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Dr. Bob is Robert Hsiung, MD,
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Posted by delna on December 15, 2009, at 2:23:05
In reply to Re: Atypical Depression versus Bipolar Depression » SLS, posted by Phidippus on December 14, 2009, at 15:05:14
> Motor agitation seems to be a larger part of bipolar depression than atypical depression. Also, racing thoughts may present more often than in atypical depression.
>
> PP,
Racing thoughts and agitation during depression sounds more like a mixed state.Tc
D
Posted by delna on December 15, 2009, at 2:34:25
In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02
> Atypical depression and bipolar depression look very similar. Anergia and reverse vegetative symptoms predominate (hypersomnia, hyperphagia, and leaden paralysis). However, mood-reactivity seems to be a feature specific to atypical depression, although it does not always manifest. This is still being debated. It may be that there is a great deal of misunderstanding between posting members of Psycho-Babble when an atypical compares themself to a bipolar and doesn't understand why the bipolar is not reactive to the same things that they are. Perhaps this includes psychotherapy and exercise.
Scott,
I am confused about the exact same thing. I have the 'anergia and reverse vegetative features' of atypical depression but definitely not the mood-reactivity. I too am wondering what makes bipolar depression distinctive (since I have bipolar disorder)
I also agree that an attempt to correctly identify and label can be very helpful. For example, it helps decide if you are a good candidate for ECT or not.TC
D
Posted by morganator on December 15, 2009, at 4:43:41
In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02
I am bipolar and have benefited from both therapy and exercise. I know others that are bipolar that benefit from both as well. It appears that you may be generalizing that bipolars to do not respond to these things, when in fact it is you that does not respond. I'm not trying to be harsh I am telling you how I see it. I just think you tend to believe that because it does not work for your bipolar depression it must not work on bipolar depression in general.
Posted by morganator on December 15, 2009, at 5:08:05
In reply to Re: Atypical Depression versus Bipolar Depression » Phidippus, posted by delna on December 15, 2009, at 2:23:05
I think bipolar depression often carries more anxiety with it. Isn't the main difference between being bipolar and suffering from atypical depression is simply that bipolars experience mania of some sort before and/or after their depression and atypical depressives do not? I know it can be confusing, especially when today someone who has not ever really experienced mania- mixed, hypomanic, or euphoric-can be diagnosed with bipolar. Maybe, in these cases, the diagnosis should have been atypical depression. Yes, this can get confusing.
Posted by SLS on December 15, 2009, at 5:55:35
In reply to Re: Atypical Depression versus Bipolar Depression » Phidippus, posted by delna on December 15, 2009, at 2:23:05
> > Motor agitation seems to be a larger part of bipolar depression than atypical depression. Also, racing thoughts may present more often than in atypical depression.
> >
> > P
>
> P,
> Racing thoughts and agitation during depression sounds more like a mixed state.
>
> Tc
> DI agree. However, there are a few who propose that there exists a unipolar depression with racing thoughts. This presentation looks more like endogenous or psychotic depression than atypical deperession, though. This argues in favor of viewing the varying presentations of bipolar disorder as a spectrum.
Designing diagnostic paradigms is a work in progress with mental illness. Very little is set in stone. I think one must avoid thinking unidimensionally.
- Scott
Posted by SLS on December 15, 2009, at 6:03:02
In reply to Re: Atypical Depression versus Bipolar Depression, posted by morganator on December 15, 2009, at 4:43:41
> > Atypical depression and bipolar depression look very similar. Anergia and reverse vegetative symptoms predominate (hypersomnia, hyperphagia, and leaden paralysis). However, mood-reactivity seems to be a feature specific to atypical depression, although it does not always manifest. This is still being debated. It may be that there is a great deal of misunderstanding between posting members of Psycho-Babble when an atypical compares themself to a bipolar and doesn't understand why the bipolar is not reactive to the same things that they are. Perhaps this includes psychotherapy and exercise
> It appears that you may be generalizing that bipolars to do not respond to these things, when in fact it is you that does not respond. I'm not trying to be harsh I am telling you how I see it. I just think you tend to believe that because it does not work for your bipolar depression it must not work on bipolar depression in general.
Irony. Pot. Kettle. You know?
It was a proposition and not a definitive statement.
What symptoms or features of your illness suggests that you are bipolar?
What symptoms or features of your depression do you think might help one differentiate it from unipolar depression?
- Scott
Posted by SLS on December 15, 2009, at 17:02:17
In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02
> Atypical depression and bipolar depression look very similar. Anergia and reverse vegetative symptoms predominate (hypersomnia, hyperphagia, and leaden paralysis).
I forgot about rejection sensitivity as being a symptom. After doing a bit of follow-up snooping, I found that some researchers believe that it is present in bipolar depression. There is still debate regarding mood reactivity.
I was hoping to get some more feedback from people with bipolar depression regarding the presence or absence of mood reactivity (If you are depressed and something nice happens, you feel better for a while).
- Scott
Posted by bleauberry on December 15, 2009, at 18:34:01
In reply to Re: Atypical Depression versus Bipolar Depression » bleauberry, posted by SLS on December 14, 2009, at 21:11:22
Hi SLS,
Thanks for your response. I knew as I was writing it would push some of your buttons. :-) I know you well.
One problem you and I have is that we are often mistaken by each other in our interpretations of what we see in writing from one another. It is not the same as being face to face. You very often misinterpret things I say, or accidentally read things into what I say, or become overly defensive in a way that completely blots out huge chunks of things I said. I accidentally do the same with your posts. I
I have no doubt if we were in a living room together chatting and debating over snacks and tea, we would find we actually agree on just about everything, with minor nuances here and there.
As to your reply to my post, I pretty much agree with everything you said...while at the same time agreeing with everything I initially said. If that makes any sense. It is all the above together, not either-or.
Basically, I have not seen our DX terms be of much use. I'm sorry, I just haven't. Have you? I don't think so. Once in a while maybe. I agree with you, that does not mean throw it away or give up the whole idea. I am just saying, "keep it in perspective". Meanwhile, try to improve it.
But above all, use the diagnosis to ask, "why is this happening", before pulling out a prescription pad and completely ignoring why it is happening.
Your example of a diagnosis of depression with some bad thyroid numbers indicating hashimotos, well, the problem with that is that 8 of 10 of the doctors who gave that diagnosis of depression never would have even checked thyroid, and only half of those who actually did check it would have done a thorough enough check to uncover hashimotos. Most clinicians only look at TSH, a few at T3 and T4, but hardly any for the antibodies.
Here's my diagnosis:
1. Depression.
2. Double depression.
3. Dysthymia.
4. Depression with anxiety.
5. Bipolar depression.
6. Bipolar II.
7. Borderline Personality Disorder.
8. Anhedonia not depression.
9. Yuckiness of Lyme, not depression.I mean, you can see why DX has not been helpful to me. Nine different doctors, nine different takes on it. Not one was in agreement with the other. Too much overlap. No clear boundary lines. One can look like another. They can mimic each other. They can change from week to week or month to month. Things are not stationary. Things are much too subjective, despite our best efforts to make them objective. I suspect I am not the only way that encounters this problem.
But it is still a worthwhile pursuit. I just think too much emphasis is placed on it at the expense of other more important issues.
Posted by morganator on December 15, 2009, at 21:44:36
In reply to Re: Atypical Depression versus Bipolar Depression » morganator, posted by SLS on December 15, 2009, at 6:03:02
That's funny, I see the pot-kettle thing. I also know that these things have not just helped me but a few other people I know suffering from bipolar and depression. This is one reason why I really believe exercise and therapy may be helpful for many sufferers, not all, but possibly a significant number. Anyway, I know this is not the topic.
>What symptoms or features of your illness suggests that you are bipolar?
>What symptoms or features of your depression do you think might help one differentiate it from unipolar depression?
I think answering the first should answer the second. I have had 3 periods of mixed states in my life, I am sure of this. The last mixed state was horrific and if it went on any longer I may have started to experience psychotic symptoms. It went on much much longer without being treated than it ever should have. I finally had to decide I was going to the hospital after not being able to find a psychiatrist who had the ability or balls to try to give me the right medication to bring me out of the episode. What symptoms did I experience during this last episode? I could not stop obsessing and regretting things I had done. I could not slow my mind down. I could not sleep for more than 3 hours a night. I was extremely agitated, depressed, and manic all at the same time. Actually, I was probably feeling the agitation and mania more than the depression. You could say that the racing thoughts, extreme fear, agitation, and mania were a manifestation manifested out of a very deep but fairly brief state of depression that came first.
Over the years I've been able to stay on an antidepressant alone and function at a fairly high level. But when I look back on my behavior during those I realize that I was hypomanic much of the time. I often engaged in risky sexual behavior and I at times acted like a raging lunatic(it was all in fun and entertained people around me but it was definitely indicative of a certain type of bipolar. Actually, most of the friends I grew up with and hung out with through the years were on the crazy wild side with very exuberant personalities, including my brother. None of them were bibolar. I tended to take it to the next level and was less in control of it). I had a ton of energy throughout the years and often could go without sleep easier than the average person. I would experience this even more sometimes when I was drinking heavily, believe it or not.
I have always had issues with depression and anxiety and they always coexisted. I remember in college when I was very depressed and obsessed with death I reacted to it by behaving in a more hyperactive manner and I would stay up very late(I know, everyone stays up late in college). No one would have ever guessed I was that depressed. I remember thinking about death and getting old at a very very young age. Not sure if this has anything to do with having a bipolar predisposition.
People who have unipolar depression simply experience the depression and maybe some anxiety. They do not have tons of energy, periods of hypomania or mixed mania, and they do not cycle in and out of depression in brief periods of time. Unipolar depressives are not likely to go around having unprotected sex like stray dogs in an alley.
Posted by morganator on December 15, 2009, at 21:52:34
In reply to Re: Atypical Depression versus Bipolar Depression, posted by SLS on December 15, 2009, at 17:02:17
If I am depressed and something good happens, at least in the past, I most certainly felt good about it. I could probably say that over the years I often needed good things to happen to feel good. While on Zoloft and feeling young and strong, I did not get depressed very severely. If I did feel depressed, I had to do something to make myself feel better. Going to the gym played a major role in constantly making me feel good :).
I have to say, I have been more on the hypomanic and anxiety side of bipolar than the depressed side, until just recently. My life has take a turn for the worst and I do not have the same things to feel good about that I believe protected me from this depression for so many years. If I could erase all the damage from the last 3 years, I would be a pretty damn happy bipolar right now.
Posted by morganator on December 15, 2009, at 22:00:03
In reply to Re: Atypical Depression versus Bipolar Depression » SLS, posted by bleauberry on December 15, 2009, at 18:34:01
My recent dignosis has not only not helped me, but because of the time in my life and the way I was diagnosed, it has been detrimental to me in ways. Maybe I will elaborate later.
I do think that being diagnosed much sooner may have been very helpful. If I was diagnosed at the right time I may have made decisions as far as how I approached certain things differently. I do not think I would have taken myself of Zoloft 2 and a half years ago. I may have tried to drink less alcohol at times. I may have been more aware of my behavior and tried to modify it. So I think, Bleauberry, in some cases, a diagnosis can be very helpful. But I definitely see where you are coming from.
Posted by kirbyw on December 16, 2009, at 0:05:11
In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02
In my most recent psychiatric consultation with Dr. Goldberg in New York, he found traits of bi-polar illness in both of my parents, based on their histories. But I have no manic states at all ever. I have had severe
"endogenous" depressive states, which have generally responded well to Parnate, but to no other AD's at all. Dr. Goldberg diagnosed me as having Atypical Depression, and recommended adding Lithium to my Parnate. When depressed I can sleep for 20 out of 24 hours, have ruminations, and a high degree of anxiety. When normal, that is not depressed, I am not manic but am "high functioning" in term of social relations, career etc. I have a Doctorate,and have had an interesting career. Generally I don't lose a job when i am severely depressed. I just go to work distracted, ruminating, and highly anxious but am able to keep it hidden from my peers. Its stressful. I get enough done, to avoid drawing attention to myself.I also am always very sensitive to rejection, but extremely sensitive when more depressed. Both Dr. goldberg and Dr. Scheftner at Rush Medical Center in Chicago feel that there is a latent and 'invisible' bi-polar component to my depression. Both have recommended the Lithium.
I am having a tough time with Lithium because I already have a bladder problem with a urinary frequency problem, and I have the impression that Lithium is making this worse. So, temporarily, since I will be traveling over the holidays, I am limiting the Lithium to 300 mg per day, only in the morning. Will try again at 600 mg when I get back home.
Rick
Posted by morganator on December 16, 2009, at 1:56:57
In reply to Re: Atypical Depression versus Bipolar Depression, posted by kirbyw on December 16, 2009, at 0:05:11
If both of your parents were bipolar, it is likely that you did not have the best childhood. This could result in a lower self esteem, which may be one of the reasons for your issues with rejection. Have you ever addressed or thought about addressing this in therapy. Group psychodynamic therapy would most likely be best suited for addressing this issue. Also, any issues in childhood could have made whatever predisposition you have towards depression much much worse. I'm not saying that addressing these issues will solve anything, I'm just saying I may not hurt to consider looking into addressing them. These things just don't go away. They linger inside of us for the rest of our lives if not addressed in some way.
Sorry, maybe I should have just kept my thoughts to myself. I hope you are not offended.
Posted by SLS on December 16, 2009, at 6:42:12
In reply to Re: Atypical Depression versus Bipolar Depression, posted by kirbyw on December 16, 2009, at 0:05:11
Hi Rick.
Thanks for responding.
Good luck on your lithium treatment. In the past, Parnate was considered a particularly good drug to augment with lithium in unipolar depression, and one of the best treatments for bipolar disorder as well.
From what I have read, rejection sensitivity can manifest in both atypical and bipolar depressions. However, I am most interested in whether both types of depression share mood reactivity as a presenting feature or if it can be used as a symptom to differentiate between the two depressive subtypes.
Are there situations, events, or other experiences that can elicit a substantial improvement in your depression greater than 50%?
- Scott
Posted by SLS on December 16, 2009, at 6:53:14
In reply to Re: Atypical Depression versus Bipolar Depression » SLS, posted by bleauberry on December 15, 2009, at 18:34:01
I think I understand better what you are trying to communicate.
I would agree that many, if not most, psychiatrists do not check for organic or other explanations for the symptoms they are presented with, even though the DSM is very specific to suggest that such a step be taken to diagnose major depressive disorder.
"D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)."
I don't think that the concept of diagnostics is irrelevant. It just might not be implemented properly.
- Scott
Posted by SLS on December 16, 2009, at 7:02:58
In reply to Re: Atypical Depression versus Bipolar Depression, posted by morganator on December 15, 2009, at 21:44:36
> People who have unipolar depression simply experience the depression and maybe some anxiety. They do not have tons of energy, periods of hypomania or mixed mania
Yes. But what differences are there between the depressive states of atypical depression and bipolar depression that would allow one to differentiate them? When a doctor is presented with a patient complaining of depression, it often occurs that they are looking at a case of bipolar disorder for which mania has not yet manifested. It would be ideal to be able to recognize such cases early and apply treatments that are more appropriate for bipolar disorder and that would not make the situation worse.
I think that this is really a critical issue.
- Scott
Posted by bulldog2 on December 16, 2009, at 16:52:40
In reply to Atypical Depression versus Bipolar Depression, posted by SLS on December 14, 2009, at 7:26:02
> Atypical depression and bipolar depression look very similar. Anergia and reverse vegetative symptoms predominate (hypersomnia, hyperphagia, and leaden paralysis). However, mood-reactivity seems to be a feature specific to atypical depression, although it does not always manifest. This is still being debated. It may be that there is a great deal of misunderstanding between posting members of Psycho-Babble when an atypical compares themself to a bipolar and doesn't understand why the bipolar is not reactive to the same things that they are. Perhaps this includes psychotherapy and exercise.
>
> Has anyone noted other differences between atypical and bipolar depressions?
>
>
> - ScottCan one have both atypical depression coexisting with bipolar depression? In other words have explosive periods of reactive depression but also have separate periods of mania? If so how would that be treated?
Posted by morganator on December 16, 2009, at 21:25:34
In reply to Re: Atypical Depression versus Bipolar Depression » kirbyw, posted by SLS on December 16, 2009, at 6:42:12
I think mood reactivity is present in both bipolar and atypical depression. At least my friend and I both have experienced it pretty regularly. We both agree that we could be thrust out of feeling depressed fairly quickly and suddenly feel more on the hypomanic side in reaction to something good happening to us.
Posted by kirbyw on December 17, 2009, at 0:30:52
In reply to Re: Atypical Depression versus Bipolar Depression, posted by kirbyw on December 16, 2009, at 0:05:11
Not at all offended by Morganator's comment.
I am 62 years old. My childhood was somewhat paradoxical. There were a lot of good points, but my verbally abusive father, made life very difficult. My mother was a suicide when I was 19 and the Doctor suspects that she was bi-polar. After she died I became a virtual orphan, but survived mostly by bonding with friends and with their families, because I couldn't stand to be with my Dad and my step-mother. I call them my adoptive families.I had loads of therapy, almost constantly between the age of 21, up to about 40, mostly individual but some group. For the last 22 years I have had almost no therapy and that is something I miss. I was hospitalized for a severe depressive crisis in 1982 which is when I went on Parnate, and this cleared up the depression. I was able to get a Masters and a Doctorate in Psychology and have worked for 40 years, almost without interruption. I have done a lot of interesting things, in terms of my work, and have generally had a successful career. But I am single (gay) and did not wind up in a permanent relationship so I feel isolated in that sense.
I had long term relationships (3, 5, 6 years, etc) but eventually all of them ended.
I have close friends and good peer relationships, but I am currently living out of the U.S. which is a big disadvantage in terms of a lot of factors. I liked it for most of the 20 years that I have been here in Costa Rica, but now I am missing a lot of things about the U.S., but I really can't afford to move back at this point.The depression I have been going through off and on for the past six months, is the worst since my 1982 hospitalization, but Parnate still helps.
Anyway, I could go on, but that's a brief response to your comment.
Rick
Posted by SLS on December 17, 2009, at 6:39:09
In reply to Re: Atypical Depression versus Bipolar Depression, posted by morganator on December 16, 2009, at 21:25:34
> I think mood reactivity is present in both bipolar and atypical depression. At least my friend and I both have experienced it pretty regularly. We both agree that we could be thrust out of feeling depressed fairly quickly and suddenly feel more on the hypomanic side in reaction to something good happening to us.
Hypomanic?
Sounds intense.
Do you think that you can learn to seek out hypomania through psychotherapy?
- Scott
Posted by morganator on December 17, 2009, at 8:44:22
In reply to Re: Atypical Depression versus Bipolar Depression » morganator, posted by SLS on December 17, 2009, at 6:39:09
> > I think mood reactivity is present in both bipolar and atypical depression. At least my friend and I both have experienced it pretty regularly. We both agree that we could be thrust out of feeling depressed fairly quickly and suddenly feel more on the hypomanic side in reaction to something good happening to us.
>
> Hypomanic?
>
> Sounds intense.
>
> Do you think that you can learn to seek out
hypomania through psychotherapy?I may be biased, but yes I think I can. It may depend on the individual though.
I'm not sure how hypomanic I was. I certainly had plenty of periods of feeling fairly laid back and calm(especially after playing basketball for 3 hours straight-hypomanic?) I think there are many high functioning hypomanics out there. I tended to fluctuate I think. I was not the type that was super productive and didn't require or didn't get much sleep on a regular basis. I got sleep, I just had lots of energy and I was on the wild and crazy side. Then I would go through periods of being more calm and focused, especially when I was staying away from the drinking. Let's just say I think there are different levels of hypomania.
>
>
Posted by SLS on December 17, 2009, at 8:49:12
In reply to Re: Atypical Depression versus Bipolar Depression, posted by morganator on December 17, 2009, at 8:44:22
> > > I think mood reactivity is present in both bipolar and atypical depression. At least my friend and I both have experienced it pretty regularly. We both agree that we could be thrust out of feeling depressed fairly quickly and suddenly feel more on the hypomanic side in reaction to something good happening to us.
> >
> > Hypomanic?
> >
> > Sounds intense.
> >
> > Do you think that you can learn to seek out
> hypomania through psychotherapy?
>
> I may be biased, but yes I think I can. It may depend on the individual though.
>
> I'm not sure how hypomanic I was. I certainly had plenty of periods of feeling fairly laid back and calm(especially after playing basketball for 3 hours straight-hypomanic?) I think there are many high functioning hypomanics out there. I tended to fluctuate I think. I was not the type that was super productive and didn't require or didn't get much sleep on a regular basis. I got sleep, I just had lots of energy and I was on the wild and crazy side. Then I would go through periods of being more calm and focused, especially when I was staying away from the drinking. Let's just say I think there are different levels of hypomania.
You are fortunate in this regard. If my mood were that reactive, I would try and use Maslow's hierarchy of needs to understand self-actualization and to work towards increasing my frequency of having peak experiences and reducing my exposure to depressogenic ones. The quality of mood enhancement is probably greater during these times than that which one would experience when using psychotherapy or exercise alone. It would be more consistent, too.You should look into it. It might reduce or obviate your need of using somatic treatments to resolve your depression.
- Scott
Posted by morganator on December 17, 2009, at 8:52:34
In reply to Re: Atypical Depression Morganator, posted by kirbyw on December 17, 2009, at 0:30:52
As beautiful as Costa Rica can be, I bet it is hard for you to find someone there. Sorry to hear your depression has been much worse lately.
Yeah as far as therapy goes, evidently certain types of group therapy are best for helping us have better relationships, romantic and otherwise. So if you had a chance to get back into it, I would definitely consider group therapy.
What brought you down to Costa Rica?
That's too bad it is difficult for you to come back to the states right now. It sounds like being here might be good for you for a few reasons.
I hope you find relief from this recent bout soon.
Take Care,
Morgan
Posted by polarbear206 on December 17, 2009, at 10:41:17
In reply to Re: Atypical Depression versus Bipolar Depression, posted by kirbyw on December 16, 2009, at 0:05:11
> In my most recent psychiatric consultation with Dr. Goldberg in New York, he found traits of bi-polar illness in both of my parents, based on their histories. But I have no manic states at all ever. I have had severe
> "endogenous" depressive states, which have generally responded well to Parnate, but to no other AD's at all. Dr. Goldberg diagnosed me as having Atypical Depression, and recommended adding Lithium to my Parnate. When depressed I can sleep for 20 out of 24 hours, have ruminations, and a high degree of anxiety. When normal, that is not depressed, I am not manic but am "high functioning" in term of social relations, career etc. I have a Doctorate,and have had an interesting career. Generally I don't lose a job when i am severely depressed. I just go to work distracted, ruminating, and highly anxious but am able to keep it hidden from my peers. Its stressful. I get enough done, to avoid drawing attention to myself.
>
> I also am always very sensitive to rejection, but extremely sensitive when more depressed. Both Dr. goldberg and Dr. Scheftner at Rush Medical Center in Chicago feel that there is a latent and 'invisible' bi-polar component to my depression. Both have recommended the Lithium.
> I am having a tough time with Lithium because I already have a bladder problem with a urinary frequency problem, and I have the impression that Lithium is making this worse. So, temporarily, since I will be traveling over the holidays, I am limiting the Lithium to 300 mg per day, only in the morning. Will try again at 600 mg when I get back home.
> RickHi Rick. Glad to hear you are one of Dr. Goldbergs patients. He is exceptionally one of the finest in the business. I have corresponeded with him in the past and he has been of great help. You are very lucky and in good hands. All the best to you.
Posted by polarbear206 on December 17, 2009, at 10:43:13
In reply to Re: Atypical Depression versus Bipolar Depression, posted by polarbear206 on December 17, 2009, at 10:41:17
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