Mental Health What's left to try? Treatment Resistant Depression

[TastyMud]

Tianeptine (12.5 mg 3x daily for 2 weeks, noticed a slight increase in mood/motivation)

I had wonderful results with Tianeptine Sodium, but I was taking 30-40mg BID.

What country do you live in? I was speaking with a fellow BL'er who told me they have begun, with positive results, Valdoxan (agomelatine). This person lives in Australia, though it is prescribed in the EU, too. In 2011 there were plans for Novartis Pharma to begin marketing the drug, but Im not sure what happened to it as it is 2013 and still not FDA approved, no marketed at all in the US.

It's mechanism of action is really rather interesting! Here is the Pharmacodynamics section of the Wikipedia article on agomelatine:

Of all the meds mentioned these two are definitely some of the more unusual brands. Like yourself op I tried tianeptine got an initial buzz from it which faded fast then gave up on it in a very similiar time scale to your own but I have heard that if you stick with it ie 2-3 months then the effects of it can be very good. Many people make the mistake of trying it getting an instant fix then thinking it has stopped working once the buzz wears off. I made this mistake also so something to bare in mind. Of your list I havent tried them all but been through quite a few one of the most effective for me (ie I felt something) was effexor but it made me feel totally out of my mind and I couldnt imagine being able to function normally on it. After about 3 months I gave up.

Re Valdoxan ive actually axed what the psych is telling me and made the decision to purchase this stuff myself. I too feel there is some very unusual qualities about this drug and I plan to try it soon. Other than that I feel with all of this AD medication there always seems to be something missing. It never seems to work properly. I hate to sound like a conspiracy theory developer but judging by the money the likes of Effexor make selling this junk I cant see there being a massive motive to actually develop something that works. Maybe one day there will be a pill that fixes us

 

[Anthrogirl]

Hey there! I'm sorry to hear that you haven't found the right med or combo of meds. However, I must admit that I was surprised along with the other posters at some of the meds the doc had you taking (in combination with each other).
Anyway, I wanted to ask if you have tried any type of talk therapy along with medication? Psychotherapy (whether cognitive, behavioral, psychoanalytical, etc) in conjunction with medication has been shown to be more effective at treating depression than either treatment alone. You may have to try out a few therapists and different therapy approaches until you find one that works for you (just like with meds) but studies have shown therapy to be just as effective as medication. Combined with medication it's even more effective!
Another poster mentioned exercise, I second this advice. Also, have you had a blood work up done to check your vitamin levels? I know it sounds weird but I had mine checked when I was really depressed. I found out that I had really low levels of vitamin D and that this is pretty common. I was prescribed a vitamin D supplement and I started taking a high quality Multivitamin daily. The Vitamin D supplement did help my depression. Low levels of vitamin D have now been linked to depression. Here's a link about it: http://www.m.webmd.com/depression/news/20120627/vitamin-d-deficiency-linked-to-depression
I also started taking a fish oil supplement daily. Omega 3 fatty acids have superior efficacy to a placebo in treating depression. Here's a link: http://abcnews.go.com/m/story?id=129498

As far as antidepressants go, the one that worked best for me was Effexor XR. However, it looks like you've at least tried the instant release version of this drug. You could talk to your doctor and try the extended release to see if it works better for you.
I saw that another poster mentioned opiates. Opiates are effective in treating treatment resistant depression. However, they have been used rarely as a LAST resort for people who have major depression. You have to seriously weigh the risks versus the benefits. Only you and your doctor can decide this but I would strongly caution against it since you have dysthymia and not major depression. I would try everything else first hon. I feel the same way about ECT but that's just me. I realize that it has helped some people. Good luck!

 

[Anthrogirl]

Okay, I just realized that I missed the part of your post where you mentioned that you have tried therapy and it didn't help. I'm sorry about that. However, did you try different types of therapies? There are hundreds. Perhaps one will work better for you than another. If you like art there is art therapy. Or if you're social there's group therapy. Some therapists even do pet therapy now, lol. I always liked cognitive-behavioral but there are a lot of different approaches. Just a thought..

 

[calebtrask]

Thanks for asking - I've been in various types of talk therapy and group therapy on-and-off since I was about 8. I feel like I've kind of hit a wall with it, and I'm hoping that meds can kind of push me over that so I can make progress. I got my blood checked the last time I was in a hospital (about 3 months ago) for both vitamin deficiencies and thyroid problems that can cause depression, but I'm in the healthy range for both of those. I've also done several courses of ECT with varying effects. Overall, I stopped because I wasn't feeling any better and was getting side effects that I couldn't deal with at that time.

Sorry I didn't specify, but I was on Effexor XR when I was taking it. Also, I have dysthymia, but I have gotten severe major depressive episodes my whole life and have an anxiety disorder that goes along with it. Since I've been in my latest program I've also picked smoking back up (unfortunately =/) to kind of deal with the stress, but I'm going to try and see if it has any antidepressant effect going forward.

As far as Agomelatine (Valdoxan), it's definitely caught my attention and I'm considering buying some online because it's not approved in the US. At least it seems like it would help with my sleep cycle, which is pretty erratic. I'm also re-considering Tianeptine again because I did have a positive response while I stayed on it, and if I do get more, I'll go with your suggestion TastyMud and stick with it for a few months.

Thanks for all the feedback so far - it's much appreciated.

 

[Middleway]

My personal experience.

I have been on, I think, literally everything.

I was on dexamphetamine with Nardil (maoi) it was a hard combo, dosing several times during the day.
I also gave me maked hypotension, that's right, low blood pressure, crashing through my boots low.

I even passed out a couple of times until my body got used to it.

I was on Nardil and agomeletine until recently when I dropped the ago.

The ago is a hard one to put your finger on, very benign drug, no side effects at all which is weird.

I do think it helps but I kinda feel that you geta tolerance too and it stops working.

Dexamphetamine turns me into a hoarder of junk, literally filling my house with crap I found on the street. Once I stopped it, the behaviour stopped, very very odd.

The only thing that has helped me has been Nardil but the side effects are horrendous, particularly the weight gain.
You are just starving all the time and it give you a pseudo hypoglycaemia so you actually feel sick with hunger.

I dropped from 5 tablets a day to 2 in January and I am now 12kg lighter, without even trying....but I am also unable to work on this low dose and basically a shut in.

I dunno what to do, my problem is terrible anxiety and panic attacks, life is starting to feel pretty pointless. I can't work, socialise...you star to wonder if there is really any point going on, I I say this from a relatively underdressed state of mind.
I may as well be in prison, I have no life

 

[paranoid android]

Just because you've heard something different doesn't mean I'm wrong. Drugs affect everyone differently and just because Desoxyn didn't work for one person, doesn't mean it won't work for him.

You could be right and there is the occasional person who responds well to Desoxyn when they don't to all the other ADHD meds. But in MY experience they are in the minority.

Also, it's "Adderall" not Aderrall.

Wow you arent nit picky are you?

This isn't uncommon. If you notice, he states it's Adderall IR, not XR. This leads me to assume that he take his Vyvanse in the morning, and the Adderall is as needed in the afternoon.

It's not uncommon to get a instant release form of a medication and a extended release form of a medication no. But I HAVE NEVER HEARD of someone being on 2 different amphetamine preparations. Someone taking Dexedrine IR with Dexedrine spansules is not that uncommon at all though.

He's tried literally everything, the fact that he's on so many different medications really resonates the severity of his condition. On a side note. Cymbalta is actually an SSNRI (Serotonin Norepinephrine Reuptake Inhibitor)

Your really not nit picky 8)

That's totally inappropriate. Yes - he's on many medications, I am as well due to the same reason. But saying that his medications are what is causing the problem isn't for you to decided and it actually quite rude.

Okay i maybe worded that badly but let's face it over medication can screw a person up. I have seen it happen more times then i can count. I am on alot of medications as well for bipolar disorder (lamictal, wellbutrin, Quetiapine and clonazepam to be exact) and i am not playing the doctor here. It was merely a suggestion i didn't pass it down as fuckin gospel now did i?

Assuming information, especially when it's about medication is very irresponsible. Yes there is a need to be on both - I stated that above. Please do your research before you make assumptions.

Well wouldn't saying that he needs to be on both be also making a assumption?

An MAOI may be worth a try, however, selegiline has MANY side-effects. Just because it's in the form of a transdermal patch isn't going to change this. Also, it should be clarified that an Amphetamine should NEVER be taken with an MAOI.

No but it has less side effects and is less risky then taking a non selective MAOI in pill form. The cheese reaction which is the biggest danger of MAOI's happens in the gut so transdermal application bypasses that.

Both of these are incredibly dangerous information. The potential for addiction to opiates is almost unmatched to anything and I've never heard of these being used clinically for depression. While they may provide an antidepressant effect, relying on opiates for something like depression is one of the best ways to set yourself up with an addiction. This is only done under circumstances that are even more extreme than the treatment-resistant depression the OP is dealing with and really shouldn't even be mentioned.

You should also never use experimental drugs for something like depression unless told to do so by a doctor.

I threw those out there as a last ditch option. I do no people that have been prescribed tramadol for depression (it has SNRI properties) and since it's not a controlled substance where i live doctors don't look it at as that big of a deal. I also know people that have been scripted bupe for depression as a last ditch effort. But your right of course tramadol is a very addictive drug despite what some say but i just threw that out there with the bupe, ket and scopolamine as something worth trying if everything else fails. Personally i don't think opioids and certainly not ketamine or scopolamine are as dangerous as Amphetamines but such is my opinion that i am entitled to. You are entitled to yours as well. I didn't say anything like stop taking your meds now did i?

Your awful touchy i'll give ya that

 

[Lightning-Nl]

Your awful touchy i'll give ya that

Yeah, I apologies for the assertiveness of that post. I was pissed off when I wrote that and my OCD took over when I saw "aderral."

I do have to say, however; that I don't think I would consider Ketamine safer than prescription amphetamines. Disassociatives bind to the NMDA receptor, which is the primary binding site for glutamine. By antagonizing NMDA it stops the effects of glutamine, almost literally inducing diabetes for the duration the drug is active. Ketamine also has some potent u-opioid activity.

Amphetamines have their own risks as well, but (in my opinion) to a lesser extent to that of Ketamine.

Desoxyn I personally thought would be a great choice for him due to that fact that; unlike the isomers of Amphetamine, that only have slight serotonergic activity, Methamphetamine has just as much effect on serotonin as it does for that of Dopamine and Norepinephrine as well.

 

[Starseed]

LAMICTAL! I am on a Lithium Lamictal combo for Depression/Bipolar1.. Lamictal has ZERO side effects.. once you get past the slow titration and have no adverse reactions.. you are home free. It works to keep my depression at bay.. I get low, but never dark, hopeless low. Good luck!

 

[neversickanymore]

thats at least +3 for lamictal

 

[Libby]

When you had citalopram what dosage was it?
I am aaaaaallllllllllllllll excite about the citalopram of joy in my tummy, even though I have to start to 20mg tablet and psych says he doesn't expect it to work until on 2 or 3 pills.. I await the joy that will be joyness.
I asked what would happen if the citalopram doesn't work coz I've been on a different SSRI and a tri-cyclic in past which never had any effect, and he said we will up dosage, and I said so it WILL work, and he said Yes.
I assume that means keep taking more until it has to work sometime. :D
But I am not prescribed it for depression so maybe different, but still the joyness that is to come in my tum tum tum.

 

[paranoid android]

Yeah, I apologies for the assertiveness of that post. I was pissed off when I wrote that and my OCD took over when I saw "aderral."

I do have to say, however; that I don't think I would consider Ketamine safer than prescription amphetamines. Disassociatives bind to the NMDA receptor, which is the primary binding site for glutamine. By antagonizing NMDA it stops the effects of glutamine, almost literally inducing diabetes for the duration the drug is active. Ketamine also has some potent u-opioid activity.

Amphetamines have their own risks as well, but (in my opinion) to a lesser extent to that of Ketamine.

Desoxyn I personally thought would be a great choice for him due to that fact that; unlike the isomers of Amphetamine, that only have slight serotonergic activity, Methamphetamine has just as much effect on serotonin as it does for that of Dopamine and Norepinephrine as well.

Well we will have to agree to disagree on that. The only Amphetamine i have taken is dextroamphetamine and despite it being one of the smoother amphetamines binging on that made me think i was having a heart attack and gave me chest pains on and off for about a week after. Not to mention the high doses produced a very dark depression that had a bottomless pit after 2 or 3 days of straight use even before i stopped taking it to come down. I really should have gone to the doctor about it looking back on it because the chest pains could have been very serious. But i was taking doses way past what any sane doctor would prescribe and i was eating both the IR's and spansules at the same time so i would be spun out for 3 or 4 days at a time sometimes. However when i could keep the doses low it did help the depression side of my bipolar quite abit. Fat chance of any doctor prescribing it to someone with bipolar disorder who sometimes get psychotic features . I did test positive for ADHD but i don't think i have it personally but i wouldn't mind a small prescription for it for when i am really suicidally depressed. The only anti-depressant i can tolerate these days really is wellbutrin and although it does help especially with SAD alot i still sometimes get very depressed on occasion.

With ketamine not only did it not fuck with my moods but it helped stabilize them and help the depression with no after effects. This effect lasted long after the drug had worn off. Thankfully i don't find ketamine to be compulsive at all and i can make a gram of good ket last a week.

Good point about the Methamphetamine though. It does effect serotonin quite abit where as dextroamphetamine is pretty selective in terms of affecting Dopamine and norepinephrine only. So with the different binding affinity it could very well help certain people more then others. Good thinking on that

 

[AlphaMethylPhenyl]

Try switching the lorazepam with clonazepam or alprazolam - Buenos which have clinically shown to reduce depression.

 

[Glass9979]

Tried everything. Two days ago tried nuvigil 250 mg. you can get a <very cheap> trial coupon they are expensive but already feel better. Used to sleep all day and not care to live. I see hope now. Also on we'll Turin Prozac and depakote for bipolar. Every dr has a diff diagnosis

 

[herbavore]

I realize that this discussion is about medications and I hope you will in no way construe this as trivializing what you are going through, but have you ever considered radically changing your life (emphasis on radically)? Sometimes the parameters are not real though we have been conditioned to see them that way. Sometimes there is an imbalance between the expectations of others (family, social class, culture) and our authentic natures. Sometimes we are stuck in lives that do not fit. I do not want to sound like I am anti-medication (I'm not--I am just really cautious about it and see it as a truly last resort with negative consequences that must be weighed). I also commend you for trying as diligently as you do to find what works for you; that is not easy to summon the motivation for when you are depressed.

 

[AlphaMethylPhenyl]

Sorry if someone has mentioned this, but maois are extremely effective.

Actually I have bp with psychotic features and one of the only things that helps is amp, believe it, or not...

And I'm prescribed it, just in conjunction with a medicine which reduces firings.

 

[calebtrask]

I realize that this discussion is about medications and I hope you will in no way construe this as trivializing what you are going through, but have you ever considered radically changing your life (emphasis on radically)? Sometimes the parameters are not real though we have been conditioned to see them that way. Sometimes there is an imbalance between the expectations of others (family, social class, culture) and our authentic natures. Sometimes we are stuck in lives that do not fit. I do not want to sound like I am anti-medication (I'm not--I am just really cautious about it and see it as a truly last resort with negative consequences that must be weighed). I also commend you for trying as diligently as you do to find what works for you; that is not easy to summon the motivation for when you are depressed.

Thanks for pointing this out - the more I think about it the more it seems to me that something like this has to be done if I want lasting remission from depression. I will say that I've done this once before, and initially had a wonderful experience. I stopped working full time to move to a new state and start graduate school in a topic I'm passionate about. The first two semesters were probably the closest thing I've experienced to true euthymia - I was on wellbutrin and adderall to help manage ADHD, but that was the extent of my meds. The only downside to this was that I was isolating simply because grad school is exhausting. This, combined with a really hurtful relationship that I ended, sent me into a downward spiral of anxiety and depression. Not really knowing many people around me and being detached from most of my family and friends made it really difficult to ask for help, and by the time I did, I had done some serious emotional damage. I'm currently debating whether or not I should move back to continue with school in Sept.

I'd love to hear some stories highlighting the positive effect this has had on people if anyone is inclined to share. As for meds, I'm currently titrating down on Cymbalta in the hopes of starting Parnate + Lithium in a few weeks. I've also been prescribed the antipsychotic Asenapine to deal with recurring nightmares that I've gotten since I was a child.

 

[Lightning-Nl]

Sorry if someone has mentioned this, but maois are extremely effective.

Actually I have bp with psychotic features and one of the only things that helps is amp, believe it, or not...

And I'm prescribed it, just in conjunction with a medicine which reduces firings.

Ha! I'm exactly the same way! I have bipolar type 1 with heavy phsycotic elements to it. Everybody on /mental health tried to tell me that amphetamines exacerbate bipolar, but I've found they greatly reduce my symptoms the majority of the time.

 

[paranoid android]

Ha! I'm exactly the same way! I have bipolar type 1 with heavy phsycotic elements to it. Everybody on /mental health tried to tell me that amphetamines exacerbate bipolar, but I've found they greatly reduce my symptoms the majority of the time.

There is very little hope of getting a prescription for any Amphetamine if you have bipolar disorder and especially with psychotic features. I have bipolar NOS with features of rapid cycling, mixed states and psychosis. Though i only get psychotic when in the midst of a really bad manic or depressive state or a mixed one. Every doctor seems to have it jammed into their heads that Amphetamines are absolutely contradicted in anyone with bipolar disorder. Hell the first time i took Dextroamphetamine i was so scared of setting off a severe manic episode that i made sure i had 20mg's of zyprexa zydis on me but it didn't trigger anything even close to a manic episode. In fact my overuse of Dexedrine would trigger a severe depressive episode not a manic one. I certainly find serotonic anti-depressants to be far worse for destabilizing my moods atleast.

 

[pup]

Thanks for pointing this out - the more I think about it the more it seems to me that something like this has to be done if I want lasting remission from depression. I will say that I've done this once before, and initially had a wonderful experience. I stopped working full time to move to a new state and start graduate school in a topic I'm passionate about. The first two semesters were probably the closest thing I've experienced to true euthymia - I was on wellbutrin and adderall to help manage ADHD, but that was the extent of my meds. The only downside to this was that I was isolating simply because grad school is exhausting. This, combined with a really hurtful relationship that I ended, sent me into a downward spiral of anxiety and depression. Not really knowing many people around me and being detached from most of my family and friends made it really difficult to ask for help, and by the time I did, I had done some serious emotional damage. I'm currently debating whether or not I should move back to continue with school in Sept..

I was thinking something similar. I'm all for therapy/psychs/meds but. Also for incredible life experiences. You deserve it, after having so diligently tried to slay depression, once and for all

Look into your school refund policy if they have one (like, how many weeks can you stay in school, and then take a medical leave, before they give you refund on tuition. How do they treat medical leave, if they even have one? that sort of thing.) it might be time for another go at grad school.

School x depressions SUCKS. BUT... It's possible. And for me, made my life a little more bearable, I think, than when I didn't go to school (ie: i was having mental breakdowns and stuff during school but had sympathetic friends, deans, psychs, professors. Etc. summer vacas and winter breaks I basically was like one step from falling off a cliff cos I was having mental breakdowns and no support network.)

This time around you are equipped with the right tools... Making friends or joining some sort of extracurricular in order not to isolate yourself... Feeling free to ask for help as soon as you need it (and don't feel ashamed to ask for help even if it feels a little too late to be asking for help. I know that's obvious but I hope when the time comes you'll remember me giving you permission!)

I don't know how your school is but if they have mental health services, any disability support (our school included mental health,) and student life deans .... And especially professors... Just make friends with all of them. Set up meetings, introduce yourself, most would be happy to cut you some slack if you explain that you have been dealing with this your entire life but don't want it to get in way of your education. I know it sounds really crazy but of these people are people too just like me and you and likely have been or know someone who has been affected by mental illness. So once they know what's up, hopefully it's easier to reach out for help when you really need it and you can stay in school.

My school and your school are obviously different but even if not all of these work I hope you might get some idea... And well... *hug* I'm hopeful for you and really hoping the best for you

 

[calebtrask]

I was thinking something similar. I'm all for therapy/psychs/meds but. Also for incredible life experiences. You deserve it, after having so diligently tried to slay depression, once and for all

Look into your school refund policy if they have one (like, how many weeks can you stay in school, and then take a medical leave, before they give you refund on tuition. How do they treat medical leave, if they even have one? that sort of thing.) it might be time for another go at grad school.

School x depressions SUCKS. BUT... It's possible. And for me, made my life a little more bearable, I think, than when I didn't go to school (ie: i was having mental breakdowns and stuff during school but had sympathetic friends, deans, psychs, professors. Etc. summer vacas and winter breaks I basically was like one step from falling off a cliff cos I was having mental breakdowns and no support network.)

This time around you are equipped with the right tools... Making friends or joining some sort of extracurricular in order not to isolate yourself... Feeling free to ask for help as soon as you need it (and don't feel ashamed to ask for help even if it feels a little too late to be asking for help. I know that's obvious but I hope when the time comes you'll remember me giving you permission!)

I don't know how your school is but if they have mental health services, any disability support (our school included mental health,) and student life deans .... And especially professors... Just make friends with all of them. Set up meetings, introduce yourself, most would be happy to cut you some slack if you explain that you have been dealing with this your entire life but don't want it to get in way of your education. I know it sounds really crazy but of these people are people too just like me and you and likely have been or know someone who has been affected by mental illness. So once they know what's up, hopefully it's easier to reach out for help when you really need it and you can stay in school.

My school and your school are obviously different but even if not all of these work I hope you might get some idea... And well... *hug* I'm hopeful for you and really hoping the best for you

Thanks for the support, I definitely appreciate how understanding and helpful the community has been here! Thankfully I was able to get a medical withdrawal from school because I was hospitalized and my professors have been very supportive and accommodating. The only thing that really makes me uneasy about returning to grad school is that I am in a small and very competitive environment just by the nature of the program. I'm less worried about pressure from my advisor than I am about the pressure I'll put on myself. I have found support groups really helpful in managing this recently, but my past experiences with them have been mixed and I don't want to totally rely on them to do well. Unfortunately the difficulty socializing with other grad students will be the same - I'm at least 4 years younger than all of the other students in my program. Most of them are married and/or parents whereas I'm neither, and we overall tend to lead different social lives.

Also for anyone with lingering interest on my medical situation - after stopping bupropion and amphetamine at the same time so I could start tranylcypromine (parnate), I started having several episodes of sleep paralysis almost every day. I've had these infrequently in the past but never with this kind of frequency. My doctor thinks that this and my having night terrors as a child could mean I have some form of sleeping disorder. He put me back on lower doses of bupropion and amphetamine and added 10mg of diazepam at night saying this would help eliminate the sleep problems. We're still considering the effectiveness of parnate + lithium + amphetamine, though I'm still somewhat hesitant because that's a difficult medication commitment.

Thanks again for all the positive feedback!