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Re: TREATMENT RESISTANT DEPRESSION - INFO NEEDED PaulB

Posted by sweetmarie on July 29, 2001, at 18:26:20

In reply to Re: TREATMENT RESISTANT DEPRESSION - INFO NEEDED, posted by PaulB on July 29, 2001, at 16:24:30

> I am from the UK too and have gone through the NHS for treatment of depression and anxiety.
> On first going to your GP in the UK I believe it is common practise for him/her to prescribe an SSRI. If the person does not respond then the GP can maximise the dose. When I relapsed on Paroxetine and did not respond to an increase in dose up to 40 mg I was switched to Venlafaxine. I responded but then relapsed again.

Yes, I believe that`s the reccommended `sequence` of events. I don`t think that all GPs operate that way, though.

> At this point my GP considered me treatment-resistant and made a referal for me to see an NHS psychiatrist. As a GP I guess it wasnt his job to treat a person, like me who obviously needed specialist care and also he couldnt prescribe some of the drugs I thought were options at this stage-Moclobemide(Manerix) and l-Tryptophan(Optimax) . He mentioned that he thought treatment-resistant depression is serious because the success rate of treatment becomes lower after a patient has relapsed.

Not very encouraging - or even strictly accurate.

> If I were writing an article about treamtnet-resistant depression I would consider the followiing factors to be worthy of criteria for determining a treatment-resistant case:
> -Unresponsive/relapse on SSRI and after an increase in dose of SSRI
> -Further non responsive/relapse on a dual acting antidepressant-TCA, Venlafaxine, Mirtazapine
> or/and MAOI.
> -Non response to psychotherapy alone, or in combination with antidepressant treatment
> -Further non response/relapse when given augmentation strategies to potentiate antidepressants-Pinodol, lithium, tryptophan, atypical antipsychotics
> -Unresponsive to ECT or VNS

Yes, I agree. And even then I don`t believe that the psychiatrist should `write off` a patient. My first psychiatrist informed me that there was `nothing further` he could do for me. This was after the failure of Imipramine, Lithium and ECT. I was totally devastated. Luckily, my GP helped me to change psychiatrists.

> As you have trawled the internet Im sure you have come across Dr Ivans Depression Central which contain new, good information on VNS as well as treatment-resistant depression:
>
> http://www.psycom.net/depression.central.html
>
> As for going about getting treatment for treatment-resistant depression in the UK I got the impression after I saw the NHS psychiatrist that it was out of the NHS's hands.

Complete rubbish. I was referred to the RVI by my psychiatrist. It`s NHS run, and available for all treatment resistant patients (and very good).

Then I had to see a private psychiatrist. The NHS psychiatrist was very limited in his options available to me-'we could try another SSRI'. I got the impression that he had many patients to see on the NHS.

Probably. No excuse, though. >

Thanks for replying and good luck in the future.

Anna.


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URL: http://www.dr-bob.org/babble/20010725/msgs/72411.html