[SunshineOutside]

I had my first episode of depression 15 years ago after my twins were born.  Prozac worked like a charm.  Pulled me out of it in three weeks.

Stayed on it several years and switched to Pamelor which worked well until two years ago.

I swithched to Vivactil which made me hypomanic for the first time.  Kept switching meds but spiraled down to bad bad depression.

Wound up in the hosp.  The again, second time having ECT which turned me upside down and all around.

Have not been able to get stabalized out of depression since.  It has been 2 1/2 years.

Currently taking Effexor, Lithium, Remeron, Ativan, and Cytomel.

Anyone with previous treatment resistant depression now having success with a cocktail you would like to share?

Thanks,

Rhonda

[username]

Been on Prozac, Pazil and Zoloft and am now on Effexor.  I take all these meds with resperidone which helps.  Prozac worked well but I had to quit it.  Paxil and Zoloft worked well but did not help my depression.  300mg of Effexor has been partially successful so far, but I have a long way to go.

[Loon-A-TiK]

I am bipolar, however my depressions are very deep and severe. Ask your pdoc about mood stabilizers, especially Lamictal. I love Lamictal for depression.

[stinky]

Sertraline, quetiapine, reboxetine combo. plus pericyazine as an emergency prn for anxiety etc.

i suspect that with true trd, it's not so much that you hit on an effective combination, it's that the natural history of depression means that you will eventually pull out of an episode within months, (untreated). i've had relapses on every single AD i've taken, so i'm hardly a cheerleader for effective drug treatment of depression.

cereberus makes a good point in another thread about double depression - having different etiologies. so you have to think outside the square to treat effectively.

[Fiona]

I have severe treatment resistant depression -- and I've been around the block and then some on meds. The most effective thing I've taken for depression is Parnate. I currently combine it with Seroquel and Lamictal and am doing somewhat well, much of the time.

Fiona

[Greenyflower]

Celexa was my first AD and worked great for a year. But after I quit taking it, it wouldn't work for me again. Tried Effexor - it was ok but not great. Currently on Wellbutrin and Zoloft which has been a great combination for me and several others here.  I'm pulling for you, Rhonda, and hope you find something that works fantastically.

Greeny

This post has been edited by Greenyflower: 12 June 2005 - 09:28 PM

[SunshineOutside]

stinky, on Jun 12 2005, 08:52 PM, said:

Sertraline, quetiapine, reboxetine combo. plus pericyazine as an emergency prn for anxiety etc.

i suspect that with true trd, it's not so much that you hit on an effective combination, it's that the natural history of depression means that you will eventually pull out of an episode within months, (untreated). i've had relapses on every single AD i've taken, so i'm hardly a cheerleader for effective drug treatment of depression.

cereberus makes a good point in another thread about double depression - having different etiologies. so you have to think outside the square to treat effectively.

<{POST_SNAPBACK}>

Oh God I hope thats not true for everyone.  I desperately need a medication to bring me out of this depression.  I don't want to wait for it to run its cycle.

Rhonda

[gretl]

My treatment-resistant depression turned out to be bipolar2; once I started on a mood stabilizer, I was great. Got lucky, I know.  Lithium's not a big help for you, huh?

Trileptal+Lexapro+AtivanPRN have worked for me for quite some time now.

What's your pdoc have to say?

edited to add:  have you had your thyroid checked?

This post has been edited by gretl: 14 June 2005 - 06:25 PM

[tomtyger]

I don't know what's doing what, but the present cocktail keeps me relatively stable, and the depression is less often and way less bad.

Provigil & strattera wake me up & and let me stay awake and even sort of on focus.

Seroquel & trazodone help with the lifelong sleep disorders

I think all four of these also help with the depression by themselves and with others. They don't fight, anyway.

The foundation, though, is effexor and lamictal. 300 mg/day effexor, wanting to go higher; 400 mg/da lamictal.

These two are probably the main culprits in some orthostatic hypotension, but what the hell, I just have to be VERY careful standing up, and take the lamictal & trazodone the very last thing before I pull the covers up.

This is so complicated, it would take a sophisticated mathematician just to set up all the possible interactions. But it does work, and has been working for a while.

Even more than usual, therefore, your mileage won't just vary, you're probably in a different vehicle with different fuel, etc.

tom

[Bryan]

I take 40 mg of Geodon at night in addition to 40 mg of Lexapro for my treatment-resistant unipolar depression.

Although my depression is still severe, there has definitely been an improvement for me with the addition of 40 mg Geodon.

It took a few weeks of Geodon treatment to notice the difference.  I had side effects (drowsiness, mild nausea, headaches) that were unpleasant but went away after a couple of weeks.

Of course, if you have bipolar disorder, one should use caution with Geodon, because it can induce mania.  According to Jerod, though, once you hit the higher doses of Geodon, you are safe.

This post has been edited by Bryan: 20 June 2005 - 03:49 PM

[sun_zoom_spark]

Do you absolutely have to have Ativan? Benzos have been known to cause some badass depression in some people. Lithium is usually good for suicidal thoughts but not a first-line mood stabilizer for depression. Lamictal should work much better for chronic depression in most people.

[Ella]

A couple of things I read in one of those psychiatric journals (you could probably find the abstracts on the net): prozac and zyprexa work particularly well together for refractory depression in some people; synthroid works well as an AD adjunct for some people (maybe it was strictly SSRIs...can't remember now), even if your thyroid functioning appears normal on tests. 

Then there are always the magnetic resonance treatments--don't know when insurance companies are going to pick those up.  (Soon would be nice.)  And that microchip thingy they can implant in your brain that seems to clear up depression for some people. 

Options...there are always more and different things to try.  And, you never know, maybe you'll go into a spontaneous and permanent remission.  Don't give up hope.  (Easier said than done, I know.)

:::Hugs:::

Quote

Benzos have been known to cause some badass depression in some people.

OMG, yes.  I have personal experience with this.  Klonopin in particular was a problem as it threw my emotional responses out-of-whack (I completely lost my sense of humor, didn't find anything funny!) and did, indeed, exacerbate my depression.  (It also made me catatonic, but that's another story.)

This post has been edited by Ella: 20 June 2005 - 06:20 PM

[technomom]

SunshineOutside, on Jun 12 2005, 03:57 PM, said:

Anyone with previous treatment resistant depression now having success with a cocktail you would like to share?

Effexor + Lamictal worked very well for me for a couple of years. I was also taking Seroquel to treat a sleep disorder, and it may have affected the rest.

I took Desipramine back in the late 80s, which worked great - 'til it put me in the hospital with hypotension. I don't know if anyone still uses the tricyclics, but now that I don't have such chronically low BP I think I'm going to ask my doctor about trying it again.

The other treatment that worked really well was Anafranil. I have very mild OCD in addition to TRD and PTSD, and the OCD was pretty much gone along with the depression while I took Anafranil. I couldn't stand the weight gain after a while, though.

Good luck!

[crazykatie]

Had rounds of ECT twice to stop what looked like depression non responsive to meds, now I think like Wiley that they were mixed states.  Last time, instead of the old zap, I tried the deadly Depakote and it works!  Depakote and a little Paxil. 

What my pdoc explained initially when we tried larger dose Depakote, small dose SSRIs was he was going to do "chemical ECT" .  Since then have been able to reduce Depakote and adjust Paxil as needed.

Hang in!

[cj2]

You have been through a lot, so you are strong. Give yourself credit.

I mean this to sound hopeful… I think there are some people who are lucky enough to find THE ONE medication or combination of medications that work, and continue to work over years. But I think many of us will find a certain combination that will work for awhile but then need tweaking multiple times. It is almost as if the “evil” neurotransmitters, hormones, whatever, that cause affective disorders are continuously trying to find ways around getting fixed.  So is it an ongoing battle. Like certain types of cancers.

I say this because we get so disappointed when we think we found the Holy Grail that works, and then it crashes on us, we feel like failures, and that nothing will ever work.  But that's not always true.  We can continue to tweak.  And ok, it may not be perfect, and sure some days we have to sleep 16 hours, and other days we can't sleep for more than 45 minutes at the time, but we have a really serious illness and we need to give ourselves credit for trying.  And keeping on trying. It is sheer hell sometimes… sometimes most of the time. (And, why the heck don’t they have “5 Year Survivor” cheers for us, like they have for breast cancer survivors?) Well, we are rooting for you.

So, the best cocktail for me ever was simple: Marplan, Klonopin, with flurineff to counteract the postural hypotension.

My current cocktail, which helps more than it hurts: Vivactil, Prazosin, Lexapro, Lamictal, temazepam)

Sorry, I'm not sure if this was helpful. I really empathize with you, and hope you will continue to fight.