Posted by harryp on May 7, 2004, at 0:30:52
In reply to Re: Resistant Depression » harryp, posted by jerrympls on May 6, 2004, at 23:48:33
God, that's so horrible. 11 years (at least) here, with some decent remissions--had three decent years in my 20's despite being pretty debilitated--29 now. Finally got results from Parnate--if it quits working I'm toast.
I admire your determination. I don't know if you care for philosophy, but Immanuel Kant would say your persistance in living despite your misery gives you and your act (in living) genuine goodness and moral worth, whereas the act of living because one enjoys life is morally neutral (though certainly good in the sense that happiness is a good.)
I wish I had some advice, but I can't think of anything except that I would go the MAOI route again, with a higher dose and lithium augmentation. Make sure you try both Nardil and Parnate and titrate up to the maximum dosages (~100 mg Parnate), not sure about Nardil.
Bernstein's *Drug Therapy in Psychiatry* has the following additional suggestions.
If no response to Lithium, add 25 micrograms triiodothyronine.
No reponse--add 1-2mg bid Trifluoperazine
No response--add a TCA or HCA (probably amitriptyline--titrated slowly)
No response--I'd start over with the untried MAOI.
I'm concerned that the Seroquel, Ambien, and Valium could be worsening your depression. I'd try to get rid of those and use Trazodone as a sleep aid. Maybe by simplifying things it will turn out that the Effexor is doing some good after all.
It's especially cruel that our culture makes young people feel guilty for not being happy. The twenties were a write-off for a lot of the people I know who weren't even mentally ill--blown off with drugs, alcohol, parties and random sex you can't even remember having, job hopping, video games, etc. You have time.
poster:harryp
thread:344050
URL: http://www.dr-bob.org/babble/20040505/msgs/344226.html