When and how did you decide it was time to try heavy-duty meds?

March 17, 2009 3:06 PM

Treatment-resistant depression: When and how did you decide it was time to try the heavy-duty stuff?

When did you and your doctors decide to try anti-psychotics, older antidepressants (eg. MAOIs) or even ECT?

The meds I currently take helped somewhat with my depression, but I still have days where I'm feeling foggy and tired, missing work, oversleeping, afraid to get out of bed, crying, feeling miserable and feeling suicidal and self-harming. I've used up all of my sick days, and then some, pretty much all on days like this. My docs and I have tried SSRIs, SNRIs, and ADD meds at many different doses and combinations (about 15 different types, total, over the past 10 years). Currently on Cymbalta, Wellbutrin XL, and Ritalin.

I'm trying my best to eat right and get 30 minutes of vigourous exercise per day but I am admittedly only getting about 2-3 days on average per week. Docs and I are considering a sleep study, to see if the sleep issues are separate.

I always thought of the older meds, mood stabilizers, electrical/magnetic therapies, and anti-psychotics as an last resort add on. I'm wondering how you made the choice to try them, rather than, say, change your life/work to fit the disorder as it is. I'm getting frustrated, more upset, and fed up with the situation, and it makes me feel very "f- it all" wanting to quit my job and detach from society entirely.

Sooooo... advice? As stated, i'm not like this every day, but enough days that I'm in disbelief that I hold a job still, and thus it is a problem.

(throwaway email: [e-mail])

posted by anonymous to health & fitness (11 comments total)

Meds never worked for me (over 20 different types in the past 18 years). I eventually gave up when the docs started suggesting ECT or older meds. Each time I started a new med, they were so sure that this would be the one to help me. I would get my hopes up each time, and each time they were dashed. Eventually I lost faith in what they were promising because they'd failed to deliver time and time again.

I had to accept that my depression wasn't going to be fixed by the medical profession, so it was up to me. I've had to learn to deal with it on my own, to recognize my triggers and avoid them, to make changes in diet and lifestyle, and to accept that I will deal with this for the rest of my life. It isn't easy (and maybe it never will be) but it's not as hard as it was five years ago.
posted by baho at 3:41 PM on March 17 [2 favorites has favorites]

I always thought of the older meds, mood stabilizers, electrical/magnetic therapies, and anti-psychotics as an last resort add on.

No no no. CrazyMeds is your friend here, but do not be afraid to go old school. These meds give you access to a whole range of help and chemical reactions if the SSRIs are not working for you. They are still very much in use.

Taking Lithium as an example, the very idea of it freaks people the fuck out because it has a terrible reputation, but that's historical - taking it 20 years ago was a GIANT PAIN IN THE ASS, in addition to doseages being not particularly well understood. But for some people it's like flipping a switch and nothing else works. In 1989 it saved my life and I'd take it again in a heartbeat in 2009 if it was my best shot.

ECT is poorly understood but I have no experience of that so I will leave that to others.
posted by DarlingBri at 3:51 PM on March 17 [1 favorite has favorites]

Quick question: how's the "other side" of your depression? Do you ever have manic - or even somewhat manic - states? Look up the definition of Bipolar II. A lot of treatment-resistant depression is treatment-resistant because it is actually undiagnosed bipolar, for which a whole different category of medications are available. Bipolar is often missed for -years- by even skilled therapists, especially the milder bipolar II, because treatment is often only sought for the depressive side of the disease.

If you haven't tried Cognitive-Behavioral Therapy (CBT), that could also provide some relief methods, if not relief. Pick up a copy of the "Feeling Good Handbook," by David Burns, which is very useful and cheaper than a doctor visit.

Not sure if any of the above will help, but worth checking into. Keep on it. You'll find an answer - the diligent work you are doing, and have been doing, serves as proof of your progress.
posted by soulbarn at 3:51 PM on March 17

This might sound somewhat ... annoyingly irrelevant, but have you had your thyroid checked out? By an endocrinologist, not a GP?

I'm on Cytomel, among other things, :::ahem:::, and the dose was recently increased by five times.

It was like flipping a switch, mood-wise, the next day. Zero to 60. The other hypo symptoms are much improved, also.
posted by jgirl at 5:03 PM on March 17

Get the sleep study first. Apnea and other conditions cause depression. Not to mention thyroid, diabetes, liver problems, etc.
posted by damn dirty ape at 6:13 PM on March 17

I experienced two episodes of severe depression, one so horrible that I considered having myself hospitalized and seriously looked into ECT.

Perphenazine helped (and is stunningly inexpensive) as did sub-clinical doses of Seroquel. Seroquel requires some adjustment time - the first time I took it (25 miligrams) I felt drunk, but quicly adjusted. It really helps me - I still take it for sleep.

When I was at my lowest, my psychiatrist recommended neurofeedback. It's crazy and really goes against the rational part of my brain, but it has saved my life. I still do it once a week and I'm a good two years from my worst episode. If you'd like to talk to someone about it, you can find someone here.

Good luck and I'm sorry this is happening to you. I know it's a lonely and difficult thing.
posted by orsonet at 6:21 PM on March 17

After over 20 years, 4 doctors, as many therapists and more, my current psychiatrist has started talking about treatment-resistant major depressive disorder. We have also discussed aspects of bipolar disorder and borderline personality disorder. He urges me not to focus on definitions and diagnoses -- that the key is going to be really understanding/documenting my experience, and working within the known medications to find a combination that really addresses my specific conditions.

I've tried five new-generation anti-depressants over the last 14 years, and am now experiencing more relief than I've felt in a decade with nortryptaline (a first-generation medication from the 60's).

It's still not perfect -- I'm just coming off of a particularly serious bout. But it has lifted me out of the deepest of my depressions, enough for me to understand that there really is something cyclical going on here (ie. something more like bipolar disorder than "simply" depression.)

It took some positive self-talk, but I decided to try Abilify (one of the newer bipolar disorder medications). It did not work for me (I experienced a side effect which was a dealbreaker for me). My doc says the next one to try will be Lamictal. Both of these are anti-psychotics. I can empathize with the fear and loathing that the phrase "anti-psychotic" might trigger in you, for it did for me as well. However, ultimately, I decided this: I simply cannot continue to live/exist this way. I need to find relief. As such, I'm going to continue to try things that my doctor suggests, after going over the decision with him and truly coming to an understanding of why/how the new medication might alleviate or address my problems.

I definitely suggest various kinds of talk therapy, as well. I'm not in therapy right now, for financial reasons. (Which is OK with me, as I also happen to feel that I've therapy-ed myself out for the time being.) It does, however, make the quest for medical treatment that much more poignant and essential.

I wish you the best of luck.
posted by CitizenD at 6:37 PM on March 17

Thinks to look at as precipitating health issues, very much worth checking out:
- Thyroid check
- Insulin resistance
- Sleep apnea

@soulbarn - Agree about BP II. I know docs that have missed bipolar II for years; with new diagnosis, patients responding promptly and dramatically to the new class of drugs (e.g. lamotrigine. Even small changes in dosage can make a huge difference, so expect it to take some experimentation. Also second CBT.

You've come this far, keep up the good hard work. There are possible changes out there that are worth the challenge. Be ready to experiment with new things under care from your trusted doctor(s). Close observers beside you like trusted family or friends, can help you assess the effects, but remind them they are not to there to second guess your decisions.
posted by buzzv at 6:42 PM on March 17

3rding suggesting Bipolar II to your doctors. I was misdiagnosed with depression for many years, and treated with everything under the sun -- including antipsychotics, SSRIs, mood stabilizers and eventually several courses of ECT (Wellbutrin kicked off one of the worst episodes). Finally I saw a new Dr who looked at my record and said "Dude. This is classic Bipolar II." He put me on Lamictal (now generic lamotrigine) and I've been stable and happy, with no appreciable side effects, since 2003. It was like somebody opened the curtains and showed me sunshine for the first time.

If you do decide to opt for ECT, see if you can do it outpatient. Hospitalization is far more traumatic than the actual ECT. MeMail me if you want more details.
posted by media_itoku at 7:48 PM on March 17

CitizenD: Lamictal's not an anti-psychotic like Abilify; it's an anti-convulsant used as a mood stabilizer.

Another diagnosis to consider is cyclothymia, which is a milder form of BP II that too responds to mood stabilizers. Don't try to re-diagnose yourself or anything, but if you've found that there's some cyclical pattern to your moods, mention it to your doctor.
posted by thisjax at 8:03 PM on March 17

Seconding the sleep study. If you have apnea then you probably do not realise what a difference proper sleep makes. I didn't. Wow.
posted by Joe in Australia at 4:23 AM on March 18