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Re: To SLS Roslynn

Posted by SLS on September 16, 2022, at 21:16:59

In reply to To SLS, posted by Roslynn on September 16, 2022, at 15:11:48

Hi, Roslynn.

It is hard to find the right words to describe a feeling.

> Thank you for your replies to my question. I think my depression may be changing a little. I definitely have all those movement/freezing issues that you mentioned as well as the slowness/lethargy. Does this mean my depression is getting worse? Can it change from atypical to endogenous?

There is nothing I have encountered that would give evidence that a switch between atypical and endogenous depression occurs.

Yes, biogenic depression can get worse as the decades pass. I think the quality of depression changes, too. As one ages, depression often produces greater cognitive and memory impairments.

> I unfortunately can't take lithium anymore due to my kidneys.

That's another reason why I think lithium should be taken at low dosages when mania is absent. Adverse effects to kidney and thyroid functions are dosage-dependent. I have been taking lithium at 300 mg/day for probably 10 years or so. My blood tests don't show even a hint of abnormal kidney or thyroid functions in blood tests.

> I'm also hyperthyroid (not hypo) so I have to see a specialist about it. I have just restarted ritalin.

What is the explanation for the elevated thyroid function? Lithium usually lowers it. Is your renal insufficiency irreversible? Did lithium produce any improvement in your depression at all? If so, how would you describe the improvement it gives you?

Melancholic depression seems to be more treatable when using tricyclics + lithium. Also, ECT is probably more effective for melancholic depression than for atypical depression.

Melancholic depression is almost invariably worse in the morning than in the evening, often with early morning awakenings. Feelings of dread or doom occur more often in the morning, and melancholic depression in general. Melancholic depression produces weight-loss. Atypical depression causes weight-gain. Melancholic depression is more often accompanied by body aches and pain.

Is there any family history of bipolar disorder?

> Thank you for all your thoughts and suggestions. I hope you are still doing well.

I am still improved. Thank you for asking.

If a drug treatment is going to bring you to remission, it will likely not be a rapid nor steady improvement. With more severe or long-lasting depression, it can take a year to reach. Also, improvement isn't a nice straight line slanting upwards. It's not even like a staircase. It is a saw-tooth pattern. Two steps up, then one step down.

1. Which tricyclics have you tried? What dosages?

2. Which drugs have you used in combination with tricyclics? What were the dosages of each drug?

3. Have you ever tried an anticonvulsant "mood stabilizer"?

Two other things about melancholic depression, it is more likely to end in suicide. It is mentally very painful - psychic pain. It actually hurts to be conscious.

I wouldn't know if you fit the profile for melancholic depression. If some of this sounds familiar OR your depression results from a bipolar diathesis (root pathology), you might be more apt to respond to a treatment that includes a tricyclic antidepressant. I have bipolar depression wherein manias occur, but only as a reaction to drug treatment. Without drug treatment, I appear as having unipolar depression. (This was my initial diagnosis). Even though the *presentation* of my disorder is that of unipolar depression, the *diatheses* of that depression is actually a bipolar. This is why I asked you about your family history. If any of your first-degree relatives were diagnosed as having bipolar disorder, it might be worth treating your depression as bipolar rather than unipolar. One of my ideas is that the features of bipolar depression looks like a hybrid of melancholic and atypical depressions. However, I think the depression might look more melancholic than atypical. I think Ritalin might be better for melancholic and bipolar depression than for unipolar atypical depression. I wouldn't neglect amphetamine. Consider stimulants as augmenters rather than the core treatment.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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