Rapid cycling and unipolar depression

I have experienced chronic depression for most of my life and additionally a type of "rapid cycling" that is dismissed for the most part by psychiatrists. My "rapid cycling" seemed to often occur with in one day(extreme diurnal variation) and over three or more days,  almost  a cycling within cycling. The cycling often appeared out of a substrate of chronic depression and the timing of the cycling was almost something one could set their watch to.  The extent of the mood switch was considerable, from a suicidal depression to a rather productive euthymic/hypomanic mood. To this day I am not sure what precipitated it.

PsychEducation is one site that discusses the possibility of cycles occurring within "unipolar" depression. This site also  mentions and demonstrates the possibility of mixed states occurring within various cycles when depression is subcatorgized into mood, activity, and intellect. One can, for example, have a low mood plus high activity which could equal irritability in many.

But patients do have other combinations of depression and hypomania, or mania -- not just the two worst phases together.  And they do have cycles shorter than 4 days.  The DSM can't really handle these variations, but the model shown here handles them very well.

Additionally, during this "cycling" the purity of  my depression would in turn effect the purity of the euthymia/hypomania. A "pure" depressive mood which meant low irritability/anxiety would often be accompanied, within the same day, by a pleasant and productive euthymic state.  The amplitude of the cycle was often predicted by the depression.  Prior to unusually high mood a unusually low depressive dip would often occur. Incidentally one of the most severe cycles occurred while taking Lithium.

I firmly believe that this cycling I experienced was unusual/abnormal however I am  not certain that it suggests bipolarity.  On the other hand it seems highly unlikely to me that on a molecular level, unipolar depression is dramatically different than bipolar disorder. I see the generally principle of "for every reaction there is an equal and opposite one.", operating in both disorders.

Anti-Psychiatry is simple minded

[youtube=http://www.youtube.com/watch?v=-P6_FwpVo_s&w=560&h=315]

According to this man in the video no known pathology exists in the mentally ill and consequently mental illness doesn't exist. What annoys me is that anti-psychiatrists believe that pathology or abnormality can only exist as either a lesion or something measured in the blood. I submit that they have an overly narrow view of pathology. Given the complexity of the human body numerous things could function abnormally. Migraine, for example, is a well accepted neurological disorder however neurologists aren't sure why migraines, much like mental illness, occur.

Another specific example of abnormality/pathology is the lack of circadian phase alignment between the sleep wake cycle and the melatonin cycle that exists in many depressed individuals. In SAD individuals the melatonin cycle is often delayed relative to the sleep wake cycle. This can be corrected by the use of bright light or melatonin supplements.  One particular study found a connection between the degree of depression and the lack of alignment between the two cycles.

Is melancholia the only true type of depression?

According to an article in Psychology Today melancholic depression is the only true type of depression. The author claims that what passes for major depression today is equivalent to what people used to commonly refer to as "nerves" since many people who are depressed today don't necessarily feel sad. "Depressed" individuals today often demoralized, feel extremely fatigued, anxious, and have numerous physical complaints which can be treated with SSRIs while true depressives respond more to tricyclics and ECT.

There is a major problem with the diagnosis of "depression," and this is that it doesn't exist. There is such a thing as "melancholia," a very serious from of depression entailing risk of suicide and complete lack of pleasure in life. But, hey! for years this illness was called by its proper name, melancholia, and there is no reason why we can't continue to do so. Melancholia is, in fact, in the Diagnostic and Statistical Manual of the American Psychiatric Association, the famous "DSM," but as a subtype of major depression.

I agree that depression is vaguely defined and heterogeneous in comparison to other illnesses but melancholic depression is not the only type of depression. While sadness is often associated with melancholic depression one doesn't have to feel necessarily sad in order to qualify for the label. In fact I have heard many describe typical depression's mood as a lack of feeling when very severe. In my experience one's depression can change over the course of time as well. For example, when younger, I felt much greater sadness when a teenager than as an adult.

A second issue is one regarding symptoms. The symptoms that he lists as "nerves" are more commonly associated with atypical depression which are in turn is associated more often with bipolar depression , a type of depression with a significant genetic component. Other types of depression which are also often more atypical in nature are SAD and dysthymia.  While SAD is not as severe as melancholic depression, it has a close relationship with bipolar disorder and according to some studies it has unigue biological characteristics. Instead of an overactive HPA axis some have found an underactive HPA axis. According to research atypical depression while less severe seems just as legitimate as typical/melancholic depression.

When I researched various types of depression in the past it became apparent that the typical/atypical distinction while somewhat useful is oversimplified and features such as diurnal variation could change over the course of the episode. Additionally people often have a combination of both types of depression. Bipolar depression for example, often manifests itself as melancholic and atypical.  Melancholia imparts symptoms such as sadness, guilt and a motor impairments. The atypical  aspect can cause over sleeping, weight gain and extreme fatigue. In the end depression, while vague defined, has many faces that the author doesn't see or acknowledge.

Temperament could predict diagnosis and presenting symptoms

Your temperament could affect your diagnosis, presenting symptoms, and psychopathologic conditions. The results of a recent study indicate that distinguishing between the various temperaments of irritable, depressive, hyperthymic, and cyclothymic might be helpful.

The study researchers report that in their study of 129 patients, hyperthymic temperament showed a preferential association with bipolar I disorder (BD-I) and bipolar disorder not otherwise specified diagnoses (BD-NOS), whereas depressive temperament was more frequent in patients with bipolar II disorder (BD-II) and major depressive disorder (MDD).
Anxious and depressive temperaments were more frequent in current depressive and mixed episodes compared with manic ones, while irritable temperaments were most frequent in mixed episodes and in patients suffering from alcohol dependence compared with nondependent patients.

Additionally the study showed that hyperthymic temperaments protected against depressive and anxiety symptoms while it increased the susceptibility towards manic symptoms. In contrast depressive, irritable, and cyclothymic temperaments increased the susceptiblity towards psychopathologic sysmptoms such as somatization, and interpersonal sensitivity.

The authors conclude by suggesting that temperament be taken into consideration when diagnosing and treating. Given the small size of the study and cross sectional design, the study needs to be replicated by others.

Reassessing mood disorders

New research is causing researchers to reassess the DSM's view of mood disorders. Recently a Canadian researcher by the name of McIntyre performed a study that challenges the DSM model. McIntyre gave a neuroleptic, lurasidone, to two groups of bipolar patients. One group consisted of depressed individuals while the other consisted of those in a mixed state. Somewhat surprisingly the drug helped both equally which implies the two states aren't all that different.

Additional research by John Geddes, chairman of Oxford University's Department of Psychiatry at Oxford also supports the idea that the various states in bipolar disorder are more similar than different and that instability is the key feature. The idea of pure depression or pure mania in the DSM is idealistic and limits our understanding. In reality mood episodes usually consist of depressive and manic symptoms imposed on top of an unstable temperament instead of a completely euthymic mood.

This constant mood lability throws into doubt the entire DSM-based distinction between "bipolar" and "major depressive" disorders. It is instead consistent with Kraepelin's original view of manic-depressive insanity as a broad illness of recurrent mood episodes, irrespective of polarity (in other words, recurrent depression is manic-depressive illness even without classic manic episodes), in contrast to the current faith in bipolar disorder (mania is required) vs major depressive disorder (mania is absent).

Nassir Ghaemi concluded his article by suggesting that metanalysis on antidepressants efficacy are obscured by the fact that major depression is categorized too broadly and consequently there is too much heterogeneity. I believe he is suggesting that if depression is subcategorized to a greater degree the efficacy issue will be come much clearer. Perhaps antidepressants are more efficacious in one subtype than another? Additionally he suggests the opposite of most critics which is that bipolar disorder is too narrowly defined. I have had similar thoughts regarding the heterogeneity of depression and consequently I am in agreement.

Probiotics can reduce symptoms of anxiety

I have always been interested in the relationship between diet and depression. Of all the food items yogurt is one that has consistently yielded the most improvement in my symptoms. Yogurt was unique in that it reduced my stress while at the same time increasing my motivation/energy. Additionally, I have also been interested the relationship between the vagus nerve and mood disorders. Recently there has been research that confirms my experience with diet and my intuition that the vagus nerve is somehow involved. This most recent study was performed on humans whereas previous studies were only on animals.

The vagus nerve connects the brain with the gut. A considerable percentage of the nervous system is devoted to the gut and to me that implies that something very important is going on there.

Scientists had already found that the brain sends signals to the gut, which is why stress and other emotions can contribute to gastrointestinal symptoms. The new study of 36 women show that the signals also travel the opposite way.

One method of research included brain imaging which is somewhat controversial. The fact that there was reduced activity in the part of the brain that deals with cognition agrees with previous studies on antidepressants which have shown decreased activity in the prefrontal cortex in responders. Perhaps the reduced activity in the areas associated with cognition were due to less anxious thoughts?

The women all had a functional magnetic resonance imaging (fMRI) brain scans before and after the one-month study period, which included asking the participants to match a series of faces showing angry or fearful expressions on a computer screen to other faces that appeared, the Daily Mail reported.

The women who ate the probiotic yoghurt had reduced activity in the part of the brain that handles aspects of cognition and emotion, while the women who ate non-probiotic yoghurt or no dairy showed either no change or an increase in activity, the results showed.

The study was relatively small and further studies are needed to confirm the connection.

Presence of 'activation syndrome' suggests bipolarity

When younger(in my twenties) I noticed that SSRIs initially gave me panic attacks and akathisia. I always had a suspicion that my depression had a degree of bipolarity about it and this study confirms it a little. Activation syndrome is more common among bipolar patients and it consists of the following symptoms:

The components of activation syndrome, as stated by the US Food and Drug Administration, are anxiety, agitation, panic attack, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, and mania/hypomania. The syndrome is believed to flag suicidality risk in patients taking antidepressants.

If an individual has these symptoms it increases the chance of being bipolar by 3.27 fold.

On multivariate analysis, a bipolar diagnosis was one of only two variables independently associated with activation syndrome, increasing the likelihood 3.27-fold.

The other variable was experiencing a mixed depressed state which like a bipolar diagnosis, increases suicidality. In the past another mood researcher Benazzi, a proponent of 'mixed depression', believed that individuals with a few hypomanic traits such as irritability, insomnia and agitation while depressed were more likely to have bipolar disorder.

The other significant variable was being in a depressive mixed state, which raised the likelihood for activation syndrome 4.13-fold. The researchers note that a depressive mixed state is reportedly almost as common in patients with MDD who attempt suicide while on antidepressive treatment as it is in patients with bipolar disorder.

Given the small size of the study and the naturalistic/retrospective nature, further studies are needed to confirm the connection between activation syndrome and bipolarity.