancholic/atypical dichotomy just doesn't tell the whole story. In practice, all the doctors did pretty much the same thing anyway, regardless of what major sub-catagory they thougth I was: SSRI- >Another SSRI- > SNRI- > buproprion- > TCA- > and so on. I had one doctor tell me I seemed atypical (my having BDD was "clearly indicative" of this), while another said I was clearly melancholic. This was the last doc I had before my little stint in the hospital. Anyway, I responded very well to ECT and a MAOI, which I guess would also indicate that I am "atypical". So was the "melancholic" guy wrong? In the end, did it matter? Does "atypical" mean, effectively, MAOI-responder-in-most-but-not-all cases? If so, is the dx any help in the end? I don't see any answers. I honestly don't know what to make of it. What does appear clear is that there is a pretty common algorithm that many doctors follow, and they often to set this process in motion even from the first appointment, often without even the simplest of diagnostic tests. In practice, it seems many doctors don't pay much attention, really, to category, beyond the "unipolar" layer of the onion, and will send you out the door with a script for Prozac after a 15 minute chat. Prozac, as the "classic" SSRI, is purportedly good for both melancholic and atypical depressives, so, again, what is one to think? On paper it all feels so convincing, and there's certainly a substantial body of science to support the dichotomy, but in the "real world", the emperor starts to look pretty naked. It's enough to make one wonder if there is anything really there. I wonder what more studies, done by unregenerate skeptics, would reveal.
> > Hopefully somebody will proclaim that we have dispensed with the typical/atypical dichotomy for good, and the rest will follow suit.
>
> I actually think that the distinction does have some relevance. It's one of the few leads we have on who will respond to which ADs. It may not survive in its present form, but I think it will continue to exist (and, I hope, become more refined until we've figured out the exact differences that are relevant).
>
> -e
poster:Adam
thread:83164
URL: http://www.dr-bob.org/babble/20011104/msgs/83925.html