Atypical Depression: What It Is & What Meds Work

[@mlenos22]

Nardil saved my life after I suffered atypical depression for 9 years in my 20s. I have taken it consistently-except through two pregnancies-for 35 years. I am very worried about the consequences of such long term use, but I can find very little research on this issue. I had a hypertensive crisis in my early 50s that resulted in a brain hemorrhage and neurosurgery. Still, my quality of life is far better on it than off it.

[@JeffreyKnuppelMD]

Thank you for sharing your experience. I’m not aware of any long-term harm from Nardil. When I’ve worked with patients who came to me on it, their stories were similar to yours in that they had finally found an antidepressant that worked for them, and they had therefore usually already been on it for years.

[@liamkeene89]

Would you be able to do a video on how to differentiate atypical depression from borderline personality disorder?

[@whoosh007]

Thanks. Very helpful!

[@JeffreyKnuppelMD]

You're welcome! Thanks for watching and for your comment.

[@ritik9799]

Thank you for your video. This is really informative and of high quality. I have all the symptoms that you have listed except Leaden paralysis. In addition to these symptoms I also suffer with poor attention and inability to focus. Recently I visited two psychiatrists in a span of two days. One diagnosed me with atypical depression and wanted to treat me with Fluoxetine ( SSRI ). The second psychiatrist said that my test results are not strongly indicative of ADHD but my description is suggestive of it. The second psychiatrist said that I would benefit from ADHD medicines and wants to treat me with Atomoxatine ( SNRI ).

[@JeffreyKnuppelMD]

Thank you for your comment - I’m glad it was helpful. I hope you can get some help with whatever you’re struggling with. It’s frustrating when you get such different answers from different psychiatrists.

[@richardsimms251]

Great talk. Thank you.

[@JeffreyKnuppelMD]

You’re welcome! Thanks for watching.

[@ovagel1808]

Thank you for your help!

[@Kingboo1081]

Have been on Parnate for about 8 weeks now, only 2 weeks on 30mg though. Fingers crossed it works for me, as 30 + others haven’t. :-(

[@JeffreyKnuppelMD]

I hope it works for you. That’s a lot of med trials to go through.

[@famousutopias]

Speaking for myself, leaden paralysis episodes were very close to being just that, where effort to move my limbs at all was not forthcoming. On the plus side, there was no pain at all during these episodes! My depression was early onset, say, by about 12 years old. SSRI drugs were mediocre, with snri being a nightmare. So for over 10 years Selegiline MAOI at 30+ mg per day has been profound. I actually don’t feel like I’m taking anything in that there’s no blunting of affect, I still get sad and cry in situations, etc. That said, I do still struggle with overall energy but am able to manipulate my rest vs activity times so I can do work tasks when I need to and crash on a schedule of my own making. Another plus is I don’t long to be dead anymore, which is saying something. Frankly the toughest thing is dealing with the financial precipice I’m on due to a lifetime of poor earnings resulting from depression unsuccessfully managed for so long before. Overall I manage quite well on MAOI med and vit B supplements. But no one will call me Perky 😁

[@JeffreyKnuppelMD]

Thanks for sharing all of that!

[@tutel.warthunder_mobile]

I have questions like is it a mental health disorder and do you whve it for life?

[@Kingboo1081]

What dose do you personally use with Parnate for TRD and anxiety? max dose? In Australia, the guidelines suggest 30mg is the max, but I see other countries it is 60mg. I have to try and convince my psychiatrist to let me go above 30mg. :(

[@JeffreyKnuppelMD]

For a given patient, I use the lowest dose that is effective and tolerated. In the US, the FDA recommended max daily dose for Parnate (tranylcypromine) is 60 mg.

[@elpropiaso4]

Ive chronic atypical depression , non ssri have worked for me , only desvenlafaxine, but partially what can i agument to boost the antidepressant effect?

[@JeffreyKnuppelMD]

There are actually quite a few options-that’s a pretty big topic though and not something I can give you a quick answer to. You should definitely discuss this with your prescriber. Your question may be a good topic for a future video.

[@karenpeart5997]

What are your thoughts on mirtazapine please

[@JeffreyKnuppelMD]

Mirtazapine is a useful med for the right circumstances (especially for someone with depression who is having trouble sleeping and has a low appetite since it tends to be sedating and increases appetite). But atypical depression typically involves excessive sleeping and appetite, it would not typically be one of my first several choices for it.

[@karenpeart5997]

@@JeffreyKnuppelMD thanks 👍 I have tried so many and I have a problem with really bad side effects