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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 48 to 72 of 72. Go back in thread:
Posted by River1924 on March 20, 2007, at 0:01:46
In reply to Re: Atypical depression vetted out of studies? » FredPotter, posted by Ines on March 19, 2007, at 17:57:58
Hi,
Thanks for reading my previous posts and the comments.
I'm not sure how to respond to your post. I am much the same. (My niece who died recently was much more like you.... Crying in the toliet and feeling phoney seem to be more of a female experience.) When people ask me how are you, I feel like a fake if I say awful because at that moment, I usually don't. I think the right question with those with atypical depression is "How were you when you were alone ten minutes ago?" I can usually answer, I felt kinda down and was thinking of suicide. I understand the the ocd component. Without zoloft, I can kinda live with suicidal thoughts (which will appear) for a few days because they don't even seem like my ideas... slowly the ideas leak in and I feel swamped with sorrow. My emergency meds are stelazine and razadyne. Stelazine calms me down without making me sleepy. I can take it alone but, after a week, I feel kinda brain dead. The razadyne prevents that. Abilfy isn't sedating either. You might want to try it. It can make one feel tense and cause insomnia initially. I think if one is prone to suicidal thoughts, one needs an anti-psychotic to use for a month or two now and then. There is a connection between atypical depression and bipolar depression. Don't let youself treat your illness according to how you appear to others. It is serious. Even at my best, I test extremely depressed when my pdoc has me feel out a form. I can't imagine life any other way and most people don't really think there is much wrong with me. Perhaps, I should carry around the test and ask other people to take it. I'm sure they would be shocked at my answers. That's their problem.
Does any of this make sense? I hope so. River.
Posted by FredPotter on March 20, 2007, at 5:04:19
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by River1924 on March 20, 2007, at 0:01:46
Thanks Ines are you female? I have a dear (I thought) friend back in Wales where I used to live. He emailed a little while ago saying he'd always thought that there was nothing wrong with my mind but that often I didn't realise this. Well, so long as he's got it straight in his mind and is free from worrying about it. His daughter has had CFS for years. I could say something spiteful back in the same vein, but I won't.
River said, "How were you when you were alone ten minutes ago?" That's a good question. But it must be mystifying to friends to whom we appear normal. I even make people laugh. But it's not faked. I respond well to people.
Now that the Effexor withdrawal is nearly over I hope, I have felt pretty good today. Particularly lucid as a colleague said to me at work "considering you haven't slept properly for 5 days".
I'll let you know how Nardil works. I'm worried about getting fat(ter) and about all the nice foods and drinks I'll have to forego.
Thanks for your kind response
Fred
Posted by Ines on March 20, 2007, at 13:13:13
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by River1924 on March 20, 2007, at 0:01:46
Hi River and Fred,
I so agree with the 'how were you 10 minutes ago when you were alone' question!. Your posts got me thinking- I don't so much pretend that I'm feeling ok but rather I actually do feel ok at the moment I'm asked. It's so true and I'd never thought of it like that. I seem to perk up immediately when in company- unless it is someone I really trust; paradoxically, the contrary can happen then, i.e. feeling really low. It's almost like I have permission to feel bad then.
You know, it really helps to hear other people's similar experiences. It makes me feel less of an outsider... Thanks a lot for support.
River, I've thought of the bipolar connection- and the possibility that I'd respond well to mood stabilisers. So far I haven't responded to any to the AD medications I've tried- in fact, they've made it worse. I'm on the waiting list to see a psychiatrist and hopefully I'll get a proper diagnosis then, and proper help. Although the idea of being diagnosed is slightly scary as well: 'have-for-sure': atypical depression & binge eating disorder. Very probables: OCD, generalised anxiety disorder. Possibles: bipolar spectrum, even some borderline personality disorder traits. Yikes!
Just a few weeks ago I did a depression scale test on a not-so-bad day and tested extremely depressed as well. It actually shocked me: I was expecting moderately depressed or something along those lines. I'm down to very depressed now. The small victories!
Take care and keep well,
Ines
(Fred, yes I am female btw)
Posted by River1924 on March 21, 2007, at 0:34:24
In reply to Re: Atypical depression vetted out of studies?, posted by Ines on March 20, 2007, at 13:13:13
One of the big researchers in the US is Hagop Akiskal. I found this article which includes info about him and many of the probable diagnosis-es you mentioned. http://www.psycom.net/depression.central.lieber.html
I don't know what system they use in your country but I'd recommend bringing in several of those depression tests from various dates. It will show you are serious and that your "appearance" may not give him the full story. Tell him/her what you think you might have (bring your own info) but in the end, the diagnosis is secondary to treatment. If he/she wants to label you a gorilla, that's fine if the treatment is correct.
After my niece's suicide, I found this workbook for "mixed depression." The first few chapters helped her father understand her state of mind. The therapy is similar to cognitive behavioral but was developed for "borderliners" and those with eating disorders. "Depressed and Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression & Anxiety "
Posted by Ines on March 21, 2007, at 13:53:13
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by River1924 on March 21, 2007, at 0:34:24
River,
Thanks a lot for that post. I found that article by Akiskal very helpful, and reassuring re. treatment possibilities- and I'm going to try find that book to look through. I also really really liked your suggestion of taking depression test scores for different dates with me to an appoinment- I've found in the past that doctors don't seem to take my depression seriously. I'm always very matter of fact about my symptoms and don't get emotional when talking about it, (I also have an annoying tendency to smile at them- it's actually a nervous thing) and it just seems to make them think I'm just overstressed, in need of time off or something like that, and making too big a deal of it.
Thanks again. Take care,
Ines
Posted by FredPotter on March 21, 2007, at 17:55:57
In reply to Re: Atypical depression vetted out of studies? » River1924, posted by Ines on March 21, 2007, at 13:53:13
Ines there's a lot in your post. I want to reply at length but I'm supposed to be working right now. BTW River's idea of taking in test scores is a masterstroke as well as being good for measuring one's own progress
Later
Fred
Posted by FredPotter on March 22, 2007, at 0:12:02
In reply to Re: Atypical depression vetted out of studies? » River1924, posted by Ines on March 21, 2007, at 13:53:13
Ines I know. I was in a desperate anxiety crisis and had been taken to hospital, where they left me writhing with akathisia and periodic vomitting.
After several hours of this, 2 very attractive nurses came to talk to me. I can't help it, it'chemistry. One in particular was gorgeous and whenever I looked her way she smiled at me and she made me smile back. (She wasn't doing much of the interrogation.)
Eventually I smiled and said, "you keep smiling at me" then went back to writhing and saying things like, "what do you want, blood!?" I just wanted some valium or something. It was just me on different levels.
A friend of mine years ago was dying of stomach cancer but even at the end when she was vomitting every 2 minutes, her humour was irrepressible. To the point where we round the bed were laughing instead of looking suitably grave. That didn't prove she hadn't got cancer. She died about 2 weeks later. I'll never forget her
I read a story in Time magazine where a man's head was stuffed full of lung cancer. It had destroyed the brain. The family said to the surgeon after he died (not the surgeon I don't mean) that he came out of his coma, sat up stroked everybody, smiling and then collapsed and was dead. Even though there really was no brain left. "And I believed them", said the surgeon. Obviously the whole thing hangs on these 4 words.
I give these examples to show that with the kind of mental illness that doesn't show psychotic features, people usually have to take your word for it, or sometimes they don't.
During a voluntary hospitalisation some years ago (I hoped they might actually help me - silly me to think that - they just ignored me) a young girl with schizophrenia said, "There's nothing wrong with YOU is there?" Hitherto she'd taken me for a staff-member. In those days (1980) mental illness WAS schizophrenia. One of the patients told me to eat my dinner as I'd never feel better. I was feeling too anxious and sick to eat.
In a way (I THINK but perhaps not) I was suffering more than them.
"Whitewashed tombs do worms enfold", to quote the Bard.
Fred
Posted by Ines on March 22, 2007, at 7:35:42
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by FredPotter on March 22, 2007, at 0:12:02
Hey Fred,
Your post about the anxiety crisis and the nurses made me smirk (not that there is anything funny about the anxiety crisis obviously). My ex boyfriend was admitted into hospital at one point for major surgery. He too suffered from depression. Apparently the nurse that held his hand whilst they anaesthetised him had 'a lovely face and a kind smile'. He said he just sort of dosed off whilst her face became more and more distant and could've died 'a perfectly happy man'!
What is it with men and nurses?!
I might add this took place before we were going out, otherwise I would have been quite offended at his recounting of the story.. ;-)Hope the effexor withdrawal's getting more bearable.
Ines
Posted by TheMeanReds on March 22, 2007, at 13:18:43
In reply to Re: Men and nurses, posted by Ines on March 22, 2007, at 7:35:42
Yeah, like all of the sex-kitten nurse costumes for halloween. It seems like a very common fetish.
At least he wasnt dosing off to the heavenly, sexy & beautiful face of an older male doctor, and still describing the experience. =)
Posted by Ines on March 22, 2007, at 15:34:21
In reply to Re: Men and nurses, posted by TheMeanReds on March 22, 2007, at 13:18:43
Yes now that might have put me off! ;-)
Posted by FredPotter on March 22, 2007, at 16:00:24
In reply to Re: Men and nurses, posted by Ines on March 22, 2007, at 7:35:42
Thanks Ines I still have Effexor withdrawal symptoms even though I've started Nardil. Still I'm not going back now. I'm afraid they may be permanent, but let's hope not. I still have whooshing in my head on moving my eyes, I do go straight to sleep now though but wake at 1am not knowing who I am, what's outside the house or whether I live alone or with others. It takes a few minutes to work out. Maybe that's a Nardil side-effect.
My last post was to try and work out why atypical depressive types appear normal. It's genuine too and not just a brave front
Bye
Fred
Posted by FredPotter on March 22, 2007, at 16:03:38
In reply to Re: Men and nurses, posted by TheMeanReds on March 22, 2007, at 13:18:43
to be fair to me, they were not in nurses' uniforms and one stage up from nurses (charge nurses?). But gorgeous women in normal clothes
Posted by FredPotter on March 22, 2007, at 16:05:13
In reply to Re: Men and nurses » TheMeanReds, posted by Ines on March 22, 2007, at 15:34:21
You see we're not all rugby freaks (I used to have this notion that NZ was all male)
Posted by TheMeanReds on March 22, 2007, at 17:06:12
In reply to Re: Men and nurses » TheMeanReds, posted by FredPotter on March 22, 2007, at 16:03:38
Sorry, I only read the 'men and nurses' post by Ines. It caught my eye. I'm glad you had a pleasent experience with the other charge nurses though.
> to be fair to me, they were not in nurses' uniforms and one stage up from nurses (charge nurses?). But gorgeous women in normal clothes
Posted by TheMeanReds on March 22, 2007, at 17:14:01
In reply to Re: Men and nurses » FredPotter, posted by TheMeanReds on March 22, 2007, at 17:06:12
Oops, I forgot to add I have had a pleasent experience when I went under for and operation. I had a motherly figure type nurse, and she asked me little questions about where I grew up. Very calming, and made me smile before I was under. I felt very greatful because I was very nervous while in the pre-op waiting room all alone.
She actually inspired me very much to think of going into her type of work. I was out of high school and deciding about my major at the time. I never pursued it, but she will always be in my memories.
> Sorry, I only read the 'men and nurses' post by Ines. It caught my eye. I'm glad you had a pleasent experience with the other charge nurses though.
>
> > to be fair to me, they were not in nurses' uniforms and one stage up from nurses (charge nurses?). But gorgeous women in normal clothes
>
>
Posted by Phillipa on March 22, 2007, at 20:01:45
In reply to Re: Men and nurses, posted by TheMeanReds on March 22, 2007, at 17:14:01
You're very young and I didn't graduate from nursing school til 38 and always sat on my patients bed after asking permission to start an IV. Found always got it the first time that way as human touch is very calming. And Fred street clothes so a psych unit. My favorite are scrubs feels like you're in your pajamas. So comfortable. Love Phillipa
Posted by FredPotter on March 23, 2007, at 7:28:47
In reply to Re: Men and nurses, posted by TheMeanReds on March 22, 2007, at 17:14:01
I've experienced nurses like that. Worth their weight in gold, but severely underpaid
Posted by football on March 23, 2007, at 14:31:25
In reply to Re: Atypical depression is typical, posted by River1924 on March 2, 2007, at 1:45:58
It's actually fairly common with abilify.
Posted by stargazer on March 23, 2007, at 18:45:11
In reply to Re: Atypical depression is typical, posted by football on March 23, 2007, at 14:31:25
What is fairly common with abilify? I can't find the post you are referring to.
SG
Posted by River1924 on March 24, 2007, at 0:47:00
In reply to Re: Atypical depression vetted out of studies?, posted by Ines on March 20, 2007, at 13:13:13
J Clin Psychiatry. 2007;68 Suppl 3:25-9.
Treating depression with atypical features.
Stewart JW.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. jws6@columbia.edu
Depression with atypical features was first recognized in a subset of patients with depression who preferentially responded to the monoamine oxidase inhibitor (MAOI) phenelzine, in contrast to patients with melancholic depression. This article reviews the history of approaches in treating depression with atypical features. Initial studies in the early 1980s focused on phenelzine, but an unfavorable adverse effect profile limits its clinical use. Despite such difficulties, phenelzine remains the gold standard in eliciting high response rates in nearly two thirds of patients with atypical depression. Searches for agents with improved safety profiles led to studies of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), chromium, and cognitive therapy approaches. Of these, TCAs showed inferior efficacy to MAOIs but also had cumbersome adverse effects. SSRIs have reported efficacy, but a lack of direct comparative studies limits clinical decision making. Cognitive strategies have shown promise, but demonstrating efficacy in comparison with an MAOI and placebo is limited to a single study. Despite advances in agents for melancholic depression, treatment for atypical depression remains dependent upon older agents for the greatest efficacy.
Posted by Ines on March 25, 2007, at 15:54:39
In reply to Re: Men and nurses » Ines, posted by FredPotter on March 22, 2007, at 16:00:24
Hey Fred,
Sorry for late reply- I've been away. I'm REALLY sorry if I offended you with my post about nurses. I did take your email seriously, and I really identify with your experiences. It's just my way to look for the humour in awkward situations. It helps me cope and I forget not everyone feels the same. I certainly didn't mean to make light of what you said. Hope you are feeling a bit better re: effexor withdrawal by now. It's supposed to be hell to come out of, so maybe what you're experiencing is normal- particularly if you're adding in Nardil to the equation.
Keep well, Ines x
Posted by Ines on March 25, 2007, at 15:57:34
In reply to Re: Atypical depression vetted out of studies? » Ines, posted by River1924 on March 24, 2007, at 0:47:00
Hi River,
Thanks for posting that abstract. That's brilliant! I'm going to try and track it down athe article. And by sounds of it it'll be a good one to take for an appointment with pdoc if I want to try and convince him to prescribe MAOIs.
Ines
Posted by FredPotter on March 25, 2007, at 16:40:11
In reply to Re: » FredPotter, posted by Ines on March 25, 2007, at 15:54:39
Ines BLESS YOU! No offence taken at all. I think atypical depressives usually lighten up serious situations, I certainly do
Fred
Posted by FredPotter on March 26, 2007, at 18:07:46
In reply to Re: Atypical depression, posted by Meri-Tuuli on March 2, 2007, at 1:21:55
Free consultation yes but sometimes the prescription charges are higher than here in NZ. I persuaded my Dr to let me have a go with Nardil and drop Effexor (not in that order). How a dr can happily prescribe that stuff (Effexor) but not an MAOI I can't understand. Sorry, I should say, you may be doing very well on Effexor. If so I wish you well. But if ever you withdraw (you may not need to) do it slowly. I've never demonised an AD before Effexor so I'm not going over the top (AGAIN!).
A babbler from a few years back, Elizabeth, who I think was doing a doctorate or post-doc in psychopharmacology and used to sign herself "-elizabeth" had a highly-informed MAOI diet. It's not as strict as Drs often think.
I'll try to find it and send a link if you don't already have it. As the diet is what Drs are chiefly worried about, it might be an idea to show them her post.
Fred
Posted by River1924 on March 27, 2007, at 2:55:59
In reply to Re: Atypical depression » Meri-Tuuli, posted by FredPotter on March 26, 2007, at 18:07:46
A history of the concept of atypical depression.
Davidson JR.
J Clin Psychiatry. 2007;68 Suppl 3:10-5.
Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA. jonathan.davidson@duke.edu
The term atypical depression as a preferentially monoamine oxidase inhibitor (MAOI)-responsive state was first introduced by West and Dally in 1959. Further characterization of this syndrome and its responsiveness to antidepressants came to occupy the attention of many psychopharmacologists for the next 30 years. Different portrayals of atypical depression have emerged, for example, nonendogenous depression, phobic anxiety with secondary depression, vegetative reversal, rejection-sensitivity, and depression with severe chronic pain. Consistency across or within types has been unimpressive, and no coherent single type of depression can yet be said to be "atypical." In successfully demonstrating superiority of MAOI drugs to tricyclics, the Columbia (or DSM-IV) criteria have established their utility and become widely adopted, but other criteria have also passed this test. In this "post-MAOI" era, no novel compound or group of drugs has been clearly shown to have good efficacy in atypical depression, leaving the treatment of atypical depression as an unmet need.
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