Seems like no medication is working. Opinions?

[Cjb124]

Hey guys. Just looking for some opinions here and see who could relate. 

I’ve been an insomniac for 10 years now and suffered from depression for 5. 

I recently stopped seroquel 25mg which I was on for 10 years for sleep since it stopped working and made me sedated all day. Changed to ambien 10mg and can FINALLY sleep and feel some energy during the day.

My problem is finding th correct med to deal with my depression. I feel like I haven’t felt my confident, creative self in years and homesick for that person to come back if that makes since. Lexapro I was on for three years. Worked okay, but I was also in a daze, so sedated and tired 24/7. And no sexual interest. I then broke down and switched to trintellix, worked well for depression but anxiety it was HORRIBLE. I picked at my face 24/7 and after 7 months went into another breakdown and was very unstable. I was then switched to Wellbutrin and then pristiq. Both turned me into zombies and couldn’t even get out of bed. 

Finally took genomind test and found out no SSRIS will do the job. So I was put on adderall for resistant depression treatment. That was a fail, ended up in hopsital because I couldn’t stop crying. So I was then put on lamictal which seemed to be okay until I got the rash and am forced to discontinue.

Does ANYONE have any reccomendations? I’m just so exhausted of trying everything and not having it work. But hey at least I can sleep on the ambien and that’s half the battle

[Blahblah]

I have the same issue as you, most A/Ds help alot with anxiety and a bit with depression, but then I am left in a dazed fog with no feelings, an awful sort of apathy.

If Adderall was too much, you could try Ritalin as a stimulant instead, often helps with motivation and energy.

Then you could try another antidepressant SNRI like Cymbalta or Effexor - they initially work a bit on Serotonin, but the difference is they hit more Norepinephrine and possibly Dopamine when you get up to the max dose which is more activating...Or perhaps an atypical A/P like Abilify or Rexulti, these Atypicals are less predictable (like for some people more activating, and others possibly more sedating) the effect varies depending on the dose. Many people need to be on combos of 2-3 meds in order to hit the right target.

There are also the MAOIs which would likely be the next class of meds a pdoc would try you on. There are also Tricyclics, but those are often less used because they often cause more side effects like sedation.

Edited December 1, 2017 by Blahblah

[Cjb124]

4 minutes ago, Blahblah said:

If Adderall was too much you could try Ritalin as a stimulant instead, often helps with motivation and energy.

Then you could try another antidepressant SNRI like Cymbalta or Effexor - they initially work a bit on Serotonin, but the difference is they hit more Norepinephrine and possibly Dopamine when you get up to the max dose which is more activating...Or perhaps an atypical A/P like Abilify or Rexulti, these Atypicals are less predictable (like for some people more activating, and others possibly more sedating) the effect varies depending on the dose. Many people need to be on combos of 2-3 meds in order to hit the right target.

There are also the MAOIs which would likely be the next class of meds a pdoc would try you on. There are also Tricyclics, but those are often less used because they often cause more side effects like sedation.

Thank you sooo much! This is very helpful 

[Iceberg]

Have u ever tried remeron? Very Good for sleep and possibly for anxiety as well

[Cjb124]

3 minutes ago, Iceberg said:

Have u ever tried remeron? Very Good for sleep and possibly for anxiety as well

No I haven’t, I have heard of it before tho. I’m meeting with my p doc soon. Hopefully can figure out the right meds!

[BrianOCD]

I'd recommend Effexor as well...

It usually gives me blissful sleep, at least after the first couple weeks pass...

[Cjb124]

15 minutes ago, BrianOCD said:

I'd recommend Effexor as well...

It usually gives me blissful sleep, at least after the first couple weeks pass...

I tried pristiq and my doctor said it was very similar to Effexor. Pristiq caused me horrible insomnia, daziness and felt like a zombie. However I know Effexor is a little different. I’m honestly willing to try anything that lets me function more normally 

[BrianOCD]

3 minutes ago, Cjb124 said:

I tried pristiq and my doctor said it was very similar to Effexor. Pristiq caused me horrible insomnia, daziness and felt like a zombie. However I know Effexor is a little different. I’m honestly willing to try anything that lets me function more normally 

I actually talked to another patient about that, and Pristiq was more activating for them too (which they liked)

It's hard to know how Effexor will treat you, I just know when I take it, it makes me tired/sleepy (which I like since I have GAD)

Edited December 2, 2017 by BrianOCD

[Riggs1]

Have you tried lithium?

[Cjb124]

15 minutes ago, Riggs1 said:

Have you tried lithium?

I have not. I'm meeting with my p doc soon, so I am going to bring up other options since SSRI's just arent doing anything for me. 

[jt07]

Have you tried Lamictal?

[Cjb124]

23 minutes ago, jt07 said:

Have you tried Lamictal?

Lamcital I just got off three days ago. I was put on 25mg for depression, hoping to go up to 50mg. Two weeks in I got the rash on my face and MD told me I had to stop. Now I am back to square one. I enjoyed the lamictal from what I could tell. I had energy/motivation, and not in a fog 24/7.

I find that when I am feeling tired and fighting the daze, I just fall into a worse depression. That's why I'm hoping for something that doesn't make me as sedated as many SSRI's do.

[looking for answers]

lithium

[Bubble]

SSRIs have either done jack shit for me or made things worse.

Wellbutrin was a game-changer, though. I can't take it right now because it's not safe to take if you're pregnant or trying to have a baby, but as soon as I'm able to, I'm going back on it.

[withthesmallones]

I've tried about 15 different meds, including 2 tricyclics, nothing has worked for me either so far, I'm on an MAOI now as a last resort, I haven't been on it long enough to tell you whether it's worked for me but I do know people for whom it's been an absolute lifesaver

[Remnants]

I've tried a bunch, with almost no success. I know how horrible it is and to deal with the withdrawals all the time. Mirtazapine is the only thing that worked for me, for a little while and is kind of in it's own class of antidepressant medication. It's good for sleep too, I've not slept well my entire life. Might be worth a try.

[mikl_pls]

@Cjb124, how are things? How did your pdoc appointment go? Did s/he get you fixed up? What did your pdoc do for you as far as meds go?

Just in case you are still in need of recommendations, I've been around the medi-go-round a time or two, so I figured I could offer some recommendations.

It sounds like you need a medication with as few liver CYP450 enzyme interactions as possible if your Genomind test said that no SSRIs will do the job. That would mean some of the newer medicines like... well... Trintellix (which didn't work for you), Viibryd, or Fetzima might be good candidates for you. But not being able to tell what you are a poor metabolizer or rapid metabolizer of, I can't really say with any vague sense of uneducated certainty which medicines you might have a chance of doing well on.

I second perhaps giving RItalin a try, as @Blahblah mentioned, since it, I believe, isn't metabolized by the CYP system. 

I also second trying an MAOI, especially something like Emsam, a skin patch, which my pdoc claims to remove the chances (or reduce the chances) of drug-drug interactions. Personally, I didn't have luck with Emsam, but it may be a blessing for you. Also, Marplan is another one (an oral tablet), which I did okay by, and I don't believe it is metabolized by any CYP450 enzymes. You will have dietary and drug restrictions with this class of medicines if you don't already know that. It's not that bad, but just be sure to speak with your pdoc about it if s/he doesn't readily discuss it with you. There are plenty of online resources about it too, but many of them are over-hyped and describe it as being too strict. If you need help with the diet should you try an MAOI, you could always come back here and make a post about it. The package insert for the medicine also comes with a general guide for the dietary restriction and drug-drug interactions, but your pdoc may even prescribe a medicine to take with the MAOI that is usually contraindicated, like for example, a stimulant, to help its therapeutic effectiveness.

There are also more mood stabilizers than Lamictal. There is also Tegretol, Trileptal (may not really have an antidepressant so much as an anti-anxiety effect), Zonegran (it's not well known, but is used for bipolar depression, so may be beneficial for depression)... The atypical antipsychotics as aforementioned (Abilify, Rexulti, Vraylar, Geodon, Latuda, Zyprexa, Seroquel/Seroquel XR, etc.) These aren't typical treatments for depression when used alone, but you are after all an "atypical" case...  I'm joking with you, of course, you know that!

Check in with us and let us know how you're doing!

Best of luck to you!

[looking for answers]

On 12/1/2017 at 8:16 PM, Riggs1 said:

Have you tried lithium?

lithium was what pulled me out of dark depression, im still depressed but able to function. it was a game changer, i still need help, but lithium should be an option

[browri]

On 12/1/2017 at 11:36 AM, Cjb124 said:

Finally took genomind test and found out no SSRIS will do the job.

Interesting! The GenoMind test looks way better than the GeneSight test. GeneSight looks specifically at medication metabolism. So it only looks at the genes that encode metabolic functions. But the GenoMind looks at that plus all of the actual genes that matter like the ones that encode the various monoamine receptors and transporters.  I wonder what yours said for SLC6A4/SERT. If you're a "short" like me then that would mean low levels of the transporter, therefore TECHNICALLY something that inhibits the transporter should be used with caution.

What dose were you on when you took Trintellix?

On 12/1/2017 at 2:04 PM, Iceberg said:

Have u ever tried remeron? Very Good for sleep and possibly for anxiety as well

I second this. If the report indicates low levels of SERT and to avoid SSRIs, SNRIs, or SMSs like Viibryd and Trintellix; then mirtazapine seems like the next logical option.

What is your diagnosis?

[argh]

.

Edited February 8, 2019 by argh

[Cjb124]

On 2/12/2018 at 1:03 AM, argh said:

+1 to Wellbutrin.

So far it's been quite effective.

How much Wellbutrin were you on? IR? SR? XL? Zombie like you were sedated? Or zombie like you couldn't think?

My pdoc has also added a low dose of gabapentin for sleep. I see that isn't an issue for you, however that too has significantly helped with the depression. Not quite sure what to make of that, there's no real evidence or studies that suggests that it helps MDD at all. Aside from some studies which have found that gapabentin increases slow wave sleep, there therefore quality, the change in sleep hasn't been too dramatic for me. About 4.5 hrs a night to about 5.5.

Now that we're about 2.5 months since your OP, has the sleep made any difference for your depression?

Hey! I havent been on here in a while but here is an update.

 

The wellbutrin was SR I believe. Made me so sedated to the point I could not get out of bed during the day or function.

Currently I am off most medication. On 5mg of lexapro and seems to be doing alright. I don't feel zombie like brain fog anymore, which was making me more depressed. Also, after 10 years of sleeping pills I had to get off of them since the ambien was affecting my body so badly (I know TMI but I was constipated for two months and it was the worst experinece of my life). I was on seroquel 25 for years, but that ended badly as it made me sooo tired during the day I could not function.

Now I'm too a point I'm taking a natural sleep aid and smoke medical weed. Both don't really help. It's been very very very hard. I find I drive myself into exhaustion, sleep well 1-2 nights a week, then the rest is hell. (Maybe sleeping 4-5 hours, waking up every hour). I really don't want to go back on sleeping pills, but at this point I think I need too. The lack of sleep is affecting my moods, I breakdown from being so tired, and anxiety can get through the roof.

So right now depression isn't really the problem. Just sleep. 

Anyone have any input? Also my p doc is starting me on deplin. Just waiting for it to come in the mail. He's convienced I have a mood disorder, however I believe my moods have always been up and down due to lack of sleep and side effects for SSRI of making me so tired.

How can you live life and you're tired and brain fogged 24/7? Cause I sure cant.

[Complicated toad]

Have you tried Remeron yet?  I've heard it's very good for sleep plus mood.  I haven't, but I've heard good things & my pdoc has said we'll talk about it at my next visit.  

Right now I take 10 mg of melatonin to sleep, sometimes it works, sometimes it doesn't.  But it's better than nothing.  I have done low dose seroquel for sleep but it gave me the same problem you had with ambien and no one wants to deal with that for months on end.  

[browri]

Dr. Stephen Stahl refers to the combo of venlafaxine+mirtazapine (Effexor+Remeron) as "California rocket fuel". It's apparently become a very popular combo. My doctor recommending augmenting with mirtazapine once. We didn't go that route though and ended up using olanzapine.

[JoJoBBY924]

On 12/1/2017 at 11:36 AM, Cjb124 said:

So I was put on adderall for resistant depression treatment. That was a fail, ended up in hopsital because I couldn’t stop crying.

That’s interesting-

I’ve heard of people taking Vyvanse for treatment resistant depression though. Anyway, you said that Seroquel was too sedating during the day- Have you tried Seroquel XR? Maybe since it’s a slower/more gradual release than instant,  it could maybe give you a more smooth and less “knock you on your @$$” feeling. But YMMV. I take Seroquel XR for my bipolar (really helps squash my mania and depression and racing thoughts) and that seems to be working wonders for me, but we all have different brain chemistry. Maybe you could try Remeron like someone else suggested? You could also try Wellbutrin- It shouldn’t mess with your sex drive at all. It didn’t work for me and did make me anxious, but like I said, YMMV (your mileage may vary). Anyway, I wish you the best of luck and really hope you find the right medication. Please call your doctor and make an appointment ASAP! Also, please keep us updated! ??

[Cjb124]

Meeting with my p doc sat! Deff gonna bring up remeron as an option. 

Ive tried seroquel XR and had no luck. Same with Wellbutrin, just made me wayyyy to tired during the day.

Starting to think my body’s very sensitive to a lot of medication.

Started deplin a week ago and feeling better. Seroquel was also started a week ago (again), although sedated- not breaking down at all! I guess that’s a plus. Just rlllyyy want to find an option where I’m not tired all day!! 

Thanks everyone for being so supported it feels good knowing I’m not alone. I’ll keep you updated!

[Iceberg]

I would bring that exact statement up-"...an option where I'm not tired all day" 

[BrianOCD]

Yes, I too would love to hear about the solution to not feeling exhausted all day long if someone finds it...

[Cjb124]

So update- just saw my p doc this morning. Reiderated the fact I cannot deal with the sedativeness seroquel makes me feel all day. He agreed it’s not the right option.

Ive struggled with insomnia for 10 years now (I’m only 23 btw so it’s been most of my life) and have tried a variety of meds. I don’t struggle with an eating disorder, however I do get some anxiety surrounding weight gain on meds and my p doc does know that.

Taken everything into consideration he wants to try me on clonidine, if that doesn’t work, Trazodone and then gabapentin If all else fails.

Im hopeful and just excited to get off this nasty drug seroquel. I’ll keep you updated and really hope one of these meds works! Also btw im having really good results wirh deplin on my mood!!

[Iceberg]

If nothing else works take a look. At halcion triazolam. It's a benzo so not a first line idea but it worked  for me when nothing else did...and no weight gain. Downside is tolerance if used long term 

[Cjb124]

21 minutes ago, Iceberg said:

If nothing else works take a look. At halcion triazolam. It's a benzo so not a first line idea but it worked  for me when nothing else did...and no weight gain. Downside is tolerance if used long term 

Thank you!! I will definitely keep that in mind