Posted by CareBear04 on January 13, 2008, at 23:35:51
In reply to What else is there for me to try?, posted by jms600 on January 13, 2008, at 16:21:14
hi! i agree with phoenix-- you have lots of options still to try, and if your current pdoc is set on being pessimistic or ignoring your suggestions, if you can, maybe you'd be better switching to someone else. it sounds like you're keeping a positive attitude about your options, though, which is great. seriously... i'm in the same place as you are, except that i've unsuccessfully tried many many more drugs than you have. sometimes i feel like i'm destined to be a treatment failure and there's no point in trying any longer, but from an objective standpoint, i know that there's probably some med or some combo for everyone; it's just a matter of finding it.
here's some thoughts from my experiences:(1) except for effexor, the other three ADs you've tried are all SSRIs. not everyone responds to them, although you said the paroxetine was effective the first time around. i had the same rebound depression/ineffectiveness experience with zoloft, and i don't want what to suggest. i would probably go with an AD from another class, which appears to be what you're doing with the mirtazapine. wellbutrin, either alone or with mirtazapine, might also help with the apathy and depression. on the other hand, it sounds like you've done better on more sedating meds, and wellbutrin is fairly activating. how long were you on 225mg of effexor? i think it's at about that dose that the NE effects start kicking in, so some people start feeling relief at 225mg or above. if you didn't stay on that dose long, you might try it again since Effexor is one of the few ADs found to be effective for both depression and generalized anxiety. cymbalta is another drug that, i think, works very much like effexor. i was on it briefly, but i was also on a million other meds at the same time, so i can't say how effective it was for me. i've heard some good things about it, though, so it might be one to think about. and i have no experience with TCAs or MAOIs, but like the others suggested, i would look into those, although they do tend to have more side effects than the newer drugs.
(2) Lithium augmentation-- even for people who are not bipolar, lithium can be effective in increasing an AD's mood effect. for me, lithium just really takes the edge off everything and maintains a baseline, allowing the other meds to work. as far as side effects, people react in different ways, and you'd have to try it to really know whether its benefits outweigh the side effects you experience. the side effects do generally correlate with the serum lithium level, so when you use it just to augment an AD and not as a mood stabilizer, you need a lower dose and are less likely to discontinue do to SEs. the downside is the need for periodic blood tests to check levels, but again, if you're on a low dose, you probably won't need to get the level checked often. i would really encourage considering lithium.
(3) how are you currently taking your valium? prn or on a schedule? if you're not already taking it regularly, maybe you could try that. if you're like me and anxiety and agitation underlie your depressions, it may be worth it to take the valium three times a day (or however often needed to keep a steady level) even if it increases your tolerance to it. maybe your pdoc would allow prescribe extra doses for you to take prn if you suddenly feel panicky or overwhelmed. i just think anxiety is so closely related to depression that, unless the anxiety is under control, it's not much use treating the depression. i haven't taken valium, but ativan, xanax, and klonopin have been lifesavers for me! also, you may keep haldol in the back of your mind as an option. for me, it did amazing things at low doses. i was reluctant to try it for a long time because i associated it with crazy institutionalized people, but it solved a lot of problems for me when i did. my thoughts tend to race almost all the time, and haldol just slowed them down, but not so much as to impair my thinking. since it's a high-potency antipsychotic, it's not very sedating, and i only needed a tiny dose to get the effects.
Anyway, those are just some initial thoughts. hope you start feeling better soon!
cb
poster:CareBear04
thread:806208
URL: http://www.dr-bob.org/babble/20080105/msgs/806313.html