Posted by Elizabeth on December 2, 2001, at 16:19:48
In reply to Difference btwn Atypical Major Depression » JohnDoenut, posted by pat c. on December 2, 2001, at 11:01:08
> Atypical depression is a mix of social phobia, chronic anxiety (panic)attacks, and depression.
No, it's not. Social phobia, generalized anxiety, and panic attacks can co-occur with atypical depression, but they aren't symptoms of atypical depression. They also are not specific to atypical depression; people with all types of depression can have anxiety, including full-blown anxiety disorders. Atypical depression is *not* defined as "depression with anxiety." Anxiety is not even part of the definition.
> Oversleeping is a trait, and appetite is not an issue.
Appetite is often a serious issue for people with atypical depression: they tend to overeat when depressed, instead of eating less.
> But the most determining factor of atypical is mood reactivity. For example, if you think someone ignored you (rejection), you made a simple mistake, or stumbled over a word, you then blow that out of proportion and believe the world is coming to an end.
Mood reactivity (being able to be cheered up from depression temporarily) and rejection sensitivity (which is what you're describing) are considered two different things, but both of them are features of atypical depression.
"Major depression" is a general term for any type of depression of a certain level of severity. People who have atypical depression may have "major depression with atypical features" or they may have "dysthymia with atypical features." Sometimes people with bipolar disorder have atypical depressions. Seasonal depression often has atypical features.
Major depression may or may not be mood-reactive. Most people with major depression have some degree of mood-reactivity. I think that people who are depressed often feel like nothing can cheer them up even if sometimes they can be cheered up, so (IMO) mood-reactivity is best assessed by observing the person rather than just asking them (self-reports can be misleading).
The symptoms you mentioned -- absense of mood-reactivity, not eating, feeling bad all the time -- are usually associated with "melancholic depression," not with major depression in general.
You didn't describe melancholic depression completely and I'm not saying that's necessarily what you have, but not everyone with major depression has completely nonreactive mood and appetite loss, for example. Again, major depression is not a qualitative subtype of depression.
"Atypical" and "melancholic" are not the only two types of depression, and most depressions probably don't fall under either category.
Tricylics do not work very well for atypical depression; ECT has not been studied much in atypical depression and has a reputation for being relatively ineffective. MAOIs are known to work well, and SSRIs and newer antidepressants also may work although it's not clear whether they work as well as MAOIs. (There is no evidence that Nardil works better than Parnate, or vice versa, in atypical depression.)
The antidepressants best known to work for melancholic depression are the tricyclics, Remeron, Effexor, and ECT. There is not much evidence regarding the use of MAOIs for melancholic depression, but what evidence exists is positive. There is some evidence that SSRIs do not work well for melancholic depression.
The reason why researchers come up with different categories like this is because they hope that the categories will prove helpful in predicting treatment response. If all you know about someone is that they have "major depression," you don't have enough information to predict what kind of antidepressants would be most likely to work for them (and therefore best to try first).
Here are a couple of web sites that discuss different types of depression:
http://www.mentalhealth.com/dis1/p21-md01.html (definition and description of major depressive disorder)
http://www.lorenbennett.org/atypical.htm ("atypical depression - pharmacotherapy response and diagnostic validity" - includes definition)
http://www.holisticonline.com/Remedies/Depression/dep_types_melancholic.htm ("depression with melancholic features" - good general description and list of symptoms)
http://www.postgradmed.com/issues/1996/07_96/mallakh.htm ("Clues to depression in primary care practice" - includes diagnostic criteria for melancholic features)
-elizabeth
poster:Elizabeth
thread:85718
URL: http://www.dr-bob.org/babble/20011202/msgs/85822.html