Newer developments in antidepressants for this member of the 60%
August 24, 2017 10:54 AM   Subscribe

The 60%, that is, of people who take anti-depressants and do not get any benefit from them.

I haven't taken antidepressants for several years. For the 20 years before that I tried many, many different types of meds, dosages, combinations, you name it, but none of them touched the depression. I then went through a course of ECT which was successful for about a year and a half, but for various reasons I'm not willing to repeat the ECT. I'm really in the depths of depression now, and I'm thinking that there may have been some developments in antidepressants since I last took them, and I might find one that works better (or at all) for me.

I've been in therapy for decades, and with my current therapist for 5 years. But it's not enough. I'm willing to try meds again, but I'm skeptical. Among my fears that meds simply won't work again, meds have also always triggered Restless Legs Syndrome for me. That makes it a non-starter. I already have issues with insomnia (due to being post-menopausal), and I can't add that to the mix.

A couple of years ago a psychopharm had me try Brintellix (maybe it's called Trintellix in the U.S?), saying it was a new type of drug, and I had hopes. But each of the 5 nights I forced myself to take it, I had terrible RLS and had to stop.

Compounding my fears is the fact that I've been looking for a psychopharmacologist for about a year now (my old one left the area), and am unable to find anyone who's taking on new patients or takes my insurance (BC/BS). I have gotten lists through BC/BS, my primary care person, and my shrink--no dice so far.

Anyway, has anyone else who suffers from RLS found success with antidepressants? Especially new types that may work when older ones didn't?
posted by primate moon to Health & Fitness (16 answers total) 13 users marked this as a favorite
Have you looked into ketamine? It's been pretty effective for two people I know with severe treatment-resistant depression.
posted by lalex at 10:57 AM on August 24, 2017 [3 favorites]

(and briefly Googling ketamine + restless leg syndrome, it appears that it may actually have a positive effect on RLS.)
posted by lalex at 10:59 AM on August 24, 2017

Yes, I have. Right now there seems to be only 1 trial program running in the Boston area (!), and it's insanely expensive. Hundreds of dollars a dose, several doses a week.
posted by primate moon at 11:12 AM on August 24, 2017

One of the people I know is in Boston, has similar issues with the cost of IV treatment, and receives a prescription to administer it intranasally at home. If you would like to try it, nasal administration is one avenue to look into.
posted by lalex at 11:18 AM on August 24, 2017 [2 favorites]

Have you looked into transcranial magnetic stimulation (TMS)? I have treatment resistant depression (I still take 2 different types of antidepressants) and TMS helped a bit for me. Most insurance companies are covering it now as well.
posted by Fullofcrazy at 11:40 AM on August 24, 2017 [2 favorites]

Some thoughts:
- if it's been many years get your thyroid checked
- ketamine, rTMS are new hotness
- I know you've done many things but did you get to mood stabilizers (lamotrigine, lithium)
- is your problem anxiety related? Have you tried beta blockers? This is a UK protocol
- exercise, nutrition programs are also popular now
- some people are into supplementation - notably vitamin B12, d, and in the US you can have Deplin to supplement with folate
posted by crazycanuck at 12:20 PM on August 24, 2017 [1 favorite]

One other suggestion along the lines of supplemental therapy. If you have the benefits coverage, you can try massage, acupuncture, exercise therapies, etc as an adjunct to talk therapy. Mindfulness based cognitive therapy is a thing but it's not suited for serious episode, just adjunct on the way out. Basically working the mind/body connection is trendy in treatment.
posted by crazycanuck at 12:28 PM on August 24, 2017

You've probably covered all of these but I'm just listing them in case there's a few that you haven't:

- Are you 100% sure that it's depression and not some other thing that doesn't respond to antidepressants, eg 'soft' bipolar, BPD or another personality disorder (note - this wouldn't be a bad thing, BPD at least is super treatable), ADHD, an autism spectrum condition?
- Are you 100% sure it's not a physical problem like, as some people have suggested, hypothyroidism?
- Does your life Objectively Suck? Are there parts of it which, while they don't Objectively Suck, are unpleasant for you and not necessary? Some really great mental health interventions I've made in my life have involved eg becoming vegan (immediately not so guilt-ridden about food stuff), hanging out more with people I had things in common with, doing more art, working in an office with natural light
- Is your nutrition excellent, providing you in particular with enough vitamin D, B12, folate, iron, magnesium? The first four can be easily tested for.

Related suggestions, even if you've excluded all these things:
- Have you taken reasonably high-dose magnesium supplements? They have a lot of evidence for RLS, and for me personally they give me a lot more energy/clearmindedness although I wouldn't necessarily say they affect my mood as such.
- Sometimes thyroxine is used as an antidepressant even in the absence of clinical hypothyroidism; could be worth a try.
- DBT, the gold-standard treatment for borderline personality disorder, has some evidence in treatment-resistant depression even when people don't have a personality disorder. Might be worth looking into programs in your area.
posted by Acheman at 12:42 PM on August 24, 2017 [7 favorites]

This may be obvious, but have you tried physical exercise?
There is a growing, consensus among researchers that exercise is an effective treatment of depression. This NY Times article is a good summary, with appropriate caveats of a study that found that exercise used an adjunctive treatment in people who hadn't responded to antidepressants was effective, comparable to adding a second medication (but with only positive instead of negative side effects)
posted by metahawk at 1:50 PM on August 24, 2017 [1 favorite]

I took mirtazapine for a while. While I can't say it helped my state of mind, it did help me sleep and I didn't have any side effects or withdrawals.
posted by Diag at 4:07 PM on August 24, 2017 [1 favorite]

If you want information on microdosing, PM me. I recently had a nurse friend pull a bunch of journal articles... everything from ketamine to psilocybin. Happy to share
posted by fritillary at 5:13 PM on August 24, 2017 [1 favorite]

I've been taking antidepressants for years and was diagnosed as having restless leg syndrome, although nobody connected the antidepressants to the RLS. I was given neurontin for the RLS; I believe at the time (around 2002) neurontin was considered some kind of cure-all.
posted by Napoleonic Terrier at 6:47 PM on August 24, 2017

Wow, this was like reading my story...I was on so many med combos for depression THAT DIDN'T HELP. I'm in the US but my psych said this had been being conducted in other countries for the last 12 years. Have you had a DNA swab done to match you with psych meds? They take a cheek swab and it comes back with 3 columns; one red- with the meds that are not compatible with you, period. One yellow- with meds that might or might not help, and green- meds that work with your DNA to help you. Once we did this, I got on a great little med cocktail that finally works. Best of luck to you. I hate that you're having to go through all of this. (((HUGS))) 🤗 Here is the link to the company that did mine, if you wanted to ask your doctor.
posted by Amalie-Suzette at 6:49 PM on August 24, 2017 [3 favorites]

A friend of mine has been prescribed dexamphetamine sulphate 15mg a day (normally used for ADHD) for treatment resistant depression.
posted by b33j at 2:58 AM on August 25, 2017 [1 favorite]

Have you actually tried all the antidepressants available on the market? A lot of psychiatrists will prescribe a wide range of the more recently developed drugs--SSRIs, SNRIs, etc.--but have no experience with or don't think to try older drugs (or new formulations thereof) While some of the reason they've fallen out of favor is because of side effects, there are groups of people for whom MAOIs and tricyclics actually do works substantially better (and some of them have updated formulations, such as the selegeline patch, that lessen the side effects). I'd talk in depth with a really skilled psychopharmacologist about expanding your medication options if you haven't already.
posted by decathecting at 7:30 PM on August 27, 2017

Oh also, ask your doctor to try combining antidepressant drugs with something to help you sleep more soundly, or a RLS treatment. A doctor skilled in psychopharmacology should be open to helping you deal with your sleep issues, especially if they're a barrier to effective depression treatment.
posted by decathecting at 7:33 PM on August 27, 2017

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