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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by idolamine on May 31, 2006, at 0:57:03
My doctor told me today that MAOIs are bad for BPII, specifically, "because of the chemical or something." I wasn't impressed. Anyone else hear of this?
Posted by jedi on May 31, 2006, at 3:02:13
In reply to MAOIs not good for BPII?, posted by idolamine on May 31, 2006, at 0:57:03
> My doctor told me today that MAOIs are bad for BPII, specifically, "because of the chemical or something." I wasn't impressed. Anyone else hear of this?
Hi,
Many researchers consider atypical depression as a point on the bipolar spectrum. Since the MAOIs have been shown to be most effective for treatment resistant atypical depression, I would question the logic of your doctor's opinion.
JediJ Affect Disord. 2005 Feb;84(2-3):209-17.
Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II?
Link:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15708418&query_hl=5&itool=pubmed_docsum
Posted by SLS on May 31, 2006, at 6:19:15
In reply to Re: MAOIs not good for BPII? » idolamine, posted by jedi on May 31, 2006, at 3:02:13
> > My doctor told me today that MAOIs are bad for BPII, specifically, "because of the chemical or something." I wasn't impressed. Anyone else hear of this?
>
> Hi,
> Many researchers consider atypical depression as a point on the bipolar spectrum. Since the MAOIs have been shown to be most effective for treatment resistant atypical depression, I would question the logic of your doctor's opinion.
> Jedi
>
> 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?
> Link:
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15708418&query_hl=5&itool=pubmed_docsum
I agree with Jedi.Parnate is considered particularly useful when treating bipolar depression.
The only thing that ever worked for me was a combination of Parnate + desipramine.
- Scott
Posted by naughtypuppy on May 31, 2006, at 7:43:42
In reply to Re: MAOIs not good for BPII?, posted by SLS on May 31, 2006, at 6:19:15
Bipolar II, atypical depression and mixed anxiety/depression are probably just different names for the same thing. Diagnosis and labels (and treatments) tend to be very trendy. It just depends who your talking to at the time.
Posted by Phillipa on May 31, 2006, at 22:34:08
In reply to Re: MAOIs not good for BPII?, posted by naughtypuppy on May 31, 2006, at 7:43:42
So if your pdoc says you have treatment resistant depression and high anxiety does this mean since he says he leaning toward bipolar that it's bilolar ll. Love Phillipa
Posted by jedi on June 1, 2006, at 3:06:29
In reply to Re: MAOIs not good for BPII? » naughtypuppy, posted by Phillipa on May 31, 2006, at 22:34:08
> So if your pdoc says you have treatment resistant depression and high anxiety does this mean since he says he leaning toward bipolar that it's bilolar ll. Love Phillipa
Hi Phillipa,
Here is a good article on diagnosis and treatment across the bipolar spectrum. This article was published in 2004 in the Journal of the American Psychiatric Nurses Association.
Take care,
JediLink:
http://j*p.sagepub.com/cgi/reprint/10/3_suppl/S6.pdfAbstract:
http://j*p.sagepub.com/cgi/content/abstract/10/3_suppl/S6
Posted by jedi on June 1, 2006, at 3:22:34
In reply to Article on diagnosis across the bipolar spectrum » Phillipa, posted by jedi on June 1, 2006, at 3:06:29
Link:
http://j*p.sagepub.com/cgi/reprint/10/3_suppl/S6.pdfAbstract:
http://j*p.sagepub.com/cgi/content/abstract/10/3_suppl/S6I think Babble is interpreting j*p in the link as improper use of slang. The * should be an a. Copy the link to the address bar on your browser and change the * to a. It really is a good article and worth the hassle.
Jedi
Posted by SLS on June 1, 2006, at 7:52:18
In reply to Re: MAOIs not good for BPII?, posted by naughtypuppy on May 31, 2006, at 7:43:42
> Bipolar II, atypical depression and mixed anxiety/depression are probably just different names for the same thing. Diagnosis and labels (and treatments) tend to be very trendy. It just depends who your talking to at the time.
I can't be sure of this, but I suspect that the presence of mood-reactivity might differentiate between atypical unipolar depression and bipolar disorder. Someone with bipolar depression would be much less likely to experience a mood elevation as a reaction to positive events.
- Scott
Posted by naughtypuppy on June 1, 2006, at 11:08:07
In reply to Re: MAOIs not good for BPII? » naughtypuppy, posted by Phillipa on May 31, 2006, at 22:34:08
> So if your pdoc says you have treatment resistant depression and high anxiety does this mean since he says he leaning toward bipolar that it's bilolar ll. Love Phillipa
No. What I'm trying to say is the same condition can be given different names. I've read posts here from people with identical symptoms as me, but have been given a different diagnosis.
Posted by naughtypuppy on June 1, 2006, at 11:17:38
In reply to Re: MAOIs not good for BPII?, posted by SLS on June 1, 2006, at 7:52:18
> > Bipolar II, atypical depression and mixed anxiety/depression are probably just different names for the same thing. Diagnosis and labels (and treatments) tend to be very trendy. It just depends who your talking to at the time.
>
> I can't be sure of this, but I suspect that the presence of mood-reactivity might differentiate between atypical unipolar depression and bipolar disorder. Someone with bipolar depression would be much less likely to experience a mood elevation as a reaction to positive events.
>
>
> - Scott
That sounds right, but what I am getting at is doesn't it make more sense to have just a few diagnostic catgories instead of inventing another one just because of one extra symptom. It seems the more catagories that are created the murkier the picture gets. There is so much crossover of symptoms in DSM IV that it just tends to confuse the issue, particularly since some symptoms can be either present or absent and still meet the diagnostic criteria.
Posted by CEK on June 1, 2006, at 16:16:30
In reply to Re: MAOIs not good for BPII? » SLS, posted by naughtypuppy on June 1, 2006, at 11:17:38
> > > Bipolar II, atypical depression and mixed anxiety/depression are probably just different names for the same thing. Diagnosis and labels (and treatments) tend to be very trendy. It just depends who your talking to at the time.
> >
> > I can't be sure of this, but I suspect that the presence of mood-reactivity might differentiate between atypical unipolar depression and bipolar disorder. Someone with bipolar depression would be much less likely to experience a mood elevation as a reaction to positive events.
> >
> >
> > - Scott
> That sounds right, but what I am getting at is doesn't it make more sense to have just a few diagnostic catgories instead of inventing another one just because of one extra symptom. It seems the more catagories that are created the murkier the picture gets. There is so much crossover of symptoms in DSM IV that it just tends to confuse the issue, particularly since some symptoms can be either present or absent and still meet the diagnostic criteria.
>
> That's basically what my pdoc says. I mentioned to him a couple of weeks ago that I had all of the symptoms of borderline personality disorder and he looked like he wanted to slap me. He told me what you just said and told me that we were going to stick with trying to treat me as bipolar 2 with mixed states and major depression. Oh yeah with GAD and obsessional features. He won't try me on any more AD's. He said they weren't good for my bipolar. I've never even tried an MAOI. None of my doctors have ever even mentioned trying one, yet nothing yet has been able to break through this wall of depression. He said all we've got to work with now is the mood stablizers and benzos. I'm on Lamictal and Klonopin now and am going to see how it goes. The only thing I don't understand is that he says that Klonopin is not depressing, yet other pdocs and most of everyone here on babble say it is. I've decided to try to do without it and see if the Lamictal alone helps. I seem to trust y'all's opinions on Klonopin than I do his. And with my depression there is no elevation in mood to possitive life events. It's all gloom and doom even if daisys are sprouting out of everyones butts in my house. There is no break in it.
Posted by jedi on June 1, 2006, at 17:27:19
In reply to Re: MAOIs not good for BPII? » naughtypuppy, posted by CEK on June 1, 2006, at 16:16:30
> > That's basically what my pdoc says. I mentioned to him a couple of weeks ago that I had all of the symptoms of borderline personality disorder and he looked like he wanted to slap me. He told me what you just said and told me that we were going to stick with trying to treat me as bipolar 2 with mixed states and major depression. Oh yeah with GAD and obsessional features. He won't try me on any more AD's. He said they weren't good for my bipolar. I've never even tried an MAOI. None of my doctors have ever even mentioned trying one, yet nothing yet has been able to break through this wall of depression. He said all we've got to work with now is the mood stablizers and benzos. I'm on Lamictal and Klonopin now and am going to see how it goes. The only thing I don't understand is that he says that Klonopin is not depressing, yet other pdocs and most of everyone here on babble say it is. I've decided to try to do without it and see if the Lamictal alone helps. I seem to trust y'all's opinions on Klonopin than I do his. And with my depression there is no elevation in mood to possitive life events. It's all gloom and doom even if daisys are sprouting out of everyones butts in my house. There is no break in it.
Hi,
There is a school of thought that the definition of atypical depression in the DSM-IV is too complex and difficult to diagnose. The definition can be simplified to just major depression with oversleeping and overeating. If your trial of Lamictal does not work, find a MD that will prescribe a MAOI. Nardil is the only med out of about 35 different combinations that has worked on my major atypical depression. Sounds to me like your current PDOC would really freak out at this suggestion.
Good Luck,
Jedi
PS I am one of the people for which clonazepam is not depressing. When combined with Nardil it is simply the best medication for my social anxiety.Eur Arch Psychiatry Clin Neurosci. 2002 Dec;252(6):288-93.
Can only reversed vegetative symptoms define atypical depression?
Benazzi F.
Outpatient Psychiatry Center, Ravenna and Forli, Italy.BACKGROUND: The definition of atypical depression (AD) has recently seen a rebirth of studies, as the evidence supporting the current DSM-IV atypical features criteria is weak. Study aim was to compare a definition of AD requiring only oversleeping and overeating (reversed vegetative symptoms) to the DSM-IV AD definition (always requiring mood reactivity, plus overeating/weight gain, oversleeping, leaden paralysis, and interpersonal sensitivity [at least 2]). METHODS: Consecutive 202 major depressive disorder (MDD) and 281 bipolar II outpatients were interviewed, during a major depressive episode (MDE), with the Structured Clinical Interview for DSM-IV. The DSM-IV criteria for AD were compared to a new AD definition based only on oversleeping and overeating, which was the one often used in community studies. Associations were tested by univariate logistic regression. RESULTS: The frequency of DSM-IV AD was 42.8 %, and that of the new AD definition was 38.7 %. DSM-IV AD, and the new AD definition, had almost all the same significant associations: bipolar II, female gender, lower age, lower age of onset, axis I comorbidity, depressive mixed state, MDE symptoms lasting more than 2 years, and bipolar family history. DSM-IV AD was present in 86 % of the new AD definition sample. The new definition of AD was significantly associated with all the other DSM-IV AD symptoms not included in it. The new AD definition was strongly associated with DSM-IV AD (odds ratio = 17.8), and had sensitivity = 77.7 %, specificity = 90.5 %, positive predictive value = 86.1 %, negative predictive value = 84.4 %, and ROC area curve = 0.85, for predicting DSM-IV AD. CONCLUSIONS: Results support a simpler definition of AD, requiring only oversleeping and overeating, and support the similar AD definition previously used in community studies. This definition is easier and quicker to assess by clinicians than the DSM-IV definition (mood reactivity and interpersonal sensitivity are more difficult to assess). Some pharmacological studies support this new AD definition (by showing better response to MAOI than to TCA, as shown in DSM-IV AD).
PMID: 12563537 [PubMed - indexed for MEDLINE]
Posted by CEK on June 1, 2006, at 19:38:54
In reply to Re: MAOIs not good for BPII? » CEK, posted by jedi on June 1, 2006, at 17:27:19
I'm a big Star Wars fan so I'm going to enjoy writing to you. Thank you for your input. I have social anxiety too. I've had it all my life and I've never taken anything that has helped that. Are you bipolar also or do you just have the depression and social anxiety? (If you don't mind me asking.) Thanks, Cara
Posted by jedi on June 2, 2006, at 0:57:01
In reply to Re: MAOIs not good for BPII? » jedi, posted by CEK on June 1, 2006, at 19:38:54
> I'm a big Star Wars fan so I'm going to enjoy writing to you. Thank you for your input. I have social anxiety too. I've had it all my life and I've never taken anything that has helped that. Are you bipolar also or do you just have the depression and social anxiety? (If you don't mind me asking.) Thanks, Cara
Hi Cara,
I wanted to use Yoda, but it was already taken! I haven't been officially diagnosed as bipolar but I have had medication induced hypomania. It was the Nardil that caused it. To be honest the hypomania felt pretty good after years of dysthymia and a long period of major depression. Looking back, it probably wasn't a good thing. But after the pit of major depression, anything feels better. My depression is definately atypical with major weight gain and sleeping 12+ hours per day. At least I could sleep; it was the only way to escape the pain.I have just started Nardil again after about four months off. During this time I used high doses of Omega-3s, which I still believe has some major health benefits. I also had six week trials of Wellbutrin(300mg) and nortriptyline(150mg). None of this kept the major depression from returning. I am crossing my fingers that the Nardil will work again. It has not failed me in the past, though the last two recoverys were not as dramatic as the first two. I wanted to try EMSAM but I just could not risk another unproven med trial at this time. I have a family to support and have taken a huge financial hit from the depression. Maybe after I recover and get on my feet, I'll risk an EMSAM trial. Then again, I may be a lifer on Nardil. There are side effects but nothing is as bad as major depression. Good luck in your search for a medication that works for you. Lamictal is on my list of augmentation meds that I want to try with my MAOI.
Take care,
Jedi
Posted by SLS on June 2, 2006, at 8:17:26
In reply to Re: MAOIs not good for BPII? » CEK, posted by jedi on June 1, 2006, at 17:27:19
> > > That's basically what my pdoc says. I mentioned to him a couple of weeks ago that I had all of the symptoms of borderline personality disorder and he looked like he wanted to slap me. He told me what you just said and told me that we were going to stick with trying to treat me as bipolar 2 with mixed states and major depression. Oh yeah with GAD and obsessional features. He won't try me on any more AD's. He said they weren't good for my bipolar. I've never even tried an MAOI. None of my doctors have ever even mentioned trying one, yet nothing yet has been able to break through this wall of depression. He said all we've got to work with now is the mood stablizers and benzos. I'm on Lamictal and Klonopin now and am going to see how it goes. The only thing I don't understand is that he says that Klonopin is not depressing, yet other pdocs and most of everyone here on babble say it is. I've decided to try to do without it and see if the Lamictal alone helps. I seem to trust y'all's opinions on Klonopin than I do his. And with my depression there is no elevation in mood to possitive life events. It's all gloom and doom even if daisys are sprouting out of everyones butts in my house. There is no break in it.
>
> Hi,
> There is a school of thought that the definition of atypical depression in the DSM-IV is too complex and difficult to diagnose. The definition can be simplified to just major depression with oversleeping and overeating. If your trial of Lamictal does not work, find a MD that will prescribe a MAOI. Nardil is the only med out of about 35 different combinations that has worked on my major atypical depression. Sounds to me like your current PDOC would really freak out at this suggestion.
> Good Luck,
> Jedi
> PS I am one of the people for which clonazepam is not depressing. When combined with Nardil it is simply the best medication for my social anxiety.
>
> Eur Arch Psychiatry Clin Neurosci. 2002 Dec;252(6):288-93.
> Can only reversed vegetative symptoms define atypical depression?
> Benazzi F.
> Outpatient Psychiatry Center, Ravenna and Forli, Italy.
>
> BACKGROUND: The definition of atypical depression (AD) has recently seen a rebirth of studies, as the evidence supporting the current DSM-IV atypical features criteria is weak. Study aim was to compare a definition of AD requiring only oversleeping and overeating (reversed vegetative symptoms) to the DSM-IV AD definition (always requiring mood reactivity, plus overeating/weight gain, oversleeping, leaden paralysis, and interpersonal sensitivity [at least 2]). METHODS: Consecutive 202 major depressive disorder (MDD) and 281 bipolar II outpatients were interviewed, during a major depressive episode (MDE), with the Structured Clinical Interview for DSM-IV. The DSM-IV criteria for AD were compared to a new AD definition based only on oversleeping and overeating, which was the one often used in community studies. Associations were tested by univariate logistic regression. RESULTS: The frequency of DSM-IV AD was 42.8 %, and that of the new AD definition was 38.7 %. DSM-IV AD, and the new AD definition, had almost all the same significant associations: bipolar II, female gender, lower age, lower age of onset, axis I comorbidity, depressive mixed state, MDE symptoms lasting more than 2 years, and bipolar family history. DSM-IV AD was present in 86 % of the new AD definition sample. The new definition of AD was significantly associated with all the other DSM-IV AD symptoms not included in it. The new AD definition was strongly associated with DSM-IV AD (odds ratio = 17.8), and had sensitivity = 77.7 %, specificity = 90.5 %, positive predictive value = 86.1 %, negative predictive value = 84.4 %, and ROC area curve = 0.85, for predicting DSM-IV AD. CONCLUSIONS: Results support a simpler definition of AD, requiring only oversleeping and overeating, and support the similar AD definition previously used in community studies. This definition is easier and quicker to assess by clinicians than the DSM-IV definition (mood reactivity and interpersonal sensitivity are more difficult to assess). Some pharmacological studies support this new AD definition (by showing better response to MAOI than to TCA, as shown in DSM-IV AD).
>
> PMID: 12563537 [PubMed - indexed for MEDLINE]
The problem with this approach is that bipolar depression looks a lot like atypical depression. Usually, it is anergic and produces a reversed vegetative symptomology - over eating and over sleeping. A misdiagnosis here might result in an exacerbation of the illness if mood stabilizers are not employed.
- Scott
Posted by jedi on June 2, 2006, at 11:18:57
In reply to Re: MAOIs not good for BPII?, posted by SLS on June 2, 2006, at 8:17:26
> The problem with this approach is that bipolar depression looks a lot like atypical depression. Usually, it is anergic and produces a reversed vegetative symptomology - over eating and over sleeping. A misdiagnosis here might result in an exacerbation of the illness if mood stabilizers are not employed.
> - ScottHi Scott,
That makes sence and may be why so many people go years without being properly diagnosed with bipolar. You would think that by now more PDOCs would be able to ask the right questions to diagnose this illness. I am pretty sure that my atypical depression would lie somewhere on the bipolar spectrum. Nardil, while being the only med that has helped my major depression, has also precipitated at least two episodes of hypomania. What do you think of Lamictal to augment my type of atypical depression?
Thanks,
Jedi
Posted by CEK on June 2, 2006, at 11:22:00
In reply to Re: MAOIs not good for BPII?, posted by SLS on June 2, 2006, at 8:17:26
I think this is what happened to me. My GP kept me on ADs for my depression and tried several that didn't work. Effexor was the only one that had any effect at all, but the depression was still there. She never thought anything about my mood swings that I had daily for no reason at all. When she finally tried Cymbalta in Nov. the hypomania started. I didn't know that was what it was. I thought it was just me starting to feel better. When I started going on ebay and started blowing money like crazy, she thought it was just me enjoying myself. I was always the type to use extra money on bills and didn't blow it on things we didn't have to have. The binge eating that I started she believed was due to the stress in my life. The eating and spending made me feel so good at the time. I was up and down several times a day. One minute I was feeling so elated, then the next I felt like killing myself, and the rest of the times it was just plan bad depression. It wasn't until I went to a real pdoc that I was diagnosed as bipolar 2. The pdocs that I have seen can not believe that I was never put on a mood stablizer before.
Posted by SLS on June 2, 2006, at 11:43:10
In reply to Re: MAOIs not good for BPII? » SLS, posted by jedi on June 2, 2006, at 11:18:57
>
> > The problem with this approach is that bipolar depression looks a lot like atypical depression. Usually, it is anergic and produces a reversed vegetative symptomology - over eating and over sleeping. A misdiagnosis here might result in an exacerbation of the illness if mood stabilizers are not employed.
> > - Scott
>
> Hi Scott,
> That makes sence and may be why so many people go years without being properly diagnosed with bipolar. You would think that by now more PDOCs would be able to ask the right questions to diagnose this illness. I am pretty sure that my atypical depression would lie somewhere on the bipolar spectrum. Nardil, while being the only med that has helped my major depression, has also precipitated at least two episodes of hypomania. What do you think of Lamictal to augment my type of atypical depression?
> Thanks,
> JediLamictal, of course, produces an antidepressant effect of various degrees. Unfortunately, it does not have appreciable antimanic properties. It is not as potent as lithium or Depakote when treating someone who is already manic, and might not prevent an antidepressant induced switch into mania. However, Lamictal is noted to have an anticycling effect. It can help prevent recurrences of depression along with rapid-cycling. This is true of both bipolar and unipolar presentations.
Your question, then, is whether or not Lamictal will prevent a switch into a mania produced by Nardil. Lamictal might not be a bad first choice. Although I question its antimanic potency, it is usually a clean drug that does not cause weight gain. There is a chance that it would work. If it fails to prevent a manic switch, I would then look at Depakote or an atypical antipsychotic to act as an antimanic mood stabilizer. Lithium is not usually effective when treating bipolar II.
- Scott
Posted by CEK on June 2, 2006, at 15:53:26
In reply to Re: MAOIs not good for BPII? » jedi, posted by SLS on June 2, 2006, at 11:43:10
I'm starting my 4th week on Lamictal and am on 5omg of it. I've noticed that it has stopped my compulsive eating and I'm not hungry or craving foods on it. When I do eat, I fill up faster. When on Lithium, Depakote and many Ad's it was just the opposite.
Posted by Phillipa on June 2, 2006, at 17:34:30
In reply to Re: MAOIs not good for BPII? » jedi, posted by SLS on June 2, 2006, at 11:43:10
I now know I don't have atypical depression as I don't binge eat and sleep all day. I can't sit still always want to go somewhere but not alone. Love Phillipa
This is the end of the thread.
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