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Hi. i'm suffering from severe chronic melancholic depression. I have no energy and motivation to do anything and I exhausted pretty much all medications available in my country. I have tried all SSRI's, venlafaxine and clomipramine, but they only made me feel worse, and sometimes, even suicidal. I've had success with bupropion for a while, but now lost its effects completely. My current AD is tianeptine, but it doesn't do nothing even at 6 x 12,5mg a day. There are no MAOIs or amphetamines in the system, and I'm hesitant to try other TCA's because all of them are mainly serotonin boosters, whereas by my psych profile and med history, I am deficient in dopamine. I don't know what else to try and my psychiatrist also agrees that I've taken pretty much all there is. Off-label options are difficult to obtain because the system is very rigid on this matter. Do you guys have ideas on what to take to boost dopamine (meds, supps, etc.). I tried a mucuna supplement (the plant from which L-DOPA is extracted) but with no effect. I am thinking of self-medicating with methylene blue, which has MAO inhibition and has been found successful in some depression trials.

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5 hours ago, keops said:

I've had success with bupropion for a while. but now lost it's effects completely.

Was your dosage of bupropion (Wellbutrin here in U.S.) high enough?.....At least 300mg?

(Max dose of WB here is 450mg, but I believe in some countries the max dose might be 300mg.)

Also, I noticed from your signature that you are taking 450mg Trazodone, and 400mg Seroquel,  just for sleep......That's got to be extremely sedating......It  might have something to do with your low motivation and low energy during the day.

Also, Seroquel at 400mg is inhibiting your dopamine to a certain degree.

Maybe you could bring up with your doc the possibility of lowering the doses of Trazodone and Seroquel ?..........I'm not a doc, of course, but lowering those doses a bit might possibly help with your problem...............Just a thought..

Edited by CrazyRedhead
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Wellbutrin was 300mg daily. But even when it worked it was barely noticeable. We have Concerta, but I doubt the pdoc is going to give me that. They also have Suboxone, which I heard is good for depression, but is only approved for opioid dependence. I wonder if I take some heroin in my system, will I be eligible? Yes, I also think the trazodone and Seroquel may make me lethargic, but I can't sleep without them. I wake up to early and can't resume sleep to get enough and feel sleep deprived if I don't take them. I tried to lower without success. I also began smoking quite a lot of cigs since my depression worsened.

Edited by keops
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Personally, I would not suggest doing heroin.....It's not worth it and the risks are too great....I would advise strongly against that.....Also, if you do that, they could very possibly not allow you to have your Lorazepam any longer, and taper you off quickly..

I understand needing the meds to sleep...I suffer from insomnia as well, so I know what that's like....If you've tried lowering your sleep meds before without success, I guess it wouldn't be worth it to try again.

In your case, I really think ECT would be worth a try, like @Iceberg mentioned above.

Is ECT available to you where you live?

Edited by CrazyRedhead
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It's rarely used but I think it's worth a shot. I brought this before but the doctor said its effect last only a little while, and it's mostly due to the amnesia.

Edited by keops
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Even if you've reacted badly to most antidepressants it's possible there is one that suits you. There are MAOIs and given you've tried only one TCA you could try some of the others. MAOIs and TCAs boost dopamine, noradrenaline and serotonin. Mirtazepine, Vortioxetine and vilazodone are newer meds with different ways of working than SNRI or SSRI.

Personally I would be looking into mood stabilisers, and antipsychotics. They are often used for treatment resistant depression. Abilify, Seroquel, Rexulti and Symbyax are all proven to help TRD. Lamictal, lithium, Tegretol, depakote and Latuda are used off label for TRD. All the aforementioned meds tend to be used alongside a conventional AD, but not always.

Transcranial Magnetic Stimulation (TMS) helps some people, as does ECT. Therapy, too. I like group programs, mindfulness training as well as Acceptance and Commitment Therapy (ACT), but they only help when I'm reasonably stable to begin with.

Edited by mcjimjam
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