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Treatment resistant atypical depression-what next?

Posted by eln on April 16, 2003, at 2:38:37

Hi -
While I haven't tried every combination of every drug out there, I have given fair clinical trials to all of the modern SSRI and other antidepressants, with a huge supporting cast of add-ons, including a myriad of anti-psychotics and also lithium over the past 6 years.

I am in my two week wash out period after my trial with Parnate failed. I got all the way up to 60 mg/day, but was having really bad blood pressure spikes when I took my medicine and also some drug interaction problems from the low-dose Surmontil and Seroquel I was adding on (those were discontinued a while ago).
Although the Parnate allowed me a clear mind, it zapped my motivation. I couldn't get myself to do anything, and was really depressed besides that. And the weight gain really didn't help.

So the question is... what next?
I've since had to take a leave of absence from graduate school because there was the possibility of severe depression hitting while I had no medications in my system. But now that I am safely away from school at my mom's house (on the other side of the country), I feel mostly fine. I want to get back to school ASAP so I can propose my PhD thesis. So, the next thing I do needs to work, and needs to work quickly.

My doctor and I ruled out other MAOIs because of the blood pressure problems I was having.

Other choices seem to be Prozac and Abilify or ECT. I was on Prozac over 6 years ago, not a very high dose, and discarded it after 6 weeks due to some strange side effect (constant burping) that may or may not have been from the drug.

I am trying to find out if there is evidence that unilateral ECT works for patients with atypical depression. I also want to know what the stay well rate is if I take antidepressants following the initial course of ECT treatments but do not have maintenance ECT treatments.

Further complicating the matter is that I have been diagnosed just recently with PCOS. The hyperandrogenism can cause and aggravate depression. Unfortunately, the best way to treat that is with diet and exercise. I'm working on it. Or rather, I will start my low simple carbohydrate diet after I get my fair share of all that cheese I've been missing after 6 months on MAOIs.

Its also going to be hard to tell if any of the treatment I receive out at my mom's is working because I am generally in a better mood when not under the pressures of school.

I'm looking for advice on where to go next:
- more drug trials that probably won't work long-term even if there is an initial response

- ECT -- unilateral, bifrontal, or bilateral
(and after ECT - continue SSRI only, or have maintenance treatments)

The other option, which no one but me seems to think is an option is to drop out of school and get a less stressful life. When I'm not stressed out by school and everything I'm not getting done there, I am ok most of the time. Not that I wouldn't require treatment, but probably even minimal treatment may work.

Suggestions? Thanks for reading this long post.
-E


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poster:eln thread:219739
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