Depression that doesn't respond to meds

Very interesting discussion this morning on NPR about drug resistant depression and new approaches researchers are looking at for treatment.

I'm seeing my psychiatrist tomorrow for a drug check up. Curious to what he knows about this because his speciality is pharmacological approaches to treatment. We usually have an interesting visit.

http://www.npr.org/blogs/health/2012/01/31/146096540/i-wanted-to-live-new-d epression-drugs-offer-hope-for-toughest-cases?ps=cprs

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Please keep us posted about your conversation with your doctor. This is very interesting!

~Bj

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what is your diagnosis ad what meds are you taking? If I've missed it, I'm sorry.
Jocelynn

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I just saw a tv program about this. Please do not take this drug. It is more addictive than morphine, heroin and other drugs. In Canada the state troopers are arresting people for selling it on the Internet. This is also happening in the USA too. They are getting these drugs from overseas. Places, like China, and India.

Please keep this out on the Internet before you see your dr. I suffer from clinical depression and take Zoloft once a day. I have been on may others such as Celexra, Paxil.

Our bodies build up a tolerance to these drugs and then they don't work as well.

Please let me know how you make out and what your dr. says.

Love,

Donna

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I'm depression pure and simple. Relieved quite well by Cymbalta, thank you! Have journeyed with this diagnosis for over 20 years and gone through a whole list of drugs, all which worked for acceptable periods of time......and then 'pooped out.'

I was really more interested purely from the clinical perspective (I'm a NP) because of treatment options, patient differences as to tolerance, side effects, efficacy. I know there are millions of people out there who are treated poorly, ignored by their docs, and live miserable lives. I hope research and knowledge can change that.

MY docs response this morning was pretty much as I expected, which was "I get so frustrated when they run these stories because people then come in wanting this particular treatment and they don't realize, it is ALL still very experimental." He said ketamine was used years ago, but not terribly effectively. I explained that I didn't bring the piece in for MY treatment - just as inquiry as to the validity of what was said. He said it would be wonderful if they could standardize a way of using these meds but so far that hasn't been done.


I suspect as they begin doing DNA testing on more patients to try to better match us with the right drug, we'll see much more effective treatment being prescribed. As you probably know, for some psychiatric diagnosis, finding the right drug can take years, only to be destroyed when some unknown changes the patient's body/biochemistry/brain damage/whatever and the drug suddenly doesn't work. I know the docs I worked with in Homeless Healthcare (psychiatrists) were really excited about the advent of DNA matching in the future. Don't know how widespread it is now, but it is certainly picking up steam according to what I read in the media (and coming down in price.)

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My Mother was very mentally ill although a physical illness is what finally took her life. I understand your pain. i use to question why God wouldn't help my Mom. I believe she was medication resistant also. I would just keep on the journey of trying new meds. My Mom was bipolar and it took years for that diagnosis. I have found that I am bipolar 2. As a NP, I am sure you are familiar with the disorder as well as having many resources to help your self.
Take care
Jocelynn

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Hi Lynn-- It's good to see that there are some new rays of hope on the horizon for severe depression sufferers.
It would be remiss of me to not mention the inclusion of talk therapy in treatment of depression. While I recognize that many depression sufferers Do seek counseling, many doctors, (especially GP's) don't make referrals for psychotherapy, but are very fast to recommend medications. Studies I've read, but don't have on hand at this moment, have strongly indicated that a combination of meds AND talk therapy can be the most effective for depression treatment.
As someone who has terrible reactions to most antidepressants, and a history of severe depression, I can attest to the efficacy of talk therapy for me and for many others I know.
Unfortunately, many health insurance companies either don't cover mental health treatment (except for meds) or only cover goal/outcome oriented "quick fix" therapies. I do best with ongoing one on one therapy, so I scrape and save to pay for the treatment that works best for me. I will consider seeking a psychiatrist who is able to Rx Ketamine, perhaps, in the future if my depression ever gets to "clinical" proportions again, AND continue the talk therapy.
thanks so much for bringing this important article to my attention!
LOVE,
Melissa

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I agree Melissa. Talk therapy has changed my life in several phases of it!

Much of the time now if I can spend enough time with a safe, close, friend I can hear my own words, and see where I've gone off the reasonable path for my life. Sometimes I get to thinking in circles and ratcheting up my thinking and I start spinning out of control with fear or anger. And occasionally, I need to go to a professional to see thru the crap!

I've gotten 'good' with words and phrases, and I can talk a good line, and will admit, I can fool my husband, even myself for sure, and some people into thinking because I sound clinical, I must be right! After all, I'm a professional now right? WRONG!!

When I saw my doc last week, I was relating my health issue with increased shortness of breath, depression, isolating, etc. Told him I had bumped my dosage up for a few days and then lowered it again, but wasn't sure if it had helped or not.

PSYCH: Then why'd you lower it again?
LYNN: Well, I didn't think I should totally take over my dosage control when I'm going to you for professional management.
PSYCH: Why didn't you come in?
LYNN: Well, finances are really scarce right now - well always, it seems. (he's not part of Medicare). I've been isolating alot lately and I just decided it was a new stage of my life and not depression.
PSYCH: So why didn't you call?
LYNN: Well, I don't know. You know, sometimes when you are depressed you don't use the best judgement. Right?
PSYCH: Well, we won't know if it's depression or another issue if we don't at least try the higher dose, will we?

He had me there! ha

Yep, I can talk a good line.

Lynn

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Big Hug to you, Lynn. I know from all of your postings that you are a lovely person. Depression can be a real booger to say the least. I'm glad you're communicating through all of this and staying connected here. You are a valued E-Friend!

xoxo Mary

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Thanks Mary! That felt very good! I consider myself e-hugged!!!

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Hi Lynn - I'm wondering what your psychiatrist said about this?

The research behind ketamine is limited, and that's putting it charitably. The young man featured in this NPR piece was part of a study done on only 17 subjects. The Yale study cited in this piece was done on rats, not humans. In most countries, ketamine is better known as a recreational 'party drug' (or as an animal tranquilizer).

I don't share Donna's views on the dangers of ketamine (we simply don't know yet about its therapeutic dosage safety, we know more about its potentially addictive properties as a party drug) And by the way, in Canada we don't have "state troopers", and all kinds of people are getting arrested here for selling all kinds of drugs illegally via the internet (e.g. without requiring a prescription from a bona fide physician) - has little to do with whether it's ketamine or not.

I feel a tad concerned when I hear stories like your dialogue between you and your psychiatrist, specifically things like "....we won't know if it's depression or another issue if we don't at least try the higher dose, will we?" This sounds like the very common clinical tendency, as Melissa says, to pull out the prescription pad first, then look at alternative options second (if at all). I wrote about this recently in "10 Non-Drug Ways To Treat Depression In Heart Patients" at: http://myheartsisters.org/2011/08/05/non-drug-therapies-for-depression-in-h eart-patients/

I've also been following the interesting controversy brewing among mental health professionals over the upcoming "Diagnostic and Statistical Manual of Mental Disorders" (the DSM-5, due out in May 2013). The so-called "shrink's bible" has had a chequered past and the new edition is no exception, specifically over growing concerns about financial conflicts of interest between the experts who are writing the DSM-5 and the Big Pharma companies that manufacture the drugs that are then the first-line treatment protocols recommended by these docs.

Good luck!!!

XOXOXO

www.myheartsisters.org

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Lynn,

There is a common syndrome called "poop out" syndrome. I'm trying to remember the actual name, but in the meantime...

http://www.johnshopkinshealthalerts.com/alerts/depression_anxiety/JohnsHopk insHealthAlertsDepressionAnxiety_3288-1.html

http://www.mayoclinic.com/health/antidepressants/AN01312

Hope these help.

xox Mary

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Yes, Mary, I've 'pooped out' on about 5 other drugs before arriving at Cymbalta! And I was afraid that was what was happening. We'll see. It's not terribly unusual for people to be on 120 vs 60 mg of it so therefore I wasn't afraid to try it (well at least for a few days) but did kind of self monitor for manic behavior on my part! ha

Kenarina, I guess I was pretty comfortable with his comment because I know (and he knows for the last 4 years) I have a 40+ year history of depression although untreated until the early 90's. I spent lots of my younger years smoking and eating my way around my feelings. Even tried sewing, quilting, knitting, golfing, tennis, any obsession I could acquire! In the 90's I started talk therapy and continued on/off with it for about 15 years. It was a life saver......as was medication. I tried several times to wean off the meds, and everytime, in about a year or so, I would realize I was back in the 'pit.' For me, the difference between life WITH meds and life WITHOUT meds is monumental.

The piece you did on other ways to treat depression was excellent, and even with meds and therapy, I have to be reminded frequently that I do have some personal control over this monster.......besides taking my meds! This is probably one of those times.

Thanks to all of you who care enough to sit down and put your comments on paper. You cold have just 'clicked' and gone away. I appreciate the time and thought that went into it!

Love,
Lynn

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I had to share. Just saw a post on FaceBook.

Two T-Rexs in a cartoon pic of NYC or some large city.
Both are clutching two hands FULL of little humans amidst the skyscrapers and one T-Rex says to the other:

"Of course we'll feel better. They're full of antidepressants!"

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Laughing along here Lynn ... I like that.

I've been going back and forth around starting the Zoloft I was prescribed by one doc and starting the 5HPT suggested by another. Still haven't decided but a dear friend sent me a book, Depression Free for Life by Gabriel Cousins which she has relied on. Her take was that the book is really helpful for understanding the supplements available so it's easier to compare info with the pharma options and hen make your choice .., either maybe right for any one of us. One thing that interested me was er sense that the "natural" options are often as strong as pharma though we tend tp think they are not. Just thought this might be a useful reference for folks looking at options. I was on pharma ones years ago and it was a very positive experience but I like having options.

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