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15 years of treatment resistant depression, so not looking for anything that "works." I've given up on that.

I'm so tired of the pain and the crying. It hurts so much... I can't stand my kids just watching me sobbing all day every day.

I don't know the right way to ask without sounding like I'm asking for medical advice; so maybe I can ask if anyone has taken any medications before that reduced the emotion?

Basically I'd just rather be a zombie. Nothing is going to make me enjoy life again, but if I could just care less, maybe it wouldn't be so painful.

I suppose it's impossible, but anything that didn't increase fatigue would be nice as I can barely get off the couch as it is, even with a max dose of Adderall.

Anything to numb this pain, it's too much...

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are you on xr or ir Adderall? I found that 60/3 ir doses was more helpful than 60/2 er doses. that won't make you an emotional zombie but maybe if you can get off the couch easier you might feel better.... idk... anything I took to zombify also brought tons of fatigue. did you try the other SNRIs (Fetzima or Pristiq)? I am not pretending youre gonna find a magic bullet or something but I'm just thinking about something that could aim for "slightly less shitty" or if nothing else cause some of the emotional blunting youre looking for  

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I agree with @Iceberg on the Adderall thing. 60 mg divided in 3 doses of IR tablets is more stimulating than 2x 30 mg XR capsules. It's way more flexible and allows you to take a nap if you feel like it simply by just holding a dose. Or if you need to take a dose slightly sooner than expected (whether you're more tired than usual or if you're expecting to go to bed earlier that night), you have that freedom, and vice versa. I take my Dexedrine as 10 mg x2 in 3 doses (it only comes in 5 mg and 10 mg tablets, unless you get the brand-name product Zenzedi). Dexedrine may be something else to look into—it's far more potent of a CNS stimulant than Adderall is and has more wakefulness-promoting at the expense perhaps of sacrificing that "kick in the butt" that Adderall gives you.

The top #1 zombifying medicine for me was Lexapro, 10 mg, while it wreaked havoc on my emotional stability at the same time (I was undiagnosed bipolar at the time, taking it in high school for "anxiety..."). I didn't give a single flying damn about anything while I was on that medicine. The downside was that my motivation nosedived at the same time too. My room went to hell in a hand basket, and so too did my grades. SSRIs in general are pretty zombifying, with the exception of perhaps Prozac and Zoloft (although many do report that Zoloft really numbs them out too). Luvox was also extremely numbing, probably even more so than Lexapro, but I was in college at the time and my academics suffered vastly, and even with mood stabilizers and an antipsychotic, Luvox was pretty trippy for me (induced lots of visual and auditory hallucinations) which is weird because it's a sigma-1 receptor agonist too which is supposed to help with psychosis.

On the side of trying to find something that works, I know you've tried Emsam, the patch MAOI... but have you tried Parnate? It's another MAOI that has literally been known to work absolute miracles within days for treatment-resistant depression sometimes even in low, low doses. Emsam is safer, yeah, sure, but like what do you want to possibly be your cause of death (besides natural cause)? Your meds, or your illness you're taking meds for? If you have a treatment-resistant illness, it's time for the big guns, IMO, especially if you've been dealing with it for 15 years. My pdoc tries to really "play it safe" more and more side effects wise as I've known her. I won't get into that. I would suggest asking about giving Parnate a try if you're up for the necessary washout (there are bridging agents you can use, like secondary amine tricyclic antidepressants, such as nortriptyline, desipramine, and protriptyline, and the atypical antipsychotics, Abilify being the one probably most often used in patients taking MAOIs). It's super, super stimulating, so you may not even need your Adderall, but in case you do, your pdoc would likely want to start low and go slow on it if they were comfortable with prescribing the two together. The TCA can be taken alongside the MAOI as well. So long as it isn't imipramine or clomipramine, you should be fine. Protriptyline is probably the most stimulating TCA I've ever taken. Taking the MAOI + TCA, MAOI + Stimulant, or MAOI + TCA + Stimulant combination route enables you to take lower doses of each agent and improves outcome better than monotherapy of the MAOI. They use these combos in people who are treatment-resistant to ECT.

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5 hours ago, mikl_pls said:

I agree with @Iceberg on the Adderall thing. 60 mg divided in 3 doses of IR tablets is more stimulating than 2x 30 mg XR capsules. It's way more flexible and allows you to take a nap if you feel like it simply by just holding a dose. Or if you need to take a dose slightly sooner than expected (whether you're more tired than usual or if you're expecting to go to bed earlier that night), you have that freedom, and vice versa. I take my Dexedrine as 10 mg x2 in 3 doses (it only comes in 5 mg and 10 mg tablets, unless you get the brand-name product Zenzedi). Dexedrine may be something else to look into—it's far more potent of a CNS stimulant than Adderall is and has more wakefulness-promoting at the expense perhaps of sacrificing that "kick in the butt" that Adderall gives you.

The top #1 zombifying medicine for me was Lexapro, 10 mg, while it wreaked havoc on my emotional stability at the same time (I was undiagnosed bipolar at the time, taking it in high school for "anxiety..."). I didn't give a single flying damn about anything while I was on that medicine. The downside was that my motivation nosedived at the same time too. My room went to hell in a hand basket, and so too did my grades. SSRIs in general are pretty zombifying, with the exception of perhaps Prozac and Zoloft (although many do report that Zoloft really numbs them out too). Luvox was also extremely numbing, probably even more so than Lexapro, but I was in college at the time and my academics suffered vastly, and even with mood stabilizers and an antipsychotic, Luvox was pretty trippy for me (induced lots of visual and auditory hallucinations) which is weird because it's a sigma-1 receptor agonist too which is supposed to help with psychosis.

On the side of trying to find something that works, I know you've tried Emsam, the patch MAOI... but have you tried Parnate? It's another MAOI that has literally been known to work absolute miracles within days for treatment-resistant depression sometimes even in low, low doses. Emsam is safer, yeah, sure, but like what do you want to possibly be your cause of death (besides natural cause)? Your meds, or your illness you're taking meds for? If you have a treatment-resistant illness, it's time for the big guns, IMO, especially if you've been dealing with it for 15 years. My pdoc tries to really "play it safe" more and more side effects wise as I've known her. I won't get into that. I would suggest asking about giving Parnate a try if you're up for the necessary washout (there are bridging agents you can use, like secondary amine tricyclic antidepressants, such as nortriptyline, desipramine, and protriptyline, and the atypical antipsychotics, Abilify being the one probably most often used in patients taking MAOIs). It's super, super stimulating, so you may not even need your Adderall, but in case you do, your pdoc would likely want to start low and go slow on it if they were comfortable with prescribing the two together. The TCA can be taken alongside the MAOI as well. So long as it isn't imipramine or clomipramine, you should be fine. Protriptyline is probably the most stimulating TCA I've ever taken. Taking the MAOI + TCA, MAOI + Stimulant, or MAOI + TCA + Stimulant combination route enables you to take lower doses of each agent and improves outcome better than monotherapy of the MAOI. They use these combos in people who are treatment-resistant to ECT.

Only reason I didn’t say parnate was I though the adderall washout might be brutal in the ops situation, and we all know that lots of “modern” docs won’t touch stim + Maoi 

what about California rocket fuel? 

Edited by Iceberg
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3 hours ago, Iceberg said:

Only reason I didn’t say parnate was I though the adderall washout might be brutal in the ops situation, and we all know that lots of “modern” docs won’t touch stim + Maoi 

True... I have been spoiled by my "classically-trained" pdoc I guess... I think it would be worth it if they were at least allowed a small amount of their stimulant while on Parnate and thus allowed to continue a small amount of the stimulant during the washout. Parnate is pretty magical stuff IME.

3 hours ago, Iceberg said:

what about California rocket fuel?

In case you don't know what this is, @climber47, that is an SNRI + Remeron. The Remeron I would worry might be too sedating for you though is the only thing, even in high doses which are... less sedating than low doses (for most people I should say). But Remeron, especally in combo with an SNRI, is known for bringing people out of the deepest, blackest of depressions. (Just not me—it worsened me by a lot...)

Another possible combination that Dr. Ken Gillman really, really likes to use is Zoloft + nortriptyline. It's like a triple reuptake inhibitor-like effect. I did this with Zoloft + desipramine for a good while and enjoyed good benefits from both. Strattera can even be used as the NRI, but beware of the kappa-opioid partial agonist effects of the metabolite, 4-hydroxyatomoxetine, which can not only cause depression but psychosis as well.

I see you tried Mirapex, how did that work? What dose did your pdoc take it up to? There're other dopamine agonists: Requip and Neupro more commonly being used in psychiatry, with Parlodel and Dostinex being less used (Dostinex is used more often in psychiatry though to alleviate SSRI-induced sexual dysfunction).

I've also heard of low-dose clozapine being used in treatment-resistant depression patients. It's a drug of last resort due to possible serious side effects, but it's worth a shot IMO.

Edited by mikl_pls
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54 minutes ago, mikl_pls said:

True... I have been spoiled by my "classically-trained" pdoc I guess... I think it would be worth it if they were at least allowed a small amount of their stimulant while on Parnate and thus allowed to continue a small amount of the stimulant during the washout. Parnate is pretty magical stuff IME.

In case you don't know what this is, @climber47, that is an SNRI + Remeron. The Remeron I would worry might be too sedating for you though is the only thing, even in high doses which are... less sedating than low doses (for most people I should say). But Remeron, especally in combo with an SNRI, is known for bringing people out of the deepest, blackest of depressions. (Just not me—it worsened me by a lot...)

Another possible combination that Dr. Ken Gillman really, really likes to use is Zoloft + nortriptyline. It's like a triple reuptake inhibitor-like effect. I did this with Zoloft + desipramine for a good while and enjoyed good benefits from both. Strattera can even be used as the NRI, but beware of the kappa-opioid partial agonist effects of the metabolite, 4-hydroxyatomoxetine, which can not only cause depression but psychosis as well.

I see you tried Mirapex, how did that work? What dose did your pdoc take it up to? There're other dopamine agonists: Requip and Neupro more commonly being used in psychiatry, with Parlodel and Dostinex being less used (Dostinex is used more often in psychiatry though to alleviate SSRI-induced sexual dysfunction).

I've also heard of low-dose clozapine being used in treatment-resistant depression patients. It's a drug of last resort due to possible serious side effects, but it's worth a shot IMO.

I’d be really worried about adding clozaril into a situation when a main symptom is fatigue though. 

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2 hours ago, Iceberg said:

I’d be really worried about adding clozaril into a situation when a main symptom is fatigue though. 

You're right about that. Having never taken it before, I don't know how insurmountable it can be at any dose, even 12.5 mg.

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