Atypical Depression/Dysthymia = unmotivated?

March 23, 2016 6:02 PM

Have you been diagnosed with atypical depression or dysthymia? What is it like for you? What has helped?

I'm considering the possibility that I might have either of these conditions. I've been to two psychiatrists and described my symptoms and neither one of them gave me a diagnosis. One said "It sounds like you are describing a condition, I don't think it's depression or anxiety, I don't know what to tell you" and the other said "I think you're depressed but I'm not sure, go research some medications and tell me what you're interested in having prescribed and I'll see if it's appropriate." So uh... I guess it's time to do some research.

Based on my symptoms and research I think atypical depression or dysthymia might be useful possibilities to explore. I've struggled with low energy, needing too much sleep, and low motivation for my entire life (from elementary school to early 30s now). For years I thought this was just how everyone worked, that everyone struggled this much to get up the motivation/desire to do anything, but I'm beginning to consider that that might not be true. I wouldn't say I'm sad (which is why I don't think I have regular depression), just kind of unmotivated and indecisive and "meh" a lot of the time. Lots of things sound appealing, but I don't feel like starting any of them or finishing them once I've started. (Then again, not all days are like that.) My doctor and I ruled out hypothyroidism. I tried therapy and it helped a bit. There's a lot more detail, but I don't want this to turn into armchair-diagnosing me.

I'm asking for personal anecdotes of what it's like to have atypical depression or dysthymia and what has helped you (medications or lifestyle changes). Maybe I'll be able to recognize some aspects in myself or learn about a different medication approach. Or maybe depression is different for everyone and there are no patterns... who knows. But I figure hearing from folks who have gotten this diagnosis could be a useful step in my research. Thanks!

posted by Questolicious to Health & Fitness (17 answers total)

Norepinephrine-targeting drugs might help.
posted by mister pointy at 6:03 PM on March 23, 2016

Response by poster: Possibly relevant: I also have a hard time feeling attachment to people or things. I hear people say that they would die for their loved ones, and I just don't think I could ever do that. Even falling in love and having romantic relationships - it feels nice, I like this person and want them in my life, but I don't feel intoxicated or like I need to shout it from the rooftops or like I couldn't stand if anything were to happen to them. Maybe that's related?
posted by Questolicious at 6:08 PM on March 23, 2016

Yes. Therapy helped. Around the same time I also got a sleep study done for unrelated reasons and using a CPAP machine helped a fair amount. I honestly never would have suspected sleep apnea but I would say I'm less depressed now.
posted by GuyZero at 6:32 PM on March 23, 2016

Honestly you need a doctor who's not going to push the diagnosis back into you, and who's experienced with treating depression, and differentiating it from, say, Bipolar II. Whether it's depression or dysthymia doesn't matter so much as treating it appropriately.
posted by chesty_a_arthur at 6:39 PM on March 23, 2016 [15 favorites]

Hmm I don't like the sound of those psychiatrists. They want YOU to pick out a medication? That's what you pay them to do. That's just stupid.

Is it possible for you to see a psychologist? They will talk to you more and try to actually help you out.

Unfortunately not all psychologists are created equal so try a couple. You need one you click with.

You do sound like dysthymia could be a possible culprit but I am no psychologist. I really think the next step should be a good psychologist who deals with depression.
posted by christiehawk at 7:04 PM on March 23, 2016 [1 favorite]

Yeah, you need to see a doctor who gives a shit, or who has a better medical degree than you do at least.

I had not realized that anhedonia and lack of motivation were considered atypical depression, but in any case the diagnosis and prescription is not your responsibility. Even if you did have a degree and specialization in psychiatry, their buck-passing would still be inappropriate.
posted by Lyn Never at 7:10 PM on March 23, 2016 [1 favorite]

Response by poster: It would still be helpful to hear from those who have had this diagnosis. What is your experience of it like?

Also good to know there are better doctors out there. Thanks for that affirmation.
posted by Questolicious at 7:37 PM on March 23, 2016

The blunted affect does not sound like atypical depression. Those with atypical depression *can* experience emotional highs when things are going well. That's one of the central ways it's differentiated from other types of depression.

Also, having struggled for years to get appropriate diagnosis and treatment for hypothyroid, I can tell you that many doctors are just terrible at accurately diagnosing it. What specific tests have you had? If it's just tsh, you need more; preferably a full panel including free t3, t4, reverse t3, and antibodies.

If your tsh was within range for a given lab, it very well may still be too high. Many labs still use 4.5 or 5 as the cutoff, whereas the American Endocrinological Society gives 3 as a cutoff, and many truly knowledgeable people say that even lower than that can be a problem, if combined with typical hypo symptoms, some of which you clearly have.
posted by mysterious_stranger at 8:20 PM on March 23, 2016 [1 favorite]

I've been diagnosed with atypical depression. I was really insulted by that diagnosis at first, like, my depression wasn't even bloody normal (not realizing that it was a different type of depression. And then one day I read this:

The features of atypical depression include:

Being able to be cheered up by pleasant events
Significant weight gain or increase in appetite (especially to comfort foods)
Excessive sleeping (hypersomnia)
Heaviness in the arms and legs
A long-standing sensitivity to interpersonal rejection —the individual is quick to feel that others are rejecting of them.
(from: http://www.blackdoginstitute.org.au/public/depression/depressionexplained/types.cfm#Atypical)

This is me! Down to the heaviness in legs, I used to feel like I was permanently wearing concrete boots. And I could sleep around the clock.
posted by kitten magic at 8:24 PM on March 23, 2016 [2 favorites]

Hi! Fellow atypical depressive over here. I don't know if you're the same as me, but let me tell you what I've done and what's worked and what hasn't.

Meds:

Zoloft - bigtime no. I was super young (15) and they know now that that is a really bad idea.

Welbutrin - at first it was great, then extra extra bad. Lifted my depression for sure. Then my anxieties kicked in and I developed agoraphobia to the point where I wouldn't leave my house. Not fun.

CBT - Helpful, but not a cure-all. Do it anyway.

MAOI (Selegiline) - Worked like a champ! Everything is better. They don't prescribe this stuff much anymore, lots of dietary restrictions, but it was a godsend for me. It's still a noted treatment for atypical depression. No other side effects like SSRIs/SSDIs etc. If you don't tolerate re-uptake inhibitors well, give this a try.

Other stuff:

Getting my vitamin and hormone levels checked was huge for me. I was low in B12, D, and iron. Started taking supplements, and that indecisive brainfog lifted a lot.

Meditate. Start after you've cleared the brainfog. It will annoy you at first. You will think nothing is happening. Just stick with it, you'll be surprised. It's a gradual process :)

Get outside more. Spend time in nature.

Best of luck, feel free to PM if you want more specifics to compare notes with.
posted by ananci at 12:46 AM on March 24, 2016 [4 favorites]

Just want to mention inattentive-type ADHD as another possible condition.
posted by lokta at 4:24 AM on March 24, 2016 [5 favorites]

It is good you had your thyroid checked out but it sounds like you may benefit from a really thorough physical, if you haven't already. And yes, you need p-docs that are a lot more competent than the ones you have described. Meanwhile, there are things within your control that you can do - eat healthy and get exercise daily, learn mindfulness, build up your social supports, and volunteer in the community with other people. In addition to the p-doc, get evaluated for a processing disorder/executive functioning as they can contribute to a lack of motivation and depressed feelings as well.

I know this is all hard to do when you already feel unmotivated, but you're worth it.
posted by saucysault at 4:53 AM on March 24, 2016

I was diagnosed as dysthymic and was also offended by my diagnosis (hmm, I'm guessing that's a common reaction). I was prescribed therapy and prozac but never filled the prozac script. Five years of once or twice weekly therapy later, I was a Lot better. Changes were small and incremental, but when I felt better I began to agree with my diagnosis more - I could look back with clearer eyes and see that it likely had some truth to it.
posted by ldthomps at 10:21 AM on March 24, 2016 [1 favorite]

My therapist said that I probably had dysthymia. Therapy really really helped and now I basically don't have it. It took finding the right therapist, though. I tried Zoloft for a while and maybe it helped, it's hard to say. I wouldn't recommend medication if therapy is an option unless you really need it. But therapy really helped.

The book Feeling Good helped too.
posted by callmejay at 12:52 PM on March 24, 2016

I have atypical depression. For me, it took a long time to talk to a doctor because I still felt happy sometimes and went to work, shopped for groceries, didn't lie in bed all day crying. However, once I took a depression inventory, I was in the severely depressed range. I agree that you should find a provider who will actually diagnose you.

The symptoms that make me realize my depression is getting bad are cognitive fog and thinking about being dead a lot. Like, I just can't think at my usual level. And I'm not suicidal, it's more like intrusive thoughts about death. I eat more carbs and sleep more. I tend to feel angry more than sad, sometimes depression manifests that way. I also tend to feel numb a lot.

I take Wellbutrin, and it's good. It has stimulant effects, so I have to make sure to eat regularly / enough and I get increased anxiety. I don't have an anxiety problem normally - anxiety is a contraindication for Wellbutrin.

Therapy helped a lot, too, mostly after I started taking Wellbutrin. It helped to look at it like an experiment - I feel crummy, I'm going to try this thing that's supposed to help me feel better even though it seems dumb, I can stop if I want to. I've done some self-directed CBT stuff, and that helped a little bit.
posted by momus_window at 1:12 PM on March 24, 2016 [2 favorites]

900/mg a day of St. John's wort makes a significant dent in my dysthymia, as does regular mindfulness meditation.
posted by zeri at 3:37 PM on March 24, 2016

I have atypical depression. The list of symptoms kitten magic lists above is exactly what I experience. But that list describes how atypical depression differs from other subtypes of depression. Atypical depression is still depression. People with atypical depression are also extremely sad and may think about death and suicide.

Zoloft didn't work for me. Wellbutrin was great at first, but after a while it made me anxious and jittery. Effexor is great. It makes me feel normal, but it does cause insomnia.

Cognitive behavioral therapy and the book Feeling Good were also helpful and gave me tools for keeping depression at bay.

When I'm having an episode of depression, I tend to avoid veggies and sunlight, so I take a multivitamin every day. There's data on exercise and mindfulness meditation, but I have trouble sticking with those.

Seconding lokta: consider inattentive ADHD. Lack of motivation is a huge problem for people with that disorder.

Find a better psychiatrist.
posted by islandeady at 7:08 AM on March 26, 2016 [1 favorite]