Posted by med_empowered on January 3, 2006, at 5:23:46
In reply to Re: Depression breakthrough vs poop-out, posted by Emily Elizabeth on January 2, 2006, at 23:10:59
hi! this sort of thing will happen. Personally, I'd avoid hospitalization unless you are suicidal. Hospitalization is usually better for jiggling meds and preventing self-harm than helping deal with the depression/mania/psychosis in and of itself.
Anyway, some docs go over the 60mgs/day cymbalta, which might help you..if it is poop out, upping the dose could restore efficacy. If its breakthrough depression, upping the dose could also help that. Adding an atypical antipsychotic--counterintuitive as that may seem, since you're already so withdrawn and lethargic--could help. If you went this route something like low-dose Abilify might help...at least with abilify if it doesn't work you probably won't gain weight or mess up your blood sugar any.
Are you on a mood stabilizer? Even if you're not bipolar, a mood stabilizer could help the antidepressant(s) work better and keep everything on a more-or-less even keel. Plus, some seem to have (modest) antidepressant effects, so that could be helfpul (lamictal could be a good option, since it seems to be so helpful for depression).
Stimulants help some people. Provigil would probably be a good first option, if your insurance will cover it; if not, Ritalin seems to help a lot of people as an add-on. The amphetamines are another option, but that's probably something that should wait for after trials of other stimulants.
Sometimes TCAs are helpful when added to other, newer antidepressants; since TCAs are tricky, especially in combo with other meds, this would probably be a combo done when other stuff fails. Personally, Tofranil PM (the newish once daily Tofranil) and Cymbalta helped alot for me. The big benefit was in **speed** of response; after a while, it kind of stabilized at low-grade depression, but the speed at which I was pulled out of hardcore misery was pretty impressive. The side effects really sucked though.
poster:med_empowered
thread:594512
URL: http://www.dr-bob.org/babble/20051231/msgs/594703.html