Posted by Andre Allard on May 10, 2000, at 6:50:12
In reply to should i go back on meds????help!, posted by Bonnie on May 9, 2000, at 21:29:56
> i am a 15 female and i have been depressed for about 8 months and two weeks ago I quit my meds and nothing is changing for the better,nothing changed on the meds either. I have taken Prozac, wellbutrin, Celexa, and Effexor. I am really sick of every thing and don't know what to do. I am feeling worse every day and don't know what I'll do, help! I really need some advice
> P.S. to greg: thank you for everything. :) *hugs*It is probably safe to say that after four unsuccessful trials of AD's you are no longer under the care of a GP, if you ever were to begin with. With this in mind, I will assume you are seeing a psychiatrist - I hope. It is uncommon for someone to be nonresponsive to four different medications from three different classes. If you are under the care of a good psychiatrist then the following should have occured with each medication;
- It is normal practice to begin AD treatment with approximately 1/6 of the maximum dosage.
- If the drug is being tolerated well (minimal side effects) then the dosage is increased at approxiamtely 1/6th of the maximum dosage no less than every fourth day (this is how long it takes to acheive steady blood plasma levels for the AD's which you have listed with the exception of Wellbutrin which takes five days).
- At least six weeks at the maximum dosage (this is how long it takes to acheive a full theraputic response).
- If there has been either a minimal reponse or no response, the AD is then switched.
- If there is a partial response and the drug is being tolerated well, the dosage is then increase beyond the recommended maximum dosage.
- If after this, a full response (50% reduction in the overall symptoms) has still not been acheived then the AD is augmented with another AD, lithium, buspirone, pindolol, or T3.
- If after this, a full response has still not been acheived then the AD is switched to another class once again.
- By this time, if the symptoms of depression are severe enough then ECT (electroconvulsive therapy) is conducted.
Most psychiatrists follow something like what is mentioned above. Noticed I mentioned that "most" psychiatrists conduct their practice in this manner. One psychiatrist I have seen studied at the University of Garbage. If given a prescription pad, I could have done a better job. Anyways, if you were taking each AD for at least six weeks then the prozac should have been titrated to a maximum of 80 mg, the Wellbutrin to 600 mg, the Celexa to 50 mg and the effexor xr to 225 mg. When you say "nothing changed on the meds either", do you mean that you still had some depressive symptoms or that you did not note any change whatsoever while on the meds. The thing is it is uncommon to not respond to three different classes of AD's if they are given at a maximum dosage. Other AD's you could try are manerix, serzone, remeron or a combination of whatever works for you. Each doc has their favourites. It may also be that you are treatment-resistent. This means that you do not respond to medications. When these people arise, ECT can be 90% effective in releiving depression. I am sure you can find a AD that works for you. If not, there is always ECT as a last line of treatment. The likes of your depression never getting better are almost one in a million. Keep your willpower up and I can almost assure that one day you will have your life back. It might be hard for you to beleive that the depression will ever improve but this is part of your illness. The suggestions I have made as well what others have written can be of great help to you when discussing the next course of treatment with your psychiatrist. Let me know what happens. Good luck!
poster:Andre Allard
thread:32960
URL: http://www.dr-bob.org/babble/20000508/msgs/33018.html