Posted by AndrewB on March 6, 2000, at 17:41:04
In reply to Re: Atypical depression, posted by Kelly on March 6, 2000, at 15:16:20
To Kelly and Janet R,
Janet, you asked what is atypical depression. You might find it interesting that the definition for atypical and dysthymia overlap somewhat. Signs of atypical include increased appetite, weight gain, and excessive sleep and, for some, a leaden sensation in the legs and arms. Compare this to the signs of dysthymia which include overeating (or poor appetite), sleeping too much (or too little), low energy or fatigue, low self-esteem, poor concentration and feelings of hopelessness. The most important sign of dysthymia is that the low mood is always there- it is chronic low-grade depression.
When I’m not medicated I show all the signs of dysthymia including eating a lot (though I don’t gain much weight), sleeping more and feeling sleepy, and feeling fatigued, especially for a few days after heavy exercise.
Serzone was the first AD I took. I took it for about six months. While on it I felt confused and foggy headed much of the time and my memory suffered. I would have a hard time waking up in the morning and getting my thoughts together.. I also had that wrapped in wool feeling. But worst of all, Serzone gave me no improvement in mood.
Anyway Serzone wasn’t for me. I figured it was the serotonin that was causing these symptoms in me because I had read stories of others having similar experiences with SSRIs. That’s why I never have tried any other serotonin activating meds.
But there are other avenues for treating depression out there. Wellbutrin is the number one alternative to SSRIs in the US. I read up on it some and I still don’t have a clue as to the nature of its pharmacological action. It can be energizing though and has helped a lot of people. It didn’t help me though. Yes I found it energizing but it didn’t do anything for my mood and the side effects were intolerable.Another option to SSRIs are drugs that increase the activity of the other two neurotransmitters involved in mood, norepinephrine and dopamine. Both neurotransmitters are also involved in energy and motivation. For example, my experience has been if you take a drug that decreases dopamine you’ll feel tired and sleepy but if you increase dopamine you’ll receive the opposite effect.
There are a lot of ADs out there that act on dopamine and norepinephrine. But if you eliminate drugs that increase serotonin activity because you respond poorly to serotonin (scratch Effexor and MAOIs), and if you eliminate drugs that have side effects that make you sleepy because you’re already tired and sleepy (tricyclics)........you end up with much more limited choices. For norepinephrine activation you can go with a tricyclic that is less sedating or with reboxetine. Reboxetine, unlike the tricyclics, acts almost exclusively on norepinephrine and thus tends to be better tolerated. It does have side effects for some however, notably; difficulty urinating, erectile dysfunction, and increased heart rate. Some of the side effects go away, some don’t. For me, once I adjusted to the reboxetine, the side effects were minor and its effect on my mood, motivation, energy, and social functioning has been quite nice. But unfortunately reboxetine is not available in the US. If you want it you need to order it from the UK (no prescription required) and it will cost about $2/day.
For dopamine activation your choices include seligiline, stimulants (John L says stimulants act on both dopamine and NE.), amineptine (no longer available), amisulpride and various dopamine agonists such as Mirapex. Seligiline, by the way, is an MAO-B (blocks the breakdown of dopamine) at low doses and at high doses is an MAO-I with a preference for MAO-B activity. Seligiline, stimulants, and amineptine act to increase activity at all dopamine receptors and people in general find these med.s to be energizing but be forewarned Kelly, most people with anxiety problems tend to not fare well on them. That was my personal experience with amineptine, it increased my (social) anxiety. Amisulpride acts only on the D2-D3 dopamine receptors, those involved with mood, and has been shown to reduce anxiety rather than increase it. I’ve personally found it to be both energizing and anxiolytic, a wonderful combination. I’ve also found it to be very good for mood, concentration, and the ability to experience pleasure. Amisulpride is well studied has been shown to be generally effective for depression and dysthymia. Most people will experience no side effects with Amisulpride. It takes effect quickly, acting in days instead of weeks. Amisulpride is available in Europe and South America but for those of us in the US it must be ordered from overseas with a prescription at a cost of about 75 cents a day. For more on amisulpride email me at andrewb@seanet.com and I will send you an information piece.
Janet, I encourage you to try a dopaminergic drug before you say that you’ve tried everything. Seligiline was tested for people with CFS with positive results. You also must be aware that because you have CFS you may need to start your ADs at doses much smaller than normal.
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EXCERPT FROM THE INTERNET:
Several additional empiric therapies have been tried for CFS. Because well-designed clinical trials have demonstrated the benefit of low doses of tricyclic antidepressant drugs in fibromyalgia, tricyclics such as amitriptyline, desipramine, doxepin, and nortriptyline are widely prescribed for CFS patients. Anecdotal experience with tricyclics and selective serotonin reuptake inhibitors (SSRIs) generally has been positive. Besides targeting depression, some antidepressants appear to act by improving the quality of sleep and/or decreasing pain. However, CFS patients often report that antidepressants given in full, therapeutic doses exacerbate their fatigue. It may be necessary to escalate doses very slowly and urge patience in detecting benefit, or to try the more activating antidepressants such as desipramine, SSRIs such as fluoxetine and sertraline, or monamine oxidase inhibitors. Many CFS patients are extremely sensitive to these drugs, and it is common practice to start a patient at one-tenth to one-quarter of the usual clinical dose.
-------------------------------------------------------------------------------------------Janet, do you ever get dizzy upon standing or when working in the sun? Have you ever fainted? These are signs of neural mediated hypotension. I thought you may be interested in the following except from the net:
Recently, a strong link between CFS and neurally mediated hypotension was reported. The study found that 22 of 23 CFS patients tested positive for neurally mediated hypotension by specialized tilt-table testing and pharmacologic provocation. Of those who tested positive, 16 reported full or partial recovery from fatigue after uncontrolled treatment with fludrocortisone, beta-adrenergic blocking agents, and disopyramide, alone or in combination. A randomized, placebo-controlled study is under way to attempt to validate these preliminary results.
---------------------------------------------------------------------------------------------------Best wishes for your health,
AndrewB
poster:AndrewB
thread:25780
URL: http://www.dr-bob.org/babble/20000302/msgs/26145.html