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Atypical depression, whats worked for you?


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my depression feels like its changed shape on the meds Im taking. Like taking an aspirin for pain and realizing the pain is still hanging around. its just not as bad. The relief I have now is great compared to where I was.

Ive got what appear to be atypical depressive symptoms that remain. Fatigue, apathy, body pain, anhedonia and not feeling sociable at all. the anhedonia is probably the most frightening symptom. Its spring and I could care less about my outdoor hobbies that I usually live for.

Has anyone had luck treating these symptoms? Ive read a bunch of articles that suggested off the wall stuff from parnate to serzone. No idea what to try next, or stay where im at and try more therapy.

My doc told me I have 'chronic dysthymia' that will 'probably never get better'.. which I think was a rather irresponsible comment but I ignored it. Since she has no ideas Im again left searching on my own. =/

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my depression feels like its changed shape on the meds Im taking. Like taking an aspirin for pain and realizing the pain is still hanging around. its just not as bad. The relief I have now is great compared to where I was.

Ive got what appear to be atypical depressive symptoms that remain. Fatigue, apathy, body pain, anhedonia and not feeling sociable at all. the anhedonia is probably the most frightening symptom. Its spring and I could care less about my outdoor hobbies that I usually live for.

Has anyone had luck treating these symptoms? Ive read a bunch of articles that suggested off the wall stuff from parnate to serzone. No idea what to try next, or stay where im at and try more therapy.

My doc told me I have 'chronic dysthymia' that will 'probably never get better'.. which I think was a rather irresponsible comment but I ignored it. Since she has no ideas Im again left searching on my own. =/

I'm having good results with Parnate for treatment-resistant atypical depression. I don't think it's an off the wall suggestion at all. I'd had varying levels of partial remission over the past year on different med combos, and at one point I thought I was "all better" on a particular cocktail. It wasn't sustainable due to side effects, though, which seemed so cruel at the time, but it was for the best. What I was accepting as "all better" was more like 80%, which felt pretty great at the time. But now that I'm on Parnate I'm remembering what normal actually is, and getting back that last 20% is really something.

It's got crappy side effects and there're some lifestyle changes, yeah. But when I look at the bundle of side effects that went along with a cocktail of five meds that didn't get the whole job done, and compare it to the side effects of this one med that's doing it all the way... well, this is the better package. And I'd give up a lot more than cheese to not feel depression again.

I second the suggestion for a new pdoc. "Probably never get better" is what comes out of my brain when I'm depressed. It's the doc's job to help you realize how wrong that is.

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Damn apathy and anhedonia. There doesn't seem to be much research on it, either. Probably because "they" know it's the dopamine system - you need to activate the D2 and D3 receptors. Unfortunately (?), a lot of illegal drugs work via the dopamine system - cocaine, amphetamines, etc. So it's hard to develop a drug for this system that doesn't cause euphoria and will be heavily regulated.

That said, I have been researching the piss out of this recently. Here is what I found:

Parkinson's drugs: Mirapex (pramipexole), Trivastal (peribidil), and Requip (ropinirole). These are D2 and D3 agonists - meaning they activate those dopamine receptors. One potential side effect is sudden sleep attacks - bad if you're driving. Some of these drugs are approved for restless leg syndrome. All have off-label uses for anhedonia.

MAO inhibitors - especially, it seems, MAOB inhibitors. Some of the MAOI are more/equal/less selective for MAOA vs. MAOB. Inhibiting MAOB is linked to improving apathy and anhedonia--because MAOB's primary job is to degrade dopamine. There is also some research showing that depressed people have an excess of MAO - so reducing it seems like a winning strategy. Check out Emsam (selegliine) - this is a transdermal patch with selegiline in it - which releases the drug over 24 hours.This is an MAOI - but it's more selective for MAOB; also, because it is delivered through your skin, it avoids your GI tract - so your GI tract doesn't get depleted of MAO - making a hypertensive crisis from ingesting tyramine less likely. There is also Azilect (rasagiline), which is more selective to MAOB. See MAOI on Wikipedia - has a note saying they have a reputation for treating atypical depression.

DHEA - search Crazyboards for my recent post on DHEA. This is available at the health food store. No one around here seems to have any experience with it, though.

Let me know if you find anything else!

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I'd run the gamut of AD medication and ECT was almost the next thing to try, but while being assessed for this the psychiatrist in charge of the suite suggested something new.

On top of my Cipralex, he prescribed high dosage Venlafaxine and Liothyronine (despite my returning normal values for thyroid function)

He was of the opinon that some individuals with normal thyroid reading actually display some signs and symptoms of underactive thyroid, and can benefit (in energy and enthusiasm amongst other things) from having modestly higher levels.

I can only say it has been a more effective combination than anythig I've had in the last six or seven years, and that ECT has been filed away as an idea unless things change.

But we are talking both atypical and individual here... No assurance or claim that "one size fits all."

Chris.

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Bleh I feel you on that.

My mood is generally better (minus when I'm in pmdd territory) and I get things with due dates done on time because I have such a guilty conscience about it but little tasks like doing/putting away laundry, cleaning my room, TAKING SHOWERS (I hate myself for this one), etc take so much out of me and I can't concentrate on them enough to complete them. Eg. my laundry sits in the basket until I have taken things out as I need them because I can't just put it all away at once... I can only do 2 items in one time frame.

My pdoc just acted like I need more anti-depressants for that and thought 100 mg Wellbutrin would help with that and the pmdd if I took it every morning. I don't notice a difference.

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I totally agree with the suggestions about getting a new doc. My therapist has made a few comments about that as well. This would be the third one Ive seen at this particular clinic. I might try going somewhere else thats further away.

Ive read a lot of stuff (in psychopharm texts and anecdotal stuff) about parnate helping with atypical symptoms. Serzone too.. Id be more inclined to give the latter a shot first since I havent tried a serotonin antagonist yet and Im not thrilled about trying MAOIs or AAP's just yet. Some SSRIs drive me into angry dysphoric states, sertraline has been good with that so far. Ive tried going up to 150mg but it does nothing different to me at all. Just side effects at anything over 75mg. I cant raise wellbutrin.. it just gives me terrible anxiety, some depression relief and it fades to nothing within weeks.

I have tried a few different things that work on dopamine . Adderall, dexedrine, wellbutrin and maybe sertraline. Obviously I cant use the stims as antidepressants. Stims and wellbutrin both gave me antidepressant effects that faded and never came back despite dose changes and breaks between trials.

Im currently asking my doc for provigil but she wants me to do a sleep study despite the fact I can sleep all day, wake up and still feel tired and achey. I think these are depressive symptoms not lack of sleep. They improve when I have a good therapy session.

The last time I tried DHEA I felt weak and grouchy. Not sure if this plays into stress hormone systems which are probably already out of whack in my case (cortisol, PTSD?). I will try it again soon though now that Im feeling better and getting exercise.

I was on desipramine for awhile at a low dose, it helped a lot with fatigue and pain. I did really well in those areas until my doc took me off of it for suspicion of contributing to 'weight gain'. I was on celexa at the time.. Go figure that one out, lol.

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Damn apathy and anhedonia. There doesn't seem to be much research on it, either. Probably because "they" know it's the dopamine system - you need to activate the D2 and D3 receptors. Unfortunately (?), a lot of illegal drugs work via the dopamine system - cocaine, amphetamines, etc. So it's hard to develop a drug for this system that doesn't cause euphoria and will be heavily regulated.

That said, I have been researching the piss out of this recently. Here is what I found:

Parkinson's drugs: Mirapex (pramipexole), Trivastal (peribidil), and Requip (ropinirole). These are D2 and D3 agonists - meaning they activate those dopamine receptors. One potential side effect is sudden sleep attacks - bad if you're driving. Some of these drugs are approved for restless leg syndrome. All have off-label uses for anhedonia.

MAO inhibitors - especially, it seems, MAOB inhibitors. Some of the MAOI are more/equal/less selective for MAOA vs. MAOB. Inhibiting MAOB is linked to improving apathy and anhedonia--because MAOB's primary job is to degrade dopamine. There is also some research showing that depressed people have an excess of MAO - so reducing it seems like a winning strategy. Check out Emsam (selegliine) - this is a transdermal patch with selegiline in it - which releases the drug over 24 hours.This is an MAOI - but it's more selective for MAOB; also, because it is delivered through your skin, it avoids your GI tract - so your GI tract doesn't get depleted of MAO - making a hypertensive crisis from ingesting tyramine less likely. There is also Azilect (rasagiline), which is more selective to MAOB. See MAOI on Wikipedia - has a note saying they have a reputation for treating atypical depression.

DHEA - search Crazyboards for my recent post on DHEA. This is available at the health food store. No one around here seems to have any experience with it, though.

Let me know if you find anything else!

I'm not sure where your ideas are coming from, but I don't think it's anywhere near as simple as you're suggesting. If it was, wellbutrin, or stimulants, would be universally effective in the treatment of refactory depression, and AAP's would never be effective. Neither is remotely true. Most of the research I've seen suggesting antidepressant effects from Parkinson's meds has been done on subjects with Parkinson's, and so isn't really very generalizable.

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I have heard of docs using dopamine agonists to augment AD treatment. Maybe its an individual thing after a lot of trial and error? I discussed this one before but my doc was concerned about the potential for addictive behaviors and abrupt sedation which some of those meds are notorious for. She didnt think they would be a good fit. Still something to file away for later if things get worse

I think provigil as an add-on might be a good try since I have have other symptoms that could benefit at the same time. I hate using amphetamine to stay awake.. eventually I would have to escalate the dose and I dont want to do that.

Parnate would be one of my last-ditch choices. Not because I dont think its effective but because of the hypotension, diet restrictions and the washout periods to go back and forth between other drugs. I just cant afford to come to work with my brains on backwards and frothing at the mouth with irritability. Almost got fired like that once before, its bad.

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I'm not sure where your ideas are coming from, but I don't think it's anywhere near as simple as you're suggesting. If it was, wellbutrin, or stimulants, would be universally effective in the treatment of refactory depression, and AAP's would never be effective. Neither is remotely true. Most of the research I've seen suggesting antidepressant effects from Parkinson's meds has been done on subjects with Parkinson's, and so isn't really very generalizable.

Heh, from the University of Google, of course! rolleyes.gif Seriously, though, you can find lots of research articles on dopamine and apathy/anhedonia/depression using Google Scholar and Wikipedia (and looking up the references). From there you branch out to looking up details of MAOIs, then specific drugs and apathy/anhedonia/depression. Takes forever. Here's one article. In general, there seems to be a lot of theories of the importance of the dopamine system in depression - even evidence that SSRI's work indirectly via dopamine. This agrees with MAOB inhibitors being more effective for anhedonia.

But of course it's not that simple. No one knows what causes depression (although Sapolsky supports the genetics + chronic stress theory). Many puzzling findings - such as more serotonin (e.g., via an SSRI) helps depression - but then a drug that reduces serotonin also is an antidepressant. Large placebo effect in studies. Huge variation between individuals in drug response. If you go over to the ScienceDaily website, you can find articles on immune system dysfunction as a potential cause of depression.

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If I manage to get on provigil and it doesnt at least help with this leaden fatigue Ill look into parnate. Really frustrating when I dont want to do anything. Its taking all the willpower I have to keep exercising. Im surprised I havent been fired at work yet, lol.

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If I manage to get on provigil and it doesnt at least help with this leaden fatigue Ill look into parnate. Really frustrating when I dont want to do anything. Its taking all the willpower I have to keep exercising. Im surprised I havent been fired at work yet, lol.

My experience with Provigil is that it only touches sleepiness, not leaden paralysis. I've also found it to be less mood-enhancing than Ritalin; I don't think Provigil alone would do much for serious depression, though I do think it has add-on possibilities. Ritalin with Wellbutrin was a decent combo for me. Now Parnate and Provigil (and Lamictal) are working quite well together.

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Parnate would be one of my last-ditch choices. Not because I dont think its effective but because of the hypotension, diet restrictions and the washout periods to go back and forth between other drugs. I just cant afford to come to work with my brains on backwards and frothing at the mouth with irritability. Almost got fired like that once before, its bad.

That makes sense. The hypotension was problematic for me at first, but went away after a few weeks at a stabilized dosage. The diet is no big deal. I thought I'd really miss cheese, especially as a vegetarian, but I don't. But the washout, yeah, that was bad.

Do you have the sort of job where you could start saving vacation days now, in case you went the MAOI route in the future? Use a week of vacation piled up with a long holiday weekend or some such?

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Wellbutrin gave me really good results the first time I tried it. It pooped out after a few months and subsequent dose adjustments pooped out in a few weeks each time.

Im not sure whats with that. I do well on NRIs but the anxiety can be problematic.

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First thing I'd do is find a new pdoc and/or practice.

I was first dx'ed as MDD recurrent, atypical, with dysthymia thrown in for good measure. I've been on Wellbutrin for years, and augmented it with various things as things got worse (and better). I tried Provigil with the Wellbutrin at one low point, but I didn't feel anything from it at all, good, bad or indifferent.

About 2 years ago my current pdoc changed my dx to BP II even though I've never been hypomanic, and definitely have never been manic. He added Lamictal to the Wellbutrin and it's a miracle as far as I'm concerned. I feel like my old good self. I had suggested a stimulant at our first meeting, since that was one of the combos I had tried in earlier years, but he steered me towards the Lamictal instead, and I can't thank him enough.

There are other mood stabilizers as well in case Lamictal isn't a good fit for you. The fall-back plan I have with the pdoc for the (very likely) next depression is to add in lithium. It has anti-depressant as well as mood stabilization properties and may be something else for you to consider. Sorry if you mentioned mood stabilizers somewhere in here and I missed it....

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