Depression Worsens.

I have suffered with Depression for over 40 years, been through all the Therapy and meds and currently maintain a level between Severe and Moderate Depression with the aid of Mirtazapine.

For the past few months I have been spiralling ever lower and I finally brought it up with my GP yesterday. She increased my dose of Mirtazapine greatly, which I started last night.

Exactly 12 hours later my Mood plummeted to what can only be described as abject despair. Rarely have I been this low, and it has never 'switched on' like this. It has barely eased or elevated since. I have never had this effect from an AD change or increase before.

Would you all say this is a result of the Mirtazapine increase, or simply a co-incidence and just a continuation of my worsening Depression.

Dave.

Why is it that people suffer from depression now more then ever in the history of this world? Has this thought ever came across your mind? Have you ever given any thought to this thought?

Sounds like a co-incident to me but I would talk to my doctor about it.

I'm sorry you are having to go through this. I suffer from depression, too, so I understand how bad it can get. I've been about as low as you can get but right now I'm almost stable. I hope it gets better for you soon.

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Hi Dave, I don't know the answer for sure trust your gut, you're smart for me personally I'd be a little wary of a massive med increase . I suggest checking in with the GP and keep us posted -hangin with you

I checked drug reviews on WebMD . . . I did not read them all (there are currently 167 posted), but here is one reviewer's comment:

Reviewer: 55-64 Female on Treatment for less than 1 month (Patient)
I became 10 times more depressed than I had been before taking it. For two days I felt HORRIBLE but at least realized it was the drug causing it. I kept eating chocolate until I finally felt better. I'm not kidding. I'll never take it again!! I only wanted an antidepressant for about a week anyway.

Are you familiar with WebMD? Their drug database is a great resource - they post: Side Effects, Precautions, Interactions, Overdose, Images, Reviews. REVIEWS! From patients - not the doctors or drug companies. Invaluable as an informational/educational tool. It empowers you with informed decision making. WebMD.com/drugs

Thank you Gayle and Fuzzybear

Onward, thanks for the idea. I scanned webmd and drugs.com Reviews (I have problems reading with my double vision), but found most reviewers are relatively new to the med - I have been taking it for over 3 years - and few talk about increased doses.

I have to talk to my GP again in a couple of weeks, if this state continues I will have to discuss it with her - earlier if the deterioration continues.

Dave.

Aloha Dave,

Since you are posting in the "treatment resistant" forum I am assuming you have had a variety of drugs prescribed over the years. I'm guessing that you're running out of options because Mirtazapine is a weak anti-depressant medication to use as a primary medication for someone with long-term, severe depression. Mirtazapine is the strongest anti-histamine available and works great for insomnia but not so good as a "stand-alone" for severe (or even moderately severe) depression.

If you want to read more about Mirtazapine you might look up Dr. Ken Gilman (psychotropical) who has done extensive research about this drug.

In my own case, Mirtazapine has been a life saver because it's the only drug that allows me to sleep. Unfortunately there are no more anti-depressant medications for me to use, all have failed to help. But, I've had 75 meds over 25-years.

I would encourage you to work with your physician to find a better/stronger primary anti-depressant medication if there are some you haven't tried yet. Best wishes

Have you considered ECT? Check out this video: . I was going to get the juice last year at this time, but I have an unusual stroke risk from cardiac myopathy, and I had to be lucid for a major transaction.

Hi Lefty,

ECT is rather out of favour over here, and it is unlikely I would be a candidate anyway. As I understand it an epileptic fit is induced under general anaesthetic.

Firstly, I suffer from Coronary Ischaemia and Microvascular Disease, my heart is damaged from a heart attack. I become Brady Hypotensive during Angiogram or chemically induced Stress Tests. When I had Cancer I had to go the chemo/radiotherapy option as no Anaesthetist was willing to risk a General on me.

Then, I take anti-convulsants as some little preventative from Chronic Cluster Headaches. I still suffer Attacks 4-6 times a week and they contribute to my Depression, but I could not survive any length of time without the meds.

Thanks for the suggestion, but with my multiple issues ECT is not an option.

Dave.

Hi Cloudyn,

Here, Mirtazapine is used to treat Major Depressive Disorder, or Severe Depression. I have been through many SSRIs and SNRIs, Therapies and coping on my own. I have had combos to try to treat my Depression and Anxiety/Panic Attacks. Over my lifetime, since adolescence, little has eased my Depression - nothing has ever lifted it. I have even been dxed with a Depressive Personality Disorder by Psychiatrists.

All I ask of a med is to keep me stable, halt downward spirals and definitely not allow or cause a plummet.

Dave.

Aloha Dave,

Well, I'm really sorry that nothing has worked for you. If anyone understands, I do...that's why I replied. You are not alone with your frustration and sense of hopelessness. For me, I'd do anything for just a little relief.

Too bad you're not a candidate for ECT- I've seen it work miracles. I did try it despite a cardiac condition but it didn't work. I've also tried rTMS, Ketamine, T3(pure thyroid hormones) and every other therapy available here in the US (except for Deep Brain Stimulation) which is not an option. Acupuncture actually offers me 24-hours of minor relief- whatever works?!

One treatment for folks like us who have not responded to anything else is called "California Rocket Fuel" It's a combo of Mirtazapine and Effexor- Just thought I would bring it up-

Because I've spent the last 7-years researching treatments for "Endogenous Depression" (biological depression) which is what I have, I've learned a few things. Depression due to biology is different than "Exogenous Depression" (situational) and responds differently to various therapies. It's taken me a year but I've found a physician who is willing to prescribe an MAOI drug (Nardil.) It's an old but effective drug for those of us which who are out of options.

I sure hope you find some relief- Living with debilitating, long standing depression feels to me like being a hamster running non-stop on a wheel, and never getting anywhere...

Endogenous Depression? Is that what they call it now, rather than an inbuilt Personality Disorder.

I have never been one to seek out labels for this, it has just always been with me. That is not to say I haven't experienced happy events in my life, but they have always been immediately followed by feelings of guilt, remorse and lower Mood.

Dave.

Cloudyn808 - is the T3 only med natural desiccated thyroid (NDT)?

I'm so sorry to hear about the worsening and about your physical health issues.

I like your posts. They're thoughtful, considered and caring.

I'm sorry for your pain (physical, existential, the whole lot of it). You don't deserve it.

I'm sorry you're suffering so much.
Just for clarification, mirtazapine is not an antihistamine, it's an alpha 2 blocker (sympathetic response) and a serotonin agonist. It is one of the meds currently recommended as first line to try for treatment resistant or treatment refractory depression, along with Effexor and wellbutrin.
What all have you tried? Have you tried the atypical antipsychotics. Even with your heart issues, you'd probably be fine at a low dose as long as you don't have prolonged QT issues. What about lithium or thyroid supplements? I get your choices are fairly limited but there's a lot of meds out there, chances are you will find something that will at least "keep you stable".
Hang in there.

for whoever asked, natural desiccated thyroid is the same thing as Armour thyroid and is a combo of T3 and T4, whereas Synthroid or levothyroxine is solely T4 and depends on the body to covert T4 to T3, which is the active form.

Hi Pinkflower,

The list of ADs I have been on is too long to remember, either they ceased to give any stabilisation or, more usually, they did little or nothing at all. My Drs have never felt the need to try me on Antipsychotics, new or older.

My Thyroid levels test perfect every year, only my D is always low for which I then supplement for a couple of months. That brings my levels up, but I cannot stay on it due to Calcium build up and my heart meds. Raising my D levels never alleviates my Depression.

I am trying very hard to stay off Lithium for chronic Cluster Headaches, choosing to stay on Topiramate instead. I do not like the listed side effects.

Dave.

Hi Dave, I am new to this and came across your post and thought wow..

I am from Birmingham in England, it may help you to familiarise yourself with another Brit! But right okay, I have studied a degree in psychology. Believe me the content itself isnt enough to help anybody to self-diagnose or help themselves, as it was academia based which isnt helpful with things like this..experience and practice is what gets you from A to B with these things and that is why I feel many Psychologists lack the will to actually help patients..they have not been through anything in order to understand exactly what will work..I sat and completed a degree, but the information I know has been based on my own research and experience in the past 5 years, I have left all medication and am working on myself with my mind and only it.

First of all, the medicine..you can have so many anti-depressants, you can have anything you like..and you may feel either a placebo effect or genuinely feel a bit more energetic, as most of them work on raising your serotonin levels..and that is where it is believed to be that your motivation expires from. This is also so with all other anti-depressants..But NOTHING will work, NO MEDICATION unless you are focusing on something positive.

When you feel down, or have done..consciously think now, where does your mind go, where has your mind conditioned to be for the past couple of years? the longer you think of things the longer you programme them into your brain, the worse you will feel. Are you focusing on negativity..or even your depression? or the past etc.. Your mind is everything, you can push your body up and do anything you like but eventually it will get tired and you will no longer be able to push yourself up anymore, because you will run out of energy to run away from what is in your mind. The way to get better is to change your thoughts. YOUTUBE 'Eckhart Tolle-depression' 'Tony Robbinson-depression' and if they interest you, there are books I purchased, these have helped me immensely. What you think you attract.

Cluster headaches? I hear those are even worse than the typical migraine. I cannot imagine. My heart goes out to you.

Hi Baj,

Nice to meet a fellow Brit here.

Up until 7 months ago I helped control my MH issues with daily Meditation hours. Then, my physical pain (neck/referred down arms) became so bad and such a distraction I lost the ability to achieve Clarity. This has had a profound effect, especially on my ability to control Anxiety/Panic Attacks and generally strengthen my mind. Even simple Breathing Meditation is impossible.

Until/unless this particular issue is resolved I fear I am trapped, having lost the one tool I had complete control over.

Dave.

My physical problems, including pain in neck, head and other joints also affect what I can physically do to help my depression though not as bad as yours sounds to be.I really feel for you!!

Onward,

Imagine a white hot railroad spike driven into your brain behind your temple/eye for 45 minutes to 3 hours. Being a Chronic sufferer, I get no Seasonal or months-long breaks like most afflicted. I get hit about 5-8 times a week and I cannot use the most common, most effective treatment for curtailing Attacks - breathing pure Oxygen. I am incapable of breathing deeply enough for long enough for it to work.

Thank you for your words of concern.

Dave.

Fizzyo,

I am sure your, and other's, physical issues are just as draining as mine. That is why we need each other in this Community of ours. The support I receive here and at our Sister Site, NeuroTalk, is what keeps me going and is more than I get in the Real World.

I do appreciate your kind words and hugs.

Dave.

We have so much in common! I get cluster headaches too though not as continuously as you; it's sort of seasonally triggered for me and can last for up to around 9 months, but I do get breaks. Topiramate was the only thing that ever helped me, but strangely when I was taking anti-depressants at the same time it stopped working for me, and now it doesn't even work for me on its own. Which leaves me a bit stranded. Other prophylactic drugs I've tried either don't work (most everything), or have given me permanent injury via their side effects (depakote! grr.).

I actually get what seems like almost every kind of headache there is, and some trigger the others.. I get tension headaches because of some botched spinal surgery I'll forever be suffering the after effects of, and migraine with aura since I was a kid. Clusters started in about my mid 30s.

It's probably no coincidence that it's only now I've been cluster free for 6 months or so that my last major depressive episode finally had a chance to break. I don't think people that haven't had experience with persistent severe pain can entirely imagine just how much it can impact one's mental and spiritual powers. It really does stack the deck, I feel for you.

Is the topiramate still working well for you?

P.S., Your white hot railroad spike in the eye description is indeed apt.. very similar to how I describe mine to my friends, right before they wince. I always feel badly afterwards, but I'm just trying to be accurate..

Vonmoxie,

I am never happy to hear of another Clusterhead Pleased you are in a lull, long may it continue.

I had to increase my dose of Topiramate this time last year. It has cut my Attacks from constant, up to 5 a day, usually an hour long, to 5-8 a week (sometimes 3 a day, sometimes none). The duration has increased but the intensity remains the same.

One of the positive side effects of the Topiramate is it dulls my constant Neuropathic Facial Pain/Paresthesia and TN by about 25%. The rest of the side effects are terrible, but they get washed out amidst all my other meds.

Dave.