Posted by Elizabeth on November 28, 2001, at 16:45:55
In reply to Re: depression subtypes and med responses » Elizabeth, posted by jay on November 26, 2001, at 16:40:46
> Actually, I prefer to look at treating symptoms rather than a general Dx.
That often works better. Occasionally the symptom cluster is relevant, though. :-)
> SRI/SNRI's are well documented in causing sleep distrubance, it seems more so than with tricyclics.
Yes. SSRIs and Effexor do very strange things to sleep; although, like the TCAs and MAOIs, they decrease the amount of time spent in REM sleep, they increase REM density in REM sleep. They also increase nighttime awakenings.
Desipramine seems to be making my sleep problems worse, though (FWIW). I may end up going back to Parnate. I talked to a sleep specialist in Boston about my problems; he seemed to think that a good combination would be TCA at night + amphetamine in the daytime. (I never got around to having a sleep study to see exactly what's going on with my sleep problems.)
> I don't know about that, because in 'melancholic' depression, frequent restless sleep can exacerbate anxiety further.
Sure; like I said, "anxiety" without any further qualifiers doesn't differentiate between types of depression.
> 'Atypical' seems to indicate a *lack* of most feeling/things, and I think latching interpersonal sensitivity doesn't make a lot of sense. Again...that's why I say look at and treat symptoms first.
"Rejection sensitivity," as a trait (not just when depressed), is one of the symptoms of atypical depression. The criteria for atypical depression have been extensively studied and well validated. Atypical depressives do often experience lethargy and anxiety. I wouldn't say that they lack feelings, though: by definition a person with atypical depression has reactive mood and does respond affectively to at least some stimuli.
> Early-morning awakenings is one symptom, but frequent wakenings is also another of melancholic depression.
I know; I have both.
> > IMO, the most important distinctive feature of melancholic depression is the total absence of mood-reactivity.
>
> Absence? I have seen many with melacholic depression who have horrific crying spells, massive amounts of anxiety, panic, and experience moods just as *intense* as any depressive I have seen.Well, the first thing I would wonder is what made them "melancholic" in your opinion. But anyway -- that's not mood *reactivity*. Mood reactivity, in this context, means that a person can feel better in response to certain pleasant experiences (such as eating a favorite food). Melancholic depressives are (by definition) not mood-reactive. That doesn't mean they don't have any emotions at all; it means that what they experience isn't liable to make them feel better. (I think that it's probably generally true that their negative feelings also seem to arise from within, rather than being reactions to anything in particular.)
> > There doesn't seem to be any reason to suppose this. I have fairly clear-cut melancholic depression, and I was helped somewhat by several different MAOIs. Desipramine is about as effective as Parnate was; in fact, the main distinction that I notice is that while I never dreamed on Parnate, I have frequent intense dreams on desipramine.
>
> Again, after I have thought about this, it is an example of why we should not only focus on symptoms, but avoid the "this drug is only good for this Dx", etc.Well, then can you rephrase your original thought or question in terms of symptoms rather than categories/subtypes?
> I agree with your last statement in particular, and wonder why a doctor wouldn't give say a med like nortiptyline or desiprmaine to a person experiencing more lethargic symtoms, and even older meds like Doxepin or Clomiprmaine for more extreme anxiety prone folks, and of course a benzo thrown in the mix for anxiety present in both situations.
I'm not sure that clomipramine is an "older" TCA; what it has in common with doxepin is that it's sedating. But anyway, giving a sedating drug isn't always the most effective way to treat anxiety (and just because a drug is stimulating, that doesn't mean that it will help with lethargy).
> > Effexor has been shown to be effective for melancholic depression.
>
> I'd like to see this, in the long run (i.e. 5 years) of Effexor Vs. Nortriptyline. There are some reports of MASSIVE weight gain on some on Effexor, and even though this is true for some on Nortrip, it does have a track record for long-term lack of weight gain, and even loss.I'm not sure what you're getting at here -- yes, weight gain can be a side effect of both of these ADs; how is that relevant?
> Also, I am concerned about the constant need for dose increase with Effexor. This doesn't seem to be the case with Nortrip.
Tolerance or "poop-out" occurs with all types of ADs. Aside from toxicity concerns, though, nortriptyline and amitriptyline seem to have a therapeutic window, becoming less effective (and not just more toxic) if you increase the dose too high.
> I also found Nortrip FAR more activating without massive anxiety than Effexor. It also didn't seem to have some of the emotional 'numbing' effects of Effexor....good sometimes in the short run, but I don't think good in the long run.
I'm not clear what condition you're trying to treat. I'm also a little confused since you seem to be going back and forth between focusing on what helps specific symptoms and focusing on what treats the entire syndrome.
> If i feel better physically and mentally sharp and calm, not having put on 50 pounds and not being able to party and enjoy myself, that sure as hell is no fugging way to go.:-)
So you're saying that gaining weight makes you feel depressed? I gained 50 lbs or so on Nardil, but (for as long as it was working!) I didn't feel sluggish or anything like that. The problem there was that the effect didn't last, not that the drug was making things worse in any way. (Of course, weight gain was not a problem for me when depressed, and once I stopped taking the Nardil and became thoroughly depressed again, I quickly lost the weight!)
> > True melancholic depression is actually pretty rare.
>
> Melancholic symptoms aren't, though, and yes, they can be treated.What do you consider to be "melancholic symptoms?" As I said, I think the most important one is the absense of mood-reactivity. This is what makes melancholic depression distinct, and it's also probably much of the reason why this type of depression tends to be more severe than nonmelancholic depression. And it's unusual: most people who are depressed are able to be cheered up, at least some of the time.
-elizabeth
poster:Elizabeth
thread:84318
URL: http://www.dr-bob.org/babble/20011123/msgs/85433.html