Marilea10, have you tried an MAOI? I've been on Emsam for 10 years and that made the difference between treatment-resistant depression to very few depressions. I've had many mixed episodes but those are more on the manic side for me (and those are much better with my other magic med, clozaril). Before Emsam I was either failing on ADs constantly or needing one that allowed for 10 mg dose changes (not normally but for me) that we could tightly control. Now I can just adjust the dose a bit if needed, up or down, just like ADs should be used.

ECT is next up for me should something happen with Emsam and I'm really fine with that but I'm happy to have Emsam as long as it works which so far seems to be a long time. My pdoc told me that it doesn't tend to poop out like other ADs and that's been my experience thus far.

I hope you are feeling better soon.