Posted by jedi on January 15, 2007, at 1:53:12
In reply to Atypical depression, posted by Jimmyboy on January 14, 2007, at 10:49:23
> How much better does Atypical depression respond to MAOI's. Anyone had success on MAOI's but nothing else?
>
> How is it differant than regular depression? What exactly is mood reactivity? Could it resemble bipolar depression?Hi,
Currently, the SSRIs are going to be tried first for atypical depression. Many PDOCs will save the MAOIs for a last resort, or refuse to use them at all. However, after several med trials, if you are treatment resistant, I believe that Parnate, Nardil, or Marplan should be tried. Nardil is the only med that has worked for me (40+ combination med trials). Atypical depression is actually a misnomer. It is far more common than melancholic depression (characterized by the inability to find pleasure in positive things combined with physical agitation, insomnia, or decreased appetite).Mood reactivity is linked to atypical depression. It simply means that if something positive happens in your life, you can have a corresponding positive elevation in mood. People with severe melancholic depression will not have a positive mood reaction no matter what positive events happen in their life.
Some scientists believe that atypical depression does lie somewhere on the bipolar continuum. Probably closer to the bipolar II end of the spectrum.
JediStudy Abstract:
J Affect Disord. 2005 Feb;84(2-3):209-17.
Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II?
Akiskal HS, Benazzi F.
International Mood Center, University of California at San Diego, V.A. Hospital, 3350 La Jolla Village Dr. 116-A, La Jolla, San Diego, CA 92161, USA. hakiskal@ucsd.eduBACKGROUND: Although increasing data link atypical depression (AD) to the bipolar spectrum, controversies abound about the extent of the overlap. In particular, the Columbia group, which has pioneered in providing data on operational clarity and pharmacological specificity of atypical depressions, has nonetheless consistently avoided studying its discriminatory validity from bipolar II (BP-II). Accordingly, we undertook a full scale validation of such a link in a large clinical sample of BP-II and unipolar (UP) major depressive disorder (MDD). METHODS: Consecutive 348 BP-II and 254 MDD outpatients presenting with major depressive episodes (MDE) were interviewed off psychoactive drugs with a modified Structured Clinical Interview for DSM-IV, the structured Family History Screen and the Hypomania Interview Guide. We used the DSM-IV criteria for "atypical features" specifier. Depressive mixed state was defined as > or =3 concurrent hypomanic signs and symptoms during MDE. Bipolar validators were age at onset, high depressive recurrence, depressive mixed state and bipolar family history (types I and II). Univariate and multivariate logistic regression were used to examine associations and control for confounding variables. RESULTS: Frequency of AD was 43.0% in the combined BP-II and MDD sample. AD, versus non-AD, had significantly higher rates of BP-II. AD was significantly associated with all bipolar validators, among which family history was the most robust. A dose-response relationship was found between number of atypical symptoms during MDE and bipolar family history loading. The association between bipolar family history and number of atypical symptoms remained significant after controlling for the confounding effect of BP-II. Bipolar family history was strongly associated with the atypical symptoms of leaden paralysis and hypersomnia. CONCLUSION: These results confirm a strong link between AD and bipolar validators along psychopathologic and familial grounds. From a practical standpoint, AD is best viewed as a variant of BP-II. Clinicians confronted with MDE patients presenting with atypical features should strongly consider a BP-II diagnosis. In a more hypothetical vein, atypicality-or some associated features thereof-might serve as a nosologic bridge between UP and BP-II.
PMID: 15708418 [PubMed - indexed for MEDLINE]
poster:jedi
thread:722164
URL: http://www.dr-bob.org/babble/20070113/msgs/722430.html