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Hello, so I'm looking for some advice on medication. To start I've been on most every medication a Dr. can prescribe. Currently I take 40mg of Valium a day (Just switched from Klonopin), 30mg of Dexedrine a day, and 900mg of Neurontin. Doxepin is prescribed to me for Insomnia but doesn't do anything. My issue is I have horrible depression, but I can NOT take an antidepressant. I turn into a psychopath..well more of one lol. I've tried mostly all of the anti-depressants and they all screw me over. Does anyone know of any other medication that can help with Depression but is not an SSRI/SNRI/Trycilic or antidepressant? 

 

I've been on: Prozac, Zoloft, Celexa, Effexor, Paxil, Wellbutrin, Remeron, Depakote, Lithium, Risperdal, Zyprexa, Seroquel, Abilify, BuSpar, Sonata, Klonopin, Adderal, Adderall XR, Concerta, Vyvanse, Atarax, Trazodone, Clonidine, Trileptal...and more. 

 

Anyways, If anyone has any suggestions on medication that could help my Depression. It is mostly caused by boredom, feeling like a loser because I have too much anxiety to do anything and I'm on SSI, I seem to find negativity in everything, my mood is all over the place which damages friendships and stuff, and in general have a constant feeling of hating life. PLEASE HELP!

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Could you elaborate a little on what you mean by "turn into a psychopath"?  What precisely happens to you when you take an antidepressant?  Many of the medications you list among your previous RXs are not antidepressants per se, but may have some effect on depression; Adderall, for instance, is a central nervous system stimulant and dopamine release agent, not an antidepressant or a reuptake inhibitor.  It therefore could not have the same effect on you that an SSRI or an SNRI would have.  How long did you try each of the medications before determining that they were unsuitable for you?

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Hi, welcome to CB! I am sorry to hear about your relentless depression. 

 

I used to take lamictal, which is an anti-seizure drug / mood stabilizer for my depression. It didn't help me, but it could help you. What may not work for one person may help someone else. 

 

Also, lithium can help. Lithium is another mood stabilizer. 

 

Maybe you could look into those two medications?

 

I am also on ssi. You are not a loser for being on ssi. Anxiety is extremely tough to deal with. 

 

I hope you like it here at CB. 

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Have you tried Nardil or Parnate?  They are not what you state you cannot tolerate. 'but is not an SSRI/SNRI/Trycilic '.  They are monoamine oxidase inhibitors and are a last resort for most people and psychiatrists.  They are old, work well when they do work, cheap but require a diet free of tyramine rich foods. If you eat tyramine rich foods you will go into hypertension or hypertensive crises and possible have an artery burst in your head and die.  They are serious drugs for seriously depressed people able to stick to serious diet free of tyramine rich foods. 

 

Are you in therapy?  Do you have any hobbies?  Can you possibly volunteer one day a week as a friendly visitor in a nursing home? 

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Well Brian, thanks for that info...... I had to make sure that my Amitriptyline was not under that class of meds. I would have stopped taking it if it were. 

Edited by CynicalReality
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Hi Larry,

 

First, I want to state that I'm speaking as someone who has experience in and is studying health informatics/computational medicine (and is a patient of neuropsychological illness)... and I am *NOT* a practicing licensed physician in any way, shape, or form.

 

Anyways, sorry to hear about your conundrum.  Looks like you've had nasty reactions to many different classes of meds.  Have you talked to your doctor about general med hypersentivity?  Some people tend to be sensitive to X dosage (the FDA-regulated dosage in the US) moreso than the individuals treated in said FDA trials.  There exists the possibility that the correct dose was overshot on one or more of your drugs (I see you're on quite a few, and adding yet another could put things in a topsy turvy -- experience talking here, and I'm *in*-sensitive to meds!).

 

From that idea, I suppose there are two things to think of:

1) Hypersensitivity (see what I wrote above)

2) None of those drugs working (see what others wrote above)

 

The MAOI drugs (Nardil, Emsam, etc.) could also work well if you're refractory to anything else, but beware that you might have to go off of every other single med you're taking just to be on one of these.

 

Lastly, a word about SSI -- Yes, it is demoralizing to be forced onto it by no fault of your own.  However, this was by no fault of your own, and SSI is for those who encounter misfortune due to no fault of their own, so there's nothing in itself to feel bad about.  Granted, as a modern society, we like to take responsibility in everything that we do and everything that happens to us (I'm assuming this is why you feel bad?).  Unfortunately, there are some things we just can't control, and the best philosophy is probably to realize this.

Edited by LikeMinded
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I found lamictal very effective for depression - I haven't had a serious episode since I've been on it.

 

Do you have a tdoc? Maybe that would help with some of the boredome/negativity etc. Hating yourself and berating yourself for your situation does not help you manage it.

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I've been on Lamictal. I was wondering if there was anything non anti depressant that would make me more stable yet remain energetic enough to do thingslike go to college I'm only 19. To clarify antidepressants make me suicdal/homicidal and emotionless and angry and do crazy things. Its a NO on those. An MAOI wouldnt be appropriate for me. Any ideas...such as cocktails of meds or possibly a non-sedating AP. Dr mentioned Geodon but I dont know much about it. Anything non antidepressant.

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A very low dose of Abilify works very well for depression. At low doses it is very effective antidepressant, and at higher doses it is an antipsychotic. It is pretty expensive, but if you have insurance it should be no problem.

Edited by Forbidden91
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I know you're not bipolar, but Latuda is now approved to treat bipolar depression. This could suggest it works for unipolar depression, too. It would be worth a try at least. It is an AAP and I believe it is non-sedating. 

 

Also, I just wanted to say, medications in different combinations do different things. The ones I take have pulled me out of a depression but any of them on their own weren't effective. This means you can't completely write something off because it didn't work in the past. Having exhausted so many options I think you will need to get used to that idea. Of course, something having had an adverse reaction could be a good reason not to take it again, but if it just plain didn't work, keep an open mind and be willing to retry it if your pdoc so suggests.

 

Best of luck Larry. I know what it's like to try many things and get no relief and I really hope you find something that works soon.

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A very low dose of Abilify works very well for depression. At low doses it is very effective antidepressant, and at higher doses it is an antipsychotic. It is pretty expensive, but if you have insurance it should be no problem.

Actually its an antipsychotic at all doses, Its just not as effective in the lower doses for some people and some people need higher doses to get the desired effect.

A 2mg dose still gets 70% D2 receptor occupancy (Compared with 85% at 10mg, 91% at 30mg, 96.8%+ at 40mg). While these percentage changes might not seem like much, keep in mind an increase from 90% to 91% is actually a 10% decrease of receptors left unoccupied, and may have a larger effect than the numbers suggest.

 

http://www.ncbi.nlm.nih.gov/pubmed/18418366 - 2mg and 40mg dose values.

http://ajp.psychiatryonline.org/article.aspx?articleid=98931 - 10mg and 30mg dose values, also has a pretty picture with other receptor occupancy.

 

All that aside, they listed Abilify as one of the medications that they tried in the past that didn't work. So its a moot point.

Edited by Not me
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 How long did you try each of the medications before determining that they were unsuitable for you?

 

This is also something that I'm curious about.  I have a lot more questions too, sorry, but it may help point the group mind in the right direction for you to bring something up with your doctor.

 

Could you tell us a little about you generally?  What are you like when you're most free of symptoms?  Have you tried therapy?  Are there any physical symptoms along with the mental ones?  Which symptoms of your MIs concern you most (bother you most)?  What's your day to day life like?

 

It doesn't have to be long answers, but just a sentence or two about each would be very helpful.

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i take an MAOI (parnate).  yep, the dietary restrictions can be a pain in the ass, but not as much as being gluten intolerant or diabetic or something like that.  it's also a pain in the ass to have a headache and not be able to just pop a tylenol/advil (there's only one ancient painkiller out there that's safe, but it kinda knocks me out).

 

i take parnate with lithium and lamotrigine (lamictal) and zyprexa and clonazepam.  i didn't have to go off all my meds first, we just added parnate slowly whilie i was in hospital.  parnate is NOT sedating, which is a major bonus for me as i also battle fatigue.  it's kind of a pick-me-up without being a stimulant.

 

i was scared of MAOIs because of the "omg i'm gonna eat the wrong thing and die".  it seldom happens, and even when it does, it's mostly because someone has eaten a LOT of tyramine (like, don't eat a block of cheese or go out for lobster).  i don't eat anything on the forbidden list at all, and really life isn't too much different.  i suppose that depends on your usual daily diet.

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I know you're not bipolar, but Latuda is now approved to treat bipolar depression. This could suggest it works for unipolar depression, too. It would be worth a try at least. It is an AAP and I believe it is non-sedating. 

 

Also, I just wanted to say, medications in different combinations do different things. The ones I take have pulled me out of a depression but any of them on their own weren't effective. This means you can't completely write something off because it didn't work in the past. Having exhausted so many options I think you will need to get used to that idea. Of course, something having had an adverse reaction could be a good reason not to take it again, but if it just plain didn't work, keep an open mind and be willing to retry it if your pdoc so suggests.

 

Best of luck Larry. I know what it's like to try many things and get no relief and I really hope you find something that works soon.

 

I second this. Latuda has been one of the only drugs to really significantly improve my depression. It's not sedating, weight gain is exceedingly unlikely, and I haven't had any unwanted side effects. Maybe a little appetite suppression. If your insurance will approve it, it's a good med to try.

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For me, Neurontin, was very dulling.

How long were you on those meds? It's a good point, some meds take a while to kick in fully and titrating up can suck. Different combinations wield different results. 

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i take an MAOI (parnate). yep, the dietary restrictions can be a pain in the ass, but not as much as being gluten intolerant or diabetic or something like that. it's also a pain in the ass to have a headache and not be able to just pop a tylenol/advil (there's only one ancient painkiller out there that's safe, but it kinda knocks me out).

Not to thread jack, but I've always been told and read and acetominophen and ibuprofen and aspirin are fine with MAOI drugs. So long as they're not combined with any sort of cold medicine stuff. I'm pretty careful about interactions and can't take ibuprofen because of lithium but I use acetominophen frequently.

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you're right, i think i can take aspirin.  i just never do, because it's never helped my pain anyway.  i forget if it's parnate that doesn't like acetaminophen and lithium doesn't like NSAIDs, or the other way around.  i do have Sulindac rx'd for whenever i need it, and it does work great but makes me really sleepy (it's a really old anti-inflammatory from before the days of ibuprofen).

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@larry:

 

Again, the reason I speculated that your brain may be med-sensitive (and therefore you would want to seek a lower dose of drugs that may have seemed to have failed you in the past) was that such a wide array of drugs had made you suicidal/homicidal/other things you don't want to be, and it's not like "oh, serotonin/SSRI drugs are causing this", since that doesn't appear to be the case.  Of course, your fear of going insane on these meds is justified, and I formally recommend against any pill you're not comfortable with.

 

Thanks for giving us some social background too.  I started therapy and meds for mental illness when I was 19 and in college.  I must have been a 'good responder' to SSRI drugs, since I started being productive finally and didn't feel suicidal after about 8 weeks on an SSRI.  Haven't been off a serotonin reuptake drug (SSRI/SSNRI) since then, and it's been ten years!

 

Question -- Have you assessed your Doxepin?  IIRC, it's a tricyclic antidepressant, increasing action of serotonin and norepinephrine while blocking acetylcholine.  It also has a couple quirks, such as mild blocking of the Dopamine-2 receptor.  I was given a low dose of it for insomnia and it succeeded in making me sleep 12-14 hours a day.  Might want to talk to the pdoc about dropping it.  And with the above suggestions, Latuda might be a good replacement, although it doesn't affect other neurotransmitters to any major degree (except for blocking one type of serotonin receptor, 5-HT-2A).

 

Information on how Latuda biochemically works (or might work): http://www.rxlist.com/latuda-drug/clinical-pharmacology.htm

 

And about the questions about MAOI/pain reliever interactions.  Well, my docs won't put me on a MAOI for obvious reasons (I'd have to drop multiple other brain meds).  As a rule of thumb, since MAOIs drastically increase available serotonin, norepinephrine, and dopamine and that's about it.  Any subtle further increase and you might be toast.  Many medications that are mixed with acetaminophen in cold meds -- esp. cold meds for congestion and cough -- also increase action of those neurotransmitters.  Just a bit of speculation there.

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I really like my Lamictal / Wellbutrin combo. I don't think one without the other would be very effective. I also take Neurontin (gabapentin) for hot flashes (I'm an old broad), and I found it very sedating so I take it at bedtime. Changing the times you take meds may be helpful as they definitely don't work the same on everyone.

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