treatment resistant depression please help

[051769]

When I was 20, I was diagnosed with dysthymia. Anxiety was a major symptom. I was sucessfully treated for abou five years with prozac. About two years ago, I started effexor. Within a week, I was hypomanic. That lasted for about two months. Then my good mood began to fade, earlier and earlier in the day. I still had anxiety as a symptom. Next I tried moclobemide. I had a hypomanic reaction to that for about four months. My anxiety vanished and had not returned. Again my mood faded, but this time I went into a deep depression. I responded to various drugs combinations - reboxetine and moclobemide, celexa and moclobemide. But the response lasted a couple monhts at most. When I get a response it happens quickly, within an hour to a week of the first dose. Moreover, I can feel the response in my head. It is a pulsating sensation. I have now had ECT which temoprary lifed me out of the depression, but now it has come back. I am on Parnate and Seroquel, and lithium. I had a quick hypomanic response to seroquel (first day, a few days) and a quick response to lithium (with first dose, lasting a day). When I was responded, I could feel the pulsating in my head about an hour after the dose. What do you reccomend for treatment? Please help.

[Roger Gould, M.D.]

The one thing you did not mention was psycotherapy, on an intensive basis for a short period of time, and then maintenance for a longer period.   The doctors are treating you correctly on the medication side, but ten minutes of counseling along with the medications  is not enough.



Your quick and early response to medications suggests you would do quite well with psychotherapy.

[StupidMe]

I don’t quit get your meaning of being “hypomanic” after Seroquel, Lithium, Effexor, Moclobemide, Moclobemide & Reboxetine, Moclobemide & Celexa. Do you mean normal mood or high but not to the extent of mania? If you mean the latter, which is the usual meaning, then you are probably in normal mood now with Parnate, Seroquel and Lithium and can continue with such regime. However, if you mean the former, you are probably in low mood now and antidepressant can be adjusted.

[051769]

No I mean clinical hypomani, abnormal high but not full blown mania. I am not yet back to my dysthymic state, since I still have problems with psychomotor retardation - fatigue, loss of sex drive and concentration. I am in a major depression. How can I get out?

[Try_to_be_social]

For major depression, you can titrate Parnate upwards slowly to a maximum of 60 mg/day. Check the blood level of Lithium as well.



Kindest regards.

[deboe1]

I also suffer from treatment resistant depression. I'm just taking parnate right now. I also self medicate with hydrocodone, which my psychiatrist is aware of and realizes that is does help. I go to a pain clinic for it. They don't want to hear that I use it for depression along with chronic pain. I feel like I have to play their game. I don't take enough hydrocodone to elevate my mood enough, but I can at least have some relief on some days. I take 1/2 of a 7.5 twice a day on the average. I'd like to try bruprenorphine, but don't know how to go about getting it to try. I had a mild head injury about 6 years ago that brought on my mood disorder. I've tried just about every antipdepressant, atypical antipsychotic and mood stablizer without relief.