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Assistance appreciated

I have a treatment resistant form of depression that has not responded to numerous traditional antidepressant medications, although I have tried many. I was finally referred to a top research university to consult with a doctor who specializes in treatment resistant depression (TRD - an appropriate acronym if ever there was one). He has done many clinical studies treating TRD with Provigil (as have other research hospitals) and it is one of the few medications (well, the only, actually) that has helped me. The problem is that my insurance company refuses to cover the medication, which is $2400 out of pocket for the generic form. I just cannot afford to pay $29,000 a year for medication. I started by calling the pharmaceutical company to inquire about assistance, but they have canceled their Provigil assistance program and also told me that depression is one of the few illnesses for which they do not provide assistance anyway. I then looked into other assistance programs, but they require enrollees to be without insurance, and giving up my health insurance is just not practical. So I then considered drug discount cards and the best deal I could find was a 10% discount, a cost that is still too prohibitive. So I am left with the real possibility of either using what little savings I have to cover this medication, until my savings are exhausted, or to go without one of the only medications I've found that helps me. Has anyone found any other creative ways to cover the cost of expensive medications that aren't covered by health insurance? I do not know what to do at this point. Thank you for your help.
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Avatar universal
Hi,
I take Provigil (modafinil) also, in conjunction with my cheap Fluoxetine (prozac). But, it is expensive, so I buy it online in bulk - I would try the modafinilcat website, if you are able to spend a couple hundred it should last quite a while. I order once every 3 months or so, and shipping is pretty fast. God bless the psychiatrist at my college who actually prescribed it for me in college, since it is off-label and hardly anyone wants to give you the Rx.
Helpful - 0
Avatar universal
You must be taking the MAO because no other anti-depressant worked for you?  Am I correct? I was taking it for a couple years and never felt better before or after.  I do so remember that none of the foods tempted me until I would go off of it and then couldn't wait to totally load up my grocery basket with all the foods that I hadn't been able to eat for so long!!  I am curious as to why you chose to take the MAOI.  

And you are absolutely right that it is very important to have health insurance.  You never know whether you can get cancer--at any age, or be a victim in a crime.  A lot of the Boston Marathon victims are now very upset that their medical bills are very high and they have no insurance.  And if you have an illness, you will end up getting what you can pay for.
Helpful - 0
Avatar universal
I would never drop my insurance that is provided by an employer or school. Medical insurance is extremely expensive if you buy it as an individual. My sister pays over a $1000 a month for her premium and has a $5000 deductible.  Try for the waiver/prior authorization. Also, Abilify, an antipsychotic, is also approved for depression. I take it and it started working on my depression in the first two weeks. I also take an MAOI, Emsam, a transdermal patch which is very expensive but my insurance covers it. Oral forms are very cheap. I do follow the diet, basically you can't have dried, smoke, aged meats, aged cheeses, pickled foods... and other things including soy sauce. I miss soy sauce!
Helpful - 0
Avatar universal
I'm wondering if you ever tried an MAO Inhibitor anti-depressant?  It is an unusual one because you have to watch certain foods in your diet, but I never felt better than when I tried that one.  Let me know.  It has been on the market for at least the past 20 years and must be very cheap.
Helpful - 0
Avatar universal
I have tried Seraquel and it doesn't make me sleepy. You never know what meds will do what until you try them.

As for the insurance, this is how mine works. If my insurance does not cover the med than I have to get a prior authorization. Dr office sends form to Pharmacy, they get it to your insurance company and the insurance company either approves or denies. The MOST important thing is the dr puts on the form that you have tried other meds that did not work and that is why you need this particular med. It has worked for me every time I had to do this. Just the other day this happened to me. The med would have cost me 990.00. They went thru this process because I had tried other meds that didn't work, it was approved and I just had to pay 30.00. See if this will work for you.
Helpful - 0
Avatar universal
Thank you very much for all of your very heloful suggestions, Bubulous. I'm glad to hear that you are feeling better and have found some medications that work for you. Mental illness can be exremely difficult to deal with at times, so I feel more hopeful when I hear about the success stories. I wish you all the best. I'll come on line and let you know if I try Seroquel or Lamictal. Thank you very, very much!
Helpful - 0
1551327 tn?1514045867
Oh yeah,
The Seroquel has a very strong sedative effect.  That is one of the most helpful effects of it.  I have to get sleep or I will become manic and until I was on the Seroquel I would cycle so fast that I didn't think any medication would help.   I still cycle and I likely always will but I am enjoying a quality of life that is manageable and more stability than I have ever had.  Also the Seroquel has the added benefits of being and anti-depressant and an anti-anxiety med.
The Lamictal is just a mood stabilizer but very affective.  The only thing you have to watch out for with it is a rash that may or may not develop that can lead to Stephen's Johnsons syndrome but don't let that keep you from trying it because it is rare and even if you did happen to experience that side effect (which again is not likely) if you talk to your dr as soon as you see the rash it is treatable.  I did not experience the rash and I have only talked to one person who has and I talk to a lot of people with BPD on here and in my personal life so don't be worried about taht because the therapeutic effect it can give you is well worth the slight risk.
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Avatar universal
I have done some reading on my own about clinical studies done with both Seroquel and Lamictal, and both seem to be effective in treating TRD. I'm definitely open to trying different medications. I just want to find something that will help me to function so that my symptons don't continue to disrupt my life. Do either medication make you feel sleepy?
Helpful - 0
1551327 tn?1514045867
I think that you may benefit greatly once you try some of them.  I am on Lamictal and Seroquel and these are the medicines that I have tried that did not work:

Trileptal
Risperidone
Zoloft
Wellbutrin
Trazadone
Lithium
Topomax
prozac
Ambien
It was a long road but I am a lot better on the Lamictal and the Seroquel than I have ever been.
Helpful - 0
Avatar universal
Have you tried either Lamictal or any antipsychotic meds such as Abilify? There seems to be a lot of promising data with Lamictal, in particular.
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Avatar universal
Those are some of the medications on my doctor's list to try, but since I felt some benefit from Provigil Iand I'm actually still tapering up to the target dose), I had hoped to just stay on this medication, But it looks like I may have to now taper off and try something else - which simply prolongs my symptoms and any potential treatment. Who knows how many other medications I'll have to try before I find something as effective as Provigil. And then there is another potentially more serious problem. Most of the medications that my doctor had hoped to consider (including most, if not all, of the medications you mentioned) have not been approved by the FDA for depression, and so my insurance company may likely refuse to cover them as well.  Since mood stabilizers have been approved for bipolar depression, it's possible my insurance might cover them, But I don't know if they will be effective, and I suppose it's possible that my insurance company could refuse to cover even these medications since my DSM code does not indicate bipolar disorder.
Helpful - 0
1551327 tn?1514045867
Have you tried any mood stabalizers like anti-seizure medicines (Lamictal, Trileptal)?  Have you tried any snti-psychotics like Seroquel (which is also expensive) or Risperidone, olanzapine?
Helpful - 0
Avatar universal
Hi Liz,

Since I am a university student, my insurance options are very limited - I get what they give me. However, it might be worth investigating other insurance companies that have covered this medication for depression (and my doctor would probably know which have), and potentially dump my present insurance company for another. I hadn't considered this, so thank you very much for the suggestion!
Helpful - 0
Avatar universal
Hi Bubulous,

Here are a couple of links providing information on TRD:
http://en.wikipedia.org/wiki/Treatment-resistant_depression
http://www.mayoclinic.com/health/treatment-resistant-depression/DN00016
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887642/

In the past 15 years, studies have begun showing that some people do not respond well to the traditional antidepressant medications and, in some cases, these medications may actually worsen their depressive symptoms. The reasons for this seem to vary. Some of these people may have what is know as "soft" bipolar disorder, which looks very much like unipolar depression in that these people have only very slight, almost unnoticable, manic phases that go undignosed - in other words, there is a spectrum of bipolar disorders, some with a greater degree of mania, other with a greater degree of depression, and many in between. And since their clinical presentations are very similar, people with soft bipolar disorder are sometimes misdiagnosed with unipolar depression. Since SSRIs and SNRIs are not as effective for bipolar disorders, some of these misdiagnosed patients will not resond to treatment with SSRIs or SNRIs, and may even become more depressed. Consequently, patients with TRD need to be assessed for this possibily and, in fact, some seem to respond much better to the usual mood stabilizers given to people with bipolar disorder.

But there are now other classes of medications that have shown some benefit with people suffering from TRD - dopamine agonists and atypical antipsychotic medications to name just two. Whereas in the past all people with the common symptoms of depression were given SSRIs or SNRIs as standard practice, now these medications are sometimes augmented with the medications I've mentioned above. The problem is that many of these newer medications were developed for the treatment of other illnesses, but have been shown in clinical studies to also treat TRD. When used to treat TRD, these medications are being used off label, and this is a common loophole that insurance companies use to refuse coverage. While someone with TRD my find that one of these newer medications helps them tremendously, their insurance company may refuse to pay for the medication because it has not been FDA approved for the treatment of depression - even though numerous clinical studies have shown its effectiveness and there are currently many people safely taking this medication and deriving great benefit. This is where I find myself. I've found a medication that works for me, but I probably will not be able to take it because it is too expensive. It's likely the FDA will "catch up" at some point and eventually approve these medications for depression, but the wheels of government bureaucracy sometimes turn slowly.

Regarding your questions about medications and therapy, I've tried Imipramine, Zoloft, Paxil, Prozac, Effexor, Cymbalta, Pristiq, and Wellbutrin. One or two have had a slight benefit, but nothing substatial and consequently my depression has cycled between states of emotional paralysis to functioning, but below what would be considered normal. I've tried Rational Emotive Therapy and Cognitive Behavioral Therapy (both very similar in their approach), and more traditional forms of talk therapy over the course of 15 years. Therapy has certainly helped me, but there is probably a genetic component since all of my siblings have also struggled with depression from time to time in their lives. So, I think that medication, while not the only component, is still an important part of my treatment. But my options are being limited by my insurance company and I will likely get the same result with many of the other newer medications my physician might recommend. It's incredibly frustrating.
Helpful - 0
3060903 tn?1398565123
Is there another type of health insurance that would cover this drug?
Helpful - 0
3060903 tn?1398565123
Wow, what a terrible position to be in. You can't function with treatment resistant depression. I have heard of people who transfer their homes and their holdings to a trusted family member, and gone on the dole for long term medical costs that would bankrupt them to pay for them themselves. I guess the thought is that they might as well give their money away. It is creative, I'll give them that. Otherwise, I can't think of a thing that you can do other than to pay the price. Peace be with you friend. I feel for you. Liz
Helpful - 0
1551327 tn?1514045867
I have never heard of TRD.  What type of depression were you diagnosed with and how long have you been seeking treatment for it?  What medicines have you tried and what types of therapy have you tried?  
Helpful - 0
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