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Wednesday, May 12, 2010

My exact condition - Is it atypical depression with psychomotor retardation or ADD/ADHD?

Today I was reading research articles. I found references for my exact condition. Based on the following refefences, I can say that I have a atypical depression with impaired dopamine transmission which accounts for the psychomotor retardation.

The following information is from wikipedia on atypical depression.

The DSM-IV-TR defines Atypical Depression as a subtype of Major Depressive Disorder with Atypical Features, characterized by:


a) Mood reactivity (i.e., mood brightens in response to actual or potential positive events)

b) At least two of the following:

  • Significant weight gain or increase in appetite;
  • Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression;
  • Leaden paralysis (i.e., heavy, leaden feelings in arms or legs);
  • Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.

c) Criteria are not met for Melancholic Depression or Catatonic Depression during the same episode.


I have (a) mood reactivity - My mood usually improves when I travel long distance; when I meet people and talk with whom I can make jokes and laugh. If I am alone, my depressive thoughts start occupying my mind.

in (b) I have significant weight gain - very difficult to lose weight. If I starve very much, then only I can lose my weight. Then I have hypersomnia - I sleep for almost 9-11 hours per day. If I don't sleep this much time, I don't feel energized or refreshed. Leaden paralysis is not there. I don't feel heavy feelings in my arm or legs. My arms and legs are very weak and I am unable to get out of sofa or car seat as like normal people of my age. I think I had strong interpersonal rejection sensitivity and body dysmorphic disorder (because of my pimples) when I was 13-18 years old. Later on, it subsided to some extent. However, it did not go fully.

(c) I don't have a supressed mood always. The problem with me is the mood is unable to reach its maximum pleasure levels. I don't sink into depression also. I am unable to enjoy the pleasures in my everyday life. My anxiety is very high, incapacitating enough to make me avoid normal operations in life.

So, collectively these things imply that I have atypical depression and probably with psychomotor retardation. Actually my depression was not a problem for me in my adolescent age. Those days, I didn't have neurological issues. From 2003, my erections were not as strong as before. In 2004-2005, I started to have involuntary head twitches and sudden fainting-like feeling for few seconds.

There could be a
  • dopamine and noradrenaline deficiency - accounting for psychomotor, lack of motivation, lack of reward sensing and sexual issues
  • GABA deficiency - accounting for high anxiety
  • Acetyl choline deficiency - accounting for impaired memory and stomach bloating.

My serotonin levels seems to be normal. I have done the brain neurotransmitter survey on this site (http://www.antiagingnow.com/secure/test_forms/edge_effect_intro.html) and the results indicated that I have severe deficiency of dopamine, GABA, acetylcholine and not serotonin.

The treatment strategies for atypical depression could be as follows:

 600 microgram/day

I may need a dopamine reuptake inhibitor to really alleviate my psychomotor retardation. And I may not have parkinson's disease also.

References:

Motor and cognitive aspects of motor retardation in depression. Journal of Affective Disorders 57 (2000) 83–93.

Abstract

Background: Motor retardation is a common feature of major depressive disorder having potential prognostic and etiopathological significance. According to DSM-IV, depressed patients who meet criteria for psychomotor retardation, must exhibit motor slowing of sufficient severity to be observed by others. However, overt presentations of motor slowing cannot distinguish slowness due to cognitive factors from slowness due to neuromotor disturbances.
Methods: We examined cognitive and neuromotor aspects of motor slowing in 36 depressed patients to test the hypothesis that a significant proportion of patients exhibit motor programming disturbances in addition to psychomotor impairment. A novel instrumental technique was used to assess motor programming in terms of the subject’s ability to program movement velocity as a function of movement distance. A traditional psychomotor battery was combined with an instrumental measure of reaction time to assess the cognitive aspects of motor retardation.
Results: The depressed patients exhibited significant impairment on the velocity scaling measure and longer reaction times compared with nondepressed controls. Approximately 40% of the patients demonstrated abnormal psychomotor function as measured by the traditional battery; whereas over 60% exhibited some form of motor slowing as measured by the instruments. Approximately 40% of the patients exhibited parkinsonian-like motor programming deficits. A five-factor model consisting of motor measures predicted diagnosis among bipolar and unipolar depressed patients with 100% accuracy. Limitations: The ability of motor measures to discriminate bipolar from unipolar patients must be viewed with caution considering the relatively small sample size of bipolar patients.
Conclusions: These findings suggest that a subgroup of depressed patients exhibit motor retardation that is behaviorally similar to parkinsonian bradykinesia and may stem from a similar disruption within the basal ganglia.

Clinical and psychometric correlates of dopamine D2 binding in depression. Psychological Medicine (1997), 27:1247-1256 Cambridge University Press.

Update on 15 October 2012:

I used to feel heavily sleepy after drinking coffee especially if the coffee is taken after a good meal either in the breakfast or in the lunch. I first observed this effect in 1997 when I was taking a training in an industry. I used to feel like that most of the times after taking coffee. Today I googled on it and found a yahoo answer saying that getting sleepiness after taking coffee is one of the physiological indications of attention deficit disorder (ADD) / attention deficit hyperactivity disorder (ADHD). I got interest and searched on the symptoms of ADD/ADHD. I found a very good website detailing all information on ADD/ADHD (http://www.helpguide.org/mental/adhd_add_adult_symptoms.htm).

The major symptoms which I may have under the heading of disorganization and forgetfulness include the following:

Disorganization and forgetfulness

  • poor organizational skills (home, office, desk, or car is extremely messy and cluttered)
  • tendency to procrastinate
  • trouble starting and finishing projects
  • chronic lateness
  • frequently forgetting appointments, commitments, and deadlines
  • constantly losing or misplacing things (keys, wallet, phone, documents, bills)
  • underestimating the time it will take you to complete tasks

The suggested treatment plan