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)
- 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.
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:
- Treatment with monoamine oxidase inhibitors - lot of side effects and precautions need to be taken.
- Treatment with bupropion. (Ref: GOODNICK PJ, DOMINGUEZ RA, DEVANE CL et al. Bupropion slow-release response in depression: diagnosis and biochemistry. Biol Psychiatry 1998;44:629–632.)
- Treatment with triiodothyronine augmentation of selective serotonin reuptake inhibitors (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&dopt=AbstractPlus&list_uids=16086620)
- Treatment with St. John's wort extract 300 mg twice daily (http://www.ncbi.nlm.nih.gov/pubmed/20181361) marketed in Germany as Jarsin® 300 mg.
- Treatment with chromium picolinate initial starting dose 400 μg/day, can be increased to 600 μg after 2 weeks. (Ref: http://www.ncbi.nlm.nih.gov/pubmed/12559660)
I may need a dopamine reuptake inhibitor to really alleviate my psychomotor retardation. And I may not have parkinson's disease also.
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.
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
- Exercise vigorously and regularly (at least 4 times per week with 30 minutes of each session)
- Sleep adequately ~ 8 hours/night. Go to bed consistently on same time everyday and get up at same time everyday even if you are tired.
- Eat complex carbohydrates and little protein with every meal. Eat at regular times. Do not starve and eat all at once. Maintain the regularity of meals.
- Make sure you’re getting enough zinc, iron, and magnesium in your diet. Consider taking a multivitamin supplement.
- Omega-3 supplements seems to be effective for the inattentive subgroup of ADHD patients. A subgroup of children and adolescents with ADHD, characterized by inattention and associated neurodevelopmental disorders, treated with omega 3/6 fatty acids for 6 months responded with meaningful reduction of ADHD symptoms. For relieving the symptoms of ADD/ADHD, you have to take a supplement that has at least 2-3 times the amount of EPA to DHA. [Source: http://www.helpguide.org/mental/adult_adhd_add_treatments_therapy.htm]
- Drugs - methylphenidate, Adderall (a combination of four amphetamine salts (racemic amphetamine aspartate monohydrate,racemic amphetamine sulfate, dextroamphetamine saccharide, and dextroamphetamine sulfate)), dextroamphetamine sulfate and atomoxetine
