antidepressant options

[spikerusty]

i'm posting a question asking for your medical advice as i've suffered from long term depression since i was 18 as i'm now 38 going through various medication regimes throughout that time. I've previously been on mostly SSRI's ie prozac and seroxat, with in addition dosuphin and amtitrypline. Prozac and seroxat worked well with me for some time until they "pooped out" on me. I've been on the so-called 'californian rocket fuel' after not getting a significant response on either venlafaxine or mirtazapine separately over the last year and have now commenced escitalopram in addition as this current medication regime with all to max UK doses i.e. 375mg,45mg & 20mg respectively. I've been on the escitalopram now for 5 weeks and having second thoughts about this medication thinking that i should have asked for perhaps wellbutrin. I'm not on the extended release version of venlafaxine as wonder if this would help. I'm not involved with specialist psychiatric services per se at this time owing to myself actually working in this field. I take 5HTP for some time( to little effect) and I have now commenced heavy duty omega 3 fish oils. I remain quite depressed, mentally sluggish, irritable, socially avoidant and have no 'spark or zest' as this has been effecting me in all areas of my life for some time and now is effecting my career progression as well as personal and family relationships. As i say i've commenced this treatment regime but i'm having second thoughts as possibly feel that either wellbutrin, T3 or perhaps even lithium augmentation would be preferable to myself continuing to feel so laboured as would try anything to get myself back as this has been going on for over 2 years now as just want the good and fun person i know myself to be back. apologies for the spelling mistakes as don't know how to do that on this very informative forum. many thanks

[Peter Forster]

From what you have said I would wonder about the possible benefit of more activating treatments such as bupropion (Wellbutrin), light (especially where you live - check out BlueMax Lighting - their 70W lights have full spectrum and are bright enough to treat seasonal depression), modafanil (Provigil) or thyroid. Also your UK max doses are not actually the max doses and I would have been inclined to push the doses higher rather than add escitalopram because both venlafaxine and mirtazapine have more potency and more noradrenergic effects at higher doses than you are taking. I have used venlafaxine to 600 mg and mirtazapine to 90 mg and have seen additional benefits in refractory depression when I push the doses. Also I think you should be seeing a therapist with training in treating chronic depression... at least as beneficial as adding more medications and complementary to what you are doing. Sorry for the brevity... but wanted to reply in a timely fashion.

[spikerusty]

do you think that there is any mileage in switching from the generic versions to extended release type?? i forgot to say that i do have a Lumie SAD light and utilise this also. UK GP's won't prescribe over those levels despite what has been indicated elsewhere as you rightly say, as there's significant variation on this on the internet within the western world it seems.In the course of my work i've not seen patients being prescribed over these BNF levels.I'll perserve with this regime until i make a further decision on the lepraxo