Pooh - Sorry it has taken so long for me to answer. I have not had access to a computer with the internet for over a week. Also, I have not been feeling well of late. Also, I did go through your drug history fairly closely to try to see what the doctor's game plan was; this took a bit of time (I'm a little rusty, not being directly involved in the psych game anymore).

There is a large number of very treatment resistant depressions out in the real world. There are many reasons for treatment resistance, most of them haven't been found, yet.

When all of the classes of antidepressant medications have been given adequate trials it is time to look for other reasons for the symptoms being experienced. I prefer to have someone who is suffering from major depression - if at all possible - take an antidepressant for at least 8 to 12 weeks before giving up on it. There have been numerous times that I have seen an antidepressant have a delayed reaction. This probably has something to do with a person's individual physiology.

Actually, I (and most pdocs nowadays) like to rule out any causal factors (eg. some medications, some illnesses, something in the environment, some problem with the immune system, and so on and so on and so on) that may mimic depression. There are several differential (alternative) diagnoses that have depression-like symptoms, but most pdocs are aware of them. Sometimes it is as simple as having an underactive thyroid, but usually it isn't .

Hang in there, and keep asking questions. I will list a number of differential diagnoses, but remember, in the majority of cases of treatment-resistant depression the actual biochemical breakdown/abnormality cannot be found.

Unfortunately, one has to fumble through treatment after treatment (as you know) until you find something that partially works; then you add on something else that also complements the first medication, and see if you can achieve anymore relief; and so on.

I see that you haven't tried any of the anticonvulsant mood stabilizers (eg. Epival™/Depakote [divalproex], lithium carbonate, carbamazepine [Tegretol™], etc.). Ask your doc about these and see if he thinks that a trial for you is appropriate. The medication that Darkeyes is currently taking (Lamictal™ [lamotrigine]) has shown fairly decent results in treating depresion associated with bipolar disorder.

I know that this is not much, but I hope that this is of some help. - Cam



To fully understand a concept is to be unable to convey it's intricacies verbally; only when one can sense it emotionally, does one understand.