Posted by viridis on September 18, 2002, at 2:22:29
In reply to Unresponsive to SSRIs? What worked?, posted by Silly Brain on September 17, 2002, at 15:43:36
I had severe, recurring depression (several times a year for over 25 years), coupled with, and probably caused largely by, repeated bouts of major anxiety. I've also been diagnosed with mild to moderate ADD. I took Prozac on and off for years (at various dosages), and each time, it caused intense anxiety at first, followed by a wired yet detached feeling of no emotion or interest in life. Zoloft triggered bizarre, uncontrollable mood swings even at very low doses. Wellbutrin (not an SSRI) improved my mood a bit but made the anxiety unbearable, and had various other intolerable side effects.
I was pretty discouraged, but a little over a year ago I saw a new psychiatrist who quickly identified me as a poor candidate for SSRI therapy. He initially prescribed Klonopin daily and Xanax as needed. That immediately reduced my anxiety and things started to get better. I still had depressive episodes, but they were much milder and more manageable. Then we added Neurontin, and that may have helped a bit more. With the anxiety and mood swings under control, the next successful addition was low-dose Adderall, which alleviated many of the ADD symptoms and took care of the remaining depression. We tried other things along the way (e.g., Provigil) but when they caused side effects or weren't helpful, my pdoc moved on to other options.
This combo (Klonopin/Adderall/Neurontin, plus occasional Xanax) seems to work well for me so far, and I haven't needed any dosage increases. This is the first year that I can remember in which I've been essentially free of major depression and severe anxiety. I'm much more consistently productive than before, my moods are stable, and I'm actually enjoying life.
Of course, this wouldn't be the ideal mix for everyone, but it does show that there are lots of options. Many doctors don't know what they're doing -- for example, my GP insists that any side effects from modern antidepressants must be "imaginary" because these drugs don't cause side effects (!!!). You may have to hunt around to find an understanding doctor (probably a psychiatrist/psychopharmacologist would be best), but they do exist.
By the way, some people on this board do very well with Lamictal, which apparently has antidepressant as well as mood-stabilizing qualities. I've never tried it, but have a close friend who has benefited greatly from Lamictal for depression and bipolar issues. That's just another of the many non-SSRI options to discuss with a qualified pdoc.