Posted by Tomatheus on December 17, 2005, at 1:27:48
In reply to Re: Moclobemide? » Tomatheus, posted by peacetoy on December 16, 2005, at 6:19:58
Andrew,
I can definitely relate to the frustration you must be feeling from trying one med (or med combo) after another without much success. Personally, I've only had one partial response -- a Wellbutrin-lithium combo that I stayed on for more than a year -- but even this partial response was woefully inadequate. While I was on the lithium-Wellbutrin combo, I tried mixing all different kinds of supplements at abnormally high doses and went way overboard on caffeine (a definite no-no when taking lithium) to give myself the boost in mood I needed so I could barely get by in the classes I was taking at the time and in the student job I had. I was usually able to get by, but it's obvious in retrospect that my med combo wasn't doing much; otherwise I wouldn't have needed all those supplements just to (oh so barely) get by. Once again, my response to this combo was partial in that it allowed me to get by (sort of) with my classes and my job, but it was a constant painful struggle that really did not produce what I would consider to be an adequate antidepressant response. So, with that being my "best" response, I'm sure you can imagine how unsuccessful the rest of my med trials have been.
Considering your lack of success with meds (or perhaps I should instead say "the drug industry's lack of success of giving you the treatment you need and deserve"), I can understand why you might want to consider ECT. I'm personally not a big proponent of ECT, and that's mostly because ECT success stories tend to be few and far between. From what I've read, those who do get at least a minimally adequate response from ECT usually need to go through regular "maintenance" ECT sessions over extended periods of time so they can still get a therapeutic response. I understand that ECT is a lot safer than it used to be, but the idea of having to go to get my brain electrocuted several times a year is not something that I'm very comfortable with. I guess I'd just rather put up with the the temporary side effects of ineffective meds than the consequences of numerous ineffective ECT sessions (I know ... I'm too cynical about the effectiveness of these treatments).
With respect to your meds, there is still a lot that you haven't tried. I know that this is probably the last thing you want to hear when nothing's been working, but sometimes patients (including some who post on this board) go through years of unsuccessful trials and then finally find a med or combo that actually works. As you mentioned, Lamictal has demonstrated some efficacy at treating both unipolar and bipolar depression, so yes, that's definitely one med to consider, either as monotherapy or in combination with an antidepressants. In terms of antidepressants, you could still try going with another SSRI other than fluoxetine, or you might want to consider the tricyclics or irreversible MAOIs. I know that there are several regular posters here who have benefited tremendously from Nardil (unfortunately, it's looking more and more like I won't be one of them). Then there's also Emsam, the selegiline patch, which is expected to become available some time in 2006.
So, as frustrating as it is to go from med to med (or from combo to combo) with little success, please remember that it might very well possible to achieve remission with one of the meds you haven't tried, either alone as monotherapy, or in combination with another med. ECT is always an option, but keep in mind that ECT success stories are not very common. At least on this board, it seems that more patients get success from meds (even after many frustrating unsuccessful trials) than they do from ECT. But then again, maybe those who succeed with ECT are just not represented here. At any rate, I just wanted to give you a few things to think about and let you know that you do have other med options.
Tomatheus
poster:Tomatheus
thread:589301
URL: http://www.dr-bob.org/babble/20051211/msgs/589745.html