Posted by europerep on July 5, 2010, at 10:52:44
hey there...
I have a question, or a couple of questions, concerning my further treatment against resistant depression.. it's not directly about a medication, dosage, etc.. but I'll explain that when I get there..
I have just seen the head of the outpatient department of one the university clinics located in my city, and I am deeply disappointed. It was the first time I went to this specific clinic, and surely also the last.. he invited me into a room where he had an A/C running at max power (at 18°C outside), plus all windows open while the international airport is not that far away, so it was loud as hell and I was hardly able to get my point across.. that's not what disappointed me, but I wonder whether he, as an expert psychiatrist, shouldn't maybe have an eye on the environment in which his consultations take place.. anyway, just wanted to get rid of that.
I sent him an email with the basic elements of my "story" and my relatively short list of failed medications, which is this one:
- Amitriptyline (always XR, up to 375mg/d)
- Amitriptyline (300mg/d) + Nortriptyline (75mg/d)
- Venlafaxine (always XR, 375mg/d)+ Amitriptyline (150mg/d)
- Venlafaxine (600mg/d)
- Venlafaxine (600mg/d) + Amitriptyline (25mg/d) + Aripiprazole (5mg/d)
- Venlafaxine (600mg/d) + Mirtazapine (60mg/d)he told me that there are some good combinations among them, and that therefore he concluded I do not need a new med but psychotherapy. he repeated that about ten times, to which I always replied that there is absolutely no doubt I have to do psychotherapy, but that first I need a medication that gives me back the essential parts of what used to be "me", before a therapy can succeed. I do not want to go too much into detail here because I could go on for hours like that, but the depression took away all my "social competence": the ability to talk to people (people used to, almost unanimously say "it's great talking to him", which has been related to me through others later on) because I was interested in others, I was curious etc., while now I just do not care about anything any more; I was able to make people laugh, not by being a clown, but by just being me, and I was so proud of that; I used to be able to approach people and be self-confident, because I could just "be myself" while now I always have to think about how to act in any given situation, etc..
these kind of things were my depression's symptoms from the beginning, they were gone when the amitriptyline worked for about half a year, they were gone shortly when the venlafaxine kicked in, but that's been a year now, and nothing has happened since.. I do need a working med, noone can tell me anything else.
so the point here is that I'd actually need a psychiatrist willing to pursue pharmacologic treatment for TRD, but it appears people here do not "believe" in TRD.. this professor obviously doesn't get how much I suffer, and that this life here is definitely not worth living. instead of congratulating me to have made the effort to make appointments in different clinics etc., which is not that easy when one has almost given up hope, I am being told that my depression doesn't seem bad enough to warrant other pharmacological intervention.. at best, he told me, he would add seroquel (quetiapine) to the 600mg of venlafaxine I am taking right now, or even give aripiprazole another trial although I had severe side effecs with it and stopped taking it after 2 days (à 5mg).I do really not have the time to wait for a new treatment option until I find a psychiatrist actually doing what he's supposed to do, prescribe medications.. what happened to the stereotypical psychiatrist who would just hand out meds? anyway, I will of course continue my search for a doc, but that can take months, seeing the waiting time university clinics have.. and the docs having their own practice do not seem to be willing to go beyond SSRIs, and actually refer me to these clinics.. I do have one advantage though: I study (not medicine though) at the university which runs the clinic I used to go to, and they have sort of an "antennae" on the main campus, where people know me and where I can go to get prescriptions without having to go all the way to the actual clinic.. I can just go there, tell them which meds I'm on and they'll make me the prescription.. I was wondering whether, until I see another doc, I am just going to try something out myself.. of course one's not supposed to do that, but if those who are supposed to help me are not willing to, then I have no other option for right now..
the prof said that, in order to add an antidepressant to the venlafaxine (such as bupropion or agomelatine) I'd have to go down to 300mg venlafaxine.. what do you think about that? because I was considering giving agomelatine a try, since it seemed to me to be a relatively "benign" drug with, so far, no known severe side effects.. I know it can be combined with fluoxetine, according to the drug firm servier, but I do not know about the dosage.. would it be possible that it wouldn't do its full work while added to 600mg VFX, or is the going down just a safety measure?
or maybe bupropion? of course I do not want to try any dangerous combinations, but I guess I'll have to take a little risk, and with a doc or not, I'll take the meds at home, at university, etc., so in any case it is me who has to be vigilant to eventual symptoms and so on..
so, in a nutshell: what do you think about 600mg venlafaxine + agomelatine in terms of safety? I think they come in 25mg tablets, I would probably break them in half first to get started, and then I'd see.. am I taking a risk here? I have an appointment at a private clinic in august, I hope there they'll recognize the fact that I need medication. if agomelatine doesn't work, I'd already be a step further.
thanks for any input!
poster:europerep
thread:953367
URL: http://www.dr-bob.org/babble/20100628/msgs/953367.html