Posted by JohnL on January 6, 2001, at 5:26:52
In reply to Re: which AD for chronic depression?, posted by stjames on January 5, 2001, at 19:54:41
> The TCA's, Effexor or Remeron. The combo of Effexor and Remeron is considered a "big gun".
> Many other polydrug combos also work for chronic depression. SSRI's are not as effective for significant and/or chronic depression as the older
> TCA's. Psycothearpy is also indicated.
>
> JamesJames is absolutely correct. Effexor, Effexor+Remeron, Remeron, Nortriptyline, or Desipramine would be top choices in the antidepressant category as I see it.
Of course though, that would assume that the chronic depression has its roots in chemsitries involving low neurotransmitter levels or disregulation of receptors. This only covers about half of the possible causes. Others might be dopamine/NE failure (neuros are fine, but receptors are not functioning properly), chemical instable, or electrical instable, or GABA deficient, dopamine hypofunction, or NE hypofunction.
Just because someone has chronic depression doesn't mean an antidepressant is the correct choice. Chronic depression looks a whole lot like the negative type symptoms of schizophrenia, except without the psychosis. That is, lack of pleasure, lack of interest in normal activities, lack of motivation, social withdrawal, etc. Antidepressants can make those symptoms even worse through a flattening or numbing effect. Often times a chronic depression needs an uplifting, not a flattening.
Outside of the antidepressant category top choices, as I see it, would be Ritalin, Adderall, Modafinil, Adrafinil, Zyprexa, Amisulpride. If the chronic depression has a significant anxiety component with it, then Klonopin or Xanax might be better choices to start with. Any drugs mentioned here will often speed the response time of an antidepressant as well, so you might consider starting two drugs at the same time. There are all kinds of studies proving this, such as early psychostimulant augmentation of Zoloft for fast response, early augmentation with Zyprexa..., early augmentation with Xanax..., and more.
I have seen it in literature a lot, and from my own experience I believe it, that chronic depression is much more difficult to cure than a straight-forward bout of depression. Chronic depression often requires multiple drugs, higher doses, and longer time for response. It's easy to think that chronic is mild, but in actuality it's more serious. Attack it aggressively. My lifelong chronic depression was not helped by antidepressants or mood stabilizers. Instead, a psychostimulant (Adrafanil) combined with an antipsychotic (Amisulpride) has been the most effective of the dozens of things I've tried.
John
poster:JohnL
thread:50938
URL: http://www.dr-bob.org/babble/20001231/msgs/51022.html