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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Beckett on June 6, 2014, at 19:11:57
I am confused regarding different kinds of depression. I have experienced depression that fits the descriptions of atypical and melancholic. I have had mood worsening at night and also mood improving at night.
Is it possible for depression to change manifestation back and forth over a lifetime? Have others experienced this? Information on this particular aspect is proving difficult to find.
Posted by Christ_empowered on June 6, 2014, at 21:35:42
In reply to Different types of depression, posted by Beckett on June 6, 2014, at 19:11:57
mood lability is I think what you call that. Happens. What treatments have worked in the past? That's the big thing....
Posted by tom2228 on June 6, 2014, at 22:07:02
In reply to Re: Different types of depression, posted by Christ_empowered on June 6, 2014, at 21:35:42
I too have wondered your exact question... I feel that the depression I've had lately has had elements of both and that the cookie-cutter thinking about the subtypes isn't completely representative of the real world... I've had most of the atypical features but also the characteristic flat, melancholic mood, nonresponsive...
I feel that the Marplan helps the atypical features while it's taken the addition of despiramine to actually elevate the depressed mood (melancholic features).
Who the f*ck knows...
Posted by Phillipa on June 6, 2014, at 22:28:35
In reply to Re: Different types of depression, posted by tom2228 on June 6, 2014, at 22:07:02
Beckett same here seems at times feel best at night and other times when out of bed. And sometimes it's all anxiety and other times more like boredom with agitation as want to do something but don't know what and then not motivated to follow through. What a great question. Phillipa
Posted by Hugh on June 7, 2014, at 9:53:10
In reply to Different types of depression, posted by Beckett on June 6, 2014, at 19:11:57
I once had an atypical depression that lasted for a few months. Normally I'm an insomniac, but during my atypical depression, I'd sleep 10-12 hours every night and wake up feeling exhausted. I also felt very achy all day. When I drank alcohol, my aches would disappear. But as the alcohol left my system, the aches would return, worse than ever. Then I went back to being an insomniac and my aches were greatly reduced. I'm not sure what brought on this atypical depression, or what ended it. I wasn't taking medication at the time.
Posted by linkadge on June 7, 2014, at 21:01:00
In reply to Re: Different types of depression, posted by Hugh on June 7, 2014, at 9:53:10
Its possible that medications have altered the natural expression of certain mood disorders. Observations like the ones made about atypical and melancholic depression may be more applicable to the way pure unipolar first episodes manifest.
For instance, although I identify more with the melancholic subtype, SSRI's seem to transform it into a atypical subtype.
Linkadge
Posted by tom2228 on June 7, 2014, at 22:14:10
In reply to Re: Different types of depression, posted by linkadge on June 7, 2014, at 21:01:00
> Its possible that medications have altered the natural expression of certain mood disorders. Observations like the ones made about atypical and melancholic depression may be more applicable to the way pure unipolar first episodes manifest.
>
> For instance, although I identify more with the melancholic subtype, SSRI's seem to transform it into a atypical subtype.
>
> Linkadge
>
>
>
>
I completely agree -- you put my thoughts to words :)
Posted by Chris O on June 7, 2014, at 22:52:39
In reply to Different types of depression, posted by Beckett on June 6, 2014, at 19:11:57
My depression exerts itself as a permanent tension in my body. It is a feeling of something on top of me, holding me back, making me feel attacked. It is what I experienced growing up with my mother, but it became (very quickly, I think, probably by the time I was a young child) biologically based. My depression also gets worse at night, when I most need rest and can never seem to get it. If I had to guess, I would say my cortisol shoots up at night (from say, 7pm to 3am) making me more tense and anxious.
Posted by herpills on June 8, 2014, at 18:29:33
In reply to Different types of depression, posted by Beckett on June 6, 2014, at 19:11:57
> I am confused regarding different kinds of depression. I have experienced depression that fits the descriptions of atypical and melancholic. I have had mood worsening at night and also mood improving at night.
>
> Is it possible for depression to change manifestation back and forth over a lifetime? Have others experienced this? Information on this particular aspect is proving difficult to find.
My most recent depressive episode presented itself very differently from previous ones. I made sure to emphasize this with my healthcare providers. I really think something else was going on, but I'm not sure. I was having a lot of physical symptoms, pain, insomnia...I just felt really "sick" for awhile. One doctor even mentioned fibromyalgia but what is that really? Another wastebasket diagnosis... herpills
Posted by Phillipa on June 8, 2014, at 19:02:42
In reply to Re: Different types of depression » Beckett, posted by herpills on June 8, 2014, at 18:29:33
No it is now considered real. If the proper diagnosis there are meds to treat it. Phillipa
Posted by herpills on June 8, 2014, at 20:31:30
In reply to Re: Different types of depression » herpills, posted by Phillipa on June 8, 2014, at 19:02:42
> No it is now considered real. If the proper diagnosis there are meds to treat it. Phillipa
I think it's real that's not what I meant...just that it's really just a cluster of symptoms that they don't know what causes it...and it is still a controversial diagnosis some doctors do not believe it's real. herpills
Posted by Phillipa on June 8, 2014, at 20:45:06
In reply to Re: Different types of depression » Phillipa, posted by herpills on June 8, 2014, at 20:31:30
Now you have me curious!!!!
Posted by Beckett on June 15, 2014, at 1:27:34
In reply to Different types of depression, posted by Beckett on June 6, 2014, at 19:11:57
I did some reading and come to agreement with the ideas posted about treating symptoms and that most do not fit the into a category of the 'classic case'. About myself, I present mostly atypical symptoms right now, but I do have melancholic features, too, such as terrible mornings, diminished reactivity, and some anhedonia. The melancholic symptoms seem to indicate a worsening of the depression, and at it's most severe, I am completely (I think) melancholic. Atypical usually accompanies BPII, which I have, but I do not have any idea why the two go together, and I imagine few people do.
Anyways, that's my story. I really would like to hear someone else's. I'm tired of mine.
Posted by SLS on June 15, 2014, at 10:50:19
In reply to Re: Different types of depression, posted by Beckett on June 15, 2014, at 1:27:34
> I did some reading and come to agreement with the ideas posted about treating symptoms and that most do not fit the into a category of the 'classic case'. About myself, I present mostly atypical symptoms right now, but I do have melancholic features, too, such as terrible mornings, diminished reactivity, and some anhedonia. The melancholic symptoms seem to indicate a worsening of the depression, and at it's most severe, I am completely (I think) melancholic. Atypical usually accompanies BPII, which I have, but I do not have any idea why the two go together, and I imagine few people do.
>
> Anyways, that's my story. I really would like to hear someone else's. I'm tired of mine.I think bipolar depression often appears as a hybrid of atypical and melancholic depressions, with atypical symptomatology more often predominating. In my experience, melancholia played a greater role early in my history, while cognitive impairments worsened later on. Unfortunately, cognitive impairments began unusually early for me.
It is an interesting idea that the symptomatology of someone's baseline depression can be influenced by exposure to drugs.
- Scott
Posted by Beckett on June 15, 2014, at 14:16:11
In reply to Re: Different types of depression » Beckett, posted by SLS on June 15, 2014, at 10:50:19
Hi Scott, nice to see you :-)
>It is an interesting idea that the symptomatology of someone's baseline depression can be influenced by exposure to drugs.
Drugs meaning pharmaceutical treatment? I told my pdoc my belief that ssri/snri worsened my illness from cyclothymia to BPII. He countered that this is unproven. I still believe it, and also told him I can't imagine I will return to a baseline near my cyclothymia one. He of course feels the need to rally. I'm trying to gain some purchase and feel grief. Oh well.
I hope you are feeling a bit better.
Posted by SLS on June 15, 2014, at 17:45:10
In reply to Re: Different types of depression » SLS, posted by Beckett on June 15, 2014, at 14:16:11
> Hi Scott, nice to see you :-)
Likewise.
> > It is an interesting idea that the symptomatology of someone's baseline depression can be influenced by exposure to drugs.
> Drugs meaning pharmaceutical treatment?That was what I meant for the most part. Of course, psychotropics without a therapeutic indication would also count.
> I told my pdoc my belief that ssri/snri worsened my illness from cyclothymia to BPII.
I think there is still some debate as to whether or not antidepressants and stimulants can convert unipolar depression to bipolar disorder or hasten the age of onset of bipolar disorder. Cyclothymia often progresses to BD on its own, anyway, so your doctor might not be too swayed by your conclusions.
This is an interesting study, although it doesn't really apply well to your case:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835385/
I have a difficult time believing that drugs are incapable of influencing the course of mental illness for the worse.
> I hope you are feeling a bit better.A bit.
:-)
Thanks.
- Scott
Posted by brynb on July 16, 2014, at 19:57:10
In reply to Different types of depression, posted by Beckett on June 6, 2014, at 19:11:57
Hi Beckett-
Good question/musing. My current doc (been w him for 2 years) has labeled me MDD (I think w GAD). He actually doesn't even really stick w/ a label for me, but I'm on disability, and I'm pretty sure that's what he used as a diagnosis.
Others have suggested (and some diagnosed) Bipolar 2, and in a few cases it was suggested I had MDD w/ Borderline Personality Disorder. Personally, I'm pretty sure I have a Bipolar 2 thing going on, with a mix of atypical and melancholic depression dominating. I definitely experience speediness at times and mania from certain meds.
Basically, it reinforces to me that there is no one type of depression and that the spectrum is vast. Definitely no "one size fits all" here. After over 20 years of psychiatric care (and
suffering), it's hard to believe I can't define this disease. I'm fast losing faith in psychiatry--it still feels like the dark ages of medicine :(.Hope you're doing ok & having a good summer.
-b
Posted by Beckett on July 18, 2014, at 13:17:50
In reply to Re: Different types of depression » Beckett, posted by brynb on July 16, 2014, at 19:57:10
Yes, the dark ages, though a shade (smidge?) lighter maybe.
The borderline/BP thing is interesting. Do you think you were/are best described as cyclothymic?
A few days ago my sleep switched from atypical to melancholic :( waking early, etc. I prefer the former.
Faith in psychiatry? I have a new pdoc, and he wants to reinvent the wheel.
Curious, have you tried a MAOI?
Posted by SLS on July 18, 2014, at 13:43:26
In reply to Re: Different types of depression » brynb, posted by Beckett on July 18, 2014, at 13:17:50
> I have a new pdoc, and he wants to reinvent the wheel.
Is this a good thing?
- Scott
Posted by Beckett on July 18, 2014, at 14:07:35
In reply to Re: Different types of depression » Beckett, posted by SLS on July 18, 2014, at 13:43:26
No. Not all, at all. Actually, I misspoke. It's not reinventing, it's retreading.
I am tired of it.
I am also sorry to read that you are not feeling well and are discouraged.
Posted by brynb on July 19, 2014, at 1:17:08
In reply to Re: Different types of depression » brynb, posted by Beckett on July 18, 2014, at 13:17:50
hi beckett-
a while ago, i tried emsam, but i don't think it was a fair trial (i was a mess starting it, yanked myself off of lexapro prior, working with an idiot pdoc, etc.). needless to say, i was irritable and antsy and didn't follow through after 2 weeks. i was also on neurontin, and it made me manic. awful, awful, awful.
over the past year and a half i've seriously considered nardil many times. i'm doing ok, even pretty good, now, but it's always in the back of my mind...
Posted by Beckett on July 19, 2014, at 2:40:52
In reply to Re: Different types of depression » Beckett, posted by brynb on July 19, 2014, at 1:17:08
Nardil is my imaginary safety net. Gabapentin causes disinhibition in me, unlike Lyrica (unless I take a boatload). I can imagine how the combo (Emsam) could cause a manic-like response. Emsam was speedy at 6mg. I had a small coffee once and couldn't stop shaking. I walked and walked until I was presentable. My shrink was pissed that I tossed it for Ultram. I wanted to resume for these past months, but the tramadol complicates this wish.
I was on Emsam for about 6-8 months. It helped most at 6mg. At 12mg I remember a dreamy feeling, both calm and odd. I wonder if Nardil's anxiolytic properties would feel a bit like that.
I am very glad to hear you are doing well.
This is the end of the thread.
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