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Best AD for Melancholia

Posted by brynb on July 10, 2016, at 9:54:08

Hi All-

It's been quite a while since I've been back here. I have never been concretely DX'd with a depression "type" (meaning I exhibit many Bipolar 2 symptoms but not DX'd as such) and I'm on disability for MDD and GAD.

I recently went through a lot of changes, including changes to my meds which included dropping Tramadol (the only medicine that ever effectively treated my depression even though it was prescribed off-label). I did so because I have a substance abuse history (it's not active and is under control now), and had to stop the Tramadol as it kicked in too many triggers to want to use heavier opiates (it's an opioid) as well as other substances.

In it's place I'm using Subutex to help with the withdrawal. Its also used off-label as an AD, and I still take Lexapro and Klonopin.

Unfortunately, I've been suffering from great melancholia and loneliness and I'm sure dropping Tramadol has contributed to this. Going back on it is not an option. I've tried most every AD out there with the exception of MAOI's, which I'm very hesitant to take (and probably couldn't while on Subutex which I must take anyway). I've tried a lot of the Tricyclics with no success, every SSRI and Lexapro has been the "easiest" and at least addresses my anxiety, but I believe I need to try something in place of Lexapro again as I am in a minor depressive episode with melancholia being the biggest theme. (Note: I've been in many, many severe depressive episodes while on Lexapro and feel it most likely does nothing for my depression at this point, I'm just accustomed to it.)

I'm seeing my pdoc this week and we previously discussed switching to Pristiq, one of the few meds I haven't tried. To be clear, I've taken most AAPs and don't do well with them (but I'm willing to try Abilify with Lexapro again as I took it a while ago and don't remember anything positive or negative) and I can't take AEs/mood stabilizers (they make my depression worse).

So, ideas? Anything particularly good for melancholia?

Thanks in advance and I hope you're all faring well.

-b


Live in the sunshine, swim the sea, drink the wild air. - Ralph Waldo Emerson


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poster:brynb thread:1090338
URL: http://www.dr-bob.org/babble/20160609/msgs/1090338.html