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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Holliday on May 24, 1999, at 15:09:59
Are the pharmacological interventions for dysthymia
the same as or similar to that for major depression? I
can imagine that ECT would not be indicated for dysthymia,
whereas it might be life-saving for someone with in a
major depressive episode. Analagously, I would not be surprised
to learn that some medicines that would be readily used for
major depression might not be indicated on a cost/benefit basis
for dysthymia, but I have seen little, if anything, in print on
the subject.
I DID read from David Burns, M.D., that MAO inhibitors might
be more efficacious for dysthymia than TCAs or SSRIs used either
alone or in combination. I am not aware of any follow-up studies
supporting this, though.
Any help from the M.D.s out there?
Posted by Sean on May 24, 1999, at 17:15:52
In reply to Pharmacological Inteverntions for Dysthymia, posted by Holliday on May 24, 1999, at 15:09:59
> Are the pharmacological interventions for dysthymia
> the same as or similar to that for major depression? I
> can imagine that ECT would not be indicated for dysthymia,
> whereas it might be life-saving for someone with in a
> major depressive episode. Analagously, I would not be surprised
> to learn that some medicines that would be readily used for
> major depression might not be indicated on a cost/benefit basis
> for dysthymia, but I have seen little, if anything, in print on
> the subject.
> I DID read from David Burns, M.D., that MAO inhibitors might
> be more efficacious for dysthymia than TCAs or SSRIs used either
> alone or in combination. I am not aware of any follow-up studies
> supporting this, though.
> Any help from the M.D.s out there?
I'm not a doc, but I've read widely on dysthymia
after years of personal experience with cyclothymia,
panic, and depression.The best doctor I can refer you to is Hagop Akiskal.
He has been working on the medication issues around
dysthymia for many years. It is his opinion that
dysthymia is physiologicaly related to the bipolar
disorders and tends to respond better to drugs
usually reserved for modd stabilization or
treating the depressed phase of bipolar disorder
(e.g., Lithium, depakote, MAOI's, etc...) Not
everyone agrees with this opinion, but certainly
he has done numerous studies to back up his claims.I could ramble on for hours about his work, but
suffice to say it is very well respected and at the
cutting edge of nosology (how diseases are classified).
You can find many of his papers on the net via
Pubmed.Good luck!
Sean.
Posted by John on May 25, 1999, at 3:09:10
In reply to Re: Pharmacological Inteverntions for Dysthymia, posted by Sean on May 24, 1999, at 17:15:52
> > Are the pharmacological interventions for dysthymia
> > the same as or similar to that for major depression? I
> > can imagine that ECT would not be indicated for dysthymia,
> > whereas it might be life-saving for someone with in a
> > major depressive episode. Analagously, I would not be surprised
> > to learn that some medicines that would be readily used for
> > major depression might not be indicated on a cost/benefit basis
> > for dysthymia, but I have seen little, if anything, in print on
> > the subject.
> > I DID read from David Burns, M.D., that MAO inhibitors might
> > be more efficacious for dysthymia than TCAs or SSRIs used either
> > alone or in combination. I am not aware of any follow-up studies
> > supporting this, though.
> > Any help from the M.D.s out there?
>
>
> I'm not a doc, but I've read widely on dysthymia
> after years of personal experience with cyclothymia,
> panic, and depression.
>
> The best doctor I can refer you to is Hagop Akiskal.
> He has been working on the medication issues around
> dysthymia for many years. It is his opinion that
> dysthymia is physiologicaly related to the bipolar
> disorders and tends to respond better to drugs
> usually reserved for modd stabilization or
> treating the depressed phase of bipolar disorder
> (e.g., Lithium, depakote, MAOI's, etc...) Not
> everyone agrees with this opinion, but certainly
> he has done numerous studies to back up his claims.
>
> I could ramble on for hours about his work, but
> suffice to say it is very well respected and at the
> cutting edge of nosology (how diseases are classified).
> You can find many of his papers on the net via
> Pubmed.
>
> Good luck!
>
> Sean.I've been fighting dysthymia for years now, with no real help from SSRIs, TCAs, or others like Serzone, Wellbutrin, Remeron. From my own experience I must conclude that therapy will not come from the normal treatment of depression. I must now consider this as I explore MAOIs and/or mood stabilizers. Somewhere is Pharmacology Tips I remember someone commenting that in other countries they treat dysthymia successfully with mood stabilizers, which is a different approach, and apparently better received, than what they do in the USA. John.
Posted by Elizabeth on May 25, 1999, at 15:34:23
In reply to Re: Pharmacological Inteverntions for Dysthymia, posted by John on May 25, 1999, at 3:09:10
Hi. I agree with Sean that Dr. Akiskal is da man. Before I got hosed with schoolwork (it's finals week now), I started reading a book that he co-edited, _Dysthymia and the Spectrum of Chronic Depressions_. I didn't get very far, but I recommend it to anyone who wants to learn more about this disorder.
A major thread that runs through the articles seems to be that dysthymia is an affective disorder like major depression (though not necessarily simply a milder-but-chronic form), and not a personality flaw. There is also the bipolar II link; I'm going to reserve judgment on that part, though, as I think bipolar disorder is already overdiagnosed. (It's often missed, too, but it seems like it's getting "trendy" to the point where nobody knows what it means anymore.)
BTW MAOIs are not reserved or used preferentially for bipolar disorder. They are well suited to most subtypes of unipolar depression and, like SSRIs and other ADs, shouldn't be used for bipolar depression without an antimanic drug on board as well. They are safer in this regard than the tricyclics, but they will not stop mania (and may cause or exacerbate it).
Posted by Dr. Bob on May 26, 1999, at 1:41:16
In reply to book recommendation (Dr. Bob, are you listening?), posted by Elizabeth on May 25, 1999, at 15:34:23
> Hi. I agree with Sean that Dr. Akiskal is da man. Before I got hosed with schoolwork (it's finals week now), I started reading a book that he co-edited, _Dysthymia and the Spectrum of Chronic Depressions_. I didn't get very far, but I recommend it to anyone who wants to learn more about this disorder.
Yes, I'm listening. :-)
For those of you who didn't know why she asked, please take a look, if you have a chance, at:
http://www.dr-bob.org/books/#Babble
Bob
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