Dysthymia/atypical depression

[Zoid]

I think I have it. The symptoms match:

Dysthymia is a mood disorder that falls within the depression spectrum. Not considered to be as severe as major depression, dysthymic disorder is generally thought to be a chronic depression. According to the APA, DSM-IV (2000), two or more of six possible symptoms must be present for a diagnosis of dysthymia. These symptoms include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness [Hersen, M., Turner, S. M., & Beidel, D. C. (Eds.). (2007). Adult Psychopathology and Diagnosis (5th ed.). Hoboken, New Jersey: John Wiley & Sons, Inc.]. An individual must experience symptoms for at least two years and should have no longer than a two-month period without symptoms being present. These symptoms must result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning (APA, 2000). This disorder tends to be a chronic, long-lasting illness (Hersen et al., 2007).

While there is nothing wrong with my appetite and I sleep relatively good the last four symptoms are spot on what I've been feeling for long periods of my life. The last two years in particular...

Atypical Depression (AD) is a subtype of dysthymia and Major Depression characterized by mood reactivity — being able to experience improved mood in response to positive events.

This is also fits in, I'm somewhat happier when doing "fun" stuff. But it never lasts long. I always revert back to my depressed state quite rapidly...

So, anyone got any experience with this?

[Q Classic]

Yes.

It sucks.

You learn to live with it. Of course, the psychiatrists say you don't have to, that you can take pills, but that's a bunch of crock.

[VetLegion]

If I got a dollar for every depression thread a Scandinavian started while it was winter...

Sun should fix it right up, and summer is close. Hang in there.

[Wezil]

These symptoms include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness

Sounds like every teenager I've ever met.

[BlackCat]

If I remember rigth, then Zoid isn't exactly a teenager.

[Wezil]

I was just commenting on how wide a group such symptoms may encompass...

[Sirotnikov]

sorta feel the same :/

[Lancer]

I was ultra depressed but my prayers were answered and it stopped rather suddenly and then I was never again down too far, basicly a happy guy these last 25 years, thank you God.

[snoopy369]

I'd worry that they might have used Frogs in their tests... don't be tricked by a simple name spelling alteration.

Hersen, M

[Zoid]

I haven't had a steady job since I quit the factory in 1992. Just studying this and that, going unemployed and doing the odd job in between. No sense of direction or purpose. Never, ever seen anything through to the end. Never made a comittment and stuck to it. Feeling worthless and lost most of the time. Extremely low self esteem mixed with feelings of anger and resentment at other people for no good reason, etc, etc...

[chequita guevara]

You might consider going someplace with sunshine.

[Zoid]

That's not the problem. I need a vacation from myself I think, and a new outlook on life. Maybe also some antidepressants and therapy.

[DaShi]

http://www.psychiatrictimes.com/p020906.html

Antidepressants Versus Placebos: Meaningful Advantages Are Lacking
by Irving Kirsch, Ph.D., and David Antonuccio, Ph.D.

September 2002, Vol. XIX, Issue 9


--------------------------------------------------------------------------------

(Please see Counterpoint article by Michael E. Thase, M.D.)

(This is a preview of the Rumble in Reno II scheduled for Oct. 18. The debate between Kirsch and Thase will focus on the issues highlighted in these point/counterpoint articles. Brochures for this conference are available online at <www.dce.unr.edu>-Ed.)

Antidepressants are widely believed to be exceptionally effective medications. The data, however, tell a different story. Kirsch et al. (2002a) analyzed the data sent to the U.S. Food and Drug Administration by the manufacturers of the six most widely prescribed antidepressants (fluoxetine [Prozac], paroxetine [Paxil], sertraline [Zoloft], venlafaxine [Effexor], nefazodone [Serzone] and citalopram [Celexa]). Their research showed that although the response to antidepressants was substantial, the response to inert placebo was almost as great. The mean difference was about two points on the Hamilton Rating Scale for Depression (HAM-D). Although statistically significant, this difference is not clinically significant (Jacobson et al., 1999). More than half of the clinical trials sponsored by the pharmaceutical companies failed to find significant drug/placebo difference, and there were no advantages to higher doses of antidepressants. The small difference between antidepressant and placebo has been referred to as a "dirty little secret" by clinical trial researchers (Hollon et al., 2002), a secret that was believed by FDA officials to be "of no practical value to either the patient or prescriber" (Leber, 1998, as cited in Kirsch et al., 2002b).

Previous reports of vanishingly small drug/placebo differences (Kirsch and Sapirstein, 1998) were met with skepticism (e.g., Klein, 1998). In contrast, the basic findings from this new meta-analysis have been accepted as accurate (e.g., Thase, 2002). The dispute is no longer about the small size of the average drug/placebo difference, but rather about how to interpret this fact and what to do about it.

Various interpretive possibilities have been raised. One of the most popular theories is that there may be a subset of patients for whom at least some antidepressants are very effective, but that their relative lack of efficacy with other patients masks effect (e.g., Thase, 2002). Specifically, whereas mildly depressed patients respond to both drugs and placebos, more severely depressed patients respond only to active drugs. The FDA data contradict this hypothesis. Although severely depressed patients benefited more from medication than mildly depressed patients due to a phenomenon known as regression toward the mean, they also benefited more from placebo than their more mildly depressed counterparts.

Of course, one can never rule out the possibility of undetected moderator variables. But if there are hidden moderators, the overall mean difference between drug and placebo (two points on the HAM-D) constrains the conclusions that can be drawn from them. If the mean drug/placebo difference is greater than two points for a subset of medications or patients, then it must be less than two points for the others. For example, if the mean difference between drug and placebo is four points for half of the patients (which is still a rather small drug effect), then the mean effect of antidepressants on the other patients must be zero, and if it is more than four points for half the patients, then the medications must be interfering with responsiveness in at least some others who would fare better on placebo.

Another popular hypothesis is that drug effects are more stable than placebo effects, resulting in lower relapse rates. This hypothesis is also contradicted by the data. A meta-analysis of relapse prevention trials published between 1973 and 1990 indicated that 71% of the drug response was duplicated by placebo (Walach and Maidhof, 1999). Kirsch et al.'s meta-analysis also examined response to treatment as a function of the duration of the trial. The data indicated that responses to both drug and placebo decrease over time. Contrary to conventional wisdom, however, the correlation between duration of the trial and response to treatment was higher for active medication (r=-0.84) than for placebo (r=-0.62), suggesting a steeper decline in effectiveness for active drugs than for placebo (Kirsch et al., 2002b).

In light of these data, what should be done in clinical contexts? Some have suggested that antidepressants continue to be prescribed, even if their effects are largely placebo effects. If nothing else, these agents can be used as active placebos. Given the side effects of these medications, we suggest an alternative approach. There are many interventions that seem to be as effective or nearly as effective as antidepressants. These include physical exercise, bibliotherapy and psychotherapy (Kirsch et al., 2002b). Psychotherapy has the further advantage of demonstrated superiority to medications in long-term comparative studies (Antonuccio et al., 2002). Given these data, antidepressant medication might best be considered a last resort, restricted to patients who refuse or fail to respond to other treatments.


Dr. Kirsch is professor of psychology at University of Connecticut and former president of Division 30 of the American Psychological Association.

Dr. Antonuccio is professor of psychiatry and behavioral sciences at University of Nevada School of Medicine, and director of and staff psychologist for the stop smoking program at the Reno Veterans Affairs Medical Center.


References
Antonuccio DO, Burns DD, Danton WG (2002), Antidepressants: a triumph of marketing over science? Prevention & Treatment 5:Article 25. Available at: journals.apa.org/prevention/volume5/toc-jul15-02.html. Accessed Aug. 2.

Hollon SD, DeRubeis RJ, Shelton RC, Weiss B (2002), The emperor's new drugs: effect size and moderation effects. Prevention & Treatment 5:Article 28. Available at: journals.apa.org/ prevention/volume5/toc-jul15-02.html. Accessed Aug. 2.

Jacobson NS, Roberts LJ, Berns SB, McGlinchey JB (1999), Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. J Consult Clin Psychol 67(3):300-307.

Kirsch I, Moore TJ, Scoboria A, Nicholls SS (2002a), The emperor's new drugs: an analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention & Treatment 5:Article 23. Available at: journals.apa.org/prevention/volume5/toc-jul15-02.html. Accessed Aug. 2.

Kirsch I, Sapirstein G (1998), Listening to Prozac but hearing placebo: a meta analysis of antidepressant medication. Prevention & Treatment 1: Article 0002a. Available at: journals.apa.org/prevention/volume-1/toc-jun26-98.html. Accessed Aug. 2, 2002.

Kirsch I, Scoboria A, Moore TJ (2002b), Antidepressants and placebos: secrets, revelations, and unanswered questions. Prevention & Treat-ment 5:Article 33. Available at: www.journals. apa.org/prevention/volume5/toc-jul15-02.html. Accessed Aug. 2.

Klein DF (1998), Listening to meta-analysis but hearing bias. Prevention & Treatment 1:Article 0006c. Available at: www.journals.apa.org/prevention/volume 1/toc-jun26-98.html. Accessed Aug. 2, 2002.

Thase ME (2002), Antidepressant effects: the suit may be small, but the fabric is real. Prevention & Treatment 5:Article 32. Available at: journals.apa.org/prevention/volume5/toc-jul15-02.html. Accessed Aug. 2.

Walach H, Maidhof C (1999), Is the placebo effect dependent on time? A meta-analysis. In: How Expectancies Shape Experience, Kirsch I, ed. Washington, D.C.: American Psychological Association, pp321-332.

I've also been reading "Overtreated" which has a nice story about a college kid who was put on anti-depressants for sleeplessness and ends up committing suicide because of the drugs.

[Zoid]

Yikes!

[chequita guevara]

Originally posted by Zoid
That's not the problem. I need a vacation from myself I think, and a new outlook on life. Maybe also some antidepressants and therapy.

How do you know until you get some sun? My depression didn't go away when I moved to South Florida, but it got a lot better.