In terms of drug therapy and physiology-oriented therapy, what I want to say is that there is currently an instrument called fNIRS in Taiwan, which is said to be able to distinguish between schizophrenia, bipolar disorder, and unipolar depression. So many people did brain wave tests and the doctor found that he was suffering from type 2 bipolar disorder rather than unipolar depression. After changing the type of medication, the depression improved significantly. In addition, a treatment method called rTMS or TBS is currently popular in Taiwan. According to the doctor's experience, choosing an effective magnetic stimulation method has helped many people improve their depression. All in all, many people who think they have unipolar depression are actually bipolar 2.

I worked on psychiatry since 1980 until retirement in 2012. The last 10 years or so I worked in assisting with ECT and then again upon my return after 2 years on a casual basis. It was pretty predictable as who would really benefit from ECT based on the symptom profile that you pointed. Patient's who were in the hospital due to situational pressures such and family conflict and other relationship conflict, financial uncertainty, loss of financial support , homelessness, the.consequences of substance misuse and so forth generally benefitted little from ECT and were referred to ECT as they had been in hospital for many weeks and on many meds etc and the referring MD was basically at his or her wits end as to what to do with this patient who continued to endorse that they remained suicial. On the other hand, patients with what I called at the time "endogenous" symptoms here tended to be those who responded, often dramatically. The unit staff seemed to have a second sense about ECT candidates after years of seeing this play out again and again.

This is what happened to me, that what seemed like pure recurrent depression turned into hypomania and then into a mixed state after taking an antidepressant. Now I'm staying well on lamotrigine. Thanks for interesting video 😀Greetings from Poland from Europe❤

Very easy to follow and understand. Keep the videos coming please.

Hi dr Rossi, psych resident here. So I've heard of some research suggesting SSRIs can subtly reduce trait neuroticism in people. Recently, a small RCT comparing mirtazapine and SSRIs in depression linked high neuroticism to SSRIs being more effective and vice versa. The authors of the paper you're talking about, in my interpretation, say that SSRIs ought to have little, perhaps temporary, role in neurotic depression. Basically the views seem contradictory. Would love to hear your thoughts on the degree of utility SSRIs have in such people (either as a supplement to psychotherapy or on their own), who might get diagnosed with MDD, GAD, dysthymia.

Fantastic video! Love your perspective and I look forward to you content!

One thing if always wanted to know: I’m very glad and thankful you make these videos, however, besides helping us, do you do these to stay extra sharp in your practice? In line with if you don’t talk about it, it might more easily forgotten?

Though not diagnosed as such, I think I've had Melancholic Depression for a very long amount of time and still has( BTW I've been diagnosed to Recurrent Depressive Disorder )... As I had severe psychomotor retardation, extreme Anhedonia and sexual dysfunction to the level that I was even unable to masturbate at all... Now I feel psychomotor retardation is improved, severe Anhedonia is still there, dysfunctionality and no overall change in mindset

are there any medications that do work for neurotic type depression? or if not, what is a more fitting treatment? very nice video i liked it, id love some more reading material about this, all the articles i find are decades old

The jury's still out on whether I have bipolar II or MDD (side note, I have BPD diagnosed and temporal lobe epilepsy...RIP my limbic system) but I would say I generally fit with your description of neurotic depression, although I do sometimes get periods of mixed features, again as you describe, but with me essentially vacillating between two of the types you propose. The way I've been conceptualising depression in my head for a while now - my own depressions and others' - is somewhat similar, but with two, rather than four categories. Melancholic depression we have essentially conceptualised in the same way, although I think of it as a kind of classic bipolar I with all the mania subtracted. The neurotic and mixed depressions I had been thinking of as one "mesolimbic pathway-online" entity, with atypical features, anxious distress, and sometimes mixed features, probably reflecting my own experience rather than what I've read. It essentially made a PDD-bipolar II hybrid (which I suppose could actually just be interictal dysphoric disorder). Strangely enough, your pure depression category is the one that I essentially omitted. Maybe this is because I have no clinical experience so it's excessively coloured by my own experiences, which entail generally being very intense with the occasional period where I've just fallen to bits, essentially. What I am wondering is what tends to happen with the neurovegetative symptoms in pure depression? Do they go in opposite directions (e.g. eating less but sleeping more)? I'm having a bit of trouble picturing it clearly because it's like it's caught in between anorexia and hyperphagia, insomnia and hypersomnia, psychomotor retardation and psychomotor agitation, reactivity and nonreactivity...it almost makes it sound like euthymia: eating, sleeping, moving, and reacting neither excessively nor insufficiently - but that's clearly not what you're describing.

I definitely fall into the neurotic / chronic and mostly anxiety symptoms, have been dx with pdd several times over. SSRI and therapy had me very stable usually going ~2 years without slipping into a MDD episode of a week or more. I probably should have stayed in therapy in between but usually only went once the episode happened and then for 2-3 months after it ended.

Hi doctor. I have persistent depressive disorder (moderate) /neurotic depression. I have tried many ssris, Cymbalta, Abilify, lamictal, trileptal, and lithium. Even though I do not have manic symptoms, Lamictal was the only medication that worked for me but I had to stop it due to getting a rash twice. (Tried going on the medication 2 times.) As I really have nothing to lose, I am now trying Effexor as I have heard it’s helped people when other meds failed. I also go to therapy. Thank you for all the information in this video. My question is, what is the best treatment for someone with persistent depressive disorder? You mentioned that the typical ssris/ snris usually don’t work for people with this condition, so what is something that you have found that helps people with this disorder? I am interested in trying Spravato because I heard it effects glutamate, which is what Lamictal does as well, and figured if Lamictal helped me, maybe Spravato would too? Thank you and I look forward to hearing from you.

Very informative. In case of mixed depression taking antidepressant, you said it will get worse , what does it mean? turns to manic episode or worsening the symptoms of depression?

I got diagnosed with bipolar 20 years ago from a general family doctor. I never had bipolar but I do have seasonal depression. I live in Michigan of course. I just take Wellbutrin in the winter time. Is it common for doctors misdiagnosed people?

Are more categories really going to help us? There are so many inconsistencies with this classification system, not to mention a strong lack of empirical support for it. Many studies have found that anxiety is actually more common in melancholic depression, and have failed to demonstrate the supposedly superior response of melancholic depression to antidepressants. Furthermore, 'pure depression', as defined in this model, seems like a poorly defined category that acts as somewhat of a 'catch-all'. However, we know that depression is etiologically and symptomatically complex, and reducing presentations to simple categories provides very little in the way of clinical guidance

Hello doc; thanks for the content! Very well thought as always! Could you share the doi of the article you used the table with the spectrum from?

This is all really helpful. Do you believe TMS could be helpful for one side of this spectrum rather than the opposite side? You mentioned melancholia as an indicator for intervention and am curious on what can be done for the neurotics out there

Thank you

Could you talk about fNIRS ?

Hello Dr. Rossi. What type of depression would benefit from an MAOI? 🛡🔰⚕

Now i know i have neurotic depression since last year. Depression with anxiety symptoms after an extreme burn-out an relationship breakup together last year. The extreme stress brought me down with mayor panic attacks 11 months ago. Before i had the pure depression. Short episodes while functioning normal in between started from my 12 year. When I started Paroxetine around 24 th years i was stable till last year when all hell broke lose. Paroxetine does not do the job anymore. My question doctor is what threatment should work best for me? Thanks for the great content.

Were does psychotic depression fall ?

Besides the DSM, what would you recommend as a good textbook for psychiatric assessment and diagnosis?

I have severe anxiety and my depression is severwe as well. I wonder if part of this is because I was put on Benzos (for panic attacks only- my moods came from PMDD). and never taken off. That was over 15 years ago. I'm going through some very anxiety producing situations but my depression is also really bad. Just now, everything is worse. The only time I feel ok- for a few hours- is on Adderall. I don't have any good doctors. I don't think I ever have. I tell THEM what I thin will work or symptoms I might have and suddenly I have a script. I don't think I'll make it through this because I literally have no time to go through the side effects. About to lose eveything. Wish I had never been put on Benzos. I have no idea what to take and have about twenty bottles of antidepressants. I have no relief and it's pure hell.

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