Posted by Elizabeth on November 11, 2001, at 20:51:50
In reply to Re: Atypical Depression Actually Very Typical, posted by Adam on November 11, 2001, at 18:34:07
> 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.
Oh, I agree that it doesn't tell the story. But (to mix metaphors) I think it's one piece of the puzzle.
> 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.
Jeez! They should get their story straight.
> 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".
ECT isn't supposed to work so great for "atypical" depression, and MAOIs are very broad-spectrum (IMO) and work for lots of different kinds of depression as well as social phobia, panic disorder, etc.
> Does "atypical" mean, effectively, MAOI-responder-in-most-but-not-all cases?
Atypical depression became associated with MAOIs because tricyclics didn't work well for it and those were considered the only choices at the time. (Amphetamine was still used -- that's not a new thing -- but it's less effective than ADs for depression.) MAOIs work for a lot of different things, as I said above -- including "typical" depression. As you know, the dangers of MAOIs have been widely exaggerated, so they have generally been considered a "last resort."
> If so, is the dx any help in the end?
I think it's somewhat predictive, although it may not work for one particular individual.
> I don't see any answers.
I think that the answers to these kinds of questions are going to be very complicated, if we ever find them.
> 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.
Yes, I think so too.
> Prozac, as the "classic" SSRI, is purportedly good for both melancholic and atypical depressives, so, again, what is one to think?
Actually, SSRIs are supposed to be less effective than TCAs for melancholia, I think.
Like I said, it's just one piece of the puzzle.
-elizabeth
poster:Elizabeth
thread:83164
URL: http://www.dr-bob.org/babble/20011104/msgs/83942.html