Misc severe depression not responding to antidepressants

[phatass]

On topic:

For depression that does not respond to "normal" anti-depressants (SSRi's, SNRi's etc.) combining an effeciant anti-depressant with and AD(h)D medication (Ritalin, Modafinil, Aderrall...) will be your best bet for clinical depression.

OP do you see a psychiatrist? maybe you are bi-polar, it would explain the extreme depression, there are two main type of bi-polar, one is up's and downs, one is just downs.... in which case you may need an anti-psychotic medication and or a mood sabiliser, i'm not very familiar with bi-polar but Abilify (Aripiprazole) is an anti-psych / mood stabiliser, that may help...

Seek professional psychiatric treatment ASAP....

keep ya head up

 

[wezface]

Be careful taking SAM-e with your antidepressant as it may cause serotonin syndrome, though this is unlikely at your dose.
I have had the same issue and recently adding aripiprazole (Abilify) has helped me a lot (I switched fro 40mg citalopram to 20mg Lexapro and added the Abilify) though it makes my nerve pain worse.

Have you tried adding an atypical antipsychotic to your antidepressant?

 

[AbqDave]

Interesting thread.

You won't find much support in the medical literature for use of amphetamines or Ritalin, but I've BTDT and I absolutely believe they can be helpful.

I've always thought that buprenorphine had an antidepressant effect. I'm glad they are studying this.

Suicidality is a complex thing. No doubt your brain chemicals play a role. I feel vaguely guilty for passing on my depression genes to my daughter, although I love her just the way she is, and she feels the same, and in the final analysis, the fact that we have journeyed through life together may be the thing that saves us. The playa provides, so they say.

But. There is a psychological/spiritual aspect of it. Critically important to find meaning in life. Wiser people than me have opined that spirituality is a key missing piece for many people. Something to think about.

 

[justtellmewhy7201]

Tried a shit ton of meds for my depression. Cocktail I am on now works wonders but it is totally unconventional so doubt many doctors would go for it. I just am lucky to have an awesome doctor who listens. (Prescribed: Lamotrigine, Xanax, Adderall).

 

[The.Ghost]

Give the mirtazapine another try. When I first got on it (15 mg), it did nothing except put me to sleep, so I soon stopped taking it. Fast forward a bit and I've tried virtually everything over the course of the last half decade. Only two drugs had proven themselves to work at that point: lamotrigine and aripiprazole. But the depression was still tearing at me viciously. I gave mirtazapine another try, titrating to 45 mg. Those thoughts constantly going through my mind, the ones that tear at you every waking second, some obnoxious and some horrendous, simply stopped. I got my life back, for the most part.

Of course, every drug affects everyone differently, so take my story with a grain of salt, but consider trying mirtazapine again. And, as others have said, it can very easily take years to find the right drug / combo.

If you're curious, I got the recommendation from this thread.

 

[P.o.T.u.S]

Try Lyrica it will put u in a good mood and its pretty damn fun

 

[parttimepharmacist]

I suffered from severe depression and anxiety for prolly 6/7 years, over that time I’ve taken a c#ntload of different medications (listed below); here is my experience/advice on their effectiveness, hope it helps

[NOTE: The first group of drugs are mainly for depression but also relevant to anxiety and anxiety related insomnia; the second group mainly for anxiety and anxiety related insomnia; the other three are also relevant but didn’t really fit within the preceding two classes; Ritalin prescribed to me for ADHD (but can in SOME circumstances be effective in combating depression), Phenibut (non prescription but extremely effective), Omega 3 (natural supplement)]

- Amitriptyline (Elavil); starting 15mg> then 25mg> 50mg> 150mg.
- Fluoxetine (Prozac); 20mg (I think)
- Citalopram (Celexa); 20mg (I think)
- Paroxetine (Paxil); (can't remember dosage)
- Quetiapine (Seroquel); 25mg at night

- Alprazolam (Xanax); .5mg up to 3x daily; then 1mg up to 3x daily
- Clonazepam (Klonopin); .5mg as required
- Temazepam (Normison); 10-30mg (in 10mg tabs) as required

- Methylphenidate (Ritalin IR); 60mg (in 10mg tabs) daily in divided doses (3 doses of 20mg at 3hr intervals)

- Phenibut (HCL crystals); 500mg> 1000mg> 1500mg daily (will explain dosage below)

- Omega 3 Fish Oil (NOT the odourless); 30,000mg daily (15 x 2000mg caps)

Amitrip:
This is a tricyclic antidepressant, it is a bit older and a lot less prescribed than SSRI’s, it is also sometimes used as an analgesic for certain types of pain. I was prescribed this primarily for insomnia, starting at 15mg (blue pills), then 25mg (yellow) then 50mg (orange) and then 150mg (3xorange). Amitrip makes you VERY drowsy initially but sometimes this effect lessens over time, for me it still puts me to sleep. If you are not sleeping because you are depressed/anxious then it might pay to give amitrip a try. I think 25mg is a good dose, 50 will make you sleep for 10-12hrs if you start out on it. When you wake up after an amitrip sleep you’ll feel rested and groggy at the same time (hard to explain), it does help quiet your mind down if you get what I mean, it also is a bit more ‘numbing’ than the SSRIs. Amitrip is good if you cant sleep and don’t want SSRI’s, I take it every now and then if I want to sleep. It didn’t help ‘fix’ my depression in the way some SSRI’s can but is good if you need relief from not sleeping / over-thinking things, plus its generally regarded as having no abuse potential so it should be easy to get from your doc. Amitrip also makes you hella sweaty.
NOTE: You MUST NOT take it with Ritalin, the two medications mutually prevent each other from metabolizing i.e the amitrip will make the Ritalin not work and the Ritalin will stop the amitrip from metabolizing, then when the amitrip eventually does breakdown any Ritalin you’ve taken will have remained in your blood (in its inactive metabolite form) and will suddenly kick in all at once. Learnt this the hard way.

Fluox/Prozac:
I took this for about three weeks, didn’t give it a chance to work really, this was after I had tried amitrip so I was looking for the same kind of instant result (this was years ago before I bothered to learn anything about how these medicines work). It takes three months to start working, it also makes it really hard to cum so you end up jerking off until you hurt yourself – but to no avail – which is pretty common for SSRIs in general I think.

Citalopram:
SSRI same as above, didn’t really give it a chance, same side effects.

Paroxetine:
This worked for me BUT I gave it a chance, I took it for 6months followed by a 1month taper (the withdrawl symtoms are quite bad, nausea, headaches, insomnia, even if you forget to take it one day you’ll start feeling sick, took me a while to figure out why I was feeling like shit). This was done IN COMBINATION with CBT & counseling, healthy diet and daily exercise, and I honestly believe that you need all three to fully kick depression, no one thing works on its own; meds+therapy+diet/exercise. If you take it at night you will have CRAZY dreams so take it in the morning. This really did help me kick it but it wasn’t a quick fix and not the end of the story (I’m not going to right this long post and conclude with ‘diet and exercise, TADA!’) but it was effective as part of a full treatment plan.

Seroquel:
This was prescribed to me when I was like legit rock bottom, it is an anti-psychotic but at small doses (25mg) it is REALLY effective for chronic insomnia, plus you do wake up the next day with a more balanced (I could even go as far agreeable) mood. At this time I was taking 3mg of Xanax a day and 150mg of amitrip which were doing nothing and still not helping me sleep. When I first took the Seroquel it knocked me out and I slept for 10+ hours which made a MASSIVE difference, I kinda felt like it ‘broke the cycle’ if you know what I mean. If your depression is causing insomnia, long periods without sleeping have an exponential effect which can make it almost impossible to break out of… I really recommend Seroquel if you’re in that situation. Btw it makes you gain weight (something to do with blood sugar regulation), it also gives you vivid dreams.

Xanax:
There is a million threads on Xanax, it works at first but tolerance builds VERY fast. It reacts explosively with alcohol (makes you forget everything/act crazy dangerous/talk jibberish). It is nice and effective at first. It kicks in right away but only lasts an hour or two. It can make you sleepy. Tastes like shit.

Klonopin:
Supposedly is like long acting Xanax without the drowsiness. Its not noticeable like Xanax but lasts 4,5,6 hrs and definitely reduces anxiety, but same prob; tolerance builds super fast. Its non sedating for most people which is good. Doesn’t react as violently with alcohol as Xanax does. Tastes like mint but I still prefer Xanax (who doesn’t).

Temazepam:
30mg for insomnia, but 10mg can help with anxiety (a little, and may be placebo). Stops working after about 2 weeks. Good to drink with, it helps you get drunk quicker but not cray like Xanax. This is nice to supplement other meds with. Wont do much at all for depression.

Ritalin:
This is prescribed to me for ADHD, 60mg a day is the MAX dose. It CAN help with depression if you are really lethargic and procrastinate heaps but it can often produce WORST WORST comedowns even at the prescribed dose. If you suffer anxiety then Ritalin will prolly make it go away while its working (each dose lasts 1-2hrs) but the comedown will be unbearable; this was the case for me but without it I cant get anything done at all, if ADHD is a real disorder (I’m not 100% convinced) then I have a VERY severe case. I don’t think it is approved for treating depression BUT it is not unheard to have it prescribed off-label for this purpose but I think Adderall could be better. I think if you can get your hands on some Ritalin then give it a try, there are ways to manage/lessen the comedown (which took me some years of trial and error to figure out). The mechanism of action for Ritalin is explained in detail elsewhere but I will say it makes you fell pretty good while its working and it definitely helps you get through the day/get everything done. If you swallow it 2x10mg is enough to get you more or less high for between 1-3 hours depending on what you have eaten and how many doses you have had that day; acidic foods reduce the bioavailability as does taking it on an empty stomach (weird but true), if you take it with milk or with two teaspoons of baking soda and water it will last TWICE as long and be TWICE as strong. If you snort it then 10mg is enough and will last one hour, it will start working in a few minutes (vs 30-90min orally) and feel much much stronger, it will also be out of your system quickly so the comedown is very short (2 hrs vs 4 hrs for oral, i.e 1hr being high +2 more hrs coming down). The BAD THING about snorting is that it will only work properly for the initial dose; Ritalin is a vascular constrictor (like eyedrops) so it will work the first time but after that the blood vessels inside your nose through which it is absorbed will close up (temporarily), so if you snort more you are kinda just wasting it, it will drip down your throat so you will get some effect, but better to swallow it after the first dose until your nose opens up again, prolly not for 4/5 hours. Best to snort one and eat one, then eat take another two with baking soda 90mins later and so on. Anyway I digress, I can totally see how Ritalin can help with depression but only if you can manage the comedowns. I can almost avoid the comedown if: I don’t go beyond 60mg in a day (if im boozing/getting high with friends I’ll do 150mg in about 8hrs and then there’s no escaping the comedown bar taking a seroquel); and I remember to eat every two hours (low blood sugar makes it soooo much worse); and exercise (cardio) for at least 30 mins when it starts to wear off (there is a study for this somewhere); take 15x 200mg of omega 3 fish oil (which I will get to later).

Phenibut:
Ok well I read about this online and like everyone I thought it sounded too good to be true. I had built up a tolerance to basically every benzo to the point where even 1.5mg of Xanax did nothing for my anxiety, so I was despo for something. I ordered the HCL crystals (if you want to know where from PM me) and when they arrived it said take one scoop (500mg) so naturally I took two scoops. Two hours later I felt NOTHING and was ready to throw it out but at T-3hrs it kicked in – it was the most effective anti-anxiety drug I have ever tried in my life, better than my first Xanax, better than everything else actually and completely non-drowsy. I would say its almost impossible to feel bad while on phenibut and it lasts 24hrs+ and it makes you sleep like a baby. I had read about it being addictive so I tried to not use it every day, if you can manage to do it no more than 2wice a week then its perfect, but I just wanted that completely anxiety free feeling so I ended up taking it every day for about a month… when I stopped the withdrawal was mostly physical; rashes and itching, but also insomnia. I had to start taking it again and taper off (reducing but 250mg at a time in 3/4 day intervals) and it took about 3 weeks to come off it. Long term use (over one week) also effects cognition, to the point where I couldn’t really write anything (im a student) and all my work was kinda jibberishy… that’s why I stopped. Now I only use it on special occasions like if im going to a party or having a really bad day. I shelved it once (mixed with water) and it started working about 20mins later instead of 3hrs but didn’t last as long – I had awful anxiety and needed it asap. If you take more than 2g in a day you will overdose, which feels like a REALLY bad hangover; you cant stop throwing up, you cant sleep, the room spins and spins etc and it lasts about 12hrs…. I recommend phenibut and its quite cheap to buy but use it responsibly!

Omega 3:
Look it up, there is a study, my shrink recommended it, it works by reducing inflammation in the brain tissue (a major cause of anxiety/depression), the active ingredients (there are two, one is called EHA I think) are only about 15% (or something) of the dosage stated on the label, i.e 2000mg has about 300mg of the brain-inflammation-reducing compound, and the effective dose of the active ingredient is 3500mg (15x2000mg caps) so you need to take HEAPS but it REALLY WORKS. The difference was dramatic and immediate; if I take the omega 3 + remember to eat and exercise I can take Ritalin with pretty much no comedown….

In summary; I highly recommend Seroquel, Phenibut and maybe Amitrip (but less so) as quick-fix remedies for crisis/rock bottom depression & anxiety situations. Long-term you need to combine an SSRI with diet/exercise and CBT for at least 6 months if you really want to be rid of it. Ritalin might be of use also as above.

Hope this helps, hang in there


PS - Sorry my writing is a little jumpy, I'm currently on a Ritalin bender

dont know why but my smileys keep turning in to J's

 

[phatass]

^^interesting post^^
Mainly for severe, crippling anxiety, and a little depressive side after trying various coctails of meds, i'm more stable (only slight anxiety sometimes now, and no depression at all) than i've been in the past, and i'm Rx'ed Abilify, Zoloft, ER Ritalin, anxiolytic and hypnotic benzos.... it's a lot of meds, but it's enabled me to be more "normal" and happier than i was ie. on SSRI+benzos alone.

Obviously the benzos and ritalin have large abuse potential, and are very addictive more physically for benzos, and psychologically for Ritalin.

 

[Kilfer]

Interesting thread.

You won't find much support in the medical literature for use of amphetamines or Ritalin[...]

You could be surprised. The DEA may have abusive powers but so far it hasn't been allowed to censor medical literature and studies that don't please them; despite its efforts it failed to ban stimulants as treatment for ADD/ADHD, narcolepsy and several other neurological conditions because they could not demonstrate that the neutered stimulants we call antidepressants had any efficacy at treating those conditions. 40 years down the road it seems pretty clear that major depression does not respond to esoteric bug pills either, no matter what. Few remember that Ritalin was originally patented as an antidepressant and while it may have been overkill for treating minor depressive episodes it packed the punch required to jump-start patients dealing with systemic catecholamines depletion which causes the state of complete and total hopelessness, that incapacity to derive pleasure from anything, the utter existential dread that only someone dealing with Major Depression Disorder, Bipolar Disorder Type I and II, and Unipolar Disorder could describe.

Since the late 1970's and up until recently the treatment for such episodes was often repeated hospitalizations in psych wards where patients were kept for a couple weeks on sedatives and tranquilizers so they would sleep 18 hours a day, hopefully dreaming of a better life, then sent home with benzos, antipsychotics (which the majority of them did not need) and worthless (for their condition) antidepressants. This form of treatment is extremely expensive and, in a vast number of cases, totally inappropriate. Insurance companies employ people who know of better alternatives and are growing impatient with regulators.

Regulators like antidepressants because they are not addictive which until recently they saw as the ultimate virtue. But what good is a "virtue" that is detrimental to the best treatment of a patient's for his or her condition? Unlike the DEA its parent agency the FDA reports to Congress where nickels and dimes must be accounted for, and where insurance lobbies have sway. Congress has little time for DEA's doomsday scenarios. After all 6-year-olds take Ritalin so what's the big deal if it keeps depressive adults out of hospital? As a first step and to the DEA's dismay bupropion, an evil amphetamine, was let loose of depressive people. Amazingly no Armageddon ensued, the stuff was even more harmless than a Vicks inhaler. DEA 0 / Common Sense 1

Second inning is now in progress. As we can see in this thread, Common Sense may have a running chance at triumphing again. The DEA's view of the world is that of law enforcement. Many BPD patients have criminal records (often as a result of their condition) and a history substance abuse (mostly stimulants, guess why) and therefore should be treated in a punitive fashion and not be entrusted with substances that they may sell to drug dealers. Trust me if you have BPD you will not part with the only thing that can pull you out of Hell. Fortunately many politicians do not share the DEA's vision.

 

[umfree14]

This may sound dumb but mushrooms? Try maybe addressing the root of the depression?

 

[figaro44]

Itys taken me 10 yrs and 6 diff tries. but i was determined to find good counseling and a pychtriast at a diff place. I also had trauma so i decided when id go looking for therapists i wanted one that specialized. thats what i got and shes just amazing. I never thought it was gonna happen. and then i let her pick the psych to perscribe my meds and i like him alot too. You sound like your pretty bad right now. your at the hopelessness stage you think this is just life now and at the time i did not want to do anythiung i enjoyed nothing everything the smallest things were huge chores.The hopelessness made me take my self to the pysch hospital.Cuz i knew I wasn't going on in lifwe like that. The scary part was just oh god what if this doesn't work. but it did id say within 2 days.