Ttreatment resistant depression

[leadinglady]

Been on the med rollercoaster for years and years. Right now taking Paxil 50 mg and Seroquel 300 mg at night and still can't fall asleep. Even tried taking Benadryl on top of that and can't fall asleep. Even tried Neurontin AND Benadryl on top of that and can't fall asleep. What's worse is my depression has been getting worse recently. I don't know where to turn. I'm getting desperate and starting to think about ECT or an MAOI. The only two things I HAVEN'T tried.

Has anyone else had really treatment resistant depression? What has worked for you?

[Cetkat]

Been on the med rollercoaster for years and years. Right now taking Paxil 50 mg and Seroquel 300 mg at night and still can't fall asleep. Even tried taking Benadryl on top of that and can't fall asleep. Even tried Neurontin AND Benadryl on top of that and can't fall asleep. What's worse is my depression has been getting worse recently. I don't know where to turn. I'm getting desperate and starting to think about ECT or an MAOI. The only two things I HAVEN'T tried.

Has anyone else had really treatment resistant depression? What has worked for you?

I do. However, without knowing exactly what you've been on and in what combinations & how they affected you, along with all of your symptoms.. I can't even hazard a guess.

[San]

I had a really bad depressive episode in 2008, while I was away at school. I tried an MAOI and got worse and dropped 20lbs. I had to drop out of that school, I wasn't functional. I was hospitalized and had 6 ECT treatments. It helped tremendously. I don't have bad depressive episodes anymore, and rarely any depression. I am bipolar. Good luck.

[leadinglady]

Oh I am in therapy, do EMDR, DBT, see a psychiatrist regularly, exercise regularly, take supplements...you name it. I do know that my suicidal ideation went away with the start of Seroquel and that's why we stuck with that -- I had previously been on Zyprexa and that worked for awhile but was still having suicidal thoughts. I'm not having weight gain with the meds but that's because I had gastric bypass, too. I'm wondering if I'm just not absorbing the meds I am on. I get really bad restless legs now too. I've been on:

Lexapro

Celexa

Zoloft

Paxil

Prozac

Zyprexa

Risperdal

Lithium

Lamictal

Seroquel XR

Seroquel

Cymbalta

Effexor XR

Klonopin

Xanax

Ativan

Buspar

Wellbutrin XR

Wellbutrin

Abilify

Amitriptyline

Nortriptyline

Remeron

Serzone

Rozerem

Ambien

Requip

Valerian Root

Kava Kava

Melatonin

Benadryl

Neurontin

Probably more that I just don't remember right now.

So........treatment resistant. LOL

[Cetkat]

Ok, and what did they do, if anything?

[LynnK]

Has anyone else had really treatment resistant depression? What has worked for you?

My most recent depressive episode was treatment resistant, but it sounds like our symptoms aren't similar, so it's unlikely what's worked for me would work for you. (When depressed I sleep too much, not too little -- 12, 16, 18+ hours a day.) What pulled me out of it eventually was Parnate + Lamictal, but I hate to imagine an insomniac trying Parnate. It'd probably be like throwing gasoline on a flame. Everyone's different: working with a good pdoc you trust is the way to find what's right for you.

Have all these meds been since the gastric bypass? Does your pdoc know about the surgery? You've got a couple XR medications on there -- patients with reduced intestine surface area are supposed to avoid extended release mechanisms. The pH of your stomach acid can change too. I'd look to insufficient dosage/absorption as a possible smoking gun before considering ECT.

[Anna]

I would try an MAOI. Tx resistant depression sucks.

I'm doing okay atm w/ depression but coming off a mixed episode, so I know depression is going to hit at some point, I'm prepping my doc to prescribe me emsam, heh. He is.... resistant.

I'm not exactly treatment resistant when it comes to my depression, but I AM BP, so there are a lot of classes of ADs I just cannot take. I'm going the emsam route because I read a lit review that indicated the MAOIs are the least likely to cause manic switching. works for me. SSRIs just KILL me (I'm coming off an SSRI right now that fucked my brain just RIGHT UP).

Granted, MAOIs can be a giant PITA but I've heard of some tx resistant folks getting great results with them..... And it's a hell of a lot easier than ECT which requires a huge time commitment break from work, etc. So just personally, I would try an MAOI.

They're not the most pleasant of drugs, but when they work, they freaking WORK.

Anna

[Cerberus]

My double depression (MDD + dysthymia) has been treatment-resistant for years. I tried several SSRIs with absolutely no success, then a later pdoc put me on EffexorXR, which is the only thing that has ever even budged it. Yet it was still not enough, even at 450mg/day, to quite pull my head above water. Then my current pdoc added a small dose of Adderall to the mix, and that has made it possible to go for weeks and even months without the sadness, the suicidal ideation, and the general crushing ennui I had before. I've been on this mix for about five years now, and it has worked reasonably well, but never to the point that I feel as though I'm no longer depressed. I have given ECT a fair amount of thought, as the literature seems to suggest that it is effective for highly treatment-resistant depression. I also highly recommend therapy as a component of treatment; without it, I'm sure the meds would never have done me as much good as they have.

Cerberus

[rowen]

There are a couple of the newer AAP's you haven't tried - Saphris, Fanapt, and Latuda.

Have you tried med combinations? I assume so, but it's another thought.

Agree with doing MAOI's, though. I'd definitely try that before ECT. There's also the option of stimulants, but that's not always the greatest option.

Another thought - you mention in your sig that you're taking a med for alcohol. How long have you been sober? It takes around two years to really get your brain back.

[Cerberus]

leadinglady, in looking back over your list of meds you've tried, it isn't clear whether they were tried in combination (though I'm sure some were). As I mentioned in my previous post, my refractive depression never really budged until a central nervous system stimulant (low-dose Adderall) was added on top of my EffexorXR. That is, it wasn't enough to just treat the neurotransmitter issues; I also apparently need some degree of central nervous system stimulus to overcome the neuro/cognitive "drag" that keeps me down. It might well be worth discussing with your pdoc if you haven't tried this; it absolutely made the difference for me. My pdoc is on the faculty at the University of Louisville Medical School as well as in private practice and is exceptionally good with meds. (Although, he's a Zen Freudian(!) and his approach to cognitive therapy is... odd... to say the least.)

Definitely do some background reading and have a detailed discussion with your pdoc before deciding on an MAOI or ECT. I have never had a pdoc suggest an MAOI to me because of the myriad potential side effects and conditions for their use. What I've read about them has always scared me off ever trying them unless it were at the very, very, very last, uttermost end of need. But that has just been my impression; no experience. Likewise, I have no experience of ECT, and have been reluctant to try it largely because of the potential for memory loss. There evidently aren't a lot of other side effects, and it is supposed to be fairly effective, but the possibility of not being able to recall the last day, or week, or month of my children's lives isn't a price I'm willing to pay until all other hope is lost.

I'm a firm believer that science will catch up to us eventually. In the meantime, hang tough. You are not alone. All of us fighting the treatment-resistant beast can grit our teeth together and tell each other we're grinning.

Cerberus

[JJon]

In a similar boat here. Nothing has made much significant positive difference for me. I did try a MAOI, Emsam, but it wasn't much, if any, different than other meds, or med combos. I'm not seriously considering ECT.

What I'm trying to understand better are things such as melancholic features, which is what I have. Seems it's a real booger to treat. I do get relief from the sadness, guilt, suicidal ideation, maybe 75% of the time. It's the bedridden for weeks, months, having absolutely no interest in anything that I can't get ahead on. Indecicevness even in simple situations; recently took me 1/2 hour to figure out how to simply nail 2 boards together.

Not to hijack the thread, all about me, sorry.

I was considering something like Adderall next, but not with the anxiety, and I also have fairly serious hypertension. ugh.

hehe, gritted teeth grinning, I like it.

[Cetkat]

In a similar boat here. Nothing has made much significant positive difference for me. I did try a MAOI, Emsam, but it wasn't much, if any, different than other meds, or med combos.

Did you try the regular selegiline? Same med, but stronger (to my knowledge the patch doesn't go as high). Or Parnate? That is a common one to try as well.

[JJon]

In a similar boat here. Nothing has made much significant positive difference for me. I did try a MAOI, Emsam, but it wasn't much, if any, different than other meds, or med combos.

Did you try the regular selegiline? Same med, but stronger (to my knowledge the patch doesn't go as high). Or Parnate? That is a common one to try as well.

No, just the patch. At this point, I'm looking at all options; might be something to try another, stronger, or just different, MAOI. Also, perhaps another, different AAP. I should post my details, and thoughts, in a seperate thread, though.

As for TRD in general, boy oh boy, just, what a booger.

[Catnapper]

I find the Wellbutrin / Lamictal combo I'm on to be very effective. My original dx was MDD recurrent with dysthymia, and my current pdoc thinks maybe it's actually bipolar II. Our plan for the next depressive episode is to add in lithium to the current mix. Hopefully we'll never get there, but the pdoc seems to think those three together are good for atypical bone-crushing depression.

[jt07]

The only thing that I can say ever budged my depression is carbamazepine. I am still very depressed, but the carbamazepine keeps me from becoming too suicidal. Nothing else has helped for more than a couple of days at most. My cocktail keeps me living, but doesn't make me want to get out of bed.

[leadinglady]

Talked to the pdoc about possibly adding a stimulant. No-go. He says with my anxiety it's a no-no. Feeling a tad bit better lately but still not like myself. Whoever THAT is. I've been on Paxil off and on since I was 17. Maybe a trial WITHOUT meds is worth a shot. ? I know that antidepressants worsen things in a lot of people with borderline and bipolar and I haven't been given an official diagnosis yet but maybe I need to be!

[jt07]

Interesting that your pdoc nixed the stimulant idea. I suffer from anxiety too, but my pdoc prescribed me Ritalin. In fact, stimulants can HELP anxiety in some people.

[null0trooper]

Interesting that your pdoc nixed the stimulant idea. I suffer from anxiety too, but my pdoc prescribed me Ritalin. In fact, stimulants can HELP anxiety in some people.

I can't recall reading of anyone being prescribed a stimulant to treat anxiety symptoms. I think augmentation with a stimulant is more often an attempt to deal with anergia/anhedonia/hypersomnia symptoms that just aren't responding to second- and third- line antidepressant treatments. It does get tried earlier if there's a reason to suspect comorbid ADD/ADHD

With gastric bypass surgery, Vyvanse might be a better option than most of the older stimulants (if/when that route is tried), because the compound is supposed to be broken down and absorbed in the intestine instead of the stomach.

[leadinglady]

I really need a new psychiatrist. I think I will call the gastric bypass surgeon's office (I'm due for a check in with him anyway) and see if they can suggest a surgery-friendly pdoc who knows his stuff. Getting blood levels done is a good idea. I think I'll call my doc tomorrow! Thinking maybe we need to nix the SSRIs and try monotherapy with a mood stabilizer. Going to investigate.......