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Mental Health (Expert Forum)
Drug resistant major depression
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD) , bipolar disorder , dementia , electroconvulsive therapy (ECT) , learning disabilities, memory, obsessive compulsive disorder (OCD) , panic , personality disorders, phobias , post-traumatic stress disorder (PTSD) , schizophrenia , stress , transitions, and work problems.
Drug resistant major depression
by chris, Sep 20, 1999 12:00AM
I am a 47 yo female experiencing my third episode of major depression. I have been on many many antidepressants. I'm now on Effexor 375mg, Remeron 60mg, and Wellbutrin 300mg with very little response. This episode started, oddly enough, after my PCP decided to quit prescribing the methadone I had been taking to control chronic pain. I don't understand why my brain does not respond to these drugs? I am considering an MAO inhibitor but what is the action of MAO inhibitors and how do they differ from tricyclics or SSRI's? I've had 27 ECT's and I don't want to do that again. I've heard of something called "transmagnetic stimulation". Could you please tell me about this treatment? What is the action of anti-seizure medications, Ritalin and lithium when treating major depression? Thanks Chris
Doctor's Answer
by HFHS.MD-AJ, Sep 29, 1999 12:00AM
Chris,
I apologise for the delay in replying your question. Response to our forum has been great, and some questions require research. It is unfortunate that your depression has not responded to treatment thus far. Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant medication that increase levels of serotonin, norepinephrine, and dopamine in the central nervous system (CNS), by inhibiting their degradation (breakdown). This differentiates the MAOIs from SSRIs, which inhibit reuptake of serotonin in the CNS, and tricyclic antidepressants, which inhibit reuptake of serotonin and norepinephrine in the CNS. Some research suggests that the MAOIs are more effective than other antidepressants, particularly in depressed patients with atypical features (e.g. hypersomnia or overeating).
Methadone is used primarily for detoxification and maintenance treatment of people who are addicted to opiates (such as heroin). Methadone is less commonly used for the treatment of chronic pain. In terms of other treatment strategies, lithium is a mood-stabilizing medication that may be useful as an adjuvant to antidepressants in the treatment of depression that has not responded to adequate antidepressant trials. Anticonvulsant medications such as Depakote have been found useful in treating bipolar disorders, but there is no consistent data supporting their efficacy in treating major depression per se. Ritalin is a psychostimulant that is used to treat Attention-Deficit/Hyperactivity Disorder (ADHD), but is not approved by the Food and Drug Admnistration (FDA) for treatment of major depression.
Transcranial magnetic stimulation (TMS) is a technique, in which localized magnetic pulses are applied to the head, directed at the left dorsolateral prefrontal cortex. There are some studies that suggest that TMS may be useful as an alternative to ECT in treating severe or medication-resistant major depression. However, at the present time, there are no established guidelines for the use of TMS outside research settings.
I am not sure if you are under the care of a psychiatrist. If you are not, I urge you to request for referral to one, as well as for interpersonal or cognitive-behavioral therapy. There are studies that suggest that a combination of psychotherapy and antidepressants are more effective than either one alone.
I apologise for the delay in replying your question. Response to our forum has been great, and some questions require research. It is unfortunate that your depression has not responded to treatment thus far. Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant medication that increase levels of serotonin, norepinephrine, and dopamine in the central nervous system (CNS), by inhibiting their degradation (breakdown). This differentiates the MAOIs from SSRIs, which inhibit reuptake of serotonin in the CNS, and tricyclic antidepressants, which inhibit reuptake of serotonin and norepinephrine in the CNS. Some research suggests that the MAOIs are more effective than other antidepressants, particularly in depressed patients with atypical features (e.g. hypersomnia or overeating).
Methadone is used primarily for detoxification and maintenance treatment of people who are addicted to opiates (such as heroin). Methadone is less commonly used for the treatment of chronic pain. In terms of other treatment strategies, lithium is a mood-stabilizing medication that may be useful as an adjuvant to antidepressants in the treatment of depression that has not responded to adequate antidepressant trials. Anticonvulsant medications such as Depakote have been found useful in treating bipolar disorders, but there is no consistent data supporting their efficacy in treating major depression per se. Ritalin is a psychostimulant that is used to treat Attention-Deficit/Hyperactivity Disorder (ADHD), but is not approved by the Food and Drug Admnistration (FDA) for treatment of major depression.
Transcranial magnetic stimulation (TMS) is a technique, in which localized magnetic pulses are applied to the head, directed at the left dorsolateral prefrontal cortex. There are some studies that suggest that TMS may be useful as an alternative to ECT in treating severe or medication-resistant major depression. However, at the present time, there are no established guidelines for the use of TMS outside research settings.
I am not sure if you are under the care of a psychiatrist. If you are not, I urge you to request for referral to one, as well as for interpersonal or cognitive-behavioral therapy. There are studies that suggest that a combination of psychotherapy and antidepressants are more effective than either one alone.
I'm unable to tolerate any anti-depressant I've yet met, and there are many! All I get from them is a worsening of my anxiety and the depression increases proportionately. I'm on a mailing list that is concerned with opiod use in psychiatry; it's not a quick study, but bit by bit things do begin to make sense.
My two cents worth? Be sure you have a co-operative, rather than adversarial relationship with your docs.
Namaste.