Hi, I'm Dr. Tracey Marks.
A Psychiatrist and I make mental health education videos.
Today I'm answering the question
can a depressed person have a good day?
In other words, are you really depressed
if you can feel good for part of the day?
Usually we think of someone who is moderately
to severely depressed, as being very sad
and unresponsive to things, maybe even zombie-like.
But that isn't always how it looks.
But when it does look like this, we call it
having melancholic features or a melancholic depression.
When someone is able to have a good day
or enjoy somethings, we call it having atypical features
or an atypical depression.
Atypical depression is actually
the most common way depression looks.
It's kind of an unfortunate name because it sounds as though
atypical means it's rare or unusual
but it's actually the more common presentation.
Let's take a look at the two types of depression
and compare them.
First, there's mood reactivity.
How easily you're able to express your emotions.
With atypical depression, you can brighten up
when something good happens.
It is a momentary brightening though
and it's not something that you feel for weeks.
But you can feel like your mood has lifted
usually in response to a positive event
like a party or watching a good movie.
With melancholic depression, you don't have much
positive response when good things happen.
You just feel really low and it just seems like nothing
can lift you up.
With atypical depression, you have an increase in appetite
and usually weight gain.
And with melancholic depression, you lose your appetite
and you may lose weight.
With atypical depression, you oversleep.
Usually 10 hours or more.
It's like, you can't get enough sleep.
You're always tired and it's easy for you
to fall back asleep if you're left alone.
And this sleep may be continuous starting in the evening
or it could be a long overnight sleep
with some naps during the day.
With melancholic depression, you tend to sleep
less than your usual and wake up early in the morning.
So for example, if you usually sleep
from 11:00 p.m. to 6:00 a.m.
when you get depressed, you may start having broken sleep
throughout the night.
Or you may start waking up at 4:00 a.m.
and be unable to fall back asleep.
With atypical depression, you can experience
leaden paralysis where you feel weighted down
in your arms and your legs.
Some people can feel this way most of the day
but some people can feel it
for only a certain part of the day, like in the morning.
Making it really hard for you to get out of bed.
With melancholic depression, you can be very slowed down
where you move about slowly.
But it's not because your limbs feel heavy
but internally you feel like you're slowed
in all of your responses.
You can also have agitation, where you move faster
like pacing or shaking your legs when you sit.
For atypical depression
it affects your thinking differently.
You tend to be more sensitive to rejection.
And this may be part of your personality
to read more into someone's comments or actions
but when you get depressed, it's even worse
and my cause problems for you in your relationships.
With melancholic depression you become very guilt ridden.
You may bring up stuff from way back
that you feel bad about and wish you had done
things differently.
We call it ruminating, when you run things
over and over in your mind.
And lastly, sometimes with depression
how you feel can vary during the day.
With atypical depression, there is more of a trend to feel
worse in the evenings.
And with melancholic depression you feel worse
first thing in the mornings.
And you can feel a little bit better as the day wears on.
Some people would refer to atypical or melancholic features
as sub-types of depression.
But they're really called, course specifiers.
So the terminology would be, major depression
with atypical features.
You can have these atypical features with depression
that comes with bi-polar disorder and the chronic depression
that we used to call, dysthymic disorder
but we now call it, persistent depressive disorder.
Are there certain kinds of people
who tend to have more atypical depression features?
Some literature suggests that atypical depression may be
more prevalent in people with histrionic, borderline
and avoidant personalities.
I talk about each of these personalities
in separate videos that you can watch
in my personality disorder playlist.
Another pattern we see with atypical depression
is that the course tends to be more chronic
meaning people stay depressed longer.
And because of the increased appetite and sleep
people can gain a lot of weight.
Also, the leaden paralysis can make you feel very fatigued.
And some people can even be misdiagnosed
as having chronic fatigue syndrome.
Or you could really have chronic fatigue
but the depression gets missed because it looks so similar.
Atypical depression has been shown to respond better
to a different kind of anti-depressant called
a monoamine oxidase inhibitor or MAOIs.
These drugs aren't used as much as they once were
20 to 30 years ago, before the selective serotonin
reuptake inhibitors or SSRIs came out.
Those would be medications like, prozac, zoloft and lexapro.
These medications have less side effects overall.
So, they're better tolerated.
But they're not as good for atypical depression.
The MAOIs fell out of favor because they have a lot of
drug interactions and they have a serious interaction
with foods high in tyramine.
If you consume those foods while taking one of these drugs
you could have a hypertensive crisis
where your blood pressure shoots up very high
and this could be fatal.
So people taking the medication were given a list of foods
that you couldn't eat while you were on the medication.
Some of these foods were aged cheeses and wine.
Also, you have to be careful taking certain prescription
and non-prescription medications
including allergy medications.
Those interactions could cause serotonin syndrome.
Which could also make you very sick
where you need to go to the hospital.
There's a newer version of the MAOIs
called reversible MAOIs
that don't require the dietary restrictions.
But you still have to be careful
about other medications that you take.
One of these medications is called, selegeline.
And there is a patch version of it called, emsam.
The MAOIs have also been shown to do a better job
with treatment resistant depression.
But it still wouldn't be a good choice for you
if you take a lot of other medications
or don't think that you could be vigilant
about checking all of the pills
that you take in the future.
So the MAOIs are good drugs.
Back in the day when I used them 20 years ago
they did work better.
However, better was relative because we didn't have
all of the medications that we have now.
But even so, fast forwarding 20 years
we've used the other medications more
because there is less side effects
but there is still these issues and these conditions
where the MAOIs still seem to be superior.
So, I'm bringing this up so that if you do feel like
you fit a profile of having atypical features
with your depression, this may be something
you wanna talk with your doctor about.
A lot of people aren't using them very much these days.
I don't use them very much these days.
Because it takes work, you really have to be
on top of things to make sure that you don't have
the drug drug interactions.
Even if you are using one of the newer ones.
So, just something to think about.
Check out my other videos on depression
like this one on psychotic depression.
Or my personality disorder video playlist.
See you next time.