What would you try next?

Well I've had severe depression for years and I'm running very short on options here. Here's what I've tried:

SSRIs (Prozac, Zoloft, viibryd, celexa, lexapro)
SNRIs(Effexor, cymbalta)
NDRIs (Wellbutrin)
APs and AAPs (ability, seroquel, lithium, Latuda)
Mood stabilizers (lamictal)
Benzos (all except Valium)
Stimulants (Ritalin, adderall, vyvanse, concerta)
Nonstimulants (straterra)
Tricyclics (desipramine)
MAOIs (emsam)
Ketamine (intranasal)

In addition to meds I've also had a failed round of TMS... so, as you can see, not a lot left to try I've tried various combinations of those meds with almost no reaction good or bad to any of them.

I did find out that my genetic test said emsam would need to be a higher dose, but in order to do that or try a different one, I have to be off adderall, the only med that helps, even if marginally.

The way I see it the only things left to try are another maoi at the right dose, and ECT.

Failing ketamine really hit me hard I'm really not looking forward to etc or an maoi, and I'm hitting the end of the road so getting scared that pretty soon I'll have nothing left to try just wondering if anyone has any ideas?

Hi Climber47. Welcome to Psych Central. Oh that sounds rough dealing with treatment resistant depression. Sorry to hear that.

A friend had good results with ECT over a period of years. It also helped that they discovered a medical condition that was contributing to depression before it became more serioius. There are a couple articles that may be of interest.

https://psychcentral.com/lib/what-yo...nt-depression/

https://psychcentral.com/lib/about-t...epression-trd/

https://psychcentral.com/lib/an-over...e-therapy-ect/

https://psychcentral.com/lib/what-to...ect-treatment/

It could also be a misdiagnosis.
The most popular that I know are bipolar, thyroid problems, early dementia, thyroid issues, prodromal psychosis.

This page also list various other medical conditions that may mimic some or all of the symptoms of depression. https://en.wikipedia.org/wiki/Depres...ial_diagnoses)

Thanks for the replies... I've explored most of those options, at least as much as my doctors will cooperate... been evaluated for hormone imbalances, thyroid, vitamin D, vitamin B, iron, fibromyalgia, chronic fatigue, all the common medical causes. Even tried a naturopath, they took 25 vials of blood samples to test for various things, but nothing they tried helped, otherwise everything came back normal.

They've looked at other conditions like bipolar, and I may be slightly on that scale but it hardly matters since bipolar meds haven't worked either.

I can't do ECT anytime soon because I'll need someone to stay with me and my kids for six weeks... my parents are trying to move closer so they can help, but I don't know when that will be.

Just so hard to have any hope right now... any that I had went down the drain with the ketamine

I am so sorry that you are going through this. Please don't lose hope.

Have you been tested for Lupus?

Also, have you tried Pristiq? Just because you've tried Effexor does not mean Pristiq won't work. The stuff worked for me for a long time when nothing else did. I had to go off of it last year because it finally wore off after several years. Thankfully, Cymbalta is working pretty well.

You might give it a try.

I take ECT in the morning and go right back to work afterward. All and all I am in at 7:30 am and back to work by 9 or 9:30 It has not incapacitated me or my ability to carry on my day to day responsibilities:-0 It has also helped tremendously. I would definitely try it.

Gook luck to you.

My daughter has been on Lexapro, Abilify and Wellbutrin in the past. She is now on a cocktail of Tegratol, Serezone and Disipramine. Before starting the Disipramine her psychiatrist took her off off of the Seroquel that she was on. She was originally started on Limactical but got the rash so had to be taken off of that. So far it's not working well, but the Disipramine levels are well below therapeutic so the dosage was recently raised for that. ECT was recommended to her during a recent hospitalization, but she turned it down. Her psychiatrist (different from the one who treated her while she was hospitalized) told me that "ECT is a life saving treatment that is under-utilized". Sorry no help here, but it sounds like my daughter may be anti-depressant resistant too and possibly, just possibly, discussing it may help either you or my daughter, or both.