Treatment Resistant Depression / Anxiety
 

I have treatment resistant depression / anxiety. Maybe lack of a better word, high sensitivity to SSRIs. I've dealt with depression and anxiety for years and nothing seems to really work for me. I cannot take SSRI meds at all. They throw me into a manic episode. I get so bad on those meds, I will pace the carpet for hours at a time. I am currently taking the highest doses of Remeron and Wellbuturin, along with major doses of Klonopin. These don't really help, but my Doctors throughout the years have tried all the meds out there on me, with no relief.

I've had a couple Psychiatrist try to push Electro-shock-therapy on me and there is no way in hell, I'm doing that. See, they have ran out of options and have nothing for me. I've asked for the old MAOIs, but they won't give them to me. Why not? I've tried heart meds for depression, that were prescribed. Those are dangerous too correct? I was on Depakote for a while and my tongue had swollen up so bad, I thought I was going to choke on it.


Prior meds: Prozac, Effexor, Seroquel, Lithium, Depakote, Stellazine, Buspar, Neronton, Zoloft and at least 20 others I can't think of at the moment. Why won't they let me try the MAOIs? It baffles my mind. This has been going on for years now.

So many meds... no help
 

I have also been on just about every med in the book. I am hyper sensitive to most of the meds. I don't know why they have to make they so strong! All of them seem to have major negative physical effects on me. Has your doctor done any analysis on your thyroid levels? I mean, like looking not just at the TSH, but at the T4, T3 and T3 uptake levle? My doctor recently put me on T3 to help with my depression. I don't know if it works or not yet, but I wondered if you had been given a drug like Cytomel that is T3?

Hi there, definitely get your thyroid checked if you haven't already, mine was terrible so am on meds for it.

I've been on many antidepressants for years, some worked better than others but had awful side effects, felt like I couldn't win and none of them truly helped that much, I had (have) severe, severe depression, since about age 18.

Was on Zoloft for years, gained a lot of weight, ugh..that stopped working so was put on Wellbutrin, what a miracle, (had a concussion from an accident and dosage had to be doubled but that's another story)

So many have terrible side effects but Wellbutrin so far, touch wood, has none.

I know how you feel, for years and years I felt like I was fighting to get well.

Hugs...

I had the T3 uptake checked and it is normal. I would my Doctor to try me on the old maoi's. Those are the only ones I haven't tried. There dangerous, but living like this the benefits out weigh the risks.

I just started on the Wellbutrin last month, 200 mg. It makes me feel like i'm in a fog. it's 2:10am and i'm wide awake.

dear friend
i have been with my psychotherapist for a good number of years now
as i read you seem to know your body well
you too are at an age where changes happening
as a female our menses is to also be watched as
one goes through PMS a factor women must pay attention
to
your state of mind is very important
all experience differently
but it is also important to factor many other
happenings that us women suffer with their menses
keep a log it can help

Depression and GABBA
 

[If you are already taking antidepressants and considering taking supplements containing GABBA You should check with your MD. There is a lot of uncertainty about the possible negative effects of GABBA and other "brain" supplements.

My wife had been recovering from a deep depression when her mother, brother, father, and sister died one at a time over a 4-year period 2006-2010. She was the primary caregiver for each one of them.

She was put on ARMOUR THYROID, TRAZODONE, EFFEXOR, and ABILIFY by her own doctor and her recovery from depression was progressing well when we moved to Florida for the winter.

She was slowly improving and was about 85 % of her normal self when her friend suggested that she see a well- respected doctor who specialized in GABA supplements and might be able to help her complete her recovery. She did see the doctor and he convinced her to try several GABA products (which he sells).

But after about a a month of taking the supplement products she was beginning to suffer an increase Depression symptoms again. The doctor told her to have patience and that she should continue to use the products assuring her that things would get better. But hey didn't get better….. if fact after 2 months her depression symptoms were getting much worse than any she had experienced in the past. At that point, with my urging she stopped taking the supplements. As of today she still has the following depression symptoms:

1. Constant Fatigue, 2. Whole body tremors, 3. loss appetite, 4. constant "head in a vice" aches, 5. chest pressure, 6. confusion, lack of concentration, 7. greatly decreased energy , 8. emotional numbness, 9. a loss of pleasure in everyday activities that she used to enjoy, 10. constant anxiety, 11. lack of sleep, 12. difficulty remembering, 12. excessive worrying, 13. difficulty making decisions, 14. "heavy legs" , and 15. no libido.

Most of these symptoms only happened at a high level after taking the supplements.

I'm not suggesting that the GABA products are the cause of my wife's continuing symptoms listed above. But there seems to be much uncertainty about GABA.

perhaps GABA when combined with one or more antidepressants may have triggered her "crash" She has been off of all Supplements for about 2 months but she still has the above symptoms.

She is still taking ARMOUR THYROID, TRAZODONE, EFFEXOR,and ABILIFY. In addition she is taking. , Vagifem, Prometrium, Estradiol, and DHEA-KETO.. She has been taking these medications for several years without problems. According to her own Doctor Her Sarotonin levels and Thyroid are excellent and her Brain Scan was also fine.

I'm very interested in any ideas and suggestions that may help her particularly in the area of MEDICATIONS. She has already had counseling, and talk therapy sessions with no change.

I will pass along any suggestions to her doctor and to the psychiatrists she will be seeing over the next few weeks. She has already seen one psychiatrist who adjusted some of her meds but after several weeks there had been no change in her condition.

Here is an explanation of GABA...

http://en.wikipedia.org/wiki/Gamma-Aminobutyric_acid

This neurotransmitter is not typically used in treatment of depression. It is predominately for anxiety and drugs like Valium and Klonopin which affect GABA receptors are also muscle relaxers and have some antiseizure effects. The most common GABA agonists are benzos, like Valium. They may be used WITH antidepressants for some patients with agitated depressive symptoms. But not all people taking antidepressants get that side effect or have that type of depression to begin with.

I'd visit a good drugchecker like this one and plug in all those drugs your wife is using:
http://www.drugs.com/drug_interactions.html
You will find that vagifem and estradiol are both estrogens, and typically not used together.

I'd say just now without doing all the research in detail that her 3 psychiatric drugs that affect serotonin in the brain could easily be interacting in some negative way with behaviors.
SSRI drugs are notorious for negative effects on libido and sexual functioning. Long term use of SSRI drugs lower dopamine in the brain, which results in loss of pleasure and motivation. Effexor is a mixed serotonin and norepi drug and the norepi portion could easily raise blood pressure, increase anxiety and cause insomnia.

The use of many drugs like you list is called an RX drug cocktail and the potential interactions are complex and still being discovered even. If you can get a hold of a pharmacologist specialist who could evaluate this mixture of drugs, I think you will find that adjustments in dosing, or changes in the drugs themselves might be worthwhile.

When a person is taking so many RX drugs that affect the brain and neurotransmitters there, significant long term effects are possible. Many drugs are not tested for long term use, so post marketing data is all you have to go by.

This site has Medwatch reports to the FDA listed for most drugs.
http://www.drugcite.com/
This site is very helpful to put side effects in perspective that have been reported after the drug reaches the market. Drug inserts do not always have post marketing information.

Here is the list for Abilify:
http://www.drugcite.com/?q=Abilify

It has most of the drugs used today listed either by brand name or generic. You can click on any field and it will expand with more information.
I've given the Abilify link because listed there are many of the side effects you give that are troubling your wife.

I hope things work out for you and your wife eventually.
Your caution to not use any supplements that affect neurotransmitters when using RX drug combinations that are very potent in this regard, is valuable, so thank you for posting that.

Gaba oral supplements don't really work well (except for one called PharmaGaba which is specifically an exception. ), because gaba does not get into the brain, like drugs do. To affect the brain, an agonist drug is typically prescribed therefore... like Valium etc.
The brain has a barrier called the blood brain barrier that screens out many things. Here is an article explaining that in more detail:
http://en.wikipedia.org/wiki/Blood%E...3brain_barrier

Take care.

Hi brianblue,
I'm really sorry that there has been so much loss in the family.
I hope your wife is feeling better soon.

Please do check out those links that mrsD has left you.

I don't know much about GABA at all except for what I've read, but what does concern me most today from your post and considering that she has been off all supplements for 2 months, is below...

Some of those could be related to the medications.

Whole body tremors? Chest pressure? Constant "head in a vice" aches?

I don't understand how that is a symptom of depression.

I can understand that difficulty remembering, difficulty making decisions and confusion and lack of concentration may play a part in depression, but they can also be due to a medication, or in your wife's situation, a combination of medications.

Trazodone combined with Effexor comes up with a major warning for serotonin syndrome but that is usually when a medication is started or is increased.

MedlinePlus - Serotonin Syndrome

Has there been an increase in one of those medications lately?

Has there been a change in the times that the medications are taken? Different meds have different half-lives and sometimes if there's a change in the time that it's taken, that can cause side-effects.

I was reading an interesting news article in a local paper here (in Australia) by a GP who is concerned about the over prescription of antidepressants here.

I was particularly interested in his take because it's difficult to find a GP here who will entertain alternative treatments and his approach makes so much more sense to me.

Anyway, I will leave the link to the news article below in case it is of interest to you.

http://www.goldcoastbulletin.com.au/...-1226946103619

_____


[NEVER stop a medication yourself without a doctor's advice]

Thanks Lara... good input as usual...;)

I forgot to mention that there has been new discussion about the perceived efficacy of antidepressants, or lack of efficacy thereof.

This is one article from 2010:
http://www.huffingtonpost.com/dr-mar..._b_550098.html

There remains some controversy today in fact.
http://www.theguardian.com/science/h...nts-depression

But the bottom line, is that if the drug(s) are not working, or if add on drugs are needed to minimize side effects, etc, then patients need to consider that a therapy change should be discussed with the doctor.

How are you doing on the Wellbutrin now, any relief?

I'm told Wellbutrin can act like a stimulant, I do notice that sometimes.

Hope you are ok?

Depression and Meds
 

[QUOTE=Lara;1075157]Hi brianblue,
I'm really sorry that there has been so much loss in the family.
I hope your wife is feeling better soon.

Please do check out those links that mrsD has left you.

I don't know much about GABA at all except for what I've read, but what does concern me most today from your post and considering that she has been off all supplements for 2 months, is below...

Some of those could be related to the medications.

Whole body tremors? Chest pressure? Constant "head in a vice" aches?

I don't understand how that is a symptom of Depression. I can understand that difficulty remembering, difficulty making decisions and confusion and lack of concentration may play a part in Depression, but they can also be due to a medication, or in your wife's situation, a combination of medications.

Trazodone combined with Effexor comes up with a major warning for serotonin syndrome but that is usually when a medication is started or is increased.

-----I agree...the list I generated for our doctor was for symptoms that my wife has described or that I've observed which may be related to her Depression not necessarily those that I thought were caused directly by her Depression.

Are some of problems caused by Depression or by the meds that she is taking to help overcome it? I don't know enough about it to tell the difference and so far none of the doctors she has seen have figured it out either.....my feeling is that it is mostly a medication problem (as you described above) even though she has been on these same meds for several years without major problems. Perhaps one or more of the meds that had helped her in the past are no longer effective?

Has there been an increase in one of those medications lately?

------No increase

Has there been a change in the times that the medications are taken? Different meds have different half-lives and sometimes if there's a change in the time that it's taken, that can cause side-effects.

------She takes her meds about the same time....each day. She is very good about that.

I was reading an interesting news article in a local paper here (in Australia) by a GP who is concerned about the over prescription of antidepressants here.

I was particularly interested in his take because it's difficult to find a GP here who will entertain alternative treatments and his approach makes so much more sense to me.

Anyway, I will leave the link to the news article below in case it is of interest to you.

Thanks for the info and the links.

Since Depression to this degree is all new to me, I read and appreciate ALL of the links that are suggested. As far as headaches and chest pressure and tremors and what I've observed about her.... She worrys about her health situation especially the number of meds she is ingesting which adds to her anxiety & stress. I know that much stress gives Me a headache.

It's like wanting badly to solve an Algebra equation with most of the variables missing.

You and MrsD have made some very helpful suggestions for My wife (of 45 years) and I and probably to others who may have read your suggestions on this website in just the last few days. You can be sure I will be checking this website regularly.

Thanks again

Hi again Brian,
I just hope it can all be sorted out and that your wife is feeling better very fast.

take care there...

Depression Symptoms - Some Improvements
 

After several months of very little positive change in her symptoms (Depression or Antidepresant Side effects?) She has had some recent successes. She is finally sleeping more normally at night after several months of very little sleep. Her stomach pains are almost gone and she is no longer losing as much weight. She has gone from 140 lbs to 120 lbs in about 6 months but certainly NOT the way she would want to lose it. She had only been eating only Yogurt, Cottage Cheese, rice pudding, tapioca pudding and protein Shakes. Those were the only foods that she could swallow. She thought that an almost empty stomach much of the time might be the problem so she started drinking ENSURE and so far the stomach pains are gone!

She still has:

tremors when she moves about after sitting or laying down for awhile and at times passes out for a few seconds when she stands up. Could that be from the Armour Thyroid? From what I've read, it's a “known side effect” of A T.

Her head aches like it's in a vice.

She has chest tightness.
------------------------------------
Here are the recent changes in her medications by her psychiatrist:

Taken Off: Trazodone

Taken Off: Abilify

Taken off Ritilyn (she was on for a short time with no positive change)

Added Seroquel 100mg at bed time Bed Time is usually between 10:00pm and 11:30pm

She is Still on:

EffexorXR 150mg in a.m. And 150mg at bed time.

Mirtazapine- 30mg at bed time

Armour Thyroid- 60mg morning
---------------------------------------------------------------------------------------------------------
From Drugs.com: I know that Effexor XR and Mirtazapine have a MAJOR interaction warning and I will ask the Doctor about that at our next meeting with him.

She is also still on:

Prometrium- 200 mg at bed time

Estrodial- 1mg at bed time

DHEA 7 Keto – 3.5 mg Morning

-------------------------------------------
OTC, Vitamin D3 2000IU, Vitamin B-12 Sub Lingual

She is walking 15 to 20 minutes a day

She sits or lays in the sun for 30 minutes a day.

Some friends and relatives who have stopped by to visit with her have remarked that she seems more like her former bubbly upbeat self that the last time they saw her.

I agree, however she still expresses (to me) her frustration and deep concern about her situation.

Thank you for your past help. If you have any more suggestions for us, please don't hesitate to let us know.

I had to try maois 22 years ago because doctors were desperate. and they did work until that one time twenty 11 years later when I drank dark beer with them and had a minor stroke. so they can be dangerous if you have risky behavior. but I thought there was a patch out now for maoi's that circumvents the danger. you should mention it to them EMSAM: A User-Friendly MAOI

----------------------------------------------------------------
Continual Headache for many weeks FYI:

After trying several "best" OTC Headache Pain Meds recommended by local Pharmacists with no good results, my wife's doctor prescribed MELOXICAM 7.5 mg and it has worked very well so far. She still gets a temporary headache at times when she moves about but now it goes away. Her doctor had said that if MELOXICAM didn't work, she might have to try a NARCOTIC..... adding to all the other drugs she's taking.....Didn't Want To Do THAT! Hope this helps someone else. Thanks again your concern and support. BB

Hi BB. I'm truly sorry for all that you and your wife have endured these years, words are just inadequate. I'm not up to posting much right now but wanted to quickly say that with the serequel your wife may find she has an increase in her appetite and given her weight loss by the wound of it that won't be a bad thing. I tried meloxicam but found it gave me the jitters.

I think the reason they don't want to give you Maois is because they are so dangerous and I found out that the hard way by having thalamic insult from drinking dark beer with them. However they did work for me as a last resort from 20 years ago but it is quite a paradox. Do you give someone who is depressed and medication that if taken with two dozen different foods could cause a stroke due to a certain chemical reaction. That person is depressed and may do something dangerous in the first place. I have never understood if it was good to give the medication or not. It gave me 15 years of my life but might have taken the rest.everyone else I know who took the medication abide by the rules but people I saw on the internet were not abiding by the rules. If you are that desperate then find a doctor who will give you them as there are now patches that do not have interaction with foods that the old ones did.

Hi Pamela June...thanks for the advice on Seroquel and hope you are doing better..

I hope this information might be of some help to others who are in a similar situation like my wifes'.

She has continued on the Seroquel 200mg AND she has been taking MEGACE (a prescription appetite enhancer). Whereas before she could only eat yogurt, and rice and tapioca pudding (I added lots of rasberries and blueberries) she is now eating (daily) lots of mashed potatoes and gravy and Graeter's high calorie ice cream, along with some pieces of fried fish, fried and bbQ chicken and finally she ate the triple cheeseburger and fries (with my urging) that I brought home for my supper. Her weight had dropped to an unhealthy 116lbs from 140 before this so hopefully this will get the scales moving in the right direction.

The biggest problem is still her whole body tremors when she stands up. The Docs are still trying to determine if the primary cause is a medication or side effect of one, or thyroid malfunction. The shaking seems to be amplified by her weak legs from lying down too much so I'm gathering information from some physical therapists on things she can do at home to strengthen her leg muscles.

Take care.....and best wishes to you.....from Brian blue

In my last message reply we very concerned with my wife's weight loss. Her doctor had prescribed MEGACE (an appetite enhancer) in the hopes that some of her weight would be restored. I'm happy to report that on her last weight check yesterday (Oct. 2nd) she had gained 17 pounds in the last 2 1/2 weeks still several pounds under her normal weight but She is now feeling somewhat better with more energy. Granted it is not a diet that one should consider unless they are grossly underweight and an M.D. recommends it. Hopefully, she'll be able to gradually resume a more balanced diet with lots of veggies and minimum sugar and fat.

Her doctor has also substituted WellbutrinXL for the Effexor that she has been on for quite a while to see if it might help her overcome some of her Depression symptoms.

I hope the information in some of my posts will help others who are in a similar situation as my wife. I know that I have gained a lot of knowledge and ideas from other's posts regarding her Depression and it really has helped her. Thank you all.

That's really good news.

Thanks for the update Brian.

Brian I'm so pleased to hear she is doing better and putting on weight. I hope her other symptoms are lessening and all in all you can both begin to get as much enjoyment out of life possible. Life may be different to what it was so take time to smell the roses and fresh air and to just be! :hug::hug:

My wife has been on Wellbutrin XL for a few weeks now and things have changed quite a bit for her. Her constant shaking when she stands up has diminished a lot at least in part (I think) because she is exercising her legs which have been very weak. She has started to do more domestic chores around our home on her own. She is more able to engage in conversation with her friends although she still needs me to be nearby for morale support as she still has a lot of anxiety. "The lower part of her body" has awakened for the first time in almost a year. On the negative side, she feels the need to be constantly pacing in the house or taking numerous slow walks outside each day even in our miserable Michigan winter-like weather. I was finally able to convince her to use our treadmill more to replace some of the outside walking. Fortunately, we'll be leaving for our place in sunny Florida right after Christmas and staying there for 5 months. Lots of places to walk there and no below-zero temperatures to cope with. Overall, I'd say that she is making good progress towards overcoming her Depression. Some of the biggest help has come from her many friend's support, her Two excellent doctors, the change from Effexor to Wellbutrin and the MEGACE appetite enhancement medication which helped her get her weight back.

RECENT INFO: Her Doctor prescribed Ativan (Lorazepam) 1 mg. per day which has resulted in much much less pacing and hand wringing. She continues to have frustration and worry about her poor memory and confusion.

For anyone reading this "diary" of my wife's experiences with depression over the last 11 months, our hope is that some of this information may be useful for others dealing with similar problems. We wish the very best for you in the coming days. Brian Blue & J.B.

Hi justcurious43

Apart from ECT, Transcranial Magnetic Stimulation (TMS) is an option that you could consider.

I spent about 18 months going once a week to a mood disorders therapy group. Another group member had treatment-resistant depression and she found TMS very helpful.

Something that it might be worthwhile discussing with your care team?

You all have had to face a lot of adversity. I too have treatment resistant depression. Fortunately, I am able to function when not in the grips of lack of concentration.