Its interesting how much variation there can be in the symptoms experienced by patients with depression and the underlying disease process involved. In the DSM-V (or simply DSM five, basically the latest version of an American diagnostics manual thats used worldwide to diagnose psychiatric disorders) there are several different subtypes of major depression. These subtypes include: (NOTE: NOT ALL THE ADDITIONAL SYMPTOMS LISTED NEED TO BE PRESENT FOR A MAJOR DEPRESSIVE EPISODE [BOUT OF DEPRESSION], TO MEET THE DSM-5 CRITERIA FOR THESE ADDITIONAL FEATURES) * Atypical depression (characterised by hypersomnia [excessive sleeping], increase in appetite leading to weight gain, the responsivity of mood to positive events in the persons life. Leaden paralysis [a heavy, leaden feeling in the arms or legs] and an increased sensitivity to rejection even when the individual is not depressed) * Psychotic depression (characterised by additional symptoms [on top of the normal depressive symptoms] of hallucinations and delusions that can be either mood-congruent [i.e. they fit in with the depression and the general sense of worthlessness, sadness, guilt, death, etc.] and are not totally random] or mood-incongruent) * Anxious depression (which is characterised by additional anxious symptoms) * Melancholic depression (characterised by an inability to experience pleasure or happiness in everyday activities, general non-reactivity of mood to good news/life experiences, severe despondency, increased depression in the morning, waking up abnormally early, a general slowing of movements and thoughts [or conversely, an increase in purposely movements], weight loss and excessive or inappropriate guilt) * Seasonal depression (a depression that affects the individual in a particular season or seasons) * Catatonic depression (depression with an accompanying catatonia. Catatonia is basically where the person becomes disconnected with the outside world and their normal behaviours or personality. They may because totally still and silent, unresponsive to whats happening around them. They may also repeat what other people say or do. They may also do repetitive, purposeless movements. They may going into a fixed, rigid position (even if the position is opposed by gravity)) * Mixed depression (this is basically where the symptoms of mania or hypomania [a potentially dangerously elated/agitation mood] are present at least some of the day as well as depressive symptoms) * Bipolar depression (that is depression due to an underlying case of bipolar disorder) Its very important for the attending psychiatrist (i.e. the shrink thats taking care of the affected person) to pay attention to these additional features as they often dictate the best course of treatment and the likely prognosis. An example is bipolar depression, in bipolar depression the best first-line treatment is usually adjusting the dosage or type of mood stabiliser the patient is on (e.g. if theyre on valproate it might be a good idea to switch them to lithium). In these patients giving standard antidepressants is, in general, a very poor idea, as they, more often than not, just dont work and they can also induce a manic switch (i.e. a switch from depression to mania) which can be very dangerous for the patient, their family and friends. There is also emerging evidence to say that if an antidepressant has to be used in these patients the best (both less likely to induce mania and more likely to induce a therapeutic response) type to use is a monoamine oxidase inhibitor (MAOI). MAOIs are definitely not considered a good option in most depressed patients as they interact with just about everything. An example is if you eat some cheese, liverwurst, avocado or drink some wine while on a MAOI you can go into a hypertensive crises (a rise in blood pressure so severe that it can cause deleterious effects in the short-term) and die. Other examples include psychotic depression which is usually a subtype that responds particularly well to electroconvulsive therapy (ECT) and the older, worse in side effects and more dangerous on overdose class of antidepressants, the tricyclic antidepressants. Another effective treatment option in these patients is a combination of a newer antidepressants (e.g. sertraline [ZOLOFT]) and a newer antipsychotic (e.g. olanzapine [ZYPREXA]). This subtype of depression also shares a number of neurobiological (the biology and functioning of the brain in this context) and genetic similarities with bipolar disorder. One of these similarities is that people with a relative thats affected by bipolar disorder are more likely to experience psychotic depression. Atypical depression also responds abnormally well to MAOIs as MAOIs have a stimulating effect in many patients which reduces the excessive sleeping seen in atypical depression and also reduces their appetite and hence causes weight loss. Ronald Slyderink, Joshua Punshon
Posted on: Tue, 15 Oct 2013 05:41:41 +0000
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