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

[paranoid android]

I used to get sleep paralysis on a regular basis. I would get the kind where you think you are awake and you can't move despite how hard you try. I would also see things out of the corner of my eye and this coupled with not being able to move was terrifying. Where i'm from people call this "the old hag" as people catch glimpses of what looks like a old witch out of the corner of their eye. I remember my uncle woke up screaming once at my nans house after he had a episode of this while he was trying to sleep off a hangover. I found that certain medications such as amitriptyline and especially alcohol made it worse. Benzos are the only drugs i found to work against sleep paralysis and the clonazepam i am now on pretty much stopped them completely. Valium would be better though as it's abit more sedating the clonazepam. I also found zopiclone to work as well but Z hypnotics such as zopiclone, zolpidem and zaleplon can make sleep disorders worse for some people so benzos are a better bet.

 

[Libby]

I got sleep paralysis a few times years and years back. That's funny you say you also saw things during the paralysis, I have a friend who has had that too. I never saw things though, odd. I'm glad as it was scary enough without seeing things, but still odd.

 

[Vaya]

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.

Agreed; I'm prescribed Desoxyn 150 5mg tablets/month and, by way of comparison with dex/methylphenidate and dex/amphetamine, I most certainly feel the serotonergic activity that the methamphetamine produces. However, we would obviously pray that you had enough willpower not to abuse the pills. In actuality, they're weak by way of producing euphoria, but they are certainly helpful on a pharmacological level!


....kiiiiiinda difficult to get prescribed it, however.

 

[Animal Mother]

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.

let me start off by saying that I didn't read everybody else's advice.

Have you tried consistent strenous workouts?

I was very unstable and down until I went to prison and started lifting weights. 4 years of of revamping my hormones anx I havd never felt better in my life. I honestly believe that today's sedentary lifestyle and lack of physically demanding activities are depressing people's hormones. Man was not meant to sit on a couch and shove food in his face.

sorry if you feel like I may be belittling your problem. I just wanted to share what helped me

 

[cashmunny]

I had a 4 week treatment with rTMS and it was quite helpful and the effects lasted maybe 6 months to a year.
I'm about to try ketamine and it has a very high success rate, although it is expensive.

In terms of pharms Nardil, plus Nortriptyline is highly recommended over on dr-bob's psychobabble. But obviously since you are combining a MAOI with a TCA it's a little dicey.

A safer combo would be Remeron with Effexor, sometimes known as California rocket fuel because the combo has at least three different modes of action. I've tried it and it it's an appropriate analogy.

 

[Pretty_Diamonds]

I know electro shock therapy has worked for patients suffering from depression. Treatment anywhere from once every 2 weeks- 6 months.

 

[rcsx]

This is a really interesting thread..

I live in the UK and am amazed at the liberal approach to prescriptions in the US, Six separate medications including two types of amphetamines?? These meds are practically unheard of in the Uk and, I must admit, I am kind of envious!

Having suffered from depression/anxiety for over 30 years, I have been prescribed everything from sepia 5c (homeopathic) to lagactyl and found no lasting benefits from anything. Cognitive behavioural therapy, psychs and support workers DID actually help to a certain degree but without chemical maintenance, it was not enough.

I have experimented with amphetamine ( both street and illicitly obtained Methylphenidate), and was encouraged by the results until the supply was exhausted and I found myself back at square one. (a prescription for these types of drugs in the UK is not the norm, especially having informed my GP of my use of these compounds- I am now classed as a 'drug seeker' and therefore labelled for life and have no real chance of being 'accepted' in medical terms)

The use of ketamine in experimental usage is highly interesting to me also, I experimented with the legal analogue methoxetamine for many months on a daily basis and actually became enthusiastic about my life for a while. ( Re: dosing: 1 gram would last 2 or more weeks, so not chaotic use).. Naturally, like anything else that I feel benefits me, It was banned and is now unobtainable.

These days, I admit, I am struggling. My GP will still give me SSRI AD's and Diazepam or zopiclone if I ask but these do not really help. I am now kind of reliant on alcohol everyday, Yes, a depressant which does far more harm than good.

I know from experience that my inactivity is a major factor in my depression but I have returned to that 'hole' , in which I have little control over facts and no control over my fluctuating mood.

I'm beginning to wonder why I even replied to this thread, waffling and getting nowhere..meh! like I said..

STRUGGLING

 

[calebtrask]

Update for those still interested -

So after coming off of 120 mg of duloxetine (cymbalta), 450 mg of bupropion, and ~70 mg of amphetamine, despite tapering off of some of these, I unsurprisingly crashed and ended up in inpatient again. Luckily, this time I was able to work with the same psychiatrist I had been seeing for outpatient and we were able to work on finding a combination that works. I'm happy (more like ecstatic) to say that I finally found a med combo that offers some relief from my recent episodes of severe depression while I was in the hospital.

The meds I'm on right now are:

40 mg tranylcypromine (parnate)
900 mg lithium
2 mg aripiprazole (abilify)
5 mg asenapine (saphris)
10 mg diazepam

The last two are for ptsd related nightmares/sleep issues and were the same as before I entered the hospital. I was a bit hesitant to try abilify again after having a bad experience with restlessness/akathisia in the past, but I'm on a substantially lower dose now and don't really experience this side effect currently. It might have been that I was in a safe/highly structured setting, but what was amazing to me was that literally within 2 days of finding this combination, my mood was noticeably better. Right now we're experimenting with low doses of amphetamine to deal with ADHD because it's technically contraindicated with parnate, but so far I've been taking 5 mg adderall as needed and there haven't been any sort of significant side effects.

I guess the biggest difference I notice is that I've started to feel hopeful about the future again, something I've struggled a lot with in the past. I'm able to make plans and follow through on aspirations (like recently starting up school again) that I didn't feel were even possible given my mood before. Thanks for all the suggestions and feedback everyone has given me and maybe this thread can give a bit of hope to people who, like me, felt like they'd tried everything and were lost on where to go. I will say that I feel like finding a doctor that I can trust and who values my opinion has been crucial to this process for me.

Thanks again for all the support from the community!

 

[paranoid android]

^ Real glad to hear you are doing better . It's all about finding the right combo of meds and this is why i always tell people not to give up trying. I guess the Parnate is brightening your mood by the sounds of it. Unlike most anti-depressants Parnate tends to have a mood brightening effect right away even before the anti-depressant effects really kick in. It often works when everything else has failed.

 

[Charles Ferdinand]

I think Lithium antagonizes the effects of amphetamines (via the PKC and DAT phosphorylation)

 

[exists]

Lamictal has ZERO side effects.. once you get past the slow titration and have no adverse reactions.. you are home free.

No, no, no, that's not true! I was on lamotrigine for years, but had to stop earlier this year because I started getting a skin rash. My hands were swollen, sore and itchy, my whole body was covered in itchy, red bumps, and it was just getting worse with each passing night (I would take the lamo before bedtime). So I stopped taking the lamotrigine, and the rash cleared up.

The rash can happen at any time: don't make the mistake of believing you are home-free just because you got past the initial dosage increase without incident!*

Anyway, I have found a drug that treats my depression better than anything else. But because of this forum's guidelines, I am not going to tell you what it is (just look at my posts, and you'll know).

exists

* Obviously you shouldn't spend any amount of time worrying over whether you'll develop a rash or not, but if you're taking lamotrigine and do start developing a rash, see a doctor immediately!

 

[a dream]

I had a pretty serious side effect after increasing my Lamictal dose from 50 to 100 mg: suicide ideation (created a thread about it when it happened)

 

[Lightning-Nl]

If you're still having issues - I've found a great combination for my depression and also great for mood stabilization is 75MG's of Lamotrigine (Lamictal) and 80MG's of Vyvanse (Lisdexamphetamine) it's doing a lot of good for me.

 

[a dream]

I take 30 mg Vyvanse as needed (when I'm working) but would be wary of taking it every day as an antidepressant. Just a thought. I'm afraid if I use 30 mg every day, it will stop working and then I'll keep increasing the dose every once in a while until I'm at the max, and then what?

I suppose this is the case for a lot of drugs. But since I don't need to take it every day, I don't.

 

[Lightning-Nl]

I take 30 mg Vyvanse as needed (when I'm working) but would be wary of taking it every day as an antidepressant. Just a thought. I'm afraid if I use 30 mg every day, it will stop working and then I'll keep increasing the dose every once in a while until I'm at the max, and then what?

I suppose this is the case for a lot of drugs. But since I don't need to take it every day, I don't.

Normally, my Vyvanse would be as needed for work and focus (due to the fact that it's prescribed for ADHD) however, in combination with Lamictal, it's done an excellent job at leveling out my mood. And mood swings have been a huge problem for me.

Because of this my doc OK'd the idea of me taking it everyday, as soon as I get up, in order to help me keep a level head all day.

 

[a dream]

Stimulants definitely do help with my mood and motivation. Temporary hypomania; not very stable for mood because it goes away when the dose wears off. Maybe I should bring this up at my next visit. The problem is that they inevitably wear off before I go to bed, and usually well before. Before I switched from Adderall XR to Vyvanse, there would be days where I'd be fine at work until about 3 PM and then start to totally crash and get anxiety and end up either wasting the rest of the day, taking walks around the block hoping I'd calm down, and often leaving early for no other reason. Vyvanse lasts a little longer and the comedown is smoother, so that wouldn't be a problem... but it's still not enough to last a whole day. It can get me through a typical work day, but then I'd come home and be no better. Would be nice on the weekends, especially if I took it in the early afternoon or evening and was going out (which I rarely do, so..)

 

[paranoid android]

I think Lithium antagonizes the effects of amphetamines (via the PKC and DAT phosphorylation)

Lithium does reduce some of the effects of Amphetamines but it certainly does not block their effects. Hell i know people that still get spun on Meth even though they are taking Lithium and the meth still works as good as ever. I also know people who are prescribed Lithium+Dextroamphetamine and Lithium+Adderall so Amphetamines do seem to work with Lithium it's just that Lithium may dull some of the effects abit.