Need help with options

So I saw my pdoc this morning and he added Mirapex to my meds for the mean time but he also laid out my options. None of them are great and all require me to take time off of work which I am not sure I can do right now.

So the options were:
Do another full course of ECT - this is his preference

Do a Ketamine drug trial

Change to an MAOI but to do that I would have to go off all my current meds for a weeks and he wants me in at least a day hospital while doing that

Inpatient - He said him and my T are counting on me to let them know when I need to go to the hospital but I told him I probably couldn't do that.

I don't really like any of these options but I need to choose one of them. To do ECT I might need to go inpatient because I won't have a way to get to the appointments three times a week as an outpatient. The Ketamine trial is just temporary because after the trial is over I have no way to get more treatments because the closest place that does them to me is in New Jersey. Changing meds is tricky because that will take the longest to work, if it does, and I hate the day hospital. So that leaves the hospital that I really don't want to do again since I did it twice last year.

I just don't know what to do. What are your opinions? Help me hash this out. What are the pros and cons?

Crook - SO glad you had your doctor visit and happy that you have options. Not that any option appears ideal, but at least there are options. . .

I know next to nothing about the ketamine therapy, but some other PC forum members are currently discussing it: http://forums.psychcentral.com/other...epression.html
How long is the trial? How long are anticipated effects to last once a patient has their last trial treatment? I'm wondering if that by the time your trial ends, and if it is successful and is something you'd want to continue, that it could be available in your area by then? Also, here is a link of providers that you could check from time-to-time:
Ketamine Advocacy Network - Provider Directory Note that as this site states that this may not be a full listing of providers, so there could be some closer than you realize.

ECT . . . well, how has it worked for you in the past? If this is something that you generally respond well to, then I definitely think it is worth considering. No one wants a stay in the hospital, but if this option gets you to a safe and productive place and the positive results can transpire relatively quickly it may be quite worth it. My thought from my own perspective is that if you find yourself in the position of going inpatient, then may as well pick the most effective treatment, short and long-term, don't fight it while there, and just get it over-and-done-with. (It's not that simplistic for you, I'm sure, but framing things in such a core, simplistic way for myself is extremely effective. It feels better to make a reasoned choice than getting stuck in place of endless questioning.)

For me, I would think I would be open to an MOAI or other Rx, but only after I stabilized. The key thing for you is to stabilize, to live and to be engaged with your family, job, and life - Step 1. But, I would consider switching drugs as Step 2, and I would not blow it off after the crisis passes.

Hopefully, some others can chip in with some thoughts.

Good luck Crook32. Sorry I am not familiar enough to help you with your choice but while it seems all have downsides they also all have the upside of a good outcome for you so hoping you achieve that no matter what the path.

Thanks for the information. You have given me stuff to think about. ECT worked the last time but the effects were only temporary. Plus I do not like the memory issues. I just feel like I have been backed into a corner. I really wish my T would email me back.

I have read in several places that ketamine is a miracle drug for some people with treatment resistant depression. If I could find a nearby place to try it, I would do so. Just my opinion. But if ECT didn't last and changing drugs is a crap shoot and involves day treatment I think I would not give those another chance. But again, that's me. I've tried so many drugs that haven't worked...

What would they do if you were inpatient? In my experience they just change up all your meds and send you home without the meds having had a chance to work. But maybe that is just my location/MI/insurance.

If I was inpatient they would just change meds and send me home like you said. None of the options are ideal for me.

ECT may have some of the faster results but I would most likely have to go inpatient for that because I have no way to get to appointments three times a week as an outpatient.

Ketamine I am worried about what happens after the trial is over. I have no way to continue treatments because the closest center is in New Jersey.

Changing to an MAOI is the way I would choose to go but I would like to do it and still work. I don't want to do the day hospital but I don't know if my pdoc will agree to this.

Inpatient just seems like a waste of time.

I feel so trapped. I don't know what to do. I have to call my pdoc tomorrow and I have no idea how that is going to go.

Sent from my iPhone using Tapatalk

Maybe ask what happens if ketamine works? Like is pdoc suggesting it because if it works there might be a way to get treatment closer to home?