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Tried so many meds for depression


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My psychiatrist finds it easier to ask if I have been on one than even asking me what I have tried I can't even remember anymore there have been so many...she was researching meds. That help PTSD more and she found research that remeron does but I believe I have taken it amongst other meds for anxiety and other things I told her I would be willing to try it again she hadn't gotten back to me on that. Is it worth it she has even mentioned ECT which I wrote about elsewhere I just want to try everything before it comes to that. Any experiences on remeron I honestly don't even remember j have been on so many...

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Remeron is a good med except it has two bad side effects that are very common: sedation and appetite increase. Remeron at first hit me like a sledgehammer, but after a month or so I became more used to the sedation and it didn't bother me so much. The appetite increase never went away or even eased up though. I recently just came off the Remeron because of its effect on my appetite. (I want to lose some weight.)

Have you tried any MAOIs? What about tricyclics like amitriptyline?

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At this point I have tried so many I can't keep track anymore I have anorexia I don't know how I feel about an appetite increase. But I know some were MAOI's and tricyclics. I often don't get many side effects med wise not sure why just I will do anything for a mood change right now. I will talk to my psychiatrist the only reason she said that one is because there is research for Ptsd and well for sleep she wants me to be almost sedetated so that wouldn't maybe be bad ...I am taking trazedone for sleep right now. She just increased my lamictal feel no change it will be a week Friday she said to check in then...

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I keep a spreadsheet list of psych meds I've tried. I list stuff like dates I took it, max dose, prescribing doctor, and effects (both positive and negative). I organize it by intended impact because I take meds for multiple reasons, so anti-depressants, sleep, ADHD, anxiety PRNs, etc. I am a bit of a geek (surprise!), but maybe something similar would be useful for you? You and your doctor could start one together based on what you remember. (I also keep info on dates/locations of psych IP stays, and how many and when my ECT treatments were). This info makes it easy to get second opinions.

My experience with Remeron has been largely kind of 'meh'. It stopped making me sleepy about 2-3 days after each dose change. My appetite is heavily suppressed by other meds I take. I get weird vivid dreams about food though. 

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Interesting we will see how it works for me my mother takes care of medication spreadsheets not sure she just has recent ones or all the meds I have been on I know everyone has different effects on meds I just hope it helps if it doesn't it doesn't 

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I know Zoloft, Prozac and Paxil are use to treat PTSD and are very effective, depending on the person. Remeron is very sedating and will give you an appetite like no tomorrow. For appetite I cannot more highly suggest cyproheptadine, which has been great at helping me to from 120 to 145. Hopefully the traodone helps with more than sleep, since it's an anti-depressant also.

When I was on Remeron I recall myself falling asleep with a bag of chips in my lap, and I was on 15mg. It was verrrry sedating for me.

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I have tried everything it's a losing battle I have even taken remeron before we are giving it another shot with my current med cocktail. I will try anything at this point I am scared of the ECT and/or going back to treatment either means taking time off work which I don't want at all granted I live my job but have found myself more tired and not as motivated. I am a daycare teacher I love the kids and it's the only thing keeping me going really...

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Have you ever had testing done to determine which medications are likely to work and which medications are more likely to cause side effects or not work as well? I found two different sites www.genesight.com and www.pathway.com/mental-health-dna-insight/ which do genetic testing for psychiatric medications to determine which will suit you best, depending on your genes, metabolism and other things. It may be costly, but it can prevent you from going on the med merry go round, or at least reduce it, and provide your doctor with a medical based report of which medication(s) would work best for you. 

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5 hours ago, Hermione said:

I have been on it a while and i generally don't have an appetite anyway last time i was hungry i can't even remember...

 You could add the antidepressant Remeron which might help both your appetite and your depression, that is if yøu haven't tried it already.

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I am going on remeron now I just started it last night. We will see how it works for me. I could look up genetic testing that's not a bad idea I will read your links. If it's pricey we shall see about that but I will research I have tried so many already... 

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21 hours ago, Hermione said:

I am going on remeron now I just started it last night. We will see how it works for me.

Good luck! Let us know how it works.

21 hours ago, Hermione said:

I could look up genetic testing that's not a bad idea I will read your links. If it's pricey we shall see about that but I will research I have tried so many already...

There are plenty of them, but I don't believe insurance covers them anymore, and they're multiple hundreds of dollars.

If you can remember them, it is always helpful to list your current and past meds in your signature. It helps us help you. :)

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52 minutes ago, mikl_pls said:

There are plenty of them, but I don't believe insurance covers them anymore, and they're multiple hundreds of dollars.

My pdoc did genetic testing through Millenium Health and it was in-network lab work for my United Healthcare insurance plan. The cash price was around $2300, my insurance brought the cost down to around $1500. It was still quite expensive because it went against my (high) deductible. My doctor had been told the out of pocket cost was $200 for people with no insurance (which was what convinced me to try it). When I got the bill for $1500+ I shared it with her. Her office got the cost negotiated down for me so my out of pocket cost ended up being around $250.

So my takeaway is it's worth asking your insurance company about if this stuff is covered, because it might be. Also your provider can be a useful advocate for you, don't be afraid to ask them for help. Negotiating health insurance and coverage and stuff is hard. 

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1 hour ago, Geek said:

My pdoc did genetic testing through Millenium Health and it was in-network lab work for my United Healthcare insurance plan. The cash price was around $2300, my insurance brought the cost down to around $1500. It was still quite expensive because it went against my (high) deductible. My doctor had been told the out of pocket cost was $200 for people with no insurance (which was what convinced me to try it). When I got the bill for $1500+ I shared it with her. Her office got the cost negotiated down for me so my out of pocket cost ended up being around $250.

So my takeaway is it's worth asking your insurance company about if this stuff is covered, because it might be. Also your provider can be a useful advocate for you, don't be afraid to ask them for help. Negotiating health insurance and coverage and stuff is hard. 

Wow, Geek, you have a great pdoc!

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2 hours ago, Geek said:

My pdoc did genetic testing through Millenium Health and it was in-network lab work for my United Healthcare insurance plan. The cash price was around $2300, my insurance brought the cost down to around $1500. It was still quite expensive because it went against my (high) deductible. My doctor had been told the out of pocket cost was $200 for people with no insurance (which was what convinced me to try it). When I got the bill for $1500+ I shared it with her. Her office got the cost negotiated down for me so my out of pocket cost ended up being around $250.

So my takeaway is it's worth asking your insurance company about if this stuff is covered, because it might be. Also your provider can be a useful advocate for you, don't be afraid to ask them for help. Negotiating health insurance and coverage and stuff is hard. 

That's amazing! My pdoc refuses to let me get the genetic test done because she believes I'll obsess over it too much... T__T (I may just ask my gdoc to get it done for me...) I have already gotten the 23andme test done and analyzed as much as I can through Livewello and looking stuff up around the Internet about which SNPs do what and whatnot, but I think an actual legit psychiatric genetic test would provide me with more accurate information.

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Genetic testing seems expensive can't afford that right now..this is what i have so far. I listed some meds i have been on that i remember and i have all i am on now. I was tired last night didn't get hungry but it was my first does of remeron so we will see still and i can up it if it doesn' twork i have to ask my psychiatrist wants me to give it before i up it. 

Diagnosis: Depression, Anxiety,  Complex PTSD but technically they have me as chronic as complex is not in the DSM, Anorexia

 

Current Psych Medications: Remeron 15mg, Trazedone- 100mg, Lamcictal-300mg, Vyvanse-20mg, Risperdone-4mg, Clonopin- 4mg 

 

Other Meds- Zofran 4mg as needed for nausea,  Linzess 145mg as needed, Lansoprazole-30mg (for GERD), Align, Colace, Multivitamin, Calcium, Magnesium and Zinc, Iron 45mg

 

Past Medications that i can remember doing my best here- Zoloft, Abilify, Seroquel, Lithium, Prozac, Lexapro, Noritryptoline, Wellbutrin, Effexor , Zyprexa, Xanax, Paxil, Cymbalta  (could be more that’s what I remember and I don’t remember dosages)

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On 8/19/2017 at 0:16 PM, mikl_pls said:

That's amazing! My pdoc refuses to let me get the genetic test done because she believes I'll obsess over it too much... T__T (I may just ask my gdoc to get it done for me...) I have already gotten the 23andme test done and analyzed as much as I can through Livewello and looking stuff up around the Internet about which SNPs do what and whatnot, but I think an actual legit psychiatric genetic test would provide me with more accurate information.

It actually won't really give you anything significant that's new unless you already suspect CYP2D6 duplication(s) are present (assuming that the test even assesses that - not all of them do). I'm assuming you're already able to competently interpret your results and have ran your raw data through Promethease - if the latter isn't true, run your raw data through there and interpret it properly! Generally speaking medical PGx testing only gives you verrrry simplified conclusions, which can usually just be be reached on your own with if you understand what you're doing, use the right tools, do enough research, and devote enough time to the issue (and I'm pretty sure that you are quite capable of doing this).

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I don't have PTSD but can say Remeron is a pretty powerful sleeping pill. It makes me really hungry (for carbs) right after I take it at bedtime, but by the next day my appetite is normal. 

I do think it is worth re-trying old meds sometimes. In a different combination, at a different time in your life, they can have a different effect.

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12 hours ago, mcjimjam said:

I don't have PTSD but can say Remeron is a pretty powerful sleeping pill. It makes me really hungry (for carbs) right after I take it at bedtime, but by the next day my appetite is normal. 

I do think it is worth re-trying old meds sometimes. In a different combination, at a different time in your life, they can have a different effect.

Yea I am re-trying this I have been on so many cocktails of meds. It's hard to know at one time what works. I have not noticed an appetite change but it does make me tired but I want to up the dose as my psychiatrist said I could maybe that could help lift my depression a little . I am struggling a lot with being deeply depressed even being on vacation but its nice to not have responsibility of work. I was lacking motivation and patience and I am a daycare teacher. It was getting harder to get out of bed. I was tempted to use sick days which I hardly do when physically sick. 

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7 hours ago, Hermione said:

Yea I am re-trying this I have been on so many cocktails of meds. It's hard to know at one time what works. I have not noticed an appetite change but it does make me tired but I want to up the dose as my psychiatrist said I could maybe that could help lift my depression a little . I am struggling a lot with being deeply depressed even being on vacation but its nice to not have responsibility of work. I was lacking motivation and patience and I am a daycare teacher. It was getting harder to get out of bed. I was tempted to use sick days which I hardly do when physically sick. 

In increased Remeron dose would definitely help as it becomes more "antidepressant-like" (the antidepressant qualities match or overcome the antihistamine properties, which is what makes you sleepy and hungry), like 30-45 mg. If you really wanted to make the antidepressant effect stronger, it's very common to put this medicine together with an SNRI (Effexor XR, Pristiq, Cymbalta, Fetzima, Savella (really only indicated for FM )). With the combination of the two, you get a potent boost in serotonin and norepinephrine, and with norepinephrine reuptake from the SNRI, you also get a little boost of dopamine in the frontal cortex. The norepinephrine and dopamine help you with any decreased positive affect, motivation, cognition, etc., and the serotonin will help with any increased negative affect, anxiety, and PTSD symptoms.

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I can't up it right now I don't have extra meds. With me on vacation but when I get home I will up it then it will be at 30mg we are trying to keep me off so many meds. But I think my psychiatrist is taking me off the vyvanse so it will be the same amount of meds. I am so tired when I wake up i don't know if that is the meds. Or just depression I need to figure something out for my depression still thinking about ECT as I was asked to do...

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1 hour ago, Hermione said:

I can't up it right now I don't have extra meds. With me on vacation but when I get home I will up it then it will be at 30mg we are trying to keep me off so many meds.

Make sure you do this with your doctor's permission (it goes without saying but it always is a good thing to remind I suppose). :)

1 hour ago, Hermione said:

But I think my psychiatrist is taking me off the vyvanse so it will be the same amount of meds. I am so tired when I wake up i don't know if that is the meds. Or just depression

Well, the fatigue/sleepiness could be both from stopping Vyvanse and from meds, especially Remeron and trazodone (but I think you mentioned that trazodone wasn't as sedating as it used to be?) I know how you feel about waking up feeling very tired. My sleep is disrupted by seizure activity (despite being on anticonvulsants) and I'm supposed to see a neurologist about it but my first appointment isn't until November. Depression can have a lot to do with fatigue and sluggishness too, especially throughout the day. Even on low dose Remeron, your depression can improve just by your sleep improving, and it still does have psychoactive properties at that dose (just not as strong as higher doses).

1 hour ago, Hermione said:

still thinking about ECT as I was asked to do...

I was on my knees begging my pdoc for ECT this time last year and she was extremely reluctant to agree after having tried practically every medicine and every possible combination of medicines... I don't know why she was so reserved about it. But it never went through. She dragged ass when it came to contacting the pdoc who would be administering it (took her from August/September until December/January just to call him the first time... then she couldn't get his schedule right... it really pissed me off because I waited a year off to go back to school for ECT and it never happened, so I pretty much threw away a year of my life doing nothing... but I did get a little better though with meds...) ECT has a very, very high remission rate, something like in the 70's of percent... it's crazy. No medication has nearly that rate of remission. ECT can also be used for such a wide range of things, like depression, mania, psychosis, etc. I'd be all about the ECT if it were me in your position, but I'm not trying to push you or anything. I'm just trying to speak positively of it even not having had it before. I will say that I have read that memory problem can be a big side effect, mostly surrounding the treatment time (patients might not remember things that happened during the time they are receiving their ECT treatments) but will regain their ability to retain memories once they stop ECT, but if they need maintenance ECT I suppose memory problems are something to stay. I've read that meds like donepezil (Aricept) can be used during ECT to lessen the memory problems though with good results.

If you still want to try medications, then at the point you're at, your pdoc needs to be trying combinations that are known to be very potentiating. Some examples of combos that would potentiate each other would be like Remeron + Effexor (or any SNRI for that matter), Zoloft + Wellbutrin, SNRI + Stimulant, SNRI + modafinil (Provigil)/armodafinil (Nuvigil), etc. Adding an atypical antipsychotic helps which you already have. There are some treatments that are more "experimental" and not approved, like using dopamine agonists (Requip, Mirapex, Neupro patch). Adding L-methylfolate, especially as the brand "Deplin," can help for some people a pretty good bit, or it may not (15 mg helped me get out of a deppressive episode over a weekend, but lost its magic over time). All it is folic acid in its active form (since some people have genetic mutations that prevent them from metabolizing it to that form which is used for many things in the body, including generation of neurotransmitters like serotonin, norepinephrine, dopamine, etc) One thing that definitely does complicate your treatment is your PTSD, because it could be that your depression hinges on your PTSD, and as your PTSD symptoms worsen, your depression may worsen independent of how aggressively your depression is treated at a chemical level. It could be that what you need is intensive therapy (of course I'm probably going up a trail many people have done before with you by mentioning therapy). Therapy + medicine is always better than either one alone, but just therapy is usually better than just medicine.

But depending on how you feel when you get back from vacation, think about whether you want to try meds or ECT. If you want to try meds, it's my very humble and uneducated opinion that you're in a perfect place to try "California rocket fue,l" as Stahl calls it, a combination of Remeron and an SNRI (Effexor, Cymbalta, Pristiq, Fetzima, it's your choice; however, Fetzima is brand-name only, but there are co-pay coupons, but the other 3 are generic, just in case that influences your decision). You've tried Effexor before, maybe you could try it again, maybe even at a higher dose this time? (225 mg? 375 mg? 450 mg?) Cymbalta, if you only went up to 60 mg, maybe you could try 90 mg or 120 mg? If you haven't tried Pristiq, you could start with 50 mg and try 100 mg if you need; despite 100 mg being the max dose, sometimes peoples' doctors try them on doses up to 400 mg. Fetzima?

Whatever the case, whichever you and your doctor decide, I really hope that you find a treatment plan that helps both your PTSD symptoms and your depression, as well as your feelings of sluggishness when getting out of bed (I know all too well how that is, and have stayed in bed and just "existed" for the day far too many times). Wishing you the best! :)

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8 hours ago, mikl_pls said:

I was on my knees begging my pdoc for ECT this time last year and she was extremely reluctant to agree after having tried practically every medicine and every possible combination of medicines... I don't know why she was so reserved about it. But it never went through. She dragged ass when it came to contacting the pdoc who would be administering it (took her from August/September until December/January just to call him the first time... then she couldn't get his schedule right... it really pissed me off because I waited a year off to go back to school for ECT and it never happened, so I pretty much threw away a year of my life doing nothing... but I did get a little better though with meds...) ECT has a very, very high remission rate, something like in the 70's of percent... it's crazy. No medication has nearly that rate of remission. ECT can also be used for such a wide range of things, like depression, mania, psychosis, etc. I'd be all about the ECT if it were me in your position, but I'm not trying to push you or anything. I'm just trying to speak positively of it even not having had it before. I will say that I have read that memory problem can be a big side effect, mostly surrounding the treatment time (patients might not remember things that happened during the time they are receiving their ECT treatments) but will regain their ability to retain memories once they stop ECT, but if they need maintenance ECT I suppose memory problems are something to stay. I've read that meds like donepezil (Aricept) can be used during ECT to lessen the memory problems though with good results.

If you still want to try medications, then at the point you're at, your pdoc needs to be trying combinations that are known to be very potentiating. Some examples of combos that would potentiate each other would be like Remeron + Effexor (or any SNRI for that matter), Zoloft + Wellbutrin, SNRI + Stimulant, SNRI + modafinil (Provigil)/armodafinil (Nuvigil), etc. Adding an atypical antipsychotic helps which you already have. There are some treatments that are more "experimental" and not approved, like using dopamine agonists (Requip, Mirapex, Neupro patch). Adding L-methylfolate, especially as the brand "Deplin," can help for some people a pretty good bit, or it may not (15 mg helped me get out of a deppressive episode over a weekend, but lost its magic over time). All it is folic acid in its active form (since some people have genetic mutations that prevent them from metabolizing it to that form which is used for many things in the body, including generation of neurotransmitters like serotonin, norepinephrine, dopamine, etc) One thing that definitely does complicate your treatment is your PTSD, because it could be that your depression hinges on your PTSD, and as your PTSD symptoms worsen, your depression may worsen independent of how aggressively your depression is treated at a chemical level. It could be that what you need is intensive therapy (of course I'm probably going up a trail many people have done before with you by mentioning therapy). Therapy + medicine is always better than either one alone, but just therapy is usually better than just medicine.

But depending on how you feel when you get back from vacation, think about whether you want to try meds or ECT. If you want to try meds, it's my very humble and uneducated opinion that you're in a perfect place to try "California rocket fue,l" as Stahl calls it, a combination of Remeron and an SNRI (Effexor, Cymbalta, Pristiq, Fetzima, it's your choice; however, Fetzima is brand-name only, but there are co-pay coupons, but the other 3 are generic, just in case that influences your decision). You've tried Effexor before, maybe you could try it again, maybe even at a higher dose this time? (225 mg? 375 mg? 450 mg?) Cymbalta, if you only went up to 60 mg, maybe you could try 90 mg or 120 mg? If you haven't tried Pristiq, you could start with 50 mg and try 100 mg if you need; despite 100 mg being the max dose, sometimes peoples' doctors try them on doses up to 400 mg. Fetzima?

Interestingly enough, ECT's effect size for depression is similar to that of stimulants for ADHD, which is infamously high (massively higher than any other psychiatric medication - it still blows my mind every time I think about it). The only issues with ECT are that the response isn't always sustained long-term (although additional rounds of ECT will often still work), and that there are some potentially major/unacceptable risks involved (variable-duration memory loss following treatment is the most concerning).

These are all excellent recommendations for meds and med combos.

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I am most scared of memory loss with ECT. I am in therapy for 4 hours a week so it's a lot of time. I am according to any professional who has treated me a touch case. Thank you for all your advice it's great to know options I have. Sometimes too my anorexia makes my depression worse but I have been eating better and mood hasn't lifted. I am very tired today and I am sick and tired of being sick and tired. My psychiatrist said I could go up on the med. I see her September 5th so we will see.

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