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

calebtrask

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I've been dealing with depression for more-or-less my entire life. Most of the time I experience dysthymia, just an overall bummed out and detached feeling, however I've also gotten severe major depressive episodes in the past and have been hospitalized for some. I've been in therapy on and off from 8 until my mid-twenties (now) without any lasting impact except diagnoses for PTSD and ADHD. I started medication at 13 and cycled through the typical SSRI's with no help and took a break from them until a few years ago when I started meds again to try and combat my latest episode of major depression. Most of the medications have no noticeable effect on my mood, and the few that do are underwhelming. I know that antidepressants don't have a sudden "wow I'm not depressed" feeling and don't think that I have unrealistic expectations about drugs. I'm just looking for something to give me a bit of energy to work through therapy programs and keep me stable and functional each day.

Here are the meds I've tried in the past:

Prozac/Zoloft (each for about a month at a normal dose)
Risperdal (to augment antidepressants)
Celexa/Lexapro (for about 6 months at a normal dose)
Effexor (300 mg for about 8 months)
Pristiq (starter dose for about 3 days - gave me terrible nausea)
Elavil (150 mg for about 2 months)
Remeron (30 mg for about 2 weeks)
Seroquel (don't remember dose, was given it in the hospital - didn't notice much difference)
Abilify (15 mg for about 2 weeks, had to stop because of restlessness side effect)
Trazodone (150-300 mg as needed for sleep, don't take it too often because it gives me a hangover)
Prazosin (1-5 mg prescribed to help with nightmares from PTSD)
Provigil/Nuvigil (200mg/150mg for excessive daytime sleepiness, positive effect on mood at first, but this went away after a week or so)
Concerta (72 mg, not very helpful with ADHD and no real antidepressant effect)
Namenda (40 mg, bought online to see if it helped with ADHD and amphetamine tolerance)
Tianeptine (12.5 mg 3x daily for 2 weeks, noticed a slight increase in mood/motivation)

And here are the meds I'm currently on:

Cymbalta 120mg
Wellbutrin 450mg
Lithium 300mg 2x daily
Tenex 2mg for sleep/ADHD
Ativan 1mg 3x daily as needed
Adderall IR 20mg
Vyvanse 100 mg

As of right now my psychiatrist and I don't think I'm getting what I should out of these meds, so I'm looking for other options. I've already tried ECT (shock therapy) without much impact and probably next week I'll start detoxing from the drugs I'm on so that I can start an MAOI. He suggested we see how I do on a combination of parnate + lithium + low dose of amphetamine and go from there. If that doesn't work, the only other option we've talked about is starting an experimental treatment where I'd get injected with a low dose of ketamine once a week.

If anyone else has tried to deal with treatment resistant depression, I'd love to hear your experience medication-wise, specifically if MAOI's were helpful. I'm a bit nervous about the parnate + amphetamine combo, but my psychiatrist said that if we regulate the doses correctly, there wouldn't be a problem. I know MAOI's boost amphetamines and parnate itself is a stimulant, so it makes sense to me to try because I've had the best responses to stimulant medications in general.

I've tried to be methodical in taking various medications and combinations for dealing with depression, but if someone has an alternative to suggest or something else that worked for them, I'm certainly excited to hear about it.
 
Hey there,

I'm sorry to hear that medication hasn't work - I myself have been depressed for as long as I can remember, and for the most part it has been 'treatment resistant'. Unfortunately in my case it's complicated by psychosis and I have yet to try any antidepressants, besides citalopram, because they trigger delusions and hallucinations.

Anyway, you didn't say where you are from, and I noticed that you haven't tried amisulpride. Although it's an antipsychotic, in low doses it's an extremely powerful antidepressant. Many people who use it start feeling better mere hours after their first dose. It's not approved for use in the US, but if you live anywhere else in the world it might be useful to try.

On the other hand, have you ever considered that you may just simply have a depressive personality? You, like myself, report depression from a very young age and, if you don't mind me asking, do you even remember what it's like to not be depressed? I can't think of a time when suicide wasn't in the back of my mind, and these days I wonder if that's just 'me'. The only time that this wasn't the case was during an episode of drug induced mania, and I can hardly expect to feel like that 'normally'.

Either way you sound like you have a psychiatrist who's determined to find what's right for you, and I'm sure one day you'll find a cure. Best of luck :)
 
Your psychiatrist seems really into combinations. If you don't mind me being honest, the list of drugs that you're currently on seems like a lot of different drugs and high doses. Are you happy with your current psychiatrist? Maybe it's time to get a second opinion from a different doctor?

What non-drug treatments/therapies/techniques have you tried? Drugs are not always the answer. Even if you are able to find drugs that are somewhat effective I think it's often very important to do other things at the same time as well.
 
When I started making a concentrated effort to find an effective medicine, at first I just took an individual antidepressant and then after some time I'd add another drug to augment. After a while, if that didn't work I'd either add another drug or replace one and keep going. So for instance, I started on Celexa and after a few weeks and dosage changes I went to lexapro. After that didn't help, my psychiatrist augmented it with Wellbutrin, then one at a time an antipsychotic, a stimulant, a mood stabilizer, etc. Then, because I still wasn't making progress, we'd increase the dose on each drug individually until now where I'm on the max dose for both Cymbalta and Wellbutrin and a reasonably high dose for most of the others.

I'm scheduled to meet with another psychiatrist before starting an MAOI to get a second opinion, and my current psychiatrist is the newest in a long line - so I'm not just getting one doctor who happens to really like combining drugs. Like I said, I'm a bit skeptical of the MAOI + amphetamine combo because the drugs are contraindicated, but I'm also open to just needing that level of stimulation to feel better.

Right now I'm focusing on meds because I've been in various types of therapy for the past decade without lasting success. I currently attend a group therapy-oriented program but at this point most of the psychological information and techniques I'm getting are ones I've heard/tried several times before. I realize that ultimately meds won't cure me, but I'm hoping that the right ones will make therapy actually effective for me.

Also, sorry about using brand names here are the generics:

Prozac = fluoxetine
Zoloft = sertraline
Risperdal = risperidone
Celexa = citalopram
Lexapro = escitalopram
Effexor = venlafaxine
Pristiq = desvenlafaxine
Elavil = amitriptyline
Remeron = mirtazapine
Seroquel = quetiapine
Abilify = aripiprazole
Provigil = modafinil
Concerta = methylphenidate
Namenda = memantine
Cymbalta = duloxetine
Wellbutrin = bupropion
Tenex = guanfacine
Ativan = lorazepam

Thanks for the feedback so far!
 
Before you start this new combination, and since you're already detoxing, may I recommend staying off medication for a week or so just to see how you feel. I'm not sure whether you have suicidal tendencies, so this may or may not be good advice, but I've found in the past it's useful to know for certain how you feel without medication, so when you do try them you can easily compare and judge improvements. Having tried so many combinations and different medication I'd put money on it that you probably don't remember well what it's like to be off of them - and before you go ahead and try these experimental treatments it could be useful to know for certain what you're trying to treat.

As for your psychiatrist, am I right in thinking, from what you've said, that you haven't tried these antidepressants individually? Now, I'm no pharmacist or psychiatrist so what I say here should be taken with a grain of salt, but surely psychiatric medication of different classes would interact. The best course of treatment, in my eyes, is to try antidepressants one by one until you can narrow down what works. My psychiatrist does it with antipsychotics, trying them one by one. If I was a psychiatrist I'd perhaps try a number of 'first line' drugs to find what major class works best - antidepressants/antipsychotics/mood stabilisers/etc - then start narrowing it down in those classes - SSRIs/SNRIs/Tricyclic/etc. Again, I'm not a psychiatrist so I could be talking bullshit, but it almost seems to me like your psychiatrists are loading you down with lots of different types of medication in the hope that, somehow, it'll work. I mean, lets say your current combination suddenly begins to work. How would you ever be able to identify what exactly is helping?

I'm going to suggest something which I probably shouldn't - I've been warned for suggesting this in the past, but I hope the moderators see that I'm trying to help here - but have you tried smoking? I know it's a horrible habit, and that me suggesting this for depression is crazy, but there is evidence that nicotine acts an antidepressant by stimulating dopamine receptors - in the same way as amphetamines do. I personally, like many schizophrenics, use it to manage psychotic symptoms and have found that there is a marked increase in mood for an hour or so after smoking. I will admit that as soon as the craving kicks in after a few hours (I'm beyond addicted now) that my mood drops, but constant smoking throughout the day keeps me going. It's a trade off at the end of the day. I'm one of those people that 'lives for the now' so I don't really care about my chances of lung cancer, I just concentrate on surviving today, but yeah - it'll kill you evetually. But if you try smoking and find it useful, but don't want to fuck up your lungs, maybe nicotine gum or something simular might help? I'm not suggesting that this is a cure, but short term it could work. Before I got addicted, I used to just smoke on the days I was severely suicidal and it'd keep me going.

Again, best of luck :)

EDIT: Just wanted to add, I noticed that you also haven't tried olanzapine - which is frequently used in treatment of resistant depression. It's very similar to quetiapine though, so that might be why :P
 
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I have a similar problem except mines primarily anxiety, severe social anxiety. Try living when you're afraid of being noticed by another, and you're afraid of any sort of confrontation with another human being, a simple conversation could ruin a couple days. I tried all the antidepressants and the more I read about the science, the mechanism of these drugs, I didn't really expect anything to help me and of course they never did. So I drank and drank, this was a temporary solution and ended up making things far worse.. Several DUIs and bar fights later I tried a magical thing called opiates. Anyways it was a match made in heaven and made me more social, made me confident raised my self-esteem but also give me energy and didn't sedate me or make me lethargic. Unfortunately this lead me down a very dark road. The point being medication is truly and only a crutch, And without some hard work nothing will change. Medication can be adjunct therapy. It's like medication can be protein powder in your smoothie after working out at the gym and trying to gain muscle mass. But you're not going again an ounce of muscle without hitting the weights. We all have deep dark secrets and usually an underlying reason why we feel the way we do, Our ego, our identity, our self-esteem, basis or Genesis. Well drug addiction severely depletes your Nero-transmitters in your brain and makes every mental problem 10 times worse.. I suggest simplifying everything in your life. Take a notebook and write down the 10 things that make you the happiest and most satisfied. Find a way to make room for these activities every single day or every other day. Basically revise your mission in life around what gives you purpose to keep pushing on and living. For myself it was film and fashion. So every day I do something that relates to both, as far as film goes watching a movie or television as a form of therapy or meditation. Fashion as inspiration to go for a much needed jog in the park or eat more nutritionally soundly. I know that when I look good, I feel good, which raises my self-esteem and confidence and really pushes me to achieve at a much higher level. Probably sounds like a bunch of BS but all of us have the simplest things that makes us so happy. Also I became very skeptical of modern-day medicine so I begin to educate myself as mush as I could, I think it's very difficult for someone that's truly in constant heartache to trust a stranger with having all the relevant answers. I personally wouldn't be on amphetamine for anything because anything that goes up must come down, It affects your appetite which in turn affects your mental morale, it affects your quality of sleep which also affects you more than you might think. So number one would be finding out what the under-lying issue is doing your best to tackle it, No lying to yourself no BS take care of business.. If you're not sure what to do, ask someone get it off your chest! Secondly do what you can do naturally.. This means sleeping eight or nine hours a night, eating three or four nutritionally balanced meals and meeting the proper requirements of nutrients, Staying away from caffeine and alcohol, Figuring out a routine and I strongly, strongly suggest doing some sort of physical activity. We need to work on the science of your medication resistant chronic depression. And I would simplify, I don't know everything specifically about you but many of the medications seem like overload. I would choose one SSRI with a strong upper effect - like Wellbutrin? I would get away from in the short-term medications, obviously these are going to create havoc in your moods, Anything with a short half-life is going to give you a rebound effect that's going be very uncomfortable and make you more polarized. I would switch to clonazepam or Klonopin, it last forever, very strong and sometimes you forget you're even taking it because it's so effective. With Ativan or Xanax, you can feel the impending sedation and then the rebound effect once it wears off, isn't so cool. So overlying theme of medication being the longer the half-life the better. And I know this is somewhat controversial but I know scientific studies have proven that Suboxone/Subutex can help with depression without many of the major downfalls of a addiction. Though we now know that coming off Suboxone is a pretty bad, If your depression is this horrible, I don't see why it wouldn't be worth a try and it is definitely less detrimental on your body than Amphetamine. So hopefully I have a few good suggestions-Also you don't really mention yourmlevel of anxiety but SSRIs are known to make anxiety worse so I used to always try mirtazapine/Remeron which is atypical anti-depression med that worked very well. More streamlining of medications with longer therapeutic ranges and longer half-life's.. And less contradiction in your meds-You want as much stability as possible.. amphetamine and a downer like ativan only creates instabilty as they are literally fighting each others effects.
 
When discussing all the new anti-depressants with my doctor and my scepticism about all the new ones he once told me they used to suggest tobacco to people back in the old days for depression (or hysteria) whatever it was called back then. I didn't believe him.
There's a reason why mentally ill individuals are far, far more likely to smoke then your average joe. Heck, 80% of schizophrenics smoke!
 
southseattle makes a good point. Exercise and good daily structure are very helpful in treating depression. I don't like saying it because I know what it feels like to be depressed, and I used to hate people telling me that exercise will somehow suddenly make it better. But in psychiatric hospitals they enforce a strict structure and it really does make people feel better. Having meals, activities, medication all at the same time everyday is truly beneficial. Every patient then would find time in between to do something they enjoyed. For some it was doing the crosswords in the papers, for other's it was the gym, but having something seemed to make people feel better. Once I left the structure dissipated and I started feeling depressed again, until I got to the point where I am now where I can't motivate myself enough to put that structure back.
 
In the county mental health system where i live, nicotene is actually viewed as harm reduction for people with schizophrenia; thus, smoking is allowed where it otherwise would not be.
 
If anyone else has tried to deal with treatment resistant depression, I'd love to hear your experience medication-wise, specifically if MAOI's were helpful. I'm a bit nervous about the parnate + amphetamine combo, but my psychiatrist said that if we regulate the doses correctly, there wouldn't be a problem. I know MAOI's boost amphetamines and parnate itself is a stimulant, so it makes sense to me to try because I've had the best responses to stimulant medications in general.

I've tried to be methodical in taking various medications and combinations for dealing with depression, but if someone has an alternative to suggest or something else that worked for them, I'm certainly excited to hear about it.

For me moclobemide has worked wonders so far, haven't been on it long enough to say whether the effects last or not, but I'm having what feels like the first true break from depression in so, so many years. It is a reversible maoi however (or RIMA, reversible inhibitor of monoamine oxidase a) in contrast with Parnate which is irreversible, meaning it's like moclobemides big brother. In practice it should mean Parnate produces more side-effects, you actually have to watch your diet and the MAOI effects stays in your body for a few weeks or so before dissipating, but I guess it should be pretty effective treatment for depression too.

I also found moclobemide quite stimulating indeed, and like you were speculating, I believe it would be of excellent help in treating ADHD, in my experience it's definately better than anything else on the market classified as anti-depressant and I believe it's always better if you don't need a combination of different medications to treat your problems. http://www.ncbi.nlm.nih.gov/pubmed/7717094 - mentions of "Two small studies have given encouraging results in the treatment of attention-deficit hyperactivity disorder." however I am unaware which these studies are and what merit there is to them.
 
Since you have been unsuccessful with literally everything, maybe you should discuss Desoxyn with your doctor. Desoxyn is pharmaceutical Methamphetamine and from the things I've heard about it, the people who tried everything had great success with Desoxyn.
 
Since you have been unsuccessful with literally everything, maybe you should discuss Desoxyn with your doctor. Desoxyn is pharmaceutical Methamphetamine and from the things I've heard about it, the people who tried everything had great success with Desoxyn.

He already takes Aderrall and from what i have heard from people who have taken it Desoxyn is not as effective as Dexedrine or even Adderral in treating their conditions.

To the OP: Holy fuck your doctor has you on 2 different Amphetamine meds, 2 different anti-depressants (though using a SNRI like cymbalta with wellbutrin is not that unheard of or that uncommon) and Lithium on top of it all 8o . That sounds like over medication if there ever was such a thing. No wonder your brain is screwed up. Aderrall is a mix of Amphetamine sulfate and dextroamphetamine and since Vyvanse converts into dextroamphetamine there is no need to be on both. I have never ever heard of someone being on 2 different Amphetamine preparations at the same time. So i would have a talk with your doctor about simplifying your meds.

I would suggest giving the MAOI's a try. There is a new one on the US market called the Emsam patch which contains selegiline which is a selective irreversible MAOI-B inhibitor in lower doses so the food restrictions aren't necessary . At the higher doses used in the Emsam patch it also inhibits MAOI-A but as the cheese reaction happens in the gut you don't need to follow the normal food restrictions with it thanks to the transdermal delivery system. If that doesnt work i would give Parnate a go personally. It's supposed to be one of those meds that work for depression when nothing else does. It is supposed to be very stimulating which makes sense as one of it's metabolites if Methamphetamine. I would not under any circumstances take any MAOI with a Amphetamine as that is asking for a hypertensive crises. Parnate and the older non selective MAOi's like Nardil have a fuck ton of food and drug interactions but if it works it would be worth it in my opinion.

Have you tried Lamotrigine (brand name Lamictal)? It was literally a life saver for me and worked better then any other drug i have tried in treating bipolar disorder. It's a mood stabilizer (one of the only 2 true ones the other being Lithium) and a anti-convulsant used not only in treating bipolar disorder but also sometimes in treating major depressive disorder often with a anti-depressant added on. It works better for the depression part of bipolar then the manic part which is good news for you. Also some of the other less sedating tricyclic anti-depressants may be worth trying such as nortriptyline, imipramine, desipramine, Trimipramine, etc.

There are also experimental drugs that can help treat major depression of either the unipolar or bipolar varieties. One of them would be the well know recreational dissociative drug used in hospitals as a very short acting anesthetic. It has shown alot of promise as it works very well in most people who have not responded to traditional anti-depressants and works with often 1 dose. Another one would be the drug scopolamine which has been in use for treating sea sickness, motion sickness of all kinds, as a anti-nausea drug, with morphine or other opiates in treating sever pain and used for creating "twilight sleep". It is also used as a anti-spasmodic in the treatment of stomach cramps. I have been on the scopolamine patch numerous times for nausea and stomach cramps and it pretty much always elevated my mood. This was long before i had heard about it being used to treat depression so it was not placebo at all. It is a potent anti-muscarinic so the side effects are the usual for anti-cholinergics such as dry mouth, constipation, drowsiness, dilated pupils, etc

Tramadol which is a serotonin norepinephrine reuptake inhibitor along with being a very weak Mu agonist opioid and it does help some peoples depression. However it is also very physically addictive even more so then regular opioids such as oxycodone, morphine, Heroin, etc according to what people who have been addicted to it have told me. Buprenorphine is also very occasionally used for treating depression as it has different properties then typical Mu agonists

Good luck on finding something that works. I know how frustrating it can be but don't loose hope.
 
He already takes Aderrall and from what i have heard from people who have taken it Desoxyn is not as effective as Dexedrine or even Adderral in treating their conditions.

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.

Also, it's "Adderall" not Aderrall.

To the OP: Holy fuck your doctor has you on 2 different Amphetamine meds.

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.

2 different anti-depressants (though using a SNRI like cymbalta with wellbutrin is not that unheard of or that uncommon) and Lithium on top of it all 8o . That sounds like over medication if there ever was such a thing.

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)

No wonder your brain is screwed up.

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.

Aderrall is a mix of Amphetamine sulfate and dextroamphetamine

Since Amphetamine is a chiral molecule; when it is unspecified whether it's the right-handed or left-handed (dextroamphetamine and levoamphetamine) enantiomer of the molecule, just the word "Amphetamine" refers to a racemic mixture of 50% Dextroamphetamine and 50% Levoamphetamine. In a sense you aren't wrong, but the proper formulation of Adderall is 75% Dextroamphetamine and 25% Levoamphetamine.

since Vyvanse converts into dextroamphetamine there is no need to be on both. I have never ever heard of someone being on 2 different Amphetamine preparations at the same time.

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.

I would suggest giving the MAOI's a try. There is a new one on the US market called the Emsam patch which contains selegiline which is a selective irreversible MAOI-B inhibitor in lower doses so the food restrictions aren't necessary . At the higher doses used in the Emsam patch it also inhibits MAOI-A but as the cheese reaction happens in the gut you don't need to follow the normal food restrictions with it thanks to the transdermal delivery system. If that doesnt work i would give Parnate a go personally. It's supposed to be one of those meds that work for depression when nothing else does. It is supposed to be very stimulating which makes sense as one of it's metabolites if Methamphetamine. I would not under any circumstances take any MAOI with a Amphetamine as that is asking for a hypertensive crises. Parnate and the older non selective MAOi's like Nardil have a fuck ton of food and drug interactions but if it works it would be worth it in my opinion.

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.

Have you tried Lamotrigine (brand name Lamictal)? It was literally a life saver for me and worked better then any other drug i have tried in treating bipolar disorder.

I agree, Lamotrigine was very successful at treating my Bipolar as well. You may want to give this one a try.

There are also experimental drugs that can help treat major depression

Tramadol which is a serotonin norepinephrine reuptake inhibitor along with being a very weak Mu agonist opioid and it does help some peoples depression. However it is also very physically addictive even more so then regular opioids such as oxycodone, morphine, Heroin, etc according to what people who have been addicted to it have told me. Buprenorphine is also very occasionally used for treating depression as it has different properties then typical Mu agonists

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.
 
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.

Also, it's "Adderall" not Aderrall.



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.



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)



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.



Since Amphetamine is a chiral molecule; when it is unspecified whether it's the right-handed or left-handed (dextroamphetamine and levoamphetamine) enantiomer of the molecule, just the word "Amphetamine" refers to a racemic mixture of 50% Dextroamphetamine and 50% Levoamphetamine. In a sense you aren't wrong, but the proper formulation of Adderall is 75% Dextroamphetamine and 25% Levoamphetamine.



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.



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.



I agree, Lamotrigine was very successful at treating my Bipolar as well. You may want to give this one a try.





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.

Thanks again everyone for the input. You're right, I think Tramadol is the wrong route to go for depression because it's an opiod. My doctor did send in an application to a study at a local university that's testing Ketamine as an experimental antidepressant. The idea is they inject you with sub-hallucinogenic doses and keep you in observation for ~1hr in case you do have hallucinations because of it. I read the reports on it myself and it seems like it's a wonder drug for some people, but of course I don't know if it will work for me yet.

Also, I do realize that MAOI's and amphetamine are contraindicated, but the combo was my doctor's suggestion because I have responded best to stimulants (wellbutrin, vyvanse, etc.), and I'll be under observation if I end up starting that combo. Like I said, it's a bit concerning to me but I have heard anecdotal accounts of the combo working well and not inducing extreme hypertension or a heart attack. That said, I would rather start parnate alone before adding amphetamine because if I don't need to add it on top of parnate, I don't want to. Also, Swampfox is right about the Adderall IR. Vyvanse doesn't last the full 12 hrs for me, so I supplement with Adderall in the afternoon, either 10 or 20 mg.

As far as Desoxyn, I don't know how much of an improvement it would offer over the doses of amphetamine I'm already on. I've also never really heard of anyone being prescribed it for depression. Nonetheless, I can at least mention it to my doctor and get his opinion.
 
Hi Calebtrask,
I've been on many of the meds you've tried with the exception of a couple over the past 25 years. It's a crapshoot really, I've found SSRI's make me spastic and cannot sleep. I guess because they make bipolar worse for some people and Cymbalta didn't help either, it was more for a pain alternative because I wanted off opiates. Early in treatment a doctor prescribed me doxepin which was very sedating. Seroquel gave me horrible side effects and risperdol seemed ok in the beginning but my blood pressure went up and I started get angry for no reason. Geodon sucked completely. I fared a bit better with amitriptyline.

There's been so many different prescriptions over the years I can't name them all. One thing I noticed with Effexor was if I forgot to take it, I would start crying for no reason. Then I told my doctor I don't like feeling like I have to take something like that. Remeron was a good one together with lamictal. I hope I get some health insurance soon because it's been since 2009 that I havn't been to a proper psychiatrist.

I do think your doctor has you on a strange mix. Perhaps you could try one by one eliminating some and see if that works better for you. It's frustrating as hell taking meds and still feeling unwell. I hated feeling like a guinea pig, but right now I'm not taking anything and I feel my mental state collapsing. It may take some time for you and your doctor to find a solution. Just don't give up! <3

Edit: Someone mentioned smoking cigarettes, and this I found to be real. When I was hospitalized, everybody smoked. Also at the shelter, all our mental health clients got at least one pack a day. They needed that to calm down, true story man.
 
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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:

Wikipedia said:
Pharmacodynamics
Agomelatine resynchronises circadian rhythms in animal models of delayed sleep phase syndrome[10] and other circadian rhythm disruptions. It increases noradrenaline and dopamine release specifically in the frontal cortex and has no influence on the extracellular levels of serotonin. Agomelatine has shown an antidepressant-like effect in animal models of depression (learned helplessness test, despair test, chronic mild stress) as well as in models with circadian rhythm desynchronisation and in models related to stress and anxiety. In humans, agomelatine has positive phase shifting properties; it induces a phase advance of sleep, body temperature decline and melatonin onset.[2]
Six placebo controlled trials have been performed to investigate the short term efficacy of agomelatine in major depressive disorder. At the end of treatment, significant efficacy was demonstrated in three of the six short-term double-blind placebo-controlled studies.[2] Efficacy was also observed in more severely depressed patients in all positive placebo-controlled studies.[2] The maintenance of antidepressant efficacy was demonstrated in a relapse prevention study.[2]
Agomelatine does not alter daytime vigilance and memory in healthy volunteers. In depressed patients, treatment with the drug increased slow wave sleep without modification of REM (Rapid Eye Movement) sleep amount or REM latency. Agomelatine also induced an advance of the time of sleep onset and of minimum heart rate. From the first week of treatment, onset of sleep and the quality of sleep were significantly improved without daytime clumsiness as assessed by patients.[2]
Agomelatine has no abuse potential as measured in healthy volunteer studies.[2]
Agomelatine’s onset of efficacy has been reported as early as the first week of treatment.[11]
The antidepressant efficacy of agomelatine 25 mg to 50 mg has been demonstrated in a 6-week, randomized, double-blind, placebo-controlled, parallel-group study in 260 patients with MDD.[12]
Agomelatine appears to cause fewer sexual side effects and discontinuation effects than sertraline and paroxetine. Additionally, possibly because of its action on melatonin receptors, agomelatine appears to improve sleep quality, with no reported daytime drowsiness.[13] Agomelatine has demonstrated anxiolytic properties in rodents.[14] Its efficacy in generalised anxiety disorder has been assessed by Stein et al (2008) who reported it significantly more effective than placebo treatment.

I'm in the States, but would jump at the chance to try that one!
In the meantime, consider increasing your dosage of Tianeptine Sodium....
 
Source? Anything to back that up? Just curious...

Nicotine - while it's more addictive in the form of Tobacco due to the MOAI inhibiting alkaloids in Tobacco, is currently being studied as a potential treatment for MANY mental illnesses. There have studies that show HUGE success in treating Schizophrenia (for instance) with Nicotine and it appears the success they are finding in treating many mental illnesses is endless!

I can cite sources if you want, although googling "Nicotine schizophrenia treatment" is pretty much all you have to do.

This is also the reason why I feel so much disgust towards AntiTobacco organization. They manipulate information to make you believe that the problem is the Nicotine, but in reality, it's been proven that Nicotine is not carcinogenic, and the real reason why Tobacco is damaging to health is purely because of THE SMOKE! If you were to dry lettuce, roll it, then smoke it - you would end up with similar problems, then if you were smoking Tobacco.

Heart disease - it's the smoke, cancer - it's the smoke, respiratory disease - it's the smoke!
 
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