Multi-Year Episodes of Depression

[0112358]

Curious if anyone else has experienced this - I'm going on 6 years in an episode of depression. I've had at most a month at a time here and there of being only mildly depressed or even well. I've been actively trying new meds and treatments like ECT the whole time.

Similar experiences?

[mikl_pls]

1 hour ago, 0112358 said:

Curious if anyone else has experienced this - I'm going on 6 years in an episode of depression. I've had at most a month at a time here and there of being only mildly depressed or even well. I've been actively trying new meds and treatments like ECT the whole time.

Similar experiences?

Personally I have been depressed at the max for maybe 3 years at a time with brief, fleeting euthymic episodes in between them and "micro-remissions" (likely the reactivity associated with atypical major depressive episodes), but very rarely am I ever hypomanic/manic/mixed (but has happened).

This, to me, sounds like text-book "double depression," which is major depressive episodes (from MDD) superimposed on dysthymia (AKA persistent depressive disorder or PDD, which are less severe depressive episodes than MDD episodes but much, much, much longer lasting; i.e., at least two years and often longer I believe).

MAOIs are said to have a slight advantage over SSRI/SNRI/TCA/other antidepressants, but ECT I would say should definitely have the highest rate of remission, especially if bilateral stimulation is used.

How have you responded to each type of therapy you've received (both psychotherapy and pharmacotherapy)? Ever tried any synergistic combinations, especially novel combinations like MAOI + TCA or MAOI + stimulant (traditionally very taboo but can be done with close supervision by an expert physician trained in this prescribing method).

[Blahblah]

14 hours ago, 0112358 said:

Curious if anyone else has experienced this - I'm going on 6 years in an episode of depression. I've had at most a month at a time here and there of being only mildly depressed or even well. I've been actively trying new meds and treatments like ECT the whole time.

Similar experiences?

Yup - Double Depression here. The whole severe/suicidal ideation/dysphoric episodes have (for the most part, knock on wood) been in remission, but I have chronic/persistent Dysthymia...this apathy, feeling negative (sometimes hopeless), lack of motivation/interest. Wanting to lay in bed all day. Inability to complete anything I start. I've had brief relief from Ritalin, but with tolerance, it doesn't work so well anymore. I've heard ECT isn't worth the risk for dysthymia...and other meds are just overkill, they really don't touch it.

[0112358]

@mikl_pls  An interesting thought... there's no question I have bipolar ii disorder, so maybe it's "triple depression." Just kidding. In any case, MAOIs are the only class of antidepressants I haven't tried, actually. ECT worked very well when I did a full course, but after that it petered out, even with maintenance treatment monthly. I take buproprion currently, but I'm very wary of antidepressants... I suspect in the past they've caused cycling, even with a mood stabilizer. Particularly SSRIs, of course.

@Blahblah Thank you for the input. I've been able to get some relief myself for a few days in the past using stimulants, but they didn't do much for me if I took them daily.

[mikl_pls]

19 minutes ago, 0112358 said:

@mikl_pls  An interesting thought... there's no question I have bipolar ii disorder, so maybe it's "triple depression." Just kidding. In any case, MAOIs are the only class of antidepressants I haven't tried, actually. ECT worked very well when I did a full course, but after that it petered out, even with maintenance treatment monthly. I take buproprion currently, but I'm very wary of antidepressants... I suspect in the past they've caused cycling, even with a mood stabilizer. Particularly SSRIs, of course.

Oops! Forgot to look at your signature... That changes things a lot. I suppose it's possible to have a dysthymic episode with a superimposed bipolar depressive episode on top of it, causing essentially a unique flavor of double depression.

MAOIs are very safe actually contrary to popular belief (if you follow the dietary restrictions, which aren't that bad, and drug-drug interactions, some of which have been debunked like taking TCAs and stimulants with MAOIs). They're very effective for bipolar depression, sometimes one of the only agents that will work. Depending on your symptoms will dictate which MAOI you might should try first. If you need stimulation (like if you have lack of energy, motivation, loss of interest/apathy, etc.), Emsam or Parnate have been the choices, leaning towards Parnate (save for the paradoxical weight gain I had with it) with my personal experience, especially when paired with a stimulant. Emsam patches can be pesky if you're even just a moderately hairy guy like me (unsure of your sex/gender or whether you shave body hair, etc., not going to ask as you have "not telling" listed, that's your business ), if you sweat a lot (like me), or are allergic to the adhesive in the patches (like me, although it's not as bad as Neupro patches for me). It gets itchy under the patch and you feel like you want to rip it off, and the higher the dose, the larger the patches. Also, if bathing is something you struggle with doing regularly during depressive episodes, that can be a problem because Emsam patches like freshly cleaned skin and don't like to stick to unwashed skin. I never got much benefit out of Emsam, but was only ever allowed to go up to the 9 mg dose for some reason my pdoc never elucidated for me. She just said "it's dangerous" to go higher. Marplan is kinda middle of the road (can be stimulating or not, or sedating—it was mildly stimulating at first for me then just kinda didn't feel like I was taking anything), rather pricey as for some reason it was repatented and is thus brand-name only again. Nardil is said to be especially effective for anxious depression as it increases GABA levels in the brain. But it is the MAOI most often associated with the greatest magnitude and duration of weight gain throughout treatment (often it never stops causing weight gain as long as you take it as is documented in the literature), however some people don't gain on it. It also has the highest incidence of liver toxicity, and can cause vitamin B6 deficiency which if left untreated can cause nerve damage (can be remedied with vitamin B6 or P-5-P supplementation). Marplan is somewhat related to Nardil being a hydrazine, and as such may cause some weight gain, liver toxicity, and/or vitamin B6 deficiency, but I had none of those problems with it. I actually lost a great portion of the weight I gained on Parnate that I took before it. Emsam is the safest in regards to food and drug interactions and is either weight nautral or can cause weight loss, while Parnate is probably the most "dangerous" or volatile in these regards yet is supposed to be the most weight neutral or most likely to cause weight loss of them all (but that didn't stop my body from gaining 50 lb in 3 months on it!).

Supposedly the maintenance medicine treatment after ECT of choice that I have read time and time again in several articles is a combination of lithium and nortriptyline, but everyone responds individually to both of those meds. I read somewhere that males tend to respond worse to nortriptyline for some reason (with increased chance of suicidality or hostility), and it tends to work better in geriatric patients. Personally nortriptyline just didn't do shit for me unless I took it up to the max dose of 150 mg on my own, which then I wasn't taking it as prescribed. It has an apparently toxic metabolite, 10-hydroxynortriptyline, that may increase relapse rate. Lithium is hit or miss, or can even be disastrous depending on the individual when used for depression, but according to my pdoc, it's the safest TCA to take if you're going to take a TCA. She claims that it's bicyclic in structure, but it clearly has a tricyclic structure. Not sure what she really is saying with that.

I don't blame you for being wary of antidepressants. For whatever reason, I tolerate them relatively well (and, really, need them). Bupropion is supposed to be one of the safest antidepressants for bipolar folks with low chances of inducing switches, accelerating/inducing cycling, etc. In case you've never done so before, you can take bupropion SR and I believe IR up to 400 mg/day or bupropion XL up to 450 mg/day (there are two special products for once daily administration of bupropion XL for this dosage but are both brand name only: Forfivo XL at 450 mg for the hydrochloride salt, and Aplenzin at 522 mg for the hydrobromide salt which is supposed to be better mostly according to anecdotal reports). My pdoc had me up to 500 mg/day (XL 300 mg + IR 200 mg/day) at one point a while back, which is beyond the maximum recommended dosage, but evidently I really needed it. It caused severe constipation and gave me internal and external hemorrhoids (that part of my digestive tract has never been the same since then).

[Iceberg]

23 hours ago, 0112358 said:

Curious if anyone else has experienced this - I'm going on 6 years in an episode of depression. I've had at most a month at a time here and there of being only mildly depressed or even well. I've been actively trying new meds and treatments like ECT the whole time.

Similar experiences?

Do you have access to some form of ketamine treatment?

I had better luck with that than ECT. Can be stupidly expensive though 

[0112358]

1 hour ago, Iceberg said:

Do you have access to some form of ketamine treatment?

In theory it is available to me as infusions, although I'm not 100% positive that it would be covered. The place where I did ECT does the infusions. I got so burned out with having to find a ride to the hospital even once a month, especially since the maintenance ECT wasn't helping... I've heard of people doing a nasal spray, though. Is that what you're talking about, or infusions?

[Iceberg]

Infusions. They have a really high bioavailability and are direct into the blood so it can be more consistent. However, I really doubt they’d be covered (if your in the us) 

[notloki]

There are already ketamine medical products and it is a matter of time that pharmacology figures a delivery system that is as good as infusions

[Catnapper]

On 2/16/2020 at 1:35 PM, 0112358 said:

Curious if anyone else has experienced this - I'm going on 6 years in an episode of depression. I've had at most a month at a time here and there of being only mildly depressed or even well. I've been actively trying new meds and treatments like ECT the whole time.

Similar experiences?

 

Sadly, yes I'm very familiar with what you're going through. My current depressive episode started around 2015 / 2016, and I've been mostly functional through it (i.e. working), although I had to take a few months of medical leave in the fall of 2018, and then went out on leave again in November of 2019, and am still off work. Since I've used up all the FMLA time, I may or may not still have a job, but at any rate I'm not able to work right now.

Please disregard my signature as it's years out of date, and I'm accessing this off my phone so can't update it. My dx is also bipolar II, and I'm also currently on Wellbutrin, plus Lamictal. I just had my seventh ECT treatment earlier today, and the needle has moved a little, but I'm not well yet. My regular pdoc sees improvement, but I'm not feeling it very much. The ECT pdoc said her experience is it will take nine to twelve treatments before I feel better.

When I took off work in 2018, I tried (crazy expensive) ketamine infusions, and they worked great at first, but then after about twelve or so, they quit working for me. I've also had success with Wellbutrin plus Ritalin, although recently I had a bad mixed episode so the pdoc stopped the Ritalin.

I'm not sure what the post-index ECT treatment maintenance schedule and med plan will be, but goddamn, it would be nice to feel like being alive is a good thing instead of some sort of cosmic misery that I'm doomed to suffer.

I'm 60 years old, and there was a ten year period in my forties where I was only able to work during six of those ten years, so my finances / retirement plans are pretty well fucked. I don't know about you, but I feel like I'm on a downwards staircase, and every depressive episode gets a little worse, lasts a little longer, and I never seem to get all the way better anymore.

[mikl_pls]

5 hours ago, Catnapper said:

I'm 60 years old, and there was a ten year period in my forties where I was only able to work during six of those ten years, so my finances / retirement plans are pretty well fucked. I don't know about you, but I feel like I'm on a downwards staircase, and every depressive episode gets a little worse, lasts a little longer, and I never seem to get all the way better anymore.

I'm 32, haven't worked a real job in my life due to the severity of my illnesses, so my financial future I'm sure looks grim, and I too relate to what you said about feeling like I'm on a downward staircase where every depressive episode gets worse, lasts longer, and never seems to get all the way better. I'm going through now what is quite possibly the worst period in my life, which given what all I've been through is saying quite a lot. Not trying to summon a pity party, just saying I feel I can relate.

[0112358]

6 hours ago, Catnapper said:

 

Sadly, yes I'm very familiar with what you're going through.... I just had my seventh ECT treatment earlier today, and the needle has moved a little, but I'm not well yet. My regular pdoc sees improvement, but I'm not feeling it very much. The ECT pdoc said her experience is it will take nine to twelve treatments before I feel better... I don't know about you, but I feel like I'm on a downwards staircase, and every depressive episode gets a little worse, lasts a little longer, and I never seem to get all the way better anymore.

Sorry you've had a similar experience - thanks for chiming in though. I wanted to say that when I did ECT - 3x a week at first - it took at least a couple weeks to start feeling better, and the improvement continued after that. So definitely give it time. Maintenance treatment works very well for a lot of people too.

I definitely feel that about every episode getting worse... and lasting longer. The worst part is the lasting longer. My uninformed, general understanding I've developed through reading all sorts of things is that this is not at all uncommon - for the disorder to get worse with time. I don't think it's talked about much - I don't hear a prognosis being talked about at all anymore. I just keep stumbling towards trying new treatments. Not just meds - DBT, meditation, meditation-like-state inducing devices, diets...

I haven't been able to work since 2015; well really since 2014 but damn did I keep trying. There's this massive variability in my capacity to do things, which is problematic enough, and then there's the simple fact that if I'm not in a moderate-severe episode of depression, it lasts at most for a month. I also definitely can't go back to my career because of all the 14 hour days and other stressors. It's pretty maddening, especially stacked with problems with my physical health that prevent a lot of types of work from being viable.

I often find myself in a trap of considering the lives of people who I know have the same or similar diagnoses as me, and wondering what the hell I'm doing wrong that they're doing right, even though I know it doesn't work like that.

30 minutes ago, mikl_pls said:

I'm 32, haven't worked a real job in my life due to the severity of my illnesses, so my financial future I'm sure looks grim, and I too relate to what you said about feeling like I'm on a downward staircase where every depressive episode gets worse, lasts longer, and never seems to get all the way better. I'm going through now what is quite possibly the worst period in my life, which given what all I've been through is saying quite a lot. Not trying to summon a pity party, just saying I feel I can relate.

Sad to hear you're going through such a hard time. Again, I think this downward staircase thing isn't uncommon. I wish someone in my treatment team would address that, maybe just to say "sometimes things get worse over time, so here's how to prepare for that..."

[Gearhead]

I’m sick and not with-it enough to give any advice, but I’ve had multiyear depressive episodes. And they suck.