Posted by papillon2 on August 16, 2012, at 12:31:16
In reply to Re: Lou's reply-koncarne » Lou Pilder, posted by SLS on August 16, 2012, at 8:33:05
Hi Alex,
I just came online to answer your question (posed in another thread) about what has helped me with my melancholic depression, but it seems that with a couple of exceptions you have tried everything I have and more.
My current regime is:
Nortriptyline 100mg
Lamotrigine (Lamictal) 200mg
Melatonin 4mg to help regulate my disturbed circadian rhythm
Various supplements and Aspirin to manage Nortriptyline related cardiac issues.Of these, I see you have not tried Lamictal. I take it to augment my anti-depressant and because studies suggest it can delay episodes of bipolar depression in people with bipolar II. We're hoping it might do the same for unipolar depression.
I'm not fully in remission, so my psychiatrist has been talking about trying Ritalin, Ketamine or rTMS. Ketamine is showing great promise as a treatment for severe and treatment-resistant depression and it may be suitable for you. Here's an article about it if you are up to reading it, otherwise you could print it out to take to your doctor: http://www.psychiatrictimes.com/mdd/content/article/10168/2090154
You mentioned Pristiq. I question whether it would be of any additional benefit to you over Effexor given its similar mechanism of action and the severity of your depression. Many people, like me, find that a broad spectrum anti-depressant such as a TCA or MAOI is necessary for melancholc depression. SSRIs and SNRIs just don't seem to do enough. As Scott has posted, there are other tricyclics you could try beyond Nortriptyline. So that's another thing to consider.
For your memory and cognitive problems, there's a non-medication treatment called cognitive remediation (rehabilitation) therapy. I haven't personally tried it and I don't know anyone who has, but I've been reading good things about it. It might help you manage your symptoms if not improve them.
Layman's description:
"Cognitive Remediation Therapy (CRT) is a cognitive rehabilitation therapy developed at King's College in London designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved social functioning."If you do a google search you'll mostly find studies involving schizophrenia patients, but it's also being used in cases of severe depression as well as traumatic brain injury, dementia and anorexia nervosa. So it has a wide range of applications. In a similar vein, I wonder if occupational therapy might also be helpful.
My psychiatrist has been exploring the potential there being a medical problem compounding my depression, making it harder to treat. So far I have been to a sleep specialist, had a sleep study done and consulted a endocrinologist. Next on the list is an immunologist to check for an auto-immune disease as these can cause fatigue and cognitive problems. These might be areas for you to explore should your doctor find it appropriate. I'd definitely get a sleep study done if nothing else. Sleep disorders are renowned for causing fatigue and cognitive problems.
I find lists helpful, so here's a summary of ideas you could raise with your doctor:
(1) Lamotrigine (Lamictal) to augment your anti-depressant
(2) Ketamine -- this I suspect would do more for you than
Lamictal
(3) A tricyclic anti-depressant other than Nortriptyline
(3) Cogntive Remediation Therapy or Occupational Therapy
(4) Seeing other specialists to rule out medical problems which could be compounding your depression, e.g. a sleep disorder.Your distress and desperation is palpable from your writing. 10 years with severe melancholic depression with very little relief must be gut-wrenchingly brutal. I admire the tenacity and fighter in you. With further treatment options still available (and new ones being developed), I wholeheartedly believe that there is reason for you to continue holding out hope for some relief. So hang in there, Alex, and be kind to yourself.
Papillon
Ring the bells that still can ring
forget your perfect offering
there is a crack in everything
that's how the light gets in
~ Leonard Cohen
poster:papillon2
thread:1023380
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