Who coined the term "atypical depression"?

Q: Why is the most common type of depression, that is atypical depression, known by such a misleading name?

A: Dr. Ronald Hoffman asked me this question during a radio interview on his excellent program, "Health Talk" (New York station WOR 710AM). I didn't have time to answer fully, so here goes:

When some people become depressed, they lose weight loss, have severe insomnia, and are agitated. This is known as depression with melancholic features, or more simply, melancholia. When some people become depressed their appetite is excessive, they tend to gain weight, they are exhausted for no known reason, and they are excessively sleepy. This is known as depression with atypical feature, or simply atypical depression. Who gave depression these names?

Melancholic depression

For centuries, writes have known about melancholic depression. That's the type of depression that is associated with changes in basic (vegetative) bodily, including loss of appetite, weight loss, severe insomnia and agitation. For centuries, these changes were thought of as typical of depression.

In addition to these bodily changes, melancholic depression comes on rapidly, like a summer thunderstorm, and people with this medical disorder loath themselves, they awaken early in the morning and cannot fall back to asleep, and they feel worse in the morning.

Shakespeare described melancholic depression in The Winter’s Tale:

[Leontes] straight declin’d, droop’d, took it deeply,
Fasten’d and fix’d the shame on’t in himself
Threw off his spirit, his appetite, his sleep,
And downright languish’d.

Atypical depression

In the 1950s another type of depression, "atypical depression," was recognized in the folowing way. Two classes of antidepressant medications were accidentally discovered. Soon thereafter, Drs. E.D. West and P.J. Dally -- two psychiatrists working at the St. Thomas’s Hospital in London -- noticed that patients responded differently to the two medications. They wanted to understand the differences, so they carefully observed over 500 depressed patients. Gradually they became aware that patients with melancholic depression responded to the tricyclic antidepressant medication, imipramine, while patients with the "opposite" body changes -- excessive appetite, weight gain, unexplained exhaustion and excessive sleepiness -- responded to the monoamine oxidase inhibitor (MAOI), iproniazid. Because these body changes were the opposite of those found in melancholic depression, Drs. West and Dally coined the term "atypical depression".

In addition to the difference in bodily changes, there are other differences between melancholic depression and atypical depression. Atypical depression begins early in life; it comes on gradually, and, like a long grey winter, it seems to last forever, if untreated. People with atypical depression tend to feel worse later in the day and they tend to overact to criticism or rejection.

Studies conducted during the 1980s have clearly supported the observations of Drs. West and Dally, namely that MAOIs are the most effective medication for atypical depression. But that's another story which I hope to discuss soon.

Will chromium replace psychotherapy?

Q: Do you think chromium will replace psychotherapy as a treatment for depression?

A: Heavens, no. I don't think there is any substitute for talking with a mental health professional about ones emotional/psychological/personal problems. Many of my patients, however, have benefited more from psychotherapy after beginning chromium. Their bodies and minds seem to work better, so they can better use the insights gained during therapy.

Safety of chromium with medications?

Q: I take Zanex and Toprol for high blood pressure. Can I also take chromium?

A: There is no evidence that chromium reacts adversely with Zanex, Toprol, or any other medication, so the answer to your question is “Yes.” You can take chromium with Zanes and Toprol I, however, strongly advise — when taking chromium with any medication — to do so under the close supervision of a physician to monitor for presently unknown, adverse effects that might emerge.

Thiothixene and chromium?

Q: Dear Doctor, My sister is taking 500 mg of Depakote per day and 4-6 mg of Thiothixene during her psychotic episodes. Recently we started her on 400 mcg of chromium per day. Is that alright?

A: I wish I could be definite, but in truth I don't know the answer to your question. If I were prescribing thiothixene to a patient,I would warn them that thiothixene can precipitate seizures,especially in people with a history of seizures or who are withdrawing from alcohol. I wonder if the addition of chromium might increase the liklihood of a seizure, but again I don't know. Please consult, or suggest that your sister consult, her psychiatrist. Please let me know if chromium helps her. Thank you.
Dr. McLeod

Should everyone take chromium?

Q: Should everyone take between 3 to 5 micrograms per pound of body weight of Chromax, chromium picolinate per day?

A: I strongly believe that certain groups of people should supplement their diets with chromium. These include people who are 1) overweight and/or who crave carbs, 2) exhausted for no obvious reason, 3) who have any of the signs of insulin resistance, including a tendency to gain weight around the abdomen, high blood pressure, low HDL ("good") cholesterol, high triglyceries and elevated blood sugar, 4) people with a family history of diabetes or heart disease and 5) women who developed gestational diabetes (diabetes during pregnancy). I believe it is dangerous for people in any of the above categories not to take chromium. They have much to gain and nothing to lose by taking chromium.

Should people who don't fall into the above categories take chromium? I'm not sure. A case can be made that most Americans should take chromium because of two facts. The USDA indicates that 85% of Americans are chromium deficient and chromium is extraordinarily safe. There may be much to gain from almost everyone taking chromium and little to lose.

What should I do?

Q: I read your book. My symptoms are the same as your patient, George. I’ve been down for a long time, I crave carbs and tend to gain weight, and I’m tired most of the time for no known reason. What do you think I should do?

A: I cannot give individual advice over the Internet, but I can make general comments. First of all, a person with your symptoms should consult a physician and have a throrough physical examination. Many underlying medical conditions -- for example, hypothyroidism, excessive adrenal function, and certain tumors, to mention only a few -- masquerade as depression. If an underlying general medical condition cannot be detected, chromium picolinate can be taken under the supervisions of a health care provider.