Lifelong Depression - considering another stab at medication

April 5, 2016 1:40 PM

I've had lifelong depression. I tried meds and therapy for years. I got little to no relief and awful side effects. I had awful withdrawal and all of it cost a ton of money. I've still having a hard time - snowflakes inside

I was on medication for years SSRI's, benzos etc. I made a decision to get off when I had TONS of side effects and little to no relief. I decided to get off the medication but continue with therapy. I had awful acute withdrawal symptoms to the point where I was suicidal.

I had tried therapy for years - CBT, Talk, DBT. Nothing helped.

I then got genetic testing done and found that I had some MTHFR and COMT mutations that I tried to treat with methylfolate etc. I tried dealing with doctors to treat my condition with B vitamins and 5htp etc. I had tons of testing done.

This all cost a fortune and I don't feel better. I am working on improving my life and am considering therapy again.

MY QUESTION IS......
has anyone tried Genesight or Genomind? Is this just another scam? I am looking to cautiously consider meds again. I am scared to death because of the withdrawal that I had. I also don't want to be a zombie again with no sex drive, dry mouth, constipation, etc etc etc

I know that some people have also had some success with CBD.

I really don't know what to do. I've tried mediation, etc too. I am currently weightlifting 6 days a week and it does help, but the effects are only after I lift. The next day they are gone until I lift again.

I have awful ruminations, pure O OCD and racing thoughts etc. Compulsions not so much.

The last therapist suggested an SNRI. I'm glad that I didn't take it, because my catecholamines are always high.

Does anyone understand this stuff?

posted by kbbbo to Health & Fitness (17 answers total)

Response by poster: I couldn't see a way a to edit. The genetic testing that I took was 23&ME

I am trying to see if these other tests are covered by insurance - which is always a whole 'nother thing
posted by kbbbo at 1:45 PM on April 5, 2016

Maybe you could list which drugs you've already tried?

I wonder about your doctor. Benzodiazepines are more for anxiety than depression and are habit-forming enough that they should be prescribed with caution and for limited periods. I'm not surprised you had serious withdrawal symptoms if you were taking benzos regularly and came off them abruptly!
posted by praemunire at 1:53 PM on April 5, 2016 [2 favorites]

There are currently multiple clinical trials running in the US testing low doses of ketamine for treatment-resistant depression. You may qualify on the basis of having not been helped a previous course of conventional antidepressants. Previous ketamine trials have been promising. If my own depression treatment were to stop working, getting in a trial for ketamine would be at the top of my list of things to try.
posted by silby at 3:20 PM on April 5, 2016 [1 favorite]

Response by poster: OP here.

I think my depression is mostly a byproduct of my extreme anxiety.

Over the years I was on Zoloft, Wellbutrin, Luvox, amphetamine salts, Prozac, Lamictal, Risperidone, Xanax, Adderall and Ativan.

They gave me the benzos to calm the adderall and amphetamine salts to wake me up as the ssris were causing me to fall asleep at stop lights.

After I got off meds, I stopped using benzos frequently. I now use a couple times a month.
posted by kbbbo at 3:54 PM on April 5, 2016

Have you investigated the possibility that you may have bipolar disorder? Because if you do, the medications you've tried and failed to thrive with may be the ones that aren't recommended for those with bipolar I, II, or some of the other forms of the disorder.
posted by Hermione Granger at 3:57 PM on April 5, 2016 [1 favorite]

Response by poster: was diagnosed (by diff docs) as OCD, ADHD, BIPOLAR2, DYSTHMIA AND GAD
posted by kbbbo at 3:59 PM on April 5, 2016

Have you looked into ECT treatment? It has been known to provide good results for otherwise treatment-resistant depression.
posted by jtexman1 at 3:59 PM on April 5, 2016 [3 favorites]

There are also transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS).
posted by XMLicious at 4:15 PM on April 5, 2016 [3 favorites]

I had some MTHFR and COMT mutations that I tried to treat with methylfolate etc. I tried dealing with doctors to treat my condition with B vitamins and 5htp etc. I had tons of testing done.

Were B12 injections tried? I'd always taken B12 oral supplements, but it wasn't until I tried the actual injections (in a real loading dose trial of 3x week for 3 weeks) that all sorts of symptoms that had been labeled for years as "anxiety" and "treatment resistant depression" lifted permanently (and I wasn't even expecting that "side effect").
posted by blue suede stockings at 4:26 PM on April 5, 2016 [1 favorite]

They gave me the benzos to calm the adderall and amphetamine salts to wake me up as the ssris were causing me to fall asleep at stop lights.

Holy cow...if you decide to go the meds route again (not in itself a bad idea), I would definitely seek out a different treatment team, with a more cautious approach! When you're on, like, your fourth drug to offset the chain of side effects caused by the previous three in succession, you'd better be dying of cancer (or something equally serious--not that depression isn't serious, but you take my point--that many medications piled on top of each other is itself a real health risk).

Perhaps, along with the other suggestions given above, you might consider the older generation of antidepressants, the tricyclics? They can require very modest dietary restrictions and do sometimes cause sleepiness, but they can also be helpful. It's not entirely clear to me that the "new" generation of anti-depressants have been adequately proven (in retrospect) that much superior to the older one. In any event, a different class of drugs altogether might have different and more tolerable side effects.
posted by praemunire at 4:43 PM on April 5, 2016 [2 favorites]

Ah, okay. I have BPD 2, OCD, and GAD. I am taking Lamictal and Klonopin, along with Xanax as needed for sleep. Eventually I will probably need to add an anti-depressant into the mix unless Lamictal pulls me back into equilibrium as I continue to take it. Lamictal is specifically for BPD 2, and the Klonopin is for the GAD/OCD.

When you say you've quit various medications, does that mean cold turkey or by following the reduced dosing schedule for each drug? Have you ever gone through a detox program as a means of starting from scratch? I ask because two other people in my family are having the same experience that you are, and for them the chaos and lack of relief is coming from having been (incorrectly) put on uppers, downers, adderal and other meds, and then going off everything cold turkey because the side effects are so miserable. The adderal has been the worst thing they've been on because it's basically made their brains and bodies act like they're on speed and it's really wreaked havoc on their recovery.

So basically what I'm saying is... Do you have the means to start from scratch as much as possible and go through a detox program and maybe find different psychiatrists who won't put you on conflicting treatments? I understand how horrible this is. I hope you find a solution soon.
posted by Hermione Granger at 5:19 PM on April 5, 2016

Response by poster: OP here -

I've been off meds for a few years. When I came off 4 things at once (prozac, lamictal, risperidal(risperidone?)/something else, it was tapering under docs supervision. I think that it was a couple weeks or so.

They were operating solely on the half life and how long until it is out of your system. I now know to go slooooooow if I ever taper and I will be much more informed about taking something.

TY
posted by kbbbo at 5:32 PM on April 5, 2016

The last therapist suggested an SNRI. I'm glad that I didn't take it, because my catecholamines are always high.

Can you explain this? It's an unusual statement to make for several reasons: Therapists can't prescribe drugs (so the advice is odd) and I'm not aware of any common testing for catecholamine levels in psychiatric disorders (the idea that your pre-existing levels are 'always high': who says?).

Also, the labels themselves are vague: The idea that an SNRI (serotonin and norepinephrine reuptake inhibitor) would boost all your catecholamine levels is really a vast oversimplification.

It sounds like you've tried a lot of meds (and maybe had some poor choices recommended for your) but for some people it really takes a long time to find the right combination - if you are rejecting suggestions from your doctors, this process can be difficult.
posted by soylent00FF00 at 5:39 PM on April 5, 2016

I've done Genomind and I'm very glad I did, in the sense that it essentially confirmed every one of my previous bizarre experiences with meds and gave me guidelines on what to try next. I took my results to a psychopharmacology specialist who explained them to me in detail, which was also very helpful.

This was all fairly recent, so I haven't worked on the suggestions yet, but getting the testing definitely can't hurt. It was covered by insurance for me.
posted by ariadne's threadspinner at 5:41 PM on April 5, 2016 [1 favorite]

Assuming your diagnoses are accurate, just medication or just therapy probably won't help you over the long term. In an ideal situation, your therapeutic provider would be on a team with your medication manager. Or, incredibly, they would be the same person. I know that these types of treatment teams/therapeutic psychiatrists tend to only exist in mystical fairylands, but if you can find such a magical arrangement, it's extremely helpful.

I strongly advise against using your GP to manage psychiatric medication.

Bipolar disorder is tricky to medicate, and bipolar II can be very stubborn. I've been on antipsychotics, benzos, antidepressants, anticonvulsants, and lithium in various combinations. I didn't personally experience unpleasant or unwelcome side effects from Lamictal or Wellbutrin, but Lamictal unfortunately stopped working for me entirely after about 18 months. Attempts to restart were unsuccessful. Wellbutrin is one of my favorite drugs, actually--no sexual side effects, no fog or numbness, no withdrawal, no weight gain or appetite increase, no real desire to smoke cigarettes. It's quite lovely. Unfortunately if I become hypomanic while on Wellbutrin I can easily slip into something more akin to true mania (risk-taking, money spending, no sleep, motor mouth, delusions of grandeur, etc.), so I had to stop taking it, much to my regret.

SSRIs are another story. Like you, I have all the bad side effects of taking SSRIs and also discontinuation syndrome when I stop taking them. Discontinuation syndrome is like, the worst. I won't take another SSRI again.

According to the International Society for Bipolar Disorders Task Force, SNRIs and tricyclics should only be used as a last resort for any flavor of bipolar disorder. And nowadays, only 20% of bipolar patients treated by specialists in the disorder are on antidepressants. They are just very tricky to work into a cycling mood disorder without creating rapid cycling or other mood instability like mixed episodes, etc. It seems that the current trend is to rely primarily on a mood stabilizer (Lamictal for depressives, lithium for manics, etc.) and then use other things to manage depression. Exercise, nutrition, sleep hygiene, CBT, light therapy, etc.

In addition to bipolar, I have struggled with anxiety and OCD (trichotillomania in particular). Once I committed to truly doing the therapy, CBT pretty much fixed my anxiety, which made the trich melt away. It's not that I don't get anxious anymore--I definitely do. But now I have tools to manage the anxiety and self-soothe, and I can very easily use the mindfulness techniques I learned to head off panic/anxiety attacks before they become a problem. For example, I know that one of my anxiety triggers is driving to unfamiliar places. The moment I notice that my shoulders are creeping upwards and that I'm gripping the wheel tightly I do some deep breathing, wriggle around a bit, put on some music or NPR, etc. And I always notice, because I've conditioned myself to do "body check-ins" when engaging in an activity that I know can cause me feel anxious. But doing CBT couldn't just be a mental exercise for me. I had to actually do difficult and traumatizing homework to make real change, and I had to admit to all of my dumbest fears and be honest with myself about what they were. In your shoes, I would specifically address anxiety and give CBT another chance. I have done tons of therapy to try to fix all kinds of things, and the only thing that stuck and made real, lasting change was doing CBT for anxiety.

I can't comment on ADD because I've never had to personally deal with it. I imagine adding ADD to anxiety and bipolar is rough. Which is why I think you should do your best to try to find a "whole person" approach to your treatment if at all possible.
posted by xyzzy at 8:33 PM on April 5, 2016 [2 favorites]

I have struggled with depression from bipolar 2 for years, and medications have either done little or had horrible side effects. I recently completed a course of ECT treatments that have played havoc with my memory but have done wonders for my mood and energy level. The change is remarkable.

There are some trade-offs - it isn't cheap, I have to drive a few hours to go to a doctor who was recommended by a psychiatrist I trust, and as I said, my memory from the past few months is very fragmented, although I'm told that I will get some of my older memories back over time. It's definitely a last-resort treatment. But memail me if you want to know more.
posted by bibliowench at 8:58 PM on April 5, 2016

I think your bit about anxiety causing depression is on the mark, in which case medication is not going to be the root of the solution unless it's a psychoactive treatment and I have no idea how widely those are available and they tend to be fairly specific to specific diagnoses.

Recently I saw some interview where the person very positively volunteered out of nowhere that transcranial magnetic stimulation had done wonders for their depression. I wish I could remember who it was, but it also is suppose to be promising for GAD. It definitely seems like something to look into, as anything that can help you as you try to resolve what your issues actually are is worth it.

If you've tried all those things then you've been at it for some time so you must have some idea of what works and what doesn't to some degree and depending on how old you were when you did whichever might have to do with how efficacious any of it was then or now. I know someone who had a lot of anxiety issues and was very adverse to talking about anything directly and basically ended up exercising as much as possible because she'd rather be exhausted. Getting a workable diagnosis would be a real start on figuring out what to do and I wonder if you've had any worthwhile brain scans recently. The results of TMS could point the way towards what works and doesn't, as it were, plus fresh eyes on everything from history to present symptoms.
posted by provoliminal at 1:22 PM on April 6, 2016