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Mental Health Treatment-resistant psychotic depression

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skibum801

Greenlighter
Joined
Sep 19, 2011
Messages
8
Hey,

I have tried a plethora of medications, ECT (electroconvulsive therapy), and psychotherapy for 4 years. A few times the drugs seemed to help, but nothing has lasted. The combination that seemed to work the best, though, was Remeron (mirtazapine) and Effexor XR (venlafaxine hcl), however, there were a few complicating factors. One was that I was told I was a rapid metabolizer of the Effexor XR. This meant that I had to take more of the drug in order to reap the same benefits. The drug seemingly stopped working, though, which is what I'm not sure about, while I was still on the Remeron (mirtazapine). I guess I can't be sure if the Effexor XR stopped working or if it was the Remeron, but it's insignificant now.

With that said, what would be a good next step as for a new drug or treatment? I am almost certainly against doing ECT again, although it may have helped a little. It was far too disorienting for me. I was interested in possibly taking an MAOI. Does anyone have experience with MAOIs? Other recommendations are good, too. I'm currently taking 10mg aripiprazole, 225mg venlafaxine hcl (effexor xr).

Thanks.
 
I've never had MAOI type antidepressants but many years ago my doctor prescribed me mirtazapine. I didn't stay on it long but it was helpful for sleep. I've heard good things about Abilify also Latuda. How is the Abilify working for you? I liked amitriptyline too but my newest doctor would rather not prescribe "older" drugs. It's not easy finding the right meds. Ask your doctor about possibly switching up them up if he's open to it.
 
Damn, imo stay away from that ECT. From what I've read that's basically just a step up from a lobotomy. Sorry that's not really any good advice but I've never actually come across anyone whether online or real life that actually had ECT. Hope you can get something figured out.
 
I'm seeing the doc on Wednesday, so that's good. I just think I need something more serious like an MAOI, because I've been on a lot of SSRI/SNRI-type meds, and also mirtazapine. I was on nortriptyline once and it caused my heart to have an arrhythmia, so that wasn't so good. I'm pretty sure all of the tricyclic medications carry that risk, too.

I want to stop the Effexor as soon as possible, though, so I can get on the MAOI, but I'm not going to do anything until talking to the doctor.

And yeah, ECT was pretty bad, even though it was way less worse than how they depict it in pop culture. It still gives you terrible amnesia and confusion, etc. but you're under general anesthesia. Still sucks though, so there's no way I'm doing that again. It only helped me "modestly" in the words of the doctor, too.
 
Go higher with your Abilify and report back. It has an activating effect. I'm on 30mg, thinking of going higher if doc allows.

There's always clozapine which while having a protocol is supposed to be the most effective at controlling psychotic positive and negative symptoms and if it fixes those maybe your depression will alleviate.
 
Yeah you are on a low dose of abilify for having a bad psychotic disorder. And clozapine is the most effective ap. I take selegiline which is a maoi; I definitely can socialize like never before and I have more energy but I want to switch to parnate.
 
I have bipolar disorder NOS with some psychotic features. When i have been extremely manic or depressed out of my mind or worse yet in a mixed state i get and I've been on a slew of psych meds myself. I was on mirtazapine for abit and it didn't seem to do much besides make me so hungry id eat half what was in the fridge. I don't know if it was the mirtazapine or the fact that i was not on a mood stabilizer at the time but i damn near hung myself one morning in a mixed state after i had been on it a week or so. So yeah that was not a good reaction. Effexor was even worse. The anti-depressants that have actually worked for me are amitriptyline, bupropion (wellbutrin, zyban) and trimipramine. Even though most doctors are wary of giving out tricyclic anti-depressants to people with bipolar they do seem to work for me. Trimipramine is a interesting one because along with being a norepinephrine reuptake inhibitor and of course a strong anticholinergic it also has some anti-psychotic properties as it's a antagonist at the 5-ht2A and D2 receptors. Also i have found some drugs that are not classified as anti-depressants but are used in treatment resistant depression or as a add on to help my depression. I am currently taking lamotrigine (trade name lamictal) as my mood stabilizer and it does help my depression as well. I am also taking quetiapine and i find that it works pretty good for depression. Although it is a anti-psychotic it also has anti-depressant properties and thus is often used as a add on to a anti-depressant or sometimes on it's own to treat bipolar depression.

I know a few people that where diagnosed as having psychotic depression. The standard treatment is a anti-depressant with a anti-psychotic as anti-depressants alone often aren't enough to treat psychotic depression. One woman i used to know who had it did pretty good once she started taking quetiapine and citalopram. It took her ages to find a combo that worked but she finally did. Another person i know was originally diagnosed as having psychotic depression but they where rediagnosed as having bipolar disorder with psychotic features. They where originally put on Prozac by itself and they went completely manic. When she was diagnosed as having bipolar disorder with psychotic features she was put on lamictal and now you would never tell she has any mental illness.

It's basically alot of trial and error and sadly enough even if a medication is working for you they can sometimes stop working especially anti-depressants. No 2 people really react the same to the same med. I reacted rather badly to 2 meds that helped you as a example. As for MAOI's if the Emsam patch is available in your country that would be a option. It's transdermal selegiline and In higher doses selegiline stops being a selective MAOI-B inhibitor but as this bypasses the gut you can take a higher dose of selegiline then you would sublingually without having to worry about food interactions. The older ones such as parnate and nardil are usually last choice anti-depressants due to the numerous food and drug interactions. I have heard good things about them from the people i know who have taken them but they are far more risky then the reuptake inhibitors. But they often do work when nothing else does.
 
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Just wondering one more thing: what would be an adequate dose of Abilify for me? I am on 20mg and have been for 2 days. I have a lot of trouble socializing and saying what I want to say, feeling good socially, and writing things as well. People always say that I seem pretty normal, but I feel awful in social situations because it seems like I cannot think correctly. Would an increase in Abilify target that, or would I just need more antidepressant to target that? I am on 375mg of Effexor XR now. Thanks for the comments.
 
I'd talk to your doctor about 30mg abilify (or the maintena shot) along with wellbutrin. Wellbutrin worked really well for me for two years. When I went off it and then back on it stopped working largely. Counter to the experience of many others, it decreased my cognition.
 
It is a bit surprising that you tried ECT before exhausting all of the different classes of anti-depressant medications. This is unusual, unless the patient presents strong suicidal ideation. Either way, I tend to agree with you. I believe ECT can be effective, but bilateral treatments can leave patients with significant memory and cognitive impairments. Hope you are able to find a medication or combination that is effective for you.
 
skibum801 said:
Just wondering one more thing: what would be an adequate dose of Abilify for me? I am on 20mg and have been for 2 days. I have a lot of trouble socializing and saying what I want to say, feeling good socially, and writing things as well. People always say that I seem pretty normal, but I feel awful in social situations because it seems like I cannot think correctly. Would an increase in Abilify target that, or would I just need more antidepressant to target that? I am on 375mg of Effexor XR now. Thanks for the comments.
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Abilify should target the problem of disorganised thinking.

How are you now that you've been on the 20mg a lot longer?

4 years is a lot of time to waste. You may qualify for clozapine.
 
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