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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by jono_in_adelaide on September 11, 2012, at 0:00:59
An interesting articly and illistration showing how the various neurotransmitters and the different types of dperession like - mild "neurotic" depression involves mainly seretonin, moderate endrogenous depression involves seretonin and noradrenalin, and severe psychotic depression also involves dopamine.
Lends weight to the throry that severe depression is best hit with a combo of an SSRI and an agent action on noradrenalin (nortriptyline, reboxetine) or noradrenalin and dopamine (bupropion) and why Parnate (which raises all three) mght be the best of all
http://www.blackdoginstitute.org.au/docs/ARATIONALMODELFORANTIDEPRESSANTDRUGPRESCRIPTION.pdf
Posted by jono_in_adelaide on September 11, 2012, at 0:10:28
In reply to Different types of depression, posted by jono_in_adelaide on September 11, 2012, at 0:00:59
I do realise that this is far from the complete story however, before I am roasted alive!
Posted by SLS on September 11, 2012, at 1:58:07
In reply to Re: Different types of depression, posted by jono_in_adelaide on September 11, 2012, at 0:10:28
> I do realise that this is far from the complete story however, before I am roasted alive!
Nice find.
:-)
- Scott
Posted by bleauberry on September 11, 2012, at 12:16:54
In reply to Different types of depression, posted by jono_in_adelaide on September 11, 2012, at 0:00:59
I totally agree with your comments on serotonin/NE approaches, and parnate. It's also consistent with what Dr Gillman saw throughout his career in clinical practice.
In the naturopath world, they use the very concepts you discussed to make the diagnosis and find the right treatment simultaneously. 5htp or tryptophan are tried. Good rapid result indicates a serotonin problem. DLPA for NE and endorphins. Tyrosine for NE and DA. Best results are usually combinations based on individual trials first. The description of the depression usually points to which one of those to try first.
Posted by schleprock on September 11, 2012, at 20:35:28
In reply to Different types of depression, posted by jono_in_adelaide on September 11, 2012, at 0:00:59
I do not agree that meloncholic depression is primarily defined by psychomotor disturbance.
Posted by jono_in_adelaide on September 11, 2012, at 21:45:42
In reply to Re: Different types of depression, posted by schleprock on September 11, 2012, at 20:35:28
I think they are saying that melancholic depression is defined by the symptoms of low mood, lack of happiness, anxiety etc PLUS psychomotor retardation.
I'd say suicide idealisation would be one of the keys for me - if you're seriously thinking of offing your self, then you probably have a melancholic depression, if you just if you have vauge thoughts that "I'd be better off dead" you might only have a mild depression.
Posted by SLS on September 11, 2012, at 21:49:09
In reply to Re: Different types of depression, posted by schleprock on September 11, 2012, at 20:35:28
> I do not agree that meloncholic depression is primarily defined by psychomotor disturbance.
How would you define melancholic depression?
Does melancholic depression ever present without psychomotor disturbances?
Is psychomotor retardation an index of severity?
I hope you had a good day.
- Scott
Posted by SLS on September 11, 2012, at 21:54:59
In reply to Re: Different types of depression, posted by jono_in_adelaide on September 11, 2012, at 21:45:42
> I think they are saying that melancholic depression is defined by the symptoms of low mood, lack of happiness, anxiety etc PLUS psychomotor retardation.
>
> I'd say suicide idealisation would be one of the keys for me - if you're seriously thinking of offing your self, then you probably have a melancholic depression, if you just if you have vauge thoughts that "I'd be better off dead" you might only have a mild depression.
The most severe case of depression I ever saw was of a young woman with melancholic depression who presented with severe psychomotor retardation. She moved agonizingly slowly when she was asked by her mother to fetch me a paper-towel. It was a horrific sight. She killed herself.
- Scott
Posted by jono_in_adelaide on September 11, 2012, at 22:22:08
In reply to Re: Different types of depression » jono_in_adelaide, posted by SLS on September 11, 2012, at 21:54:59
Well, I'm not an expert, and the guy who wrote that stuff is, but I'd say that mild or neurotic depression presents with low mood, anxiety, lack of pleasure etc, all mental symptoms, and that melancholic depression presents with some or all of these PLUS psychomotor retardation, early morning awakening etc.
I dont suppose the lines are totaly clear, there are a lot of shades of grey in there, but it struck me as a reasonable explenation that was technical enough to be of use while being simple enough for a layman to understand.
Posted by SLS on September 12, 2012, at 3:16:16
In reply to Re: Different types of depression, posted by jono_in_adelaide on September 11, 2012, at 22:22:08
> Well, I'm not an expert, and the guy who wrote that stuff is, but I'd say that mild or neurotic depression presents with low mood, anxiety, lack of pleasure etc, all mental symptoms, and that melancholic depression presents with some or all of these PLUS psychomotor retardation, early morning awakening etc.
>
> I dont suppose the lines are totaly clear, there are a lot of shades of grey in there, but it struck me as a reasonable explenation that was technical enough to be of use while being simple enough for a layman to understand.If nothing else, the article has heuristic value. It provides a model that can be used to compare the relative contributions of the different monoamines to each subtype of depression. This might not be sufficient to fully explain depression. It relies on the monoamine theory. The model does not take into account some of the more recent data and theories, but it at least demonstrates the interplay between different systems and pathways that are variable enough to allow for the presentation of pathological mental states.
Here's one they forgot: bipolar depression. It occurs to me that this type of depression presents as a hybrid of atypical and melancholic symptomatology: anergia, anhedonia, psychomotor retardation, reverse vegetative symptoms, impaired memory and congnition, rumination, slow-thinking, increased appetite, hypersomnia, weight-gain, non-reactive mood, reduced symptom severity in the morning and a worsening by afternoon, flat affect. It looks a lot like the "deficit syndrome" in schizophrenia.
- Scott
Posted by jono_in_adelaide on September 12, 2012, at 5:29:57
In reply to Re: Different types of depression » jono_in_adelaide, posted by SLS on September 12, 2012, at 3:16:16
Between DSMIV and the drug manufacturers, we seem to have reached a point where any manifestation of unhappines merits a prescription for an SSRI.....not sure that they do much good for a majority of whom they are prescribed (more than 50% of people stop their antidepressant within 6 weeks) but atleast they arnt addictive, unlike the benzos they replaced in medicating unhapiness
Posted by Phillipa on September 12, 2012, at 10:13:13
In reply to Re: Different types of depression, posted by jono_in_adelaide on September 12, 2012, at 5:29:57
If not addictive why or why can't I get off a silly low dose of 50mg of luvox which dosen't seem to work? How does one know if they could be developing Alzheimers from meds? Could it be a form of depression? Phillipa
Posted by schleprock on September 12, 2012, at 12:07:08
In reply to Re: Different types of depression » schleprock, posted by SLS on September 11, 2012, at 21:49:09
> > I do not agree that meloncholic depression is primarily defined by psychomotor disturbance.
>
> How would you define melancholic depression?
>
> Does melancholic depression ever present without psychomotor disturbances?
>
> Is psychomotor retardation an index of severity?
>
> I hope you had a good day.
>
>
> - ScottYes, I believe that's what I have. All the symptoms of meloncholic depression but WITHOUT psychomotor disturbances. The Lyrica and clonazepam are helping somewhat, but I have a feeling this remission won't last very long.
Posted by schleprock on September 12, 2012, at 12:36:06
In reply to Re: Different types of depression » SLS, posted by schleprock on September 12, 2012, at 12:07:08
Actually, would it be possible to suffer all the symptoms of melancholic depression without the psychomotor disturbance by being on a med that is a strong NA agonist(?) (but weak on SA) like Nortriptyline?
Posted by jono_in_adelaide on September 12, 2012, at 17:50:19
In reply to Re: Different types of depression, posted by schleprock on September 12, 2012, at 12:36:06
"Actually, would it be possible to suffer all the symptoms of melancholic depression without the psychomotor disturbance by being on a med that is a strong NA agonist(?) (but weak on SA) like Nortriptyline? "
I'd think highly unlikely, given that nortriptyline/amitriptyline were a standard treatment for melancholic depression for 30 odd years
Posted by brynb on September 13, 2012, at 21:51:08
In reply to Different types of depression, posted by jono_in_adelaide on September 11, 2012, at 0:00:59
Interesting.
I've been wondering, though, because my depression used to seem Melancholic, but more recently it seems Atypical (except I still get up on the early side and my depression is worse in the morning, and I have no appetite). So it's like a mix.
What do I make of that?
-b
Posted by SLS on September 14, 2012, at 0:06:54
In reply to Re: Different types of depression, posted by brynb on September 13, 2012, at 21:51:08
> Interesting.
>
> I've been wondering, though, because my depression used to seem Melancholic, but more recently it seems Atypical (except I still get up on the early side and my depression is worse in the morning, and I have no appetite). So it's like a mix.
>
> What do I make of that?
>
> -b
Is there any history of bipolar disorder in your family?
- Scott
Posted by brynb on September 14, 2012, at 9:08:45
In reply to Re: Different types of depression » brynb, posted by SLS on September 14, 2012, at 0:06:54
> > Interesting.
> >
> > I've been wondering, though, because my depression used to seem Melancholic, but more recently it seems Atypical (except I still get up on the early side and my depression is worse in the morning, and I have no appetite). So it's like a mix.
> >
> > What do I make of that?
> >
> > -b
>
>
> Is there any history of bipolar disorder in your family?
>
>
> - ScottHi Scott-
No, and there's no history of depression either. I'm the "lucky" one :/. My dx has typically been MDD, though several pdocs have thought it was Bipolar 2.
I don't know. I was doing really great for a while with the addition of Tramadol, and lately, I'm starting to spiral down again. It's pretty much doom and gloom when I wake up, that aching pit in the stomach, and I have to take Tramadol immediately just to function. I actually just left a message with my pdoc.
-b
Posted by SLS on September 14, 2012, at 15:26:52
In reply to Re: Different types of depression » SLS, posted by brynb on September 14, 2012, at 9:08:45
> I'm starting to spiral down again. It's pretty much doom and gloom when I wake up, that aching pit in the stomach, and I have to take Tramadol immediately just to function. I actually just left a message with my pdoc.
Good move.
I wish you the best.
- Scott
Posted by schleprock on September 14, 2012, at 17:27:38
In reply to Re: Different types of depression » brynb, posted by SLS on September 14, 2012, at 15:26:52
> > I'm starting to spiral down again. It's pretty much doom and gloom when I wake up, that aching pit in the stomach, and I have to take Tramadol immediately just to function. I actually just left a message with my pdoc.
>
> Good move.
>
> I wish you the best.
>
>
> - ScottWhat exactly is this "Tramadol " of which you speak?
Posted by brynb on September 14, 2012, at 18:48:47
In reply to Re: Different types of depression » brynb, posted by SLS on September 14, 2012, at 15:26:52
> > I'm starting to spiral down again. It's pretty much doom and gloom when I wake up, that aching pit in the stomach, and I have to take Tramadol immediately just to function. I actually just left a message with my pdoc.
>
> Good move.
>
> I wish you the best.
>
> - Scott
Thanks, Scott. I haven't heard back from him yet. I don't want to meddle with my med combo, but I wonder if my pdoc can give me something (even temporarily) that will work immediately (which the Tramadol does, but nothing is preventing the depression in the morning right now). Any suggestions? I'm trying to be positive and hope this will just pass. We'll see.Thanks again.
Posted by brynb on September 14, 2012, at 19:19:16
In reply to Re: Different types of depression » SLS, posted by schleprock on September 14, 2012, at 17:27:38
> > > I'm starting to spiral down again. It's pretty much doom and gloom when I wake up, that aching pit in the stomach, and I have to take Tramadol immediately just to function. I actually just left a message with my pdoc.
> >
> > Good move.
> >
> > I wish you the best.
> >
> >
> > - Scott
>
> What exactly is this "Tramadol " of which you speak?Tramadol is a synthetic opioid painkiller, but it's not controlled (it doesn't produce a "high" like other opiates/opioids do). It also works like an NRI and an NMDA antagonist. I think because it works on these different areas combined, it makes for a good antidepressant. For me, it lifts my mood in about an hour--not euphorically, it just sort of brightens and motivates.
Unfortunately, many pdocs won't prescribe it because it's "not a psych drug" and it carries the stigma of being a painkiller.
-b
Posted by SLS on September 14, 2012, at 19:20:04
In reply to Re: Different types of depression, posted by brynb on September 14, 2012, at 18:48:47
> Thanks, Scott. I haven't heard back from him yet. I don't want to meddle with my med combo, but I wonder if my pdoc can give me something (even temporarily) that will work immediately (which the Tramadol does, but nothing is preventing the depression in the morning right now). Any suggestions? I'm trying to be positive and hope this will just pass. We'll see.
I hope that things will pass, too. Zyprexa might help as a temporary bridge to your next antidepressant treatment. If I were more certain of the potential for Latuda to act as a bridge, I would suggest that because it won't cause weight gain. If your baseline depression is one in which morning is your worst time of day, that would argue for the use of a TCA like imipramine. Parnate would be another drug to consider. These are rather old-fashioned treatments, but endogenous melancholic depression is a rather old foe. (I apologize if this is a redundant post).
- Scott
Posted by brynb on September 14, 2012, at 19:45:05
In reply to Re: Different types of depression » brynb, posted by SLS on September 14, 2012, at 19:20:04
> > Thanks, Scott. I haven't heard back from him yet. I don't want to meddle with my med combo, but I wonder if my pdoc can give me something (even temporarily) that will work immediately (which the Tramadol does, but nothing is preventing the depression in the morning right now). Any suggestions? I'm trying to be positive and hope this will just pass. We'll see.
>
> I hope that things will pass, too. Zyprexa might help as a temporary bridge to your next antidepressant treatment. If I were more certain of the potential for Latuda to act as a bridge, I would suggest that because it won't cause weight gain. If your baseline depression is one in which morning is your worst time of day, that would argue for the use of a TCA like imipramine. Parnate would be another drug to consider. These are rather old-fashioned treatments, but endogenous melancholic depression is a rather old foe. (I apologize if this is a redundant post).
>
>
> - ScottThanks again, Scott. I really appreciate it. I'll see what my pdoc says (hopefully he'll return my call tomorrow). It seems as if my depression goes back and forth between melancholic and atypical. Not to mention it's not clear whether it's bipolar or not. I sometimes wonder if I should go off of everything and see what my baseline is. I say that kiddingly, really; last time I did a washout it was really bad news.
-b
Posted by SLS on September 14, 2012, at 23:30:54
In reply to Re: Different types of depression » SLS, posted by brynb on September 14, 2012, at 19:45:05
> It seems as if my depression goes back and forth between melancholic and atypical.
It is my observation that bipolar depression resembles a hybrid of melancholic and atypical depression, although atypical symptoms seem to predominate.
- Scott
This is the end of the thread.
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