Posted by undopaminergic on April 3, 2008, at 21:38:30
In reply to Please help. No med at all is helping me!, posted by alexa35 on April 2, 2008, at 20:08:33
> I've battled depression for years. I'm in CBT therapy 1-2 times each week. The past 5 months the depression is feeling unbearable. Some of this is due to personal things going on and the fact that the company I work for is insane. Past 2 years I have tried Zoloft, Prozac, Effexor and Cymbalta. Then gave up for 9 months and was on nothing. Found exercise to be effective.
> Then 2 months ago the depression became unbearable - can't get out of bed in the morning, can hardly function, 12 hours of sleep a night and all weekend.
> Dr. put me on Adderall. This seemed to work for a week...Then nothing and still nothing. He added Wellbutrin, which in the past was the one AD that might have worked a bit for me. I am up to 400 mg a day and nothing!! I am exhausted, moody and feel even more depressed. How can this be????
> Is there anything else to try?
> My dr. advised against trying an SSRI or SNRI ever again since they make me zombie-like.
> He also advised against Lamictal.
> This is the 5th psychiatrist I have seen and he is supposed to be very good.
> I have no idea where to go next. Do any of these drugs work???
> Provigil maybe?
> Anyone know of natural supplements? I really felt the most improvement from 1 hour of cardio a day but now feel too tired to do even 5 minutes.
>
> Thanks. Am at a loss. I don't wish depression on anybody....
>Amphetamines, and stimulants in general, often stop working due to tolerance. Quitting them for a week or so tends to restore efficacy, but only until tolerance returns. If you're lucky, about 20-30 mg of memantine (Ebixa, Namenda) may be helpful to avoid the tolerance, and allow the stimulant to work more reliably.
Alternatively, a monoamine oxidase inhibitor (MAOI) may be useful. The selegiline transdermal system EMSAM or tranylcypromine (or possibly even rasagiline) are best tried first, before phenelzine, as the latter is associated with several additional side effects (such as weight gain and fatigue) that rarely occur with the other (non-hydrazine) MAOIs.
Addition of a mood stabiliser to an antidepressant regiment - or possibly as monotherapy - is sometimes helpful. Low doses of lithium (up to 300 mg) may be sufficient - high doses tend to be associated with complications (tremor, hypothyroidism, etc.). Lamotrigine and oxcarbazepine are other choices.
Modafinil (Provigil) is probably not useful at this time, since even amphetamines (Adderall) are failing.
poster:undopaminergic
thread:821265
URL: http://www.dr-bob.org/babble/20080330/msgs/821476.html