[AnimalLover]

I know this is long, but please bear with me, I am desperately seeking some direction.

I have treatment resistant unipolar depression. Have been on Wellbutrin SR 150mg 2xday for more or less 10 years. No side effects.

I know my problem is NOT related to seratonin. All SSRIs have given me awful side effects.

Norepinephrine and possibly dopamine to a lesser extent are my problem areas. The guess was educated based on a lot of reading I've done and my own experience.

Since Feb 05, I've been in a major depression. Finally went to a pdoc in Aug 07. The Wellbutrin alone wasn't enough anymore. Pdoc that I go to spends an hour with you, leaves his home number on his office answering machine. I felt good about these things, how he is accessible and I wouldn't feel part of a cattle drive being moved through his office for med checks.

In Sept, I started on Nortriptyline. After a week, when I hit 50mg, something clicked in my brain. It felt like I genuinely stood a chance at getting myself out of this mess. That lasted only a couple days. Side effects did in Nortriptyline (shortness of breath, fast weight gain while on a 1200 cal diet, dry mouth to the point of my gums receding). The weight thing made me feel really nuts - I gained 6lbs in 12 days, all while not eating more than 1200 calories a day. Mystifying.

Pdoc tried adding Topamax to counteract the weight issue. That only resulted in extreme shortness of breath, pressure in my chest, a major headache that came on suddenly - all while doing the very un-aerobic activity of changing my bed linens. Took 20 minutes of laying down before my automatic BP machine could even register the BP (if it's too high it errors out).

That was the end of my Nortriptyline trial.

Next came desipramine, which succeeded only in making me extremely confused. Like I couldn't figure out how to get from one place to another when they were just a few blocks apart and I'm totally familiar with the area. Had trouble finding words, too. Overall, dumb as a brick, but no really bad side effects that I can remember. Oh, yeah, that drug affected my memory badly too.

End of desipramine trial.

The latest thing we tried was Ritalin. Started at 5mg, with instructions to go up a half pill until I felt an effect. At 25mg, I called pdoc and said no effect at all, next drug please? Only he convinced me to try it at 30mg. I did and it was the silver bullet. I was on 90mg a day. My kitchen was clean, I had energy and talked a lot, but my mood was stinky. Didn't feel like doing the stuff I used to enjoy. Then I started getting really angry which is not my style at all; and if I wasn't angry, I was crying because of how sad I felt. Called Pdoc this past Monday to tell him I thought I was losing it, with the volume of rage I was feeling toward about anything and anyone.

So now the Ritalin trial ended.

I tried to talk to him about an EEG/DB company that correlates your EEG with its DB of about 13k others. The DB houses combinations of EEGS and the drugs that worked for people with those EEGs. I asked for the second time during Monday's conversation and he was distinctly perturbed that I questioned him on it. All I said was it can't possibly hurt, and maybe it'll give us a new idea. He categorically refuses. Says there's no medical science behind it.

During my conversation with him on Monday, after he berated any doctor who would try the EEG thing, he then said he had only two options left and after that there was nothing he could offer me.

Well, that flipped me out. Both his closed mind on a non-invasive EEG that wouldn't hurt me, and how he said all he has left is Lamictal and EMSAM to try on me left me devastated. You mean there are only two more things to try and then my best bet is to go to the NIMH (he said that)? I felt like he had signed my death warrant.So despite my earlier good feelings about this pdoc, I'm now wondering if I need to find another one. And I'm just so tired, I don't know where I'll get the energy for that.

Obviously, I need to gain control of myself and have some kind of plan to move forward with - without a plan, I'm toast.

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SO MY QUESTION TO YOU ALL IS WHAT DRUGS MIGHT MAKE SENSE TO TRY NEXT?

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So here's a summary of my history:
SSRIs are out of the question

Multiple Reuptake Inhibitors:
Effexor SR worked but raised BP too much.Cymbalta same effect. Still trying to get off last 37.5mg of Effexor, it's discontinuation effects are hell to me.

Other:
Nortriptyline had the right idea, except for the side effects. This was another confirmation that norepinephrine is what needs to be mucked with (along with dopamine to a lesser extent.)

Desipramine did nothing good for me.

Ritalin got me moving, but over-activated me so I was in a constant rage or crying.
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I'm thinking of the following options, in no particular order:
- try a different stimulant at a low dose and see if that hits the brain in a different way so I don't get mad at everything.
It's low risk, immediate release, so I can get off it quickly if I need to.
Any suggestions for which one?

- Strattera was mentioned to me as an option because it addresses norepinephrine. Any thoughts?

- I don't see the point of trying Lamictal (pdoc's idea) - can anyone help me understand why this would be appropriate?

- Since pdoc's brought up mood stablilizers, what about other ones?

If anyone has experience with a drug that augmented Wellbutrin successfully for unipolar depression, please let me know.

Thank you -
Mary

[MissCharlotte]

Hi Mary,

I can't advise you on drugs but it sounds to me like you need a different pdoc--one who is a psychopharmacologist. Rather than quitting drugs abruptly, trying different dosages in combination with other meds sometimes helps. I would really change doctors to someone who has experience treating patients with treatment resistant disorders.

Best of luck.

[girlN]

Actually I am bipolar and have always had to be on anti depressants along w/ other meds b/c nothing helped w/ the depression but when on lamictal i needed no anti depressant so I think it is worth a shot. good luck w/ finding a treatment that works.

[josephina32]

I can't really give you any solid advice, but I feel so sorry for what you're going through. One thing I would say is change your doctor ! He really doesn't sound like he's helping now. I have tried most 'types' of anti-depressants, one of which made me gain 10 pounds in 5 days, partly water retention (as I could not go to the loo !), partly wanting to eat anything in sight. I have had limited success on ssri's but always stop them as they switch off my libido and can make me very agressive. I settled with an older type tricyclic - lofepramine. I am now experimenting with the supplement 5HTP as well as a low dose of my a/d. That seems to be working okay. Don't be fooled into thinking that a 'supplement' is ineffective. I tried them once and was so scared I stopped without giving them a try. The first few nights you take them you get mad, bizarre, nightmares and dreams ! so they do affect brain function ! The are connected to serotonin, I understand why you don't like SSRI's as I don't either, however the side effects are totally different. They don't affect libido, they lessen your appetite (in some cases) they don't stop you from thinking straight or make you aggressive. I hope you can find a doctor who can help you and advise. Please don't take anything I've suggested without the say-so of a doctor !

I wish you luck !

[splitimage]

Have you thought about ECT? When I was in hospital this summer, a lot of women were having ECT because there depression didn't respond to drugs. I've always been freaked out at the idea, but seeing it work changed my mind about it. Some of the women said that they started to feel better after about 4 or 5 sessions, and a "normal" course is 15 - 20. The only downside I'm aware of is some short term memory loss.

I know it's a bit controversial as a treatment, but it might be something else to discuss with your pdoc.

--splitimage

[nicole84]

For a stimulant type one I had Reboxetine, its relatively new and works on noradrenaline. For me I got too anxious and aggro, but might be worth a shot. Normal dose of it is 4-8mg daily.

Gives you energy, keeps you awake, but the anxiety for me wasn't worth it.

Good luck!

[sunrise]

I have read about correlating your EEG with others in the database and trying similar drugs to what has worked for them. I think it is worth a try and if your pdoc is not open to it, seek another doctor. You are the consumer, you can always change docs to get what you need.

Also, I don't think the NIMH is such a bad idea. They are probably open to much more than your standard in practice pdoc who finished med school years ago. They may be able to point you to some newer meds your pdoc is not acquainted with.

I read an article this summer in a popular magazine about a woman who had tried many different meds unsuccessfully for her depression. She finally found that low doses of a narcotic (can't remember which one) were very successful for her. Treating depression with narcotics is more common in Europe than the U.S. because of the American phobia against narcotics and addiction. But at the very low doses, this woman did not become addicted, and she was overjoyed to find a med that meant she didn't have to be severely depressed for the rest of her life. If you are interested, I can try to dig out this article. I believe it was in Vanity Fair this summer (but it might have been another mag).

Best of luck.

[DePressMe]

Hi Mary, I am really surprised your doctor would say he only had 2 more options--there are so many meds out there. That is one thing about my doc--he never runs out of ideas. I am taking a combination of abilify, lamictal, wellbutrin and dexedrine. It sounds like a lot, but we have spent the last several years trying to find something that works for me. I think the abilify and dexedrine have helped me the most.