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Hi, for the 1000th time this year, I'm at the end of my tether. 2005 has been an absolutely horrible year for me. It's been one med and med combo after another and almost NOTHING has worked. This is the list, beginning with a switch from fluoxetine to escitalopram in December last year:




Fluoxetine + mirtazapine

Fluoxetine + tradozone

Fluoxetine + Zyprexa (which worked really well, but just for a month)

Fluoxetine + Zyprexa + Wellbutrin/Zyban

Effexor + Zyprexa

Moclobemide + Zyprexa

As I said, I'm really getting to the end of my tether....I just started the moclobemide, and I think it's just making me feel more anxious and agitated (I had high hopes for it, particularly as it's relatively free of the sexual side fx you get with SSRIs or Effexor).

I'm pretty suicidal and hopeless. I hate being like this. I need something to pull me out of this state fast, or I probably WILL act on my suicidal thoughts.

I guess what I'm asking is: does it seem like a reasonable course of action to try ECT next? I CAN'T go through another year of hell with months of trying different meds to no avail. And I'm coming dangerously close to the kind of state that makes psychiatrists consider people for ECT.

I'd be grateful for any thoughts on this, or any ideas on meds I haven't tried yet!


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Have you considered Parnate or Nardil, the non-reversable MAOIs? From what I remember of Moclobemide, often times the therapeutic dosage turns out to be one at which the dietary restrictions come into play.

And, yes, I would definitely consider ECT after a year of trying to find some relief from unremitting depression. But that's me.


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I asked the Qs in my previous post for a couple of reasons: 1) to try to better understand what's happening with you; and 2) to see if there might be something else going on, like perhaps undiagnosed BP disorder.

The 2nd part is no doubt coloured by my own experience of having been misdiagnosed most of my life as having severe refractory MDD. Virtually no ADs or combinations worked for me. Have recently been correctly diagnosed as BPII, and having the right med (in my case Lamictal) has made all the difference. I asked this as well because you mentioned "I just started the moclobemide, and I think it's just making me feel more anxious and agitated." I not as familiar with the MAOIs, but certainly the other ADs can do this if someone has an underlying BP disorder.

However, that being said, I am certainly all for ECT if needed. I haven't had it myself, but I've seen it work amazingly well on the couple of people I've known who've had it. One was a roommate of mine during a hospitalization in 1979, and it was rememarkable how much it helped her. She was in such a deep depression she could not function in even the slightest ways, and it brought her out of that.

Please keep us posted, okay?

Best wishes,


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What is your diagnosis? What are your symptoms?


My diagnosis is, I guess, MDD. My psych doesn't think I am bipolar (I have never really had any proper hypomanic episode, though I can recall times when I've felt a bit "higher" than usual for a period of time). However, my dad is bipolar, and didn't get his first manic episode until the age of 40 (which I haven't reached yet), so I do wonder....Could you explain to me a bit more about BPII, how it is diagnosed, and how it is different from MDD?

My symptoms are extremely depressive thoughts and feelings - basically just feeling awful, with a horrible feelings of "doom", particularly when I wake up. I'm also quite anxious and agitated a lot of the time, and have very poor concentration. Also, my libido is non-existent. When I was at my worst, in the middle of last year, my sleep was severely disturbed, but that's been sorted out with the Zyprexa. So at least I can escape into the oblivion of sleep.

Have you considered Parnate or Nardil, the non-reversable MAOIs?


I actually took Nardil for a number of years, although from what I remember, it wasn't totally effective.

I was also on lithium for almost 10 years. I didn't think it made much difference at the time, but then again I don't think I had suicidal thoughts during the years I was on it either.

I spoke to my psych this morning to arrange an appt later this week, and he said we were getting closer to ECT, but we had to give the moclobemide a proper trial first. The options after that are ECT, or going back onto fluoxetine + lithium, a combo I took for a number of years. The main stumbling block to me getting ECT though is that I actually had it once, in 1989, and had a bizarre reaction to it - a second siezure, I think.

Anyway, thanks for your replies, and if you can give me any more info about BPII, that would be great.


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Hi, Andrew:

I think the best place to start is Mood swings without "manic" episodes: Bipolar II - more than plain depression, but never delusional or psychotic. This has a great amount of information, goes into detail about the entire spectrum of bipolar disorder, and at the same time is in plain English.

Start there, see what you think. I will give you a passage from it here; you'll see that some doctors and researchers now are thinking you can have bipolar disorder without the typical manias or hypomanias:


"Soft Signs" of Bipolarity

Here are eleven more factors that have been associated with bipolar disorder.

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Thanks revlow. It's very interesting stuff, and one paragraph in particular rings true for me:

There is an energy side of "depression plus" that can show up as anxiety (often severe), finally leading into attacks of panic. It can show up as episodes of rage. It can interrupt sleep so much people go night after night with 3 or 4 hours of broken sleep, and even that doesn

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  • 1 month later...

If anything, a course of ECT will increase any tendency toward mania--its strongest advocates suggest it only for uncomplicated intractable severe depression (of the sort where the patient can no longer get out of bed).

In such cases, perhaps anything is better than nothing.  Otherwise, unless you are prepared to face permanent memory loss, minor brain damage (which is cumulative with further treatments), increased risk of stroke and developing epilepsy, and a host of other delights I would think VERY carefully first.

Like you I have been on at least 20 antidepressants which did not work and in some cases made me quite ill (three caused seizures, just as ECT does, so I have some experience of the effect of same).  Then a funny thing happened, which no pdoc will ever admit occurs (and all mention of which has been removed from the DSM IV):  I simply grew out of it.

I do not mean to make light of your situation, and appreciate that you are treading a very tough road just now--I've been there, honestly.  I can tell you with some confidence that things will not always be as dark as they may be now.

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