[kacey321]

Has anyone tried many different antidepressants over years with no results. I have tried so many along with therapy and it seems that nothing gives me the slightest relief . At the moment I am on nothing due to the last thing I tried Trazadone extended release to help regulate sleep and help with severe depression seemed to make me want to sleep 20 hours a day and depress me more and cause a sort of agoraphobia which I never had before and now am expierencing even though I have been off that med over 2 weeks now.Before that I had tapered off Pristique completely,tried effexor,celexa,prozac,paxil you name it for like 20 years .SSRI's,MAOI's,Tricyclics I am done .I am only 47 and ready to say give me the old labotomy I am sick and tired of being sick and tired and feeling down 80% of my life and losing people because of the time I can't make myself happy for them.

[Jshect]

I had luck with Deplin for a little while. It worked very well for about 3 weeks and then just stopped, so today I'm upping the dosage from 7.5 mg to 15 mg. If you try Deplin start at 15 mg. It's supposed to enhance the effects of antidepressants so you might want to try it with an antidep.

[sunrise]

Have you tried Wellbutrin?

Have you tried Vyvanse?

The both work on dopamine. Vyvanse is a stimulant used for ADHD but is sometimes prescribed for treatment-resistant depression. Neither of these is a good choice if you also have problems with anxiety.

[nicoleb2]

kacey - I have tried like 30 or more drugs in 4 years for depression, I have also done ECT, so I feel your pain

[kacey321]

To sunrise yes I tried Wellbutrin after about a week it had bad effects made me a whole different person .I mean I was a screaming mad woman from someone who is normally quiet and probably to patient I hated me never mind what I was probably doing to my kids and friends etc.

To nicole my T asked if I had thought about ect and I have been wondering if it might be a good option or not and fear if it doesn't work will it have any effects .
I take topomax for severe migrains from an injury and that fogs my head reversible if I stop the med but the benefit 1 migrain a month verses 3-5 a week I guess I can ut up with being a bit dippy but if ect adds and can be permanant I'm not sure.

[Odin5]

If Wellbutrin made you manic then maybe you are bi-polar ?
Have you tried mood stabilizers ? Do you drink or do other drugs that could interfere with your medication ? I'm in a similar position to you as i am on my 7th anti-depressant with none of the previous ones doing a single thing.
Parnate was meant to be the magic bullet for depression but that did nothing....... didn't change my diet or anything so maybe that effected it working. Got to laugh at doctors reaction when you tell them you drank alcohol or even ate cheese while on parnate.
I have tried effexor, cymbalta, lexapro, prozac, parnate, zoloft, and now on paxil.
Oh yeah and i'm on seroquel for sleep.
If they had meds that could make me numb and just content to stare at the wall all day i would take it. Just take this pain away...

[Jerrypharmstudent]

Originally Posted by kacey321

Has anyone tried many different antidepressants over years with no results. I have tried so many along with therapy and it seems that nothing gives me the slightest relief . At the moment I am on nothing due to the last thing I tried Trazadone extended release to help regulate sleep and help with severe depression seemed to make me want to sleep 20 hours a day and depress me more and cause a sort of agoraphobia which I never had before and now am expierencing even though I have been off that med over 2 weeks now.Before that I had tapered off Pristique completely,tried effexor,celexa,prozac,paxil you name it for like 20 years .SSRI's,MAOI's,Tricyclics I am done .I am only 47 and ready to say give me the old labotomy I am sick and tired of being sick and tired and feeling down 80% of my life and losing people because of the time I can't make myself happy for them.

I empathize with your situation as I am in a similar situation.

One thing I want to know from you is that over the past 20 years trying various meds - how long did you stay on a med before moving to another? I ask this because many times a patient will have side effects at the beginning of treatment and either they or their doc will immediately take them off of it instead of lowering the dosage significantly to see if that remedies the side effects.

A good trial on a med is at least 6-12 weeks if not longer. 1-4 weeks is not long enough to determine if the med will work for you or not.

With Treatment-Resistant cases of depression, some people respond quickly to new meds/med changes only to have the rug pulled out from under them within a couple weeks. No one knows why this happens unfortunately. Also, there are some meds and med cocktails that seem to work better for those with Treatment-Resistant cases like:

SSRI + Simulant combo (Dexedrine, Adderall, Ritalin or Vyvanse)

SNRI (Effexor) + Stimulant

SSRI/SNRI+ Remeron (+Stimulant)

Effexor in dosages above 450mg + Lithium

MAOIs + small amounts of a stimulant (even though this is contraindicated many psych docs and psychopharmacologists use it with close monitoring)

SSRI/SNRI + tricyclic

Tricyclic + Stimulant

SSRI/SNRI + Lamictal

SSRi/SNRI + Atypical Antipsychotic (Abilify, Seroquel, Geodon, Risperdal)

It's also a VERY good idea to have your doctor do a complete blood work-up testing your thyroid, hormone levels, iron levels, vitamin deficiencies, etc.

Low thyroid (hypothyroidism) can cause depression
Low Testosterone in men can cause depression
Sleep Apnea can cause depression
Low iron/vitamin levels can cause fatigue, insomnia, low motivation and depression

Usually those who have treatment-resistant cases of depression have a more melancholic depression - trouble with motivation, fatigue, lost of interest, hypersomnia, etc that's why a combo + stimulant is frequently used.

Personally, after 20 years of med trial not unlike yourself (including ECT, therapy, and the Vegal Nerve Stimulator) I've found the best combination to be Effexor + Adderall + Abilify. However, what works for me may not work for you.

After switching doctors, my new doc ordered blood tests and found my thyroid was low, my testosterone was low and that I had sleep apnea - all of which I am currently on replacement therapy for. The thyroid controls metabolism and if yours is out of whack you will not be metabolizing medications "correctly." So I urge you to ask your doctor about some blood tests to rule out anything biological.

Hoep this helps
Jerry

P.S. Wellbutrin can cause a state called hypomania which is not full-blown mania. Actually Wellbutrin is sometimes prescribed to bipolar patients. Many of the SSRIs and SNRIs can cause hypomania as well however it is important to note that this does not mean you are bipolar.

[nicoleb2]

ECT can be great for some people, just wasn't for me.

I am really frustrated/worried right now.

Up until yesterday, I was on the Emsam patch (an MAOI), but was having nasty headaches along with insomnia from it, so chose to stop after 2 1/2 weeks of problems... I have been on so many meds, I don't even know what they're gonna try now...

I am also taking Ambien CR for sleep, and started doing things in my sleep without knowing it, so called my doc today. His response "go back to Ativan" I'm like... hold up here, I can't take Ativan because the Emsam is still in my system... his response, you're right, you can't. Stick with the Ambien...

ugh!

[Jerrypharmstudent]

Originally Posted by nicoleb2

ECT can be great for some people, just wasn't for me.

I am really frustrated/worried right now.

Up until yesterday, I was on the Emsam patch (an MAOI), but was having nasty headaches along with insomnia from it, so chose to stop after 2 1/2 weeks of problems... I have been on so many meds, I don't even know what they're gonna try now...

I am also taking Ambien CR for sleep, and started doing things in my sleep without knowing it, so called my doc today. His response "go back to Ativan" I'm like... hold up here, I can't take Ativan because the Emsam is still in my system... his response, you're right, you can't. Stick with the Ambien...

ugh!

I hope you didn't stop the Emsam cold turkey? Your doctor should have slowly weaned you off of it. Withdrawal from medications like MAOIs can cause problems of their own.

Ambien can cause amnesia and unusual behaviors while in a sleep state - but this is usually uncommon. I am unsure why you and your doctor think there is a problem taking Ativan with Emsam? Benzodiazapines like Ativan, Xanax, Valium pose no problems/interactions when combined with an MAOI. I doubled checked this.

When taking an MAOI you want to avoid OTC cough and cold medicine that contain phenylephrine and dextromethorphan. Dextromethorphan + MAOI = Serotonin Syndrome which in some severe cases can be fatal. be careful.

Have you ever taken an SSRI/SNRI + Stimulant? If not, perhaps talk to your doctor about it? Couldn't hurt.

Don't give up - even though you feel as though you've tried everything, you never really know.

Hang in there
Jerry

[nicoleb2]

I have tried probably 30+ meds/combinations of meds. I can't even get ahold of my psychiatrist to find out what to do about the Emsam. Obviously, since it is a patch, I can't cut it to lower the dose, but I can't keep up with the insomnia and headaches either. Either one will put me back in the hospital if I have to keep dealing with it...

I have done ECT, but have long term memory loss from that, so I won't do that again.

I'm in the process of switching psychiatrists (to one who won't hand me a prescription, tell me he knows nothing about it, and to go d omy own research...), so getting help right now is challenging...

[Jerrypharmstudent]

Originally Posted by nicoleb2

I have tried probably 30+ meds/combinations of meds. I can't even get ahold of my psychiatrist to find out what to do about the Emsam. Obviously, since it is a patch, I can't cut it to lower the dose, but I can't keep up with the insomnia and headaches either. Either one will put me back in the hospital if I have to keep dealing with it...

I have done ECT, but have long term memory loss from that, so I won't do that again.

I'm in the process of switching psychiatrists (to one who won't hand me a prescription, tell me he knows nothing about it, and to go d omy own research...), so getting help right now is challenging...

Again I can empathize. I've been through the same situation. I had ECT done and only got long-term memory loss.

Perhaps with the Emsam patch, removing it will act as an automatic taper - because there will still be some on the skin ans well in some of the deeper layers that hasn't yet been distributed into the blood supply?

I know changing pdocs can be very frustrating - just hang in there and keep us updated.

Jerry

[kacey321]

Originally Posted by Jerrypharmstudent

I empathize with your situation as I am in a similar situation.

One thing I want to know from you is that over the past 20 years trying various meds - how long did you stay on a med before moving to another? I ask this because many times a patient will have side effects at the beginning of treatment and either they or their doc will immediately take them off of it instead of lowering the dosage significantly to see if that remedies the side effects.

A good trial on a med is at least 6-12 weeks if not longer. 1-4 weeks is not long enough to determine if the med will work for you or not.

With Treatment-Resistant cases of depression, some people respond quickly to new meds/med changes only to have the rug pulled out from under them within a couple weeks. No one knows why this happens unfortunately. Also, there are some meds and med cocktails that seem to work better for those with Treatment-Resistant cases like:

SSRI + Simulant combo (Dexedrine, Adderall, Ritalin or Vyvanse)

SNRI (Effexor) + Stimulant

SSRI/SNRI+ Remeron (+Stimulant)

Effexor in dosages above 450mg + Lithium

MAOIs + small amounts of a stimulant (even though this is contraindicated many psych docs and psychopharmacologists use it with close monitoring)

SSRI/SNRI + tricyclic

Tricyclic + Stimulant

SSRI/SNRI + Lamictal

SSRi/SNRI + Atypical Antipsychotic (Abilify, Seroquel, Geodon, Risperdal)

It's also a VERY good idea to have your doctor do a complete blood work-up testing your thyroid, hormone levels, iron levels, vitamin deficiencies, etc.

Low thyroid (hypothyroidism) can cause depression
Low Testosterone in men can cause depression
Sleep Apnea can cause depression
Low iron/vitamin levels can cause fatigue, insomnia, low motivation and depression

Usually those who have treatment-resistant cases of depression have a more melancholic depression - trouble with motivation, fatigue, lost of interest, hypersomnia, etc that's why a combo + stimulant is frequently used.

Personally, after 20 years of med trial not unlike yourself (including ECT, therapy, and the Vegal Nerve Stimulator) I've found the best combination to be Effexor + Adderall + Abilify. However, what works for me may not work for you.

After switching doctors, my new doc ordered blood tests and found my thyroid was low, my testosterone was low and that I had sleep apnea - all of which I am currently on replacement therapy for. The thyroid controls metabolism and if yours is out of whack you will not be metabolizing medications "correctly." So I urge you to ask your doctor about some blood tests to rule out anything biological.

Hoep this helps
Jerry

P.S. Wellbutrin can cause a state called hypomania which is not full-blown mania. Actually Wellbutrin is sometimes prescribed to bipolar patients. Many of the SSRIs and SNRIs can cause hypomania as well however it is important to note that this does not mean you are bipolar.

Hi Jerry Thanks for all the info..Let me see actually the wellbutrin made me rage not a mania ..my husband (been seperated 5 years)is bi polar so I believe I know those highs and lows .I am on adderall for ADD and to keep me awake during the day as i have daytime sleepiness .I do have sleep apnea and I am also on a low dose thyroid medication.My Psych.does not think its bi-polar either as a side note.All the meds I have tried have been at least 8 weeks or more with the exception of the wellbutrin and celexa chich gave me severe heart palpitations and with a normal resting rate of 100-120 so SNRI 's sometimes do that too race it up to 180.
So I have done the ADDerall 30mg plus different anti=depressants,lab work not detailed just regular cbc's and yes thyroid my endo orders thyroid and glucose as i am also borderline diabetic and my thyroid can run normal to a little off.Psych put me on the low dose thyroid as a supplement to anti=depre.meds. So presently just the thyroid,adderrall and nothing else for depression.

[Jerrypharmstudent]

Originally Posted by kacey321

Hi Jerry Thanks for all the info..Let me see actually the wellbutrin made me rage not a mania ..my husband (been seperated 5 years)is bi polar so I believe I know those highs and lows .I am on adderall for ADD and to keep me awake during the day as i have daytime sleepiness .I do have sleep apnea and I am also on a low dose thyroid medication.My Psych.does not think its bi-polar either as a side note.All the meds I have tried have been at least 8 weeks or more with the exception of the wellbutrin and celexa chich gave me severe heart palpitations and with a normal resting rate of 100-120 so SNRI 's sometimes do that too race it up to 180.
So I have done the ADDerall 30mg plus different anti=depressants,lab work not detailed just regular cbc's and yes thyroid my endo orders thyroid and glucose as i am also borderline diabetic and my thyroid can run normal to a little off.Psych put me on the low dose thyroid as a supplement to anti=depre.meds. So presently just the thyroid,adderrall and nothing else for depression.

Hey Kacey

Thanks for the info. I know from personal experience that thyroid levels need to be checked every 6 weeks and have thyroid replacement adjusted accordingly. With thyroid meds, you must increase the dose gradually until you get within the normal range. This is VERY important. My thyroid was low and my endocrinologist has been slowly adjusting the dosage going from 50mcg to my current 175mcg over the past 5 months and it's still not in the normal range. Some people require up to 300mcg of Synthroid. It's also very important to take thyroid med in the morning, on an empty stomach with NO food for at least and hour. Otherwise the med gets absorbed by the food and doesn't fully get into the blood stream.

It's also important to note that if one's thryroid is not in the normal range, that person will not be metabolizing any other medications "correctly." This is because the major duty of the thyroid gland is to regulate metabolism.

I do not wish to condradict your doctor, but using thyroid meds for the sole purpose to agument an antidepressant is an outdated therapy. It's now the other way around, thyroid meds are only used for replacement and are monitored and adjusted on their own regardless the andtidepressant. Meaning, simply being on a low dose of thyroid replacement is not going to augment your antidepressant unless you have hypothyroidism. And let me stress again that the dose must be tailored to your speciifc level blood tests.

Sleep Apnea can cause many things to go out of whack. For men, it reduced testosterone production, causes a decrease in stamina, muscle mass, depression, fatigue and decrease sexual functioning. It's vital to have a proper sleep study done and if sleep apnea is found, being fitted with a CPAP machine/mask is the treatment. Within a couple months of using a CPAP people begin to have more energy, improved mood, some weight loss, better focus and concentration, and increased sexual drive along with other effects.

I couldn't tell from your post if you are using a CPAP machine or not? Is your thyroid in the normal range? What are you doing to combat your pre-diabetic condition? All these are important and not only effect your overall physical health but your mental health as well.

Thanks!

Jerry

[kacey321]

Hi Jerry as far as the pre diabetes situation , I have been on metformin for years for P.C.O.S. so that dose was just doubled from 1000 to 2000mg a day 1 am 1 hs. I am guilty of not using my cpap machine then again the depression and med problem was long before that.I had a neck injury so the constant pain for ten years has interfered with sleep regardless.I do take the thyroid med at night .I will try changing to am its a very low dose 50mg total can hurt.I also take 1000mcg -12 nightly for the last year (Metformin can deplete those levels over a couple years time) something my endo came upon not my primary who put me on it originaly back in 1998.
I did have a proper sleep study that did indicate a need for a cpap at a very low titration probably due to some weight gain over the last 3 years ,my sex drive has never been an issue (when I have a partner).

my endo checks my thyroid like once a year sometimes twice because I complain of the extreme fatique,weight gain without reason my eating ,activity etc. has not changed and 4 out of 5 times it comes out right at the lowest end of normal range and that other one time right below so not sure on the thyroid.And she checks cortisol every couple years after finding a benign tumor on my adrenal gland unchanged for 5 years now.I am just a walking mystery ,who wants to feel halfway normal someday

[mgran]

Sometimes a mood stabiliser can help in cases of drug resistant unipolar depression. At least so I hear. I was on different meds on and off for twenty years until they got my diagnoses right. Now I'm on a mood stabiliser and anti psychotic, and there's finally an improvement. Perhaps it's time for your psychiatrist to think outside the box?

[Jerrypharmstudent]

Originally Posted by nicoleb2

ECT can be great for some people, just wasn't for me.

I am really frustrated/worried right now.

Up until yesterday, I was on the Emsam patch (an MAOI), but was having nasty headaches along with insomnia from it, so chose to stop after 2 1/2 weeks of problems... I have been on so many meds, I don't even know what they're gonna try now...

I am also taking Ambien CR for sleep, and started doing things in my sleep without knowing it, so called my doc today. His response "go back to Ativan" I'm like... hold up here, I can't take Ativan because the Emsam is still in my system... his response, you're right, you can't. Stick with the Ambien...

ugh!

Originally Posted by kacey321

Hi Jerry as far as the pre diabetes situation , I have been on metformin for years for P.C.O.S. so that dose was just doubled from 1000 to 2000mg a day 1 am 1 hs. I am guilty of not using my cpap machine then again the depression and med problem was long before that.I had a neck injury so the constant pain for ten years has interfered with sleep regardless.I do take the thyroid med at night .I will try changing to am its a very low dose 50mg total can hurt.I also take 1000mcg -12 nightly for the last year (Metformin can deplete those levels over a couple years time) something my endo came upon not my primary who put me on it originaly back in 1998.
I did have a proper sleep study that did indicate a need for a cpap at a very low titration probably due to some weight gain over the last 3 years ,my sex drive has never been an issue (when I have a partner).

my endo checks my thyroid like once a year sometimes twice because I complain of the extreme fatique,weight gain without reason my eating ,activity etc. has not changed and 4 out of 5 times it comes out right at the lowest end of normal range and that other one time right below so not sure on the thyroid.And she checks cortisol every couple years after finding a benign tumor on my adrenal gland unchanged for 5 years now.I am just a walking mystery ,who wants to feel halfway normal someday

Hi Kacey

Hmm. Yeah - you have a lot of things going on biologically don't you?? ;-) Sorry, not to make light of the situation, but I can understand why you feel like a "walking mystery." In my opinion, it doesn't sound like your endocrinologist is keeping up with you that well. Mine is very diligent and sees me every 3 months and checks my thyroid every 6 weeks. If you're is always on the low side, sometimes being outside of the normal range, I'd think your endo would increase your thyroid and monitor it more closely. However, it is not my position to tell you or your doctor what to do or what not to do. But I can advise you to talk to your doctor about this.

Chronic pain can be a huge problem for someone in your shoes who is battling depression. Chronic pain effects our moods greatly and the day to day grind through it is exhausting. Are you on any pain medications? If so, are you being seen by a pain specialist?

I would recommend you use your CPAP even if it's at a low titration. Mine is only 8 but it helps me tremendously. It can't hurt.

Keep us informed and hang in there.
Jerry

[lavieenrose]

I'm treated for low thyroid, and have tried every anti-depressant and various combinations for unipolar depression over a 30 year period, with little to no benefit. I hate sedation as a side effect, as I struggle with ADD and mental sluggishness as it is. I also fear the potential risk of tardive dyskinesia from atypical antipsychotics. I'm currently only on vyvanse for ADD. I wish there was something that would work, and wouldn't make me either anxious or dull and tired. It's so frustrating.

[Jerrypharmstudent]

Originally Posted by lavieenrose

I'm treated for low thyroid, and have tried every anti-depressant and various combinations for unipolar depression over a 30 year period, with little to no benefit. I hate sedation as a side effect, as I struggle with ADD and mental sluggishness as it is. I also fear the potential risk of tardive dyskinesia from atypical antipsychotics. I'm currently only on vyvanse for ADD. I wish there was something that would work, and wouldn't make me either anxious or dull and tired. It's so frustrating.

I can empathize with you. It's very frustrating when nothing seems to help. I'm wondering how well the vyvanse works for you? It's a type of amphetamine so I would think it would have some mood brightening effects?

Jerry

[Tricee]

Originally Posted by kacey321

Has anyone tried many different antidepressants over years with no results. I have tried so many along with therapy and it seems that nothing gives me the slightest relief . At the moment I am on nothing due to the last thing I tried Trazadone extended release to help regulate sleep and help with severe depression seemed to make me want to sleep 20 hours a day and depress me more and cause a sort of agoraphobia which I never had before and now am expierencing even though I have been off that med over 2 weeks now.Before that I had tapered off Pristique completely,tried effexor,celexa,prozac,paxil you name it for like 20 years .SSRI's,MAOI's,Tricyclics I am done .I am only 47 and ready to say give me the old labotomy I am sick and tired of being sick and tired and feeling down 80% of my life and losing people because of the time I can't make myself happy for them.

Hi Kacey
Sorry your dealing with so much drama. I'll give you a pep talk about Zoloft.
I have ADD and other social issues. Began taking 50mg a day 15 years ago.
This drug really worked for me. Without those drugged out side effects you spoke of. You may try taking Zoloft alone for a few weeks, and see if you notice a gradual change. I found this to be very mild and effective.
Good luck Tricee

[kacey321]

Thank you for your input Tricee ,I had tried zoloft years ago didn't work and it did happen to be long before the adderral xr before prozac came out actually . When Prozac came out and approved that helped for a short period of time and then started doing the opposite for me drained me,made me sleepy etc. I have even re tried many of the ones I had done like prozac,zoloft,even the effexor also newer ones cymbalta,lyrica,most recent one pristique and trazadone to help with sleep and supposedly may help with depression ,i weaned myself off that after a couple weeks on the lowest dose it made me a zombie slept somewhere like 10 hours a night wake up and back to sleep for a few hours awake a couple sleep more and it somehow seemed to cause me great anxiety more than usual and an agoraphobia set in the only thing that had been different so I attribute it to the trazadone.