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Comment by Xcelerate | Hacker News Reader

Does anyone have experience with atypical depression? That's what I have, and SSRIs seem to do almost nothing for it. Prozac made me feel spacey, and it didn't fix any of my problems (except OCD), so I quit it. I've since read a lot of articles in psychology/psychiatry journals and it appears that MAOIs (nardil, parnate), are much more effective for this condition, although they have strong side effects and dietary restrictions. MAOIs were the original antidepressants used in the 1950s and 1960s. A lot of articles indicate nardil is particularly effective for social anxiety, over SSRIs.

Atypical depression is characterized by excessive sleeping, extreme rejection sensitivity, leaden paralysis (heavy limbs/fatigue), and the ability to feel happy in response to a positive event. This last characteristic is a distinguishing factor from regular (endogenous) depression, where even positive events won't make someone feel happier.

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You probably need something targeting dopamine, the heavy limbs/fatigue, excessive sleeping etc. are typical symptoms of dopaminergic systems not working properly.

Try an NRI like reboxetine. Exercise to make it work better. Go outside for 15 minutes in the morning, if you don't do that already. A study showed that light exposure of 30 minutes per day make a 1/3 reduction in medication possible. And stop smoking cannabis, if you do, it has catastrophic effects on dopaminergic systems.

My depression didn't respond well to five SSRIs, one SNRI, two tricyclics and one tetracyclic. It turns out I didn't have major depressive disorder, but bipolar 2. The only medication that worked to alleviate my depression was Lamictal (lamotrigine). It also caused no side effects at all.

There are a few other medications that can be safely added to SSRIs, if you're not getting enough benefit from them. Lamictal is one of them. Buspar (buspirone) can also be added to help with anxiety. It's neither an SSRI (doesn't seem to work for you) nor a benzodiazepine (addiction potential), so perhaps it's worth a try.

But talk with your doctor, because I don't know your particular disorder or medication history.

You know what? I'm not either a doctor nor a psychiatrist, but what you've described sounds like chronic fatigue syndrome, not depression. Or (second vote) hypothyroidism, which also can create some of the symptom set you describe.

Both depression and CFS have no known causes, which makes their diagnosis problematic and their treatment even more problematic. But overall I would suggest that you look at CFS -- IMHO it seems to be a better fit to your symptoms.

Again, I am not a doctor and this is just an off-the-cuff opinion.

CFS and depression can complement each other. Also the one can lead to the other.

But I second this: get a check of your thyroid gland, if you thyroid doesn't work properly, medication won't work properly!

In the spirit of pharmacology as the subject; I might suggest a Norepinephrine-dopamine reuptake inhibitor (NDRI) like Methylphenidate (Concerta). It seems to have far less abuse potential. ( Of course this is after exercise and sunlight and therapy have exhausted their potential for results ) Also, don't take with MAOI's. Don't take my advice at all obviously, but I think you ought to research it and speak to doc.

I do, similar outcomes to your experience. I haven't tried MAOIs, they were deeply out of fashion when I was first diagnosed.

Aren't those all symptoms of major depressive disorder per DSM?

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