pharmacology

Hi,
thank you for the attention you're paying to me. My name's Giovanni, I'm 30 years old, and since four years ago I've been in cure for unipolar depression.
At the beginning I was affected by greatly depressed state, persistent death related thoughts, increased appetite, especially for carbohydrates, daytime somnolence, difficulties in concentrating, lack of memory and an abnormal need of sleep. I wasn't affected at the time by <anedonia>.
I went to a physician for my cognitive problems, that I thought related to liver dysfunction, at last, seen the lack of physical problems, I ended up to a psychiatry specialist. I was diagnosed with a unipolar depression, which probably went undiagnosed for many years.
I began my therapy with <fluovoxamine>, after 3 months the mood problems were resolved. The following four years of changes and adaptations of therapy were due to the need of removing the "remaining" problems.
I have taken: "fluovoxamine, fluoxetine, clomipramine, reboxetine, sertraline, venlafaxine". These cures reduced somnolence and bettered memory and concentration (of about the 50%), but didn't give me the chance to go on with my, almost completed, studies.
The psychiatrist claimed that since we tried "serotononergic" and "noradrenergic" there is nothing else to try.
I would have given up if, after a period of latency, two medicines, sertraline e venlafaxine (This last one gave the best results and I'm still taking it), cured me completely from the cognitive disturbs, even if only for a short time.
All at once the disturbs disappeared, and as fast they vanished the came back. Increasing the doses didn't help. Two psychiatrists told me that there are no explanations for what happened, even so: it did happen. I was diagnosed depression, not paranoia.
I can't surrender to a life without the chance to follow my interests, especially my studies.
I decided then to get some information from Internet and I came to know that also "dopamine" could be involved in depression.
For the moment being there are no "dopamine" based anti-depressants in Italy, "amineptine" having been take out of distribution.
I would like to know from you if there is a plausible explanation for what happened to me with sertraline and, even more, with venlaflaxine; if I am a unique case or if cases like mine do exist and can be cured or at any rate faced.
I have some dear relatives of mine in New Heaven: is there in the surroundings, like Boston for example, a medical centre, a psychiatrist that has some experience also with the use of "dopaminergici" drugs in cases like mine that I could contact?
Even for the simple chance of bettering my conditions I would try and come there to the States swimming.
Thank you for the time you've taken and again for your attention.
  Sincerely,
  Giovanni.

[HFHS MD - RG]

Medications at their maximal dose and giving it adequate time in your system (eg 5-6 weeks) usually would work.

Although, you have mentioned that depression has shown to be influenced by serotonin and noradrenegic systems and dopaminergic, literature would indicate that no one is really sure what causes depression. What the literature reports that if you take either of these medications, depression improves. Actually, research is ongoing other neurotransmitters that may help in alleviating depression - substance P.

A good explanation of the medication to stop working is the diagnosis. You may be suffering not only depression but other comorbid psychiatric diagnosis (eg personality disorders) that medication is not known to be truly effective. Also, if you have been depressed most of your life, your diagnosis may be dysthymic disorder (rather that unipolar depression) which is more diffcult to treat with medications but more responsive to pyschotherapy.

And in reality if you are taking the medication as prescribed, there is no reasonable explanation why a medication stops working. It is a common occurence.

A dopamine-based medication here in the USA is Wellbutrin (bupropion). I have no knowledge if it available in europe, It is marketed here by glaxo-wellcome.