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is this enough tp consider ECT?
you're the only person who can make that determination.  i have a list that's even longer, and i'm still afraid to try ECT.  If I were you, I'd try taking an MAOI before ECT, but that's just me and my opinion.
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I have severe treatment resistent depression too, and I have a list like yours.

I had a miraculous  response to Nardil. I truly felt like "Me" - had forgotten there was such a person. Optimistic enough to get up (and go to bed) - but not hyper, calm - but not lethargic.

Alas, the wicked giant children playing me in the video game of my Life (how I construe things sometimes  ;) ), dictated that I would have a life-threatening medical reaction and so had to discontinue it.  No, nothing with the diet and hypertensive effect.

I am a great believer in MAO meds.  They CAN wokr miracles for those amenable.  Wish they had genetic pretesting  available (as I'm sure they will prety soon) to see what would work for whom!

Perhaps in a pinch you could be hospitalized in the SSRI washout period.  I think it's only 10 days except for Prozac. Fiona who has a similar response to Parnate is more expert.    ENSAM (the new Selegiline patch) starts working sooner than oral meds - if it works for you. Not generally as dramatic as an MAO like Nardil or Parnate. 

ECT even if effective,  needs repeating for most especally for TRD, but maybe it would help you in the washout period.  I guess you've read about deep brain stimulation? Scary but sounds promising (much more than the transvagal stuff they were pushing for a while).

Personally  (hate to confess it), I am relying on opiates - not a huge amount though tolerance is growing  (technically for my back ) and stimilant medication.  Meanwhile, I'm titrating up on  Lamictal, without huge expecations. I feel I need more dopamine,  and if you  do, there's no substitute.

I am afraid of ECT myself, though I can't have it in any case owing to a spinal condition which makes it too risky for me.  That's just me though. I have heard of people it has helped greatly. I have also seen severe memory loss in others.  .

So sorry for your pain. 

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I can relate after having gone through a stack of meds myself... I think prolly most of us can here.

I've had ECT 11 times, bout 3 years ago.

If I had a choice, I wouldn't have it again.  It did pull me out of depression.  However, that did not last long, but the memory loss did.  And there were other options available.

I think it is traumatic in itself to go through.  Your getting quite a big blow to the head... and you're having a seizure.  These things are stressful in themselves on both the mind and the body.  Plus, I find it hard to believe the doctors when they say there is no brain damage.... and I think it's a bit more "irreversable" than medication.

Anyhow, I don't want to freak you out or anything.. it's just what I think about it.  It's pretty darn frustrating when you're trying meds over a period of *years*, and you'll pretty much give anything a go.

I guess look into it, and read about it, ask heaps of questions, and work out what is best for you.  I think it is a big choice.  If there is any other options I would try those first... but yeah, again, it is up to you.

Good luck.  Keep us posted on what you decide to do.

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You've got losts of stuff left to try.

Have all of those been monotherapy except for where otherwise indicated?

If so many combinations have benifical interactions.  Cymbalta and wellbutrin can boost each others potency significantly, for example.  An SSRI + Wellbutrin combo is worth a try if you've never done that.

You've not tried cymbalta at all, actualy.

You've not tried strattera.

You've barely scratched the surface of the TCAs.

You've only tried one anti-psychotic.

You've not tried an aphetimine based stimulant (adderall, dexidrine, desoxyn).

It doesn't look like you've really explored the option of your depresson not being depression but somthing else such as bipolar or chronic fatigue.

You might want to check out Lamictal.  Of the ACs it has the strongest AD effect.

Have you had really extensive blood tests done to check hormone levels and all that?

For some people opiates are the only thing that helps.

I don't discourage people from trying ECT, but I don't know if you're at that point yet. Ask your doc about it.

edit: I had not read your other post before writing this.  If it's somthing your doc is recomending, then I say go with what s/he says.

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Ok, You don't want to combine two SSRIs as that could lead to serotonin syndrome.  Paxil has a reputation for being the strongest of the SSRIs, so swapping out what you are on now for that might be worth a shot.  It might also be worth trying Cymbalta + wellbutrin.  That's what I'm on right now for the depression part of things.  I'm still fucking miserable most of the time but I don't mind being miserable so much if that makes any sense.  *shrug*

You also didn't mention doses.  I assume you maxed out the dose on each med before trying something else.  If not, that's the way to go.  With most stuff I've been on I've felt next to nothing at lower doses, not responding at all until I was near the top of the dosing rage.  Yeah, this means a lot increase dose, wait six weeks, increase dose, wait six weeks, increase dose, find that I can't pee anymore and go on to the next med.  It's a slow slow frustrating process.  Stick with it.  That's just how it works.

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I really do suggest trying an MAOI.

The washout between your SSRI and the MAOI can be, well, hell. However, there are other things that you can take to make it more tolerable. The first time I did it my pdoc, with my permission, deliberately over-medicated me on Risperdal and lorazepam. I didn't have much personality, nor was I ever really wide awake, but I was too out of it to be as actively and dangerously suicidally depressed as I really was. Going into the hospital for that period may also be a good option.

One piece of good news about MAOIs is that they act relatively quickly. You don't have to wait as long as with, say an SSRI, to find out how you're going to respond. My depression was notably improved in only 10 days, and by 1 month I'd completely stopped feeling suicidal and those feelings haven't come back (over a year now).

You do have to pay attention to the diet and some of the side effects, and there can be weight gain. I'm successfully losing weight without changing my dose using weight watchers. And while I miss some foods -- ah, aged cheese -- the trade-off is more than worth it for me.

Parnate has completely changed my life. It pulled me out of the deepest suicidal depression -- my partner got nervous if I took too long going to the bathroom! -- and has kept me out for over a year. I've also resumed the amount of work I was doing before the depression got really bad, I've finished some other huge projects, and  no one is getting that Parnate out of my hand, ever.

If your pdoc is suggesting ECT then it's a good idea to listen. Personally, if they're an option, I would unprofessionally suggest Parnate or Nardil first -- the success rate is about the same but the treatment course if very different.


"Parnate cheerleader"

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Fiona and I are probably this Boards strongest (or at least loudest) MAO cheerleaders.

One thing neither of us thought to mention though, is extremely important.  Most if not practically all, younger shrinks do NOT prescribe them,  and in fact have no experience with  either one.  Owing to the interactions,  MAO inhibitors went way out of fashion when alternatives became available - especially the SSRIs.  This is especially so as they are a treatment of last resort, and so many pts  are suicidal at that point. That tyramine effect, is a handy way to pull it off!. 

So with all due respect for your shrink, the fact that s/he is recommending ECT over the MAOs,  is not particularly significant.  I would definitely get a second opinion - and from an  older shrink with experience with them.  People are afraid of being sued you know - and besides a dr unfaniliar with a med won't monitor you as effectively.

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VE, rereading your post this really caught my eye:

For some people opiates are the only thing that helps.

Maybe you saw that's what I'm doing now - and on purpose.  That is, it was a conscious decision to open that sealed bottle of Lortab 10/500 for relief of emotional symptoms whereas it was prescribed for my back pain. (And since then,  I've gotten several other bottles. Sympathetic docs. About my back. Or else they pretend to believe that's the main reason). 

It was a choice between that or Other.

But what do these "some people" do?  This is not an accepted off label use of narcotics, and who can get them reliably on the street.

Most important, there is a tolerance and an instability to the effect. That is, when they wear off...one crashes. When my kids were living with me I was very emotionally labile in the course of the day - largely because trying to keep tolerance to a minimum,  I toughed it out after the AM dose.  They said it was like I had two personalities .  I suppose in effect, I had created a rapidly cycling  BP disorder  for myself .

(Constipation too, but who's counting?)

If you check again, I'd really appreciate your comments.  GUess I should start another thread (substance abuse or depression??)  . I've been wanting to ask about buprenorphine too.  I did on the old Board and no one even answered.  I gather it's not very common  ;)

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Heya sunburnt22,

OK I'm joining the MAOI cheerleaders.

For sure worth a try.

So is ECT, definitely, but I would try MAOI first.

Of course you have the horrid SSRI withdrawals first.



MAOIs are good drugs, just watch the diet stuff.

(For any Canuckis reading -- we have Manerix here, a reversible MAOI, which doesn't have nearly as much dietary restriction.  Not approved yet in the States.)


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