Atypical depression

Subject: Atypical depression Sun Jan 02, 2011 9:09 pm

As with any type of
depression, atypical depression can make you feel blue and keep you from
enjoying life. When you have atypical depression, a particular pattern
of signs and symptoms tends to occur. You may feel hungry and gain
weight. You may sleep a lot, and your arms and legs may feel heavy. Many
people who have atypical depression have a hard time maintaining
relationships and are especially afraid of rejection by others.

Atypical depression often starts in the teenage years and is more common
in women than in men. Despite the name, atypical depression isn't
uncommon or unusual. As with other forms of depression, treatment for
atypical depression includes medications, psychological counseling
(psychotherapy) and lifestyle changes.

Symptoms

Depression of any kind can cause:

* Feelings of sadness, emptiness or feeling tearful
* Loss of interest or pleasure in normal activities

In addition to standard symptoms of depression, atypical depression symptoms also include:

* Increased appetite
* Unintentional weight gain
* Increased desire to sleep
* Heavy, leaden feeling in the arms and legs
* Sensitivity to rejection or criticism that interferes with your social life or job
* Relationship conflicts
* Trouble maintaining long-lasting relationships
* Fear of rejection that leads to avoiding relationships
* Having depression that temporarily lifts with good news or positive events but returns later

When to see a doctor
If you feel depressed, make an appointment to see your doctor as soon as
you can. Depression may get worse if it isn't treated. Untreated
depression can lead to other mental and physical health problems or
problems in other areas of your life. Feelings of depression can also
lead to suicide.

If you're reluctant to seek treatment, talk to a friend or loved one, a
health care professional, a faith leader, or someone else you trust.

If you have suicidal thoughts
If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:

* Contact a family member or friend.
* Seek help from your doctor, a mental health provider or another health care professional.
* Call a suicide hot line number — in the United States, you can
reach the toll-free, 24-hour hot line of the National Suicide Prevention
Lifeline at 800-273-8255 to talk to a trained counselor.
* Contact a minister, a spiritual leader or someone in your faith community.

When to get emergency help
If you think you may hurt yourself or attempt suicide, call 911 or your
local emergency number immediately. If you have a loved one who has
harmed himself or herself, or is seriously considering doing so, make
sure someone stays with that person. Take him or her to the hospital or
call for emergency help.

Causes

It's not known exactly what causes atypical depression. As with other
types of depression, a combination of factors may be involved. These
include:

* Brain chemistry. Neurotransmitters are naturally occurring brain
chemicals that are thought to play a direct role in depression. When
these chemicals are out of balance, it may lead to depression symptoms.
* Inherited traits. Depression is more common in people whose biological family members also have the condition.
* Life events. Events such as the death or loss of a loved one,
financial problems and high stress can trigger depression in some
people.
* Early childhood trauma. Traumatic events during childhood, such as
abuse or loss of a parent, may cause permanent changes in the brain
that make you more susceptible to depression.

Risk factors

Although the precise cause of atypical depression isn't known, certain
factors seem to increase the risk of developing or triggering it,
including:

* Having biological relatives with depression
* Being a woman — depression, especially atypical depression, is more common in women than in men
* Having depression that started when you were a teen or child
* Having traumatic experiences as a child
* Having biological relatives with a history of alcoholism
* Having family members who committed suicide
* Experiencing stressful life events, such as the death of a loved one
* Having few friends or other personal relationships
* Having depression after giving birth (postpartum depression)
* Having a serious illness, such as cancer, heart disease, Alzheimer's disease or HIV/AIDS
* Having certain personality traits, such as low self-esteem and being overly dependent, self-critical or pessimistic
* Abusing alcohol, nicotine or illegal drugs
* Having financial problems
* Taking certain medications, which include some high blood pressure
medications, sleeping pills and certain other medications (talk to your
doctor before stopping any medication you think could be affecting your
mood)

Complications

Like other types of depression, atypical depression is a serious illness
that can cause major problems. Atypical depression can result in
emotional, behavioral and health problems that affect every area of your
life. Complications associated with atypical depression can include:

* Substance abuse — many people with depression drink too much or abuse illegal drugs
* Anxiety, which may be connected to a fear of criticism or rejection
* Family conflicts
* Relationship difficulties
* Heart disease and other medical conditions
* Work or school problems
* Social isolation
* Suicidal feelings or suicide

Preparing for your appointment

You're likely to start by seeing your primary care doctor. However, when
you call to set up an appointment, you may be referred directly to a
medical doctor who specializes in diagnosing and treating mental health
conditions (psychiatrist).

Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared for your
appointment. Here's some information to help you get ready for your
appointment, and what to expect from your doctor.

What you can do
These steps can help you make the most of your appointment:

* Write down any symptoms you've had, including any that may seem
unrelated to the reason for which you scheduled the appointment.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, vitamins and supplements that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided to you during
an appointment. Someone who accompanies you may remember something that
you missed or forgot.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions
ahead of time will help you make the most of your appointment. List your
questions from most important to least important in case time runs out.
For problems related to depression, some basic questions to ask your
doctor include:

* Is depression the most likely cause of my symptoms?
* Other than the most likely cause, what are other possible causes for my symptoms or condition?
* What kinds of tests will I need?
* What treatment is likely to work best for me?
* What are the alternatives to the primary approach that you're suggesting?
* I have these other health conditions. How can I best manage them together?
* Are there any restrictions that I need to follow?
* Should I see a psychiatrist or other mental health provider?
* Are there any possible side effects or other issues I should be aware of with the medications you're recommending?
* Is there a generic alternative to the medicine you're prescribing?
* Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions at any time during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:

* When did you or your loved ones first notice your symptoms of depression?
* How long have you felt depressed? Do you generally always feel down, or does your mood fluctuate?
* How severe are your symptoms? Do they interfere with your daily life or relationships?
* Does your mood ever swing from feeling down to feeling euphoric and full of energy?
* How do you react to good news or positive events?
* How do you react to criticism or rejection?
* Do you constantly feel hungry or regularly overeat?
* How much do you sleep every day?
* Do you often feel fatigued or irritable?
* Do you ever have suicidal thoughts?
* Do you have any biological relatives with depression or another mood disorder? What treatment has helped them?
* What other mental or physical health conditions do you have?
* Do you drink alcohol or use illegal drugs?
* What, if anything, seems to improve your symptoms?
* What, if anything, appears to worsen your symptoms?

Tests and diagnosis

When doctors suspect someone has depression, they generally ask a number
of questions and may do medical and psychological tests. These tests
can help rule out other problems that could be causing your symptoms,
pinpoint a diagnosis and also check for any related complications. These
exams and tests may include:

* Physical exam. This generally involves measuring your height and
weight; checking your vital signs, such as heart rate, blood pressure
and temperature; and listening to your heart and lungs.
* Laboratory tests. For example, your doctor may do a blood test
called a complete blood count (CBC) or test your thyroid to make sure
it's functioning properly.
* Psychological evaluation. To check for signs of depression, your
doctor or mental health provider will talk to you about your thoughts,
feelings and behavior patterns. He or she will ask about your symptoms
and whether you've had similar episodes in the past. You'll also discuss
any thoughts you may have of suicide or self-harm. Your doctor may have
you fill out a written questionnaire to help answer these questions.

Diagnostic criteria for atypical depression
To be diagnosed with atypical depression, you must meet the symptom
criteria spelled out in the Diagnostic and Statistical Manual of Mental
Disorders (DSM). This manual is published by the American Psychiatric
Association and is used by mental health providers to diagnose mental
conditions and by insurance companies to reimburse for treatment.

For a diagnosis of atypical depression, you must first meet the general
DSM criteria for major depression — which includes feeling down and
losing interest in things you once enjoyed. You'll also need to meet
other, specific criteria for atypical depression.

For a diagnosis of atypical depression you must have this symptom:

* Being cheered up by positive events

In addition, you must have at least two of these symptoms for diagnosis:

* Gaining weight gain or having a noticeable increase in appetite
* Sleeping excessively
* Being sensitive to rejection by others
* Having a heavy feeling in the arms and legs

Atypical depression has a very specific definition as a diagnosable
condition. But, be aware that some doctors and mental health providers
may use the term more loosely. Ask for clarification if it isn't clear
what exactly your doctor or mental health provider means when he or she
says "atypical depression."

Treatments and drugs

Treatment for atypical depression is generally the same as treatment for
other types of depression. Medications and psychological counseling
(psychotherapy) are effective for most people.

In some cases, a primary care doctor can prescribe medications to
relieve depression symptoms. However, many people need to see a doctor
who specializes in diagnosing and treating mental health conditions
(psychiatrist). Most people with atypical depression also benefit from
seeing a psychologist or other mental health counselor. Usually the most
effective treatment for depression is a combination of medication and
psychotherapy.

Atypical depression most often occurs along with mild, long-lasting
depression. However, it can cause more severe symptoms in some people,
such as feeling suicidal or not being able to do basic day-to-day
activities. If you have severe depression, a doctor, loved one or
guardian may need to guide your care until you're well enough to
participate in decision making. You may need a hospital stay, or you may
need to participate in an outpatient treatment program until your
symptoms improve.

Here's a closer look at your treatment options.

Medications
A number of medications are available to treat depression. They include:

* Selective serotonin reuptake inhibitors (SSRIs). Many doctors
start depression treatment by prescribing an SSRI. These medications are
safer and generally cause fewer bothersome side effects than other
types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine
(Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram
(Lexapro). The most common side effects include decreased sexual desire
and delayed orgasm. Other side effects may go away as your body adjusts
to the medication. They can include digestive problems, jitteriness,
restlessness, headache and insomnia.
* Serotonin and norepinephrine reuptake inhibitors (SNRIs). These
medications include duloxetine (Cymbalta), venlafaxine (Effexor) and
desvenlafaxine (Pristiq). Side effects are similar to those caused by
SSRIs. In high doses these medications can cause increased sweating and
dizziness. People with liver disease shouldn't take duloxetine.
* Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion
(Wellbutrin) falls into this category. It's one of the few
antidepressants that don't cause sexual side effects. At high doses,
bupropion may increase your risk of having seizures.
* Atypical antidepressants. These medications are called atypical
because they don't fit neatly into another antidepressant category. They
include trazodone (Desyrel) and mirtazapine (Remeron). Both of these
antidepressants are sedating and are usually taken in the evening. In
some cases, one of these medications is added to other antidepressants
to help with sleep.
* Tricyclic antidepressants. These antidepressants have been used
for years and are generally as effective as newer medications. But
because they tend to have more numerous and more severe side effects, a
tricyclic antidepressant generally isn't prescribed unless you've tried
an SSRI first without an improvement in your depression. Tricyclic
antidepressants include amitriptyline, doxepin (Sinequan), imipramine
(Tofranil), nortriptyline (Pamelor) and others. Side effects can include
low blood pressure, dry mouth, blurred vision, constipation, urinary
retention, fast heartbeat and confusion. Older adults taking these
medications are susceptible to memory problems, confusion and
hallucinations. Tricyclic antidepressants are also known to cause weight
gain.
* Monoamine oxidase inhibitors (MAOIs). MAOIs — such as
isocarboxazid (Marplan) and phenelzine (Nardil) — are usually prescribed
only after other medications have been tried. That's because MAOIs can
have serious side effects. These antidepressants require a strict diet
because of dangerous (or even deadly) interactions with foods such as
certain cheeses, pickles and wines and with some medications including
decongestants. Selegiline (Emsam) is an MAOI that you stick on your skin
as a patch rather than swallowing. It may cause fewer side effects than
other MAOIs. Side effects aside, these medications are the
antidepressants most proven to treat atypical depression. They may be
effective when other medications, such as tricyclic antidepressants,
don't work.
* Other medications. Your doctor may suggest other medications to
treat your depression. These may include stimulants, mood-stabilizing
medications, anti-anxiety medications or antipsychotic medications. In
some cases, your doctor may recommend combining two or more
antidepressants or other medications for better effect. This strategy is
known as augmentation.

Finding the right medication
Everyone's different, so finding the right medication or medications for
you will likely take some work. If a family member has responded well
to an antidepressant, it may be one that could help you. You may need to
try several medications before you find one that works. This can
require patience, as some medications need eight weeks or longer to take
full effect and for side effects to ease as your body adjusts. If you
have bothersome side effects, don't stop taking an antidepressant
without talking to your doctor first.

Some antidepressants can cause withdrawal symptoms unless you slowly
taper off your dose, and quitting suddenly may cause a sudden worsening
of depression. Don't give up until you find an antidepressant or
medication that's suitable for you — you're likely to find one that
works and has tolerable side effects.

If antidepressant treatment doesn't seem to be working, your doctor may
recommend a DNA test to check for specific genes that affect how your
body uses antidepressants. Cytochrome P450 genotyping tests may be able
to help predict how well your body will processes (metabolize) a
medication. This may help guide your doctor in identifying an
antidepressant that's likely to work for you and cause the fewest side
effects. Genetic tests are new, so they aren't widely used yet. It isn't
clear how well they work to predict which antidepressant is likely to
work best.

Antidepressants and pregnancy
If you're pregnant or breast-feeding, some antidepressants may pose an
increased health risk to your unborn child or nursing child. Talk to
your doctor if you become pregnant or are planning on becoming pregnant.

Antidepressants and increased suicide risk
Although most antidepressants are generally safe, be careful when taking
them. The Food and Drug Administration (FDA) warns that children,
adolescents and young adults ages 18 to 24 may have an increase in
suicidal thoughts or behavior when taking antidepressants. If you or
someone you know has suicidal thoughts when taking an antidepressant,
immediately contact your doctor or get emergency help.

Psychotherapy
Psychological counseling is another key depression treatment.
Psychotherapy is a general term for a way of treating depression by
talking about your condition and related issues with a mental health
provider. Psychotherapy is also known as therapy, talk therapy,
counseling or psychosocial therapy.

Psychotherapy sessions can help you:

* Learn about the causes of depression so that you can better understand how to cope with it
* Learn how to identify and make changes in unhealthy behavior or thoughts
* Explore relationships and experiences that could be linked to feelings of depression
* Find better ways to cope with stressful situations and solve problems
* Set realistic goals
* Regain a sense of happiness and control in your life
* Improve depression symptoms such as hopelessness and anger
* Help you cope with a crisis or other current difficulty

There are several types of psychotherapy that are effective for
depression. Cognitive behavioral therapy is one of the most commonly
used therapies. This type of therapy helps you identify negative beliefs
and behaviors and replace them with healthy, positive ones. It's based
on the idea that your own thoughts — not other people or situations —
determine how you feel or behave. Even if an unwanted situation doesn't
change, you can change the way you think and behave in a positive way.
Interpersonal therapy, psychodynamic psychotherapy, and acceptance and
commitment therapy (ACT) are other types of counseling commonly used to
treat atypical depression and other types of depression.

Hospitalization and residential treatment programs
In some people, depression is so severe that a hospital stay is needed.
Inpatient hospitalization may be necessary if you aren't able to care
for yourself properly or when you're in immediate danger of harming
yourself or someone else. Getting psychiatric treatment at a hospital
can help keep you calm and safe until your mood improves. Partial
hospitalization or day treatment programs also are helpful for some
people. These outpatient programs provide the support and counseling you
need while you get symptoms under control.

Lifestyle and home remedies

Depression generally isn't an illness that you can treat on your own.
But you can do some things for yourself that will help. In addition to
professional treatment, follow these self-care steps:

* Stick to your treatment plan. Don't skip psychotherapy sessions or
appointments, even if you don't feel like going. Even if you're feeling
well, resist any temptation to skip your medications. If you stop,
depression symptoms may come back, and you could also experience
withdrawal-like symptoms.
* Learn about depression. Education about your condition can empower you and motivate you to stick to your treatment plan.
* Pay attention to warning signs. Work with your doctor or therapist
to learn what might trigger your depression symptoms. Make a plan so
that you know what to do if your symptoms get worse. Contact your doctor
or therapist if you notice any changes in symptoms or how you feel. Ask
family members or friends to help watch for warning signs.
* Get exercise. Physical activity reduces depression symptoms.
Consider walking, jogging, swimming, gardening or taking up another
activity you enjoy.
* Avoid alcohol and street drugs. It may seem like alcohol or drugs
lessen depression symptoms, but in the long run they generally worsen
symptoms and make depression harder to treat.

Alternative medicine

You may be interested in trying to relieve depression symptoms with
complementary or alternative medicine strategies. These include
supplements and mind-body techniques. Make certain you understand risks
as well as possible benefits before pursuing alternative therapy. Don't
replace conventional medical treatment or psychotherapy with alternative
medicine. When it comes to depression, alternative treatments aren't a
substitute for professional care.

Here are some common alternative treatments that are used for depression.

Herbal remedies and supplements
A number of herbal remedies and supplements have been used for depression. A few common ones include:

* St. John's wort. Known scientifically as Hypericum perforatum,
this is an herb that's been used for centuries to treat a variety of
ills, including depression. It's not approved by the Food and Drug
Administration to treat depression in the United States. Rather, it's
classified as a dietary supplement. However, it's a popular depression
treatment in Europe.
* SAMe. Pronounced "sam-EE," this is a synthetic form of a chemical
that occurs naturally in the body. The name is short for
S-adenosylmethionine. It's not approved by the FDA to treat depression
in the United States. Like St. John's wort, it's classified as a dietary
supplement. However, it's used in Europe as a prescription drug to
treat depression.
* Omega-3 fatty acids. Eating a diet rich in omega-3s or taking
omega-3 supplements may help ease depression and also appears to have a
number of other health benefits. These healthy fats are found in
cold-water fish, flaxseed, flax oil, walnuts and some other foods. It
isn't clear yet whether omega-3s from vegetable sources work as well as
fish oil.

Some herbal and dietary supplements for depression — particularly St.
John's wort — can interfere with prescription medications or cause
dangerous interactions. To be safe, talk to your doctors and other
health care providers before taking any supplements.

Mind-body connections
The connection between mind and body has been studied for centuries.
Complementary and alternative medicine practitioners believe the mind
and body must be in harmony for you to stay healthy.

Mind-body techniques that may be helpful for depression include:

* Acupuncture
* Yoga
* Meditation
* Guided imagery
* Massage therapy

As with dietary supplements, take care in using these techniques.
Although they may pose less of a risk, relying solely on these therapies
is generally not enough to treat depression. If you try mind-body
techniques or other alternative therapies first to treat your depression
but your symptoms worsen or don't improve, talk to your doctor.

Coping and support

Coping with depression can be challenging. Talk to your doctor or
therapist about improving your coping skills, and try these tips:

* Simplify your life. Cut back on obligations when possible, and set
reasonable goals for yourself. Give yourself permission to do less when
you feel down.
* Consider writing in a journal. Journaling can improve mood by allowing you to express pain, anger, fear or other emotions.
* Read reputable self-help books. Your doctor or therapist may be able to recommend books to read.
* Locate helpful organizations. A number of organizations offer
support groups, counseling and other resources can that can help with
depression. For example, the National Alliance on Mental Illness offers
free online and in-person education, discussion groups and classes for
people with depression and their family members. Many employee
assistance programs and religious organizations also offer help for
mental health concerns.
* Don't become isolated. Try to participate in social activities, and get together with family or friends regularly.
* Take care of yourself. Eat a healthy diet, exercise regularly and get plenty of sleep.
* Learn ways to relax and manage your stress. Examples include meditation, yoga and tai chi.
* Structure your time. Plan your day and activities. You may find it
helpful to make a list of daily tasks, use sticky notes as reminders or
use a planner to stay organized.
* Don't make important decisions when you're down. Avoid decision
making when you're feeling very depressed, since you may not be thinking
clearly.

Prevention

There's no sure way to prevent depression. However, taking steps to
control stress, to increase your resilience and to boost your
self-esteem may help. Friendship and social support, especially in times
of crisis, can help you weather rough spells. In addition, treatment at
the earliest sign of a problem can help prevent depression from
worsening. Long-term maintenance treatment also may help prevent a
relapse of symptoms.

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