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Treatment-resistant depression - what worked for you?


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I have had depression for over 15 years now with recurrent severe episodes, my current episode being the most severe. SSRIs used to work, cocktails are currently not doing the job. Have any of you had treatment resistant depression and, if so, what ended up working for you, i.e. what certain med, therapy, alternative therapy, etc.??

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We're all such unique little snowflakes that what works for one might do zip for someone else.

But.... the combo of Wellbutrin + SSRI or Effexor + Remeron have worked for treatment resistant depression.

Being that this started with postpartum depression, have you considered adding some hormones into the mix? It can be a real help.

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It's been 8 months since I've had the baby so I'm not sure if hormones would help at this point or who I'd even go to to talk about getting them, but I definitely could have used a good injection of something early on. lol So far I've tried cocktails like Abilify + Effexor or Seroquel + Effexor but neither worked much. The Xanax helps the anxiety and sleep but that's about it.

I'm now hearing good things about Lamictal and am wondering!

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I second the above opinion of Effexor (or the similar SSNRI Cymbalta) with Remeron (or the similar SSANRI* drug trazodone).

This review supports (among other things) combining an SSRI with Remeron (aka mirtazapine): [ Link ]

Cymbalta + trazodone for me lifted me out of a two month long, deep, black, and horrible Z-induced and Z-withdrawal-induced (!) depression back in 2005. Cymbalta alone didn't do jack, btw.

(*SSANRI = selective serotonin antagonist/norepinephrine reuptake inhibitor -- these block the "bad" serotonin receptors as well as increase available norepinephrine to your neurons.)

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i've always seen treatment-resistant depression as really meaning bizarrely-cured-(that shouldn't work!) kind of depression. ;)

i see that you have depression and anxiety similar to me. i'm on prozac + ativan, and that has done wonders. both of them work amazingly for me, and i think the combination of antidepressant and antianxiety kills my two biggest birds with one stone. (i'm not sure that metaphor worked...) and both SSRIs and benzos are funny about specifics. i've been on most of the other SSRIs and they weren't really successful... same with the benzos.

therapy has also helped me immensely, in conjunction with meds. group therapy in particular was helpful, although i only did that because i was hospitalized. both of those really has done wonders. therapy took some time and a hell of a lot of effort, but it was worth it. group therapy was nice because it allowed me to connect with other people safely, and those other people know what i'm going through. i'd look into something like that if you haven't already... you never know.

good luck. <3

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I've been told in the past that I have treatment resistant depression too. Nothing has totally "worked" for me, but in terms of meds Lithium has been the one to make the biggest impact.

My dx are very similar , also meds I've tried are similar. The lithium stabilized me more than anything had (and one measure is no hospitalizations since I began taking it about 3 years ago.)

recently my pdoc decided that the types of depressive symptoms i've had that he believes I am actually BPII. so for the first time in 20 years I am not on an SSRI and honestly I don't feel the differance so perhaps it wasn't doing much for me. ( they believe SSRIs can make any BP spectrum worse)

You may want to bring this up with pdoc- my understanding is that with the addition of the BPII dx- that many fit this who were previously call treament resistant.

I know a change in name means nothing but it can have implications for how you are medicated. Obviously this is my experience- yours is probably very different but I thought I'd mention it just so you might discuss with your pdoc.

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i'm BP1, so my experiences with the depression side may be different, but i've had some treatment resistant depression before and had to get out of it somehow. my drug cocktail, along with lifestyle changes brought me back to normal life.

the cocktail of paxil and lithium brought me out of the last very bad depression i was in. i had a minor depression awhile back that refused to go away, and i was switched to wellbutrin and lamictal. mood stabilizers are sometimes prescribed to the depressed and not just the bipolar. they work well.

i'd ask about a mood stabilizer and see if it would help you in your case.

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Another longstanding treatment resistant depression bod here. [with complex PTSD thrown into the mix, but yeah..]

I took efexor alone for a year. Crap.

Got put on remeron as well. Was on remeron and efexor several months, during which time I came off efexor. [it took that long, believe me...]

I'm now on remeron alone, and have been for just over a year.

I'm pretty stable at where I am now, less depressed, but still depressed, but more manageably so, less raw. I'm more able to contain feelings, and express them. Its a work in process.

The meds help, but the major factor in my ongoing journey is 3 times a week relationship/object relations focused psychotherapy. Long term.

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I am in the middle of coping with a treatment-resistant depression right now. I'm bipolar, and it's gotten to the point at times that I doubt my diagnosis--where have all the good times gone? I recall little of feeling so good, or even uneasy, but energetic. Medication seemed to take care of my manias and hypomanias (which weren't always of the ecstatic kind), and even out mood swings, but I often wonder if it's been worth it, when I feel so many shades of tired, miserable, empty, and lame all the time. It can be rough; you have my sympathy!

Several months ago I quit my mood stabilizer (supposedly a "must" for manic depressives) and just took Cymbalta. It helped. I felt better--livelier. My doc wasn't thrilled I did this without permission... ;) Although it might be unconventional, I'm still doing that, and at high dose (120 mg), because it's working, and not hurling me toward mania. (We watch for it very closely.) My doc mentioned something the other week about how she thinks my problems are with norepenephrin and dopamine, not serotonin. That surprised me, as you hear about depression and serotonin a lot. And I think she said that serotonin can actually make lethergy lack of concentration and all that worse...? I wish I had better recall, but maybe this is enough inspire you to ask your doctor if serotonin is what your previous drugs have effected, and maybe if norepinepherine and dopamine might be where the problem is.

I'm going to begin taking Risperdal this weekend--a very low dose that is for the depression as well as ADD stuff I have trouble with. I wasn't keen on this drug, but I gather it can work really well for tough depressions sometimes.

If this stuff doesn't work, I will willingly go the MAOI route.

I have become very conscious of what I eat, making sure to get lots of different fresh or steamed vegetables, especially. I cut way back on sugar and refined carbs, but caffeine is still a crutch sometimes. Also, I get regular aerobic exercise now that I'm "undepressed" enough to. This stuff should be required--we know that exercise has a lasting antidepressant effect. Period.

I have a fantastic therapist, who has helped me for a couple years. She is EMDR certified. From the stuff you'd read online (and I've read it), EMDR is a crap hoax, but I've begun it recently, and I think it may be making a difference--slight, but progressive. If for not other reason, my mind seems to work better after a bout of watching that light go back and forth. It may be working on trauma or anxiety issues, but all that is wrapped up in depression too, right?

Hope some of this can help. :)

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Supplements can make a difference. I didn't bother with omega-3 for the longest time time because I was under the impression that it was supposed to help more with bipolar than recurrent unipolar depression, which is what I tend to have. I ended up taking it after reading enough stuff about how it was supposed to help with ADD that I figured it must be worth a try. The low I've been in for the past year seems to be lifting. I've also recently added strattera back into my cocktail but it wasn't particularly effective as an AD by itself in the past. It could also be that I am now coupling the strattera with cymbalta which was not the case before. Combined they could well have a synergistic norepenephric effect. I've been taking N-Acetyl-L-Tyrosine supplements to hopefully boost this effect. I also take a whole food supplement and additional B-complex.

The multivitimin, omega-3, and b-complex are a good idea for anyone. The whole food suppliments are less likely to leave your system immediately as urine. The ones I personaly take are all listed in the crazystore. You can get similar stuff pretty much anywhere.

http://astore.amazon.com/crazyboards05-20/...UTF8&node=4

You'll want to check with your pdoc before taking any of the neurotransmitter precursors or anything like that.

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Hello;

Long time sufferer of TRD and have tried most every AD as they come available. Held off on the Emsam Patch as Parnate and Nardil failed to lift my Depression in the past. Due to being out of AD's I started the Emsan Patch 1 month ago and am experiencing slight improvement, but it is still early and I hope to know more in a couple of weeks.

Slight improvement is saying alot as no other's have worked. Emsam intensifies Insomnia so that is a problem so I need a good fast in and fast out Sleep med as w/o sleep I cannot accurately judge this med. Some slight irritability but the S/E's are nothing compared to other med's.

Oh...some weight gain, which is not something I'm trying to do, but could be that I am eating more, but I think I am eating less, sooo??? IF Emsam work's for me I will be blasting it all over the forum b/c like some of you I am through w/ the heartache of depression and endless struggle. I can no longer die this long, slow, painful, death each day, day after day, w/ no hope for relief.

Thank's for all of the suggestion's. I may be trying some of them. However...no more SSRI's for now.

Spent decades and a fortune trying them countless times, alone, and in too many combinations, and then doing it all over again just to satisfy new Dr's.

Wishing Us All Better Tomorrow's; scp

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Guest Regina

I am amongst the treatment resistant depression crowd. I went to a psychopharmacologist for a consult and he recommended ECT. Has anyone tried that?

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Regina;

Have gone for a consult for it a few times over the years but am always told I am not a canidate. Seem's you have to be actively suicidal w/ past attempts, not just have suicidal ideation.

To Tom and all...Have you tried Lamictal for depression? More and more Dr's are trying it for regular unipolar Depression as well as Bipolar now. Some people who suffer Depression only have had great results on Lamictal. That is where I am going next, if necessary, to augment Emsam providing Emsam works.

scp

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recently my pdoc decided that the types of depressive symptoms i've had that he believes I am actually BPII. so for the first time in 20 years I am not on an SSRI and honestly I don't feel the differance so perhaps it wasn't doing much for me. ( they believe SSRIs can make any BP spectrum worse)

You may want to bring this up with pdoc- my understanding is that with the addition of the BPII dx- that many fit this who were previously call treament resistant.

Thank you for your post. I am really beginning to think I am BPII and don't know it yet. I'm actually *gasp* excited about this just because it could be the explanation of why I feel like garbage!

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I have unipolar depression and well... nothing seems to lift me UP. I am on Wellbutrin currently but I really don't think it's doing much. I tried almost all the SSRIs and also Effexor. You can see them in my signature. I hope you and I can find something that works for us. That'd be nice.

Tom

It will be interesting to see if the Wellbutrin helps you at all... I've considered it. I don't really recall trying it in the past.

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  • 2 years later...

I've had recurring depression for about 7 years now, and have learned a lot through my experiences. First off, let me start by saying, the first thing people must do is to get a complete blood profile. I know of many times when a person has severe depression and it is because of an underactive thyroid, anemia, or something else that is very simple.

Second thing. If depression is chronic and gets temporarily improved by an anti-depressant but always seems to "poop out" chances are you need a mood stabalizer. I had three relapses of severe depression, and after the 3rd time it was so severe the doctor wanted to hospitalize me and I wasn't even suicidal. All I needed was Lamictal. Lamictal saved my life and brought me out of the darkest depression. Because I have never had a manic episode no one ever thought of putting me on a "bipolar" drug. It wasn't until I went to the Amen clinics and got a brain scan and they told me I need Lamictal.

After being put on Lamictal, I was fine for about 8 months but the depression started coming back but not as bad as before. I then did some more advanced testing through metametrix and found out I had a delayed food allergy to egg whites. (IGg allergic reaction) I stopped eating eggs and within 3 weeks my energy levels were back to normal.

My depression is probably about 70% biological 30% psychological. Psychotherapy can be very effective although it hasn't been for me, but for the majority it will help a lot.

Anyway, here is my list in order of stratagies to try for treatment resistant depression that is biologically based in order: (whatever doesn't work discontinue it. If it works but partially continue it and add the next thing on the list)

1) Blood tests to rule out physical factors

2) Exercise (cardiovascular 3-4x week for atleast 30 min)

3) SSRI if anxiety based depression, SNRI for apathetic depression with some anxiety, or Welbutrin if purely apathetic depression with no anxiety

5)SAM-E (400-1600 mg)

6)Fish oil (most consist of at least 2000mg EPA)

7) Metametrix blood testing to test for amino acid levels, vitamin levels, food sensitivities, and other abnormalities

8) Mood stabilizer, Preferably Lamictal as it is the most effective for depression

9) If partial response on with any of the anti depressant add T-3 (25-50mg)

10) Abilify (2.5-10mg)

11) Remeron (15-45 mg)or preferably Valdoxan (25-50 mg) which works the same way as Remeron (minus the side effects) if you can somehow manage to get your hands on it since it's only in Europe at this time

12) Any reversible MAOI e.g. moclobemide (do not take at same time as option 2)

Anyway, here's my list based on my own personal experience and reading science journals. Hope it helps

Dave

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unipolar, treatment-resistant. the effexor-remeron combo pulled me out of a suicidal depression several years ago. it eventually wore off and a year ago pdoc added lithium, which was a godsend. it boosts the action of the antidepressants. I was also on provigil and neurontin at the time. abilify was added too. I was on too much stuff, I started to feel like a zombie. so I dropped the lithium, provigil and abilify, and cut the dose of effexor in half. been on the reduced cocktail for about a month or so. I definitely have depression but suicidal ideation remains at bay.

honestly, one of the best things for my depression has been recovery from addiction-- every time I go to an NA meeting, my depression is lifted. it's like group therapy.

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I've had recurring depression for about 7 years now, and have learned a lot through my experiences. First off, let me start by saying, the first thing people must do is to get a complete blood profile. I know of many times when a person has severe depression and it is because of an underactive thyroid, anemia, or something else that is very simple.

Second thing. If depression is chronic and gets temporarily improved by an anti-depressant but always seems to "poop out" chances are you need a mood stabalizer. I had three relapses of severe depression, and after the 3rd time it was so severe the doctor wanted to hospitalize me and I wasn't even suicidal. All I needed was Lamictal. Lamictal saved my life and brought me out of the darkest depression. Because I have never had a manic episode no one ever thought of putting me on a "bipolar" drug. It wasn't until I went to the Amen clinics and got a brain scan and they told me I need Lamictal.

After being put on Lamictal, I was fine for about 8 months but the depression started coming back but not as bad as before. I then did some more advanced testing through metametrix and found out I had a delayed food allergy to egg whites. (IGg allergic reaction) I stopped eating eggs and within 3 weeks my energy levels were back to normal.

My depression is probably about 70% biological 30% psychological. Psychotherapy can be very effective although it hasn't been for me, but for the majority it will help a lot.

Anyway, here is my list in order of stratagies to try for treatment resistant depression that is biologically based in order: (whatever doesn't work discontinue it. If it works but partially continue it and add the next thing on the list)

1) Blood tests to rule out physical factors

2) Exercise (cardiovascular 3-4x week for atleast 30 min)

3) SSRI if anxiety based depression, SNRI for apathetic depression with some anxiety, or Welbutrin if purely apathetic depression with no anxiety

5)SAM-E (400-1600 mg)

6)Fish oil (most consist of at least 2000mg EPA)

7) Metametrix blood testing to test for amino acid levels, vitamin levels, food sensitivities, and other abnormalities

8) Mood stabilizer, Preferably Lamictal as it is the most effective for depression

9) If partial response on with any of the anti depressant add T-3 (25-50mg)

10) Abilify (2.5-10mg)

11) Remeron (15-45 mg)or preferably Valdoxan (25-50 mg) which works the same way as Remeron (minus the side effects) if you can somehow manage to get your hands on it since it's only in Europe at this time

12) Any reversible MAOI e.g. moclobemide (do not take at same time as option 2)

Anyway, here's my list based on my own personal experience and reading science journals. Hope it helps

Dave

David, this is perilously close to medical advice. We don't give medical advice here---we are not doctors.

Also, if you want to have a dialog with our members, why don't you join? People tend to take you more seriously if you are a registered CrazyNut.

olga

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Regardless of any specific issues I have with our guest's treatment plan, I'd like to point out that he's managed to completely miss the only med combo that's worked for me for longer than a few months. ;)

3) SSRI if anxiety based depression, SNRI for apathetic depression with some anxiety, or Welbutrin if purely apathetic depression with no anxiety

I think I'd let a real doctor handle that one, not only because "what medication should we try" comes long before it's considered "treatment-resistant", but because comorbid conditions and family history also apply - not just anxiety.

5)SAM-E (400-1600 mg)

Expensive, and only useful if there is a problem with serotonin synthesis.

7) <deleted> blood testing to test for amino acid levels, vitamin levels, food sensitivities, and other abnormalities

There are three things wrong with this:

1. Most of the non-endocrine metabolic defects that have "depression" (by which a doctor means "depressed mood" NOT "clinical depression") manifest early in life and are severe enough that depression is not your top concern.

2. If there's a family history suggesting it, most family doctors can add tests for B-12, circulating/stored iron, etc. as part of the annual physical, at little or no extra charge.

3. That's not the only lab that can do blood testing, and folks are better off seeing a real allergist or clinician first for some of those issues.

9) If partial response on with any of the anti depressant add T-3 (25-50mg)

T3 augmentation doesn't work with all anti-depressants, and jerking endocrine levels around without monitoring blood levels is a really bad idea.

10) Abilify (2.5-10mg)

A fraction of clinical depression cases may be a result of depressed dopamine transmission or excessive serotonin transmission. No matter how much you like that AP, it can be a really bad idea for people in that group.

11) Remeron (15-45 mg)or preferably Valdoxan (25-50 mg) which works the same way as Remeron (minus the side effects) if you can somehow manage to get your hands on it since it's only in Europe at this time

They work the same to the extent that both may be 5HT2c antagonists. Remeron doesn't touch melatonin, and Valdoxan doesn't touch histamine levels. I'm fairly certain that there are far more additional differences than "side effects"

12) Any reversible MAOI e.g. moclobemide (do not take at same time as option 2)

Aside from being a med that will interact with more than just SSRIs, it's not approved for use in the US

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