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Atypical depression is a chronic syndrome that tends to begin earlier in life than other forms of depression—usually beginning in the teenage years. Similarly, patients with atypical depression are more likely to have anxiety disorders, (such as generalized anxiety disorder, obsessive–compulsive disorder, and social anxiety disorder ...
Carbamazepine was the first anti-convulsant shown to be effective for treating bipolar mania. It has not been extensively studied in bipolar depression. [2] It is generally considered a second-line agent due to its side effect profile. [2] Lamotrigine is considered a first-line agent for the treatment of bipolar depression.
[1] [2] [3] Among TCAs, trimipramine is an atypical agent in that it appears not to do this. [3] In August 2020, esketamine (JNJ-54135419) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of treatment-resistant depression with the added indication for the short-term treatment of suicidal thoughts. [4]
Newer MAOIs such as selegiline (typically used in the treatment of Parkinson's disease) and the reversible MAOI moclobemide provide a safer alternative [19] and are now sometimes used as first-line therapy. Pargyline is a non-selective MAOI that was previously used as an antihypertensive agent to treat hypertension (high blood pressure). [21] [22]
Mirtazapine, sold under the brand name Remeron among others, is an atypical tetracyclic antidepressant, and as such is used primarily to treat depression. [11] [12] Its effects may take up to four weeks but can also manifest as early as one to two weeks. [12] [13] It is often used in cases of depression complicated by anxiety or insomnia.
The risk factors [110] for treatment resistant depression are: the duration of the episode of depression, severity of the episode, if bipolar, lack of improvement in symptoms within the first couple of treatment weeks, anxious or avoidant and borderline comorbidity and old age. Treatment resistant depression is best handled with a combination ...
Patients with depressive symptomology characterized as "atypical," "nonendogenous," and/or "neurotic" respond particularly well to phenelzine. [7] The medication is also useful in patients who do not respond favorably to first and second-line treatments for depression, or are "treatment-resistant."
Medium- (7–12 months) and long‐term (longer than 12 months) effects seem similarly beneficial. Psychological therapies, including cognitive behavioral therapy, added to usual care (antidepressants) seem as acceptable as usual care alone and may be used as a first line treatment for mild to moderate treatment resistant depression. [41] [23]