Depression

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    A , Family Medicine, answered
    Treatment options for people with treatment-resistant depression include taking a higher dose of their antidepressant drugs or taking a combination of depression medications. Other medications or hormones may also be prescribed to help antidepressants work better. 
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    A , Family Medicine, answered
    Antidepressants and antipsychotics are the medications used to treat psychotic depression. In this mood disorder, a depressed person experiences episodes of psychosis or losing touch with reality, such as delusions or hallucinations. When medications don't help, electroconvulsive therapy (ECT) may be used.
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    A , Family Medicine, answered
    Psychotic depression is major depression with episodes of psychosis, in which you lose sense of reality. During such episodes, you may have beliefs that are untrue (delusions) or see or hear things that aren't there (hallucinations).
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    A , Family Medicine, answered
    Psychosis means a lost sense of reality. Some people experience moments of psychosis along with their depression.
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    A , Psychology, answered

    Psychotic symptoms are: a loss of touch with reality often resulting in delusions (very far-fetched or bizarre beliefs; the belief that one’s thoughts are being broadcast on television). With psychosis delusions are believed by the patient with great conviction and they have lost the ability to recognize that such beliefs are unrealistic. The other symptoms are hallucinations, disorganized thinking, bizarre behavior and confusion. With psychosis seen in schizophrenia and drug-induced psychosis it is hard to miss the symptoms; thinking is so disorganized that just listening to the person will reveal the greatly impaired thought processes.

    Psychosis can be seen in very severe depression (in major unipolar depression and bipolar disorder). Here most of the time, despite the presence of delusions and hallucinations, over all thought processes remain normal; outward behavior may not look bizarre.

    Psychotic symptoms in depression generally are seen by the patient as unusual; they choose not to talk about the beliefs (afraid others will think they are crazy).

    Most depressive delusions are somatic delusions (e.g. fear that all of their internal organs are rotting), paranoid (e.g. being afraid that people are out to get them), and delusions involving very unrealistic feelings of guilt and worthlessness (e.g. they 100% believe that they are sinful and should be executed). Most severely depressed clients never tell others about their delusions; they suffer in isolation.

    This is important to assess. First, the presence of psychotic symptoms strongly indicate the need to treat with antipsychotic medications (such as Seroquel or Abilify). Antidepressants and mood stabilizers alone are not effective in treating depression-related psychotic symptoms

    The tragedy of unreported psychotic symptoms is three fold: it adds a huge amount of additional fear and suffering, without knowledge of these symptoms, often antipsychotic medications are not used, and some delusions, especially ones that involve guilt and worthlessness can lead to suicide attempts.

    With all depressed people this question should be asked: “Since you have been depressed have you started to worry about certain things that have never worried you before and that might, to others seem kind of bizarre or crazy?…this often can occur in severe depression and we need to know if you are experiencing this so we’ll know what treatments will be most beneficial.”


     

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    Medications to treat atypical depression work on the brain's chemistry. For example, selective serotonin reuptake inhibitors (SSRIs) are believed to work by increasing the levels of serotonin in the brain, a chemical that helps the brain cells or neurons to talk to one another and regulates mood and anxiety. When atypical depression symptoms do not respond to SSRIs, monoamine oxidase inhibitors (MAOIs) can be used. These drugs work by stopping monoamine oxidase from using up several mood-related neurotransmitters so more are left behind to improve mood. MAOIs have been proven to be especially helpful in atypical depression but they have more risks and potential side effects so are used less often than other antidepressants.
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    Atypical depression is a subtype of depression. One of the distinguishing characteristics is called mood reactivity which means your mood can brighten if you get good news or spend time with a loved one. However, the lift is only temporary. This form of depression tends to be chronic and usually begins when you are a teenager.

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    Atypical depression symptoms include a feeling of melancholy and sorrow, as well as a lack of interest in formerly enjoyable activities. These symptoms are the same for most types of depression. The difference is that with atypical depression your mood can improve temporarily if something positive happens in your life. Other symptoms of this form of depression include tendencies to overeat and/or oversleep, feelings of heaviness in the limbs, and an extreme sensitivity to rejection from others. Additionally, atypical depression symptoms do not seem to be affected by tricyclic antidepressants.

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    Medications used to treat atypical depression do cause side effects. SSRIs, such as Prozac and Zoloft, can cause a drop in sexual desire or problems achieving orgasm. Headaches, trouble sleeping, and nausea can also be caused by the medication, but these side effects usually go away with continued use. MAOIs, a drug used when the others fail, can cause mild side effects, such as diarrhea and nausea, but also more serious ones. If you eat foods containing tyramine while taking MAOIs, your blood pressure could jump and cause you to have a stroke. Also, MAOIs combined with SSRIs can cause a dangerous condition known as serotonin syndrome which requires immediate medical attention.

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    A , Psychology, answered

    Atypical Depression is a form of major (clinical) depression. Approximately 15% of people suffering with depression have this version of the disorder. Atypical depression has many symptoms that are common to all depressions, e. g. pessimistic and negative thinking, low self-esteem or lack of confidence, suicidal ideas or impulses, loss of sex drive, diminished ability to experience vitality and a sense of aliveness, withdrawal from normal life activities, mood changes: sad, despair, irritability and low frustration. The unique features of atypical depression are: hypersomnia (excessive sleeping; e. g. sleeping 10-12 hours a day, most nights), very pronounced fatigue, and increased appetite (with subsequent weight gain). The hallmark symptom is hype 

    Atypical depressive episodes range from mild to very severe (as is the case with all depressive disorders). Moderate to severe episodes may make normal life functioning difficult; people may find it extremely hard to get out of bed, to go to work, to attend school, or engage in usual life activities (e. g. going out to eat, going to church services, attend parties, etc.).

    The majority of people suffering from seasonal depression (seasonal affective disorder) have atypical symptoms. And, it is very important to note that up to 4 out of 5 people experiencing atypical depression symptoms turn out to have bipolar disorder. And, many people with bipolar disorder will suffer from atypical symptoms when in a depressive episode.

    It is well known that antidepressant medications, while being effective in treating unipolar major depression (often referred to as clinical depression) can be harmful to those who have bipolar disorder. Antidepressants given to people with bipolar disorder can provoke severe manic episodes, can intensify depressive symptoms (especially irritability) and are generally ineffective. There are specific bipolar medications that can treat bipolar depressive episodes. Because of the risk of bipolar disorder, people who have atypical symptoms should see a mental health professional who can carefully evaluate and diagnose the disorder.

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