Posted by Meatwood_Flack on July 18, 2012, at 23:45:40
In reply to Re: Melancholic Depression » Meatwood_Flack, posted by papillon2 on July 18, 2012, at 23:10:32
> Hey Fleetwood,
> If your SSRI and SNRI don't work out, I would be inclined to try a tetracyclic anti-depressant called Mirtazepine. If that didn't work out I'd try a tricyclic anti-depressant (TCA) such as Nortriptyline. Some might suggest going straight to a TCA.
> If you only got a partial response to the TCA, I would then suggest augmenting it with a mood stabilizer (e.g. Lamictal, low-dose Lithium) or an atypical anti-psychotic (e.g. Zyprexa). I would first go for a mood stabilizer over an anti-psychotic as their side effects tend to suck less.
> I have achieved partial remission from melancholic depression with the following combination:
> Nortriptyline (a TCA) 100mg
> Lamictal 200mg
> Melatonin 4mg for sleep
> Lithium 250mg, which I unfortunately had to stop as my body wouldn't tolerate it
> I also take 3g high potency fish oil and some other supplements each day. Fish oil has been proven in scientific trials to have an anti-depressant effect and to improve cognitive function. It doesn't interfere with any psych meds that I know of, though it's always best to ask your doctor before taking any supplements.
> You might like to read this short summary about melancholic depression and how best to treat it.
> Melancholic depression is a b*tch. I spent four months in hospital with it last year. The good news is that having just started out with an SSRI and an SNRI, you have whole classes of anti-depressants and other types of medications to try if your current combo doesn't work out. So hang in there.
Lots of good information I can use as suggestions to my doc should we need to change anything. Much appreciated.