Posted by papillon2 on July 18, 2012, at 23:10:32
In reply to Melancholic Depression, posted by Meatwood_Flack on July 18, 2012, at 22:12:49
Hey Fleetwood,
If your SSRI and SNRI don't work out, I would be inclined to try a tetracyclic anti-depressant called Mirtazepine. If that didn't work out I'd try a tricyclic anti-depressant (TCA) such as Nortriptyline. Some might suggest going straight to a TCA.
If you only got a partial response to the TCA, I would then suggest augmenting it with a mood stabilizer (e.g. Lamictal, low-dose Lithium) or an atypical anti-psychotic (e.g. Zyprexa). I would first go for a mood stabilizer over an anti-psychotic as their side effects tend to suck less.
I have achieved partial remission from melancholic depression with the following combination:
Nortriptyline (a TCA) 100mg
Lamictal 200mg
Melatonin 4mg for sleep
Lithium 250mg, which I unfortunately had to stop as my body wouldn't tolerate itI also take 3g high potency fish oil and some other supplements each day. Fish oil has been proven in scientific trials to have an anti-depressant effect and to improve cognitive function. It doesn't interfere with any psych meds that I know of, though it's always best to ask your doctor before taking any supplements.
You might like to read this short summary about melancholic depression and how best to treat it.
http://www.blackdoginstitute.org.au/docs/AboutMelancholicDepression.pdf
Melancholic depression is a b*tch. I spent four months in hospital with it last year. The good news is that having just started out with an SSRI and an SNRI, you have whole classes of anti-depressants and other types of medications to try if your current combo doesn't work out. So hang in there.
Ring the bells that still can ring
forget your perfect offering
there is a crack in everything
that's how the light gets in
~ Leonard Cohen
poster:papillon2
thread:1021725
URL: http://www.dr-bob.org/babble/20120718/msgs/1021731.html