Psycho-Babble Medication Thread 349830

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treatment resistant depression

Posted by LindaGail on May 23, 2004, at 6:04:39

What do I do when nothing works? I have been literally on every antideppresant and have had treatment for 10 years and am still severely depressed. I am on a cocktail of meds. remeron, zoloft, geodon, and topamax. I see a psychologist and a psychiatrist. I have been hospitalized 3 times this year-2 overdoses and one attempt at hanging myself. I also cut. Sorry if that is shocking. I am past that now. I just want to get better. Any suggestions?

 

Re: treatment resistant depression

Posted by Ilene on May 23, 2004, at 6:55:37

In reply to treatment resistant depression, posted by LindaGail on May 23, 2004, at 6:04:39

> What do I do when nothing works? I have been literally on every antideppresant and have had treatment for 10 years and am still severely depressed. I am on a cocktail of meds. remeron, zoloft, geodon, and topamax. I see a psychologist and a psychiatrist. I have been hospitalized 3 times this year-2 overdoses and one attempt at hanging myself. I also cut. Sorry if that is shocking. I am past that now. I just want to get better. Any suggestions?

I had very little success until I augmented w/ a thyroid hormone (Cytomel, or T3). I know this doesn't work for everybody, but I think it's worth a try.

 

Re: treatment resistant depression

Posted by Peter S. on May 23, 2004, at 14:11:29

In reply to Re: treatment resistant depression, posted by Ilene on May 23, 2004, at 6:55:37

Lamictal has definitely helped me after years of trials and poop outs. It's not the solution by any means but it is the only thing that has worked consistantly.

Best of luck!

> > What do I do when nothing works? I have been literally on every antideppresant and have had treatment for 10 years and am still severely depressed. I am on a cocktail of meds. remeron, zoloft, geodon, and topamax. I see a psychologist and a psychiatrist. I have been hospitalized 3 times this year-2 overdoses and one attempt at hanging myself. I also cut. Sorry if that is shocking. I am past that now. I just want to get better. Any suggestions?
>
> I had very little success until I augmented w/ a thyroid hormone (Cytomel, or T3). I know this doesn't work for everybody, but I think it's worth a try.

 

Re: treatment resistant depression

Posted by Racer on May 23, 2004, at 14:34:36

In reply to Re: treatment resistant depression, posted by Ilene on May 23, 2004, at 6:55:37

Man, that sounds more than rough. I can relate to the feeling that nothing is going to help, and that it's just time to make that last move if this is as good as it gets, but I don't know that any one thing is going to fix it at this point for me, and probably not for you, either. Isn't that a b**ch? Just when we most need something that can give us a little relief, we get to the point that we have to start fighting hardest. I'm there right now, myself, so I know how hard it is for me but can only imagine your pain.

I've got a few questions for you to think about, that might or might not help you decide what your next step is. I hope considering your answers helps you.

First of all, you've been seeing a therapist and aren't finding it helpful. Could it be that the therapist you're working with isn't the right fit for you right now? Maybe another individual or another therapeutic approach might help you find some better coping strategies for your distress? That's the first thing that comes to my mind after reading your post.

I don't know which other drugs you've tried over the years, so I can't really say anything about what to try next. Maybe an MAOI? Maybe a TCA? Maybe another SSRI or other first line drug? Maybe talk to your pdoc about going symptom by sypmtom to get you some relief before starting up again on the search for the drug or combo that will allow you to get back to living your life? For an example of what I mean by that last one, I'm so agitated and wound up and frightened out of my mind about going back into the pdoc's office and getting handed another drug that it's all I can do to be safe right now. Instead of continuing on in the same rut of knocking heads over which anti-depressant to try next, I'm going to ask him to address just that anxiety for now. It's asking for a bandaid to put over a gunshot wound, but I'm hoping that giving me a little breathing space from the distress the treatment itself is causing me might allow me to get back to where I can engage and be a little more rational about his choices for me. Does that make sense? I'm asking him to relieve the anxiety that is interfering so much in my ability to engage in my own treatment.

Also, although this is obvious it's also often overlooked: get a full physical workup, including full blood panels. This fits in with what Ilene mentioned, as thyroid function tests are not a routine part of most annual physicals. Make sure there isn't some underlying physical problem contributing and complicating your depression. This is the hardest thing in the world to do, when you're so depressed, but it's really important. What if you have an easily treated depression -- but it can't be treated because of a subclinical infection that ten days of antibiotics could fix? Hard as it is, it's worth it.

Another thing to think about is EMDR. I haven't tried it, but would like to. From what I've read, it seems to make a very significant difference for a lot of people. It's not magic, but if nothing else is working, it's worth a try.

Last thought is clinical trials, if you've got a research facility near you. I'm near enough to Stanford that I'm trying to get enough UMPH up to contact them. Most of the universities that have research programs post their current research areas online, so you can try local university websites to see if anything looks as if it might sound promising.

I'm sorry I can't give you a good, easy answer, like, "Take [x] and it will fix this." I hope that I've offered something here, though, that might give you some ideas.

Best luck to you, and be well.

 

Re: treatment resistant depression

Posted by LindaGail on May 23, 2004, at 14:51:23

In reply to Re: treatment resistant depression, posted by Racer on May 23, 2004, at 14:34:36

What is EDMR? I tried cytomel already.. No luck. and had a complete physical and blood work done. No hidden infection or health problem was apparent. I was already on an MAOI-nardil, and had a terrible reaction to it. I told you, I've done it all. I HAVEN"T tried lamictal. That one I could mention to my psychiatrist I guess, but I'm already on so many things, he would have to cut out something in order to add it I'm sure-maybe the topamax?

 

Re: treatment resistant depression LindaGail

Posted by jay on May 23, 2004, at 18:26:50

In reply to Re: treatment resistant depression, posted by LindaGail on May 23, 2004, at 14:51:23

I honestly think you really may need to "arrest" your depression AND anxiety at the same time. That may mean a very high dose benzo with a slowly building antidepressant. If the anticonvulsants haven't worked, try a new atypical antipsychotic. Zyprexa and/or Risperdal may help to clamp side effects from the antidepressant.

Best wishes,
Jay

 

Re: treatment resistant depression

Posted by man_oh_man1977 on May 24, 2004, at 2:02:04

In reply to Re: treatment resistant depression LindaGail, posted by jay on May 23, 2004, at 18:26:50

Hi Linda,

I wouldn't worry so much about having to drop something if your pdoc added lamictal. And, if he/she did, it may be for the better. Lamictal has been a steady companion for me, and has a pretty good track record. Ever consider lithium? I got the icky-toxity poisoning from it, but before that kicked it, it was the smoothest my brain had felt in years. Just ask for a small, conservative dose. And I agree w/ racer, maybe a new therapist might be the ticket and/or a new approach. CBT has helped me *so* much; I know it's probably scary to think of going to another doctor, but maybe you can find one nonetheless.

All my best,
Man-oh-man

 

Re: treatment resistant depression

Posted by rvanson on May 24, 2004, at 2:23:49

In reply to treatment resistant depression, posted by LindaGail on May 23, 2004, at 6:04:39

> What do I do when nothing works? I have been literally on every antideppresant and have had treatment for 10 years and am still severely depressed. I am on a cocktail of meds. remeron, zoloft, geodon, and topamax. I see a psychologist and a psychiatrist. I have been hospitalized 3 times this year-2 overdoses and one attempt at hanging myself. I also cut. Sorry if that is shocking. I am past that now. I just want to get better. Any suggestions?

Well, you could try ECT, but you have to weigh the benefits/risks of long term memory deficits.

 

Re: treatment resistant depression

Posted by LindaGail on May 24, 2004, at 5:43:11

In reply to Re: treatment resistant depression, posted by rvanson on May 24, 2004, at 2:23:49

Believe it or not I had ECT once a long time ago. It gave me only short term relief, short term memory loss and I still remember the horrible headaches! And I was on lithium once, but would try it again. I have been through 3 psychiatrists and 2 psychologists. I lke the ones I have now. But would be willing to try a new therapist and get a 2nd opinion from another doctor on my meds. I would try any new med. like zyprexa although I've heard it caused weight gain which I DO NOT need or risperadal although geodon is also a new generationan antipsychotic, which is supposed to be helping with anxiety symptoms. Thanks for all your ideas I will consider them. I sure would like a benzo, but my doc REFUSES to give me one-like ativan or xanax. I think I need one-but I overdosed on ativan and he thinks I'm too impulsive to have them.I may call him again today and beg for one.

 

Re: treatment resistant depression

Posted by man_oh_man1977 on May 24, 2004, at 15:24:12

In reply to Re: treatment resistant depression, posted by LindaGail on May 24, 2004, at 5:43:11

Hey Linda,

Geoden is good b/c it doesn't cause weight gain. Try asking your doc for Klonopin - it's really not a drug of addiction, although some might disagree, and is an excellent benzo. I am so sorry that you have hit such a rough patch. FWIW, I hope you get some relief soon. I am happy you would be willing to try lithium again; it's a good adjunct to a decent cocktail - according to my Pdoc, lamitcal, a small dose of lithium and then whatever else. btw, have you ever tried Neurontin?

All the best,
Man-oh-man

 

Re: treatment resistant depression LindaGail

Posted by almondjoy on May 25, 2004, at 15:02:07

In reply to treatment resistant depression, posted by LindaGail on May 23, 2004, at 6:04:39

Hey Linda,

Make sure all possible physical medical causes/contributions are eliminated. Even if you've had everything checked out before, if it hasn't been in the past year, try it again.

After 5 years of unsuccessful treatment, I just had lab tests come back abnormal (my tsh was super low even though my t3/t4 is normal). i can hardly wait for my next appt with my gp and for him to talk to my pdoc about it.

take care

d

 

Re: treatment resistant depression

Posted by wraith on May 25, 2004, at 16:06:53

In reply to Re: treatment resistant depression LindaGail, posted by almondjoy on May 25, 2004, at 15:02:07

I too suffer from Resistant Depression and had been through a slew of AD's and Mood Stabilisers with little effect. After trying Surmontil with Nardil and Tegretol sent my moods up and down, my Psychiatrist prescribed Lithium to augment Amitriptyline (100 mg) and Propranolol (80 mg). I was also given Lorazepam to smooth the transition.

This was 2 months ago and I can honestly say I have never felt so good. It seems as though the depression which has followed me most of my life has evaporated and I now view life differently. Please don't think I am gloating but there is hope.

Regards

 

Re: treatment resistant depression

Posted by LindaGail on May 26, 2004, at 11:05:34

In reply to Re: treatment resistant depression, posted by wraith on May 25, 2004, at 16:06:53

> I too suffer from Resistant Depression and had been through a slew of AD's and Mood Stabilisers with little effect. After trying Surmontil with Nardil and Tegretol sent my moods up and down, my Psychiatrist prescribed Lithium to augment Amitriptyline (100 mg) and Propranolol (80 mg). I was also given Lorazepam to smooth the transition.
>
> This was 2 months ago and I can honestly say I have never felt so good. It seems as though the depression which has followed me most of my life has evaporated and I now view life differently. Please don't think I am gloating but there is hope.
>
> Regards
> I've never heard of propranolol-is it an antideppresant?
>
>
>

 

Re: treatment resistant depression

Posted by PhoenixGirl on May 26, 2004, at 13:55:08

In reply to Re: treatment resistant depression, posted by LindaGail on May 26, 2004, at 11:05:34

Hi Linda. I totally feel your pain, I've had almost the exact same experience as you. I'm 26, and have been fighting depression since I was 12. I've been on almost everything, except an MAOI, which I am now about to try.
Have you thought about trying TMS (Trans-cranial Magnetic Stimulation)? I know you can get it in Atlanta, and there are some other places too. In Atlanta, there is a psychiatrist who does it, so you don't have to be in a study. It is still investigational, so insurance does not cover it, but the only side effect is a temporary headache. You have to get it done fairly frequently and keep getting it done for it to keep working. Of course when we suffer from treatment-resistant depression, we're willing to go to these lengths.
There is also VNS (Vagal Nerve Stimulation), in which they put a "pacemaker" type of device in you. It was originally meant for people with epilepsy, but it has been found to help people with depression too. I almost participated in a study for it in Atlanta, but the last time I looked there weren't any ongoing studies for it. I would check to find out anyway, though. It's also not approved for depression, and can have more side effects than TMS.
If I were you, I'd search for information on both of these options on the internet. Find out if and where you can try them.

 

Re: treatment resistant depression LindaGail

Posted by terrics on May 26, 2004, at 15:40:59

In reply to treatment resistant depression, posted by LindaGail on May 23, 2004, at 6:04:39

Hi LindaGail, Someone else seems to have almost the same combo as I do. It works to some degree for me. Lithium, wellbutrin, effexor, and klonopin. Also propranolol which stops the shakes from the lithium. It is a blood pressure med. and also has calming effects. terrics It is a real drag to be so depressed. [I am trying DBT ]

 

Re: treatment resistant depression

Posted by wraith on May 27, 2004, at 4:58:04

In reply to Re: treatment resistant depression, posted by LindaGail on May 26, 2004, at 11:05:34

LindaGail,

OOps sorry I am using the english name. Propranolol is a beta blocker which helps for anxiety it kind of nullifies the flight or fight response. Its also very useful in stopping the lithium shakes. Propranolol is known in the UK as Inderal.

Hope this helps,

Take care

 

Re: treatment resistant depression

Posted by LindaGail on May 27, 2004, at 5:21:13

In reply to Re: treatment resistant depression, posted by PhoenixGirl on May 26, 2004, at 13:55:08

> Hi Linda. I totally feel your pain, I've had almost the exact same experience as you. I'm 26, and have been fighting depression since I was 12. I've been on almost everything, except an MAOI, which I am now about to try.
> Have you thought about trying TMS (Trans-cranial Magnetic Stimulation)? I know you can get it in Atlanta, and there are some other places too. In Atlanta, there is a psychiatrist who does it, so you don't have to be in a study. It is still investigational, so insurance does not cover it, but the only side effect is a temporary headache. You have to get it done fairly frequently and keep getting it done for it to keep working. Of course when we suffer from treatment-resistant depression, we're willing to go to these lengths.
> There is also VNS (Vagal Nerve Stimulation), in which they put a "pacemaker" type of device in you. It was originally meant for people with epilepsy, but it has been found to help people with depression too. I almost participated in a study for it in Atlanta, but the last time I looked there weren't any ongoing studies for it. I would check to find out anyway, though. It's also not approved for depression, and can have more side effects than TMS.
> If I were you, I'd search for information on both of these options on the internet. Find out if and where you can try them.


I haven't tried them, but maybe I'll ask my doctor about them..I can't afford them if they aren't covered by insurance.

 

Re: treatment resistant depression

Posted by platinumbride on May 27, 2004, at 23:37:59

In reply to Re: treatment resistant depression, posted by LindaGail on May 24, 2004, at 5:43:11

In my experience, the next best thing (and sometimes better thing) to a benzo is neurontin. Not everyone has good reactions to it, but it has been a lifesaver for me and I am grateful for it in spite of the tweaking it does to my appetite :-(

I wish I had lots of suggestions for you.....I am still trying toi find the right combination, but I know that it would be a relief to just ..exhale.......

Neurontin is a pretty clean drug (though the marketing of it has not been). I bet your doc would write you a script.

I really, really hope that you start to get relief ...I don't know you, but hugs anyway......


Diane

> I sure would like a benzo, but my doc REFUSES to give me one-like ativan or xanax. I think I need one-but I overdosed on ativan and he thinks I'm too impulsive to have them.I may call him again today and beg for one.

 

Re: treatment resistant depression

Posted by LindaGail on May 29, 2004, at 6:10:56

In reply to Re: treatment resistant depression, posted by platinumbride on May 27, 2004, at 23:37:59

My doc gave me vistaril but refuses to give me ativan or xanax. It helps some with anxiety. I haven't tried neurontin. My doc says zoloft, remeron and geodon plus the vistiral should be enough to treat my anxiety. I am trying. My depression comes and goes-for awhile I feel better and then it descends again like a dense fog-a blanket of heavy darkness-hard to explain.

 

Re: treatment resistant depression

Posted by Ilene on May 29, 2004, at 9:07:40

In reply to Re: treatment resistant depression, posted by LindaGail on May 29, 2004, at 6:10:56

> My doc gave me vistaril but refuses to give me ativan or xanax. It helps some with anxiety. I haven't tried neurontin. My doc says zoloft, remeron and geodon plus the vistiral should be enough to treat my anxiety. I am trying. My depression comes and goes-for awhile I feel better and then it descends again like a dense fog-a blanket of heavy darkness-hard to explain.

It's not hard to explain to a person who's experienced it.

Because a drug combination "should be enough" doesn't mean it *is* enough. I *need* to take Klonopin. Nothing else works. I've been very resistant to taking it regularly, but I finally came around a couple of weeks ago and I've been doing much better. I'll be trying the new extended-release Xanax soon because it is less sedating.

You say you like your doctor so you probably don't want to switch to a new one. A second opinion might be worthwhile. I just got one. (He had some interesting, probably useful, but not terribly surprising suggestions.)


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