Posted by Bob on August 9, 2006, at 13:21:15
In reply to Re: What stage of treatment-resistance are you?, posted by Ame-Sans-Vie on August 9, 2006, at 9:49:56
> > What stage of treatment-resistance are you?
>
> Hmm, I found this a bit interesting, as I'd long wondered if there were subdivisions of treatment-resistant depression, such as this. Guess I'll go through it one stage at a time:
>
> > * Stage 1: Failure of an adequate trial of 1 class of major antidepressant
>
> Well, for this first "stage", let's just say that I've definitively failed more-than-adequate trials of all the following primarily serotonergic medications:
>
> ~~SSRIs -- Paxil, Prozac, Zoloft, Luvox, Celexa, Lexapro
> ~~SNRIs -- Effexor, Cymbalta
> ~~Atypical SRIs/TCAs -- Anafranil
> ~~NaSSAs -- Remeron
> ~~SARIs -- Serzone, Desyrel
>
> > * Stage 2: Failure of adequate trials of 2 distinctly different classes of antidepressant
>
> Well, all that I listed in Stage 1 alone technically allows me to "pass" this stage, but for good measure, neither the NDRI Wellbutrin nor the NRIs Strattera and Edronax have helped me.
>
> > * Stage 3: Stage 2 plus failure of a third class of antidepressant, including a tricyclic antidepressant (TCA)
>
> Well I guess this is where I tack on the TCAs, which have never helped me (save the little relief I achieved while having tremendous fibromyalgia pain). I've tried Elavil, Sinequan, Prothiaden, Surmontil, Tofranil, Tofranil-PM, Norpramin, Pamelor, Vivactil, Ludiomil, Asendin, Flexeril... and possibly others I can't recall at the moment.
>
> > * Stage 4: Stage 3 plus failure of an adequate trial of a monoamine oxidase inhibitor (MAOI)
>
> Had several very adequate trials of MAOIs. First was Nardil (this was before the new formulation began causing an uproar on the boards here a while back... lucky I didn't try that stuff). I was aggressively pushed to 120mg Nardil daily, and toughed out the inability to have an orgasm for six months in hopes it'd kick in. Needless to say, it never did. Not in the least.
>
> Parnate was tried for about six months last year... I believe the dose was 60mg. Never helped with my depression, except at first, but I may have been confusing the initial stimulation from Parnate (due to metabolism to amphetamines?) with actual relief of symptoms.
>
> Now giving Emsam a try.
>
> > * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
>
> Okay, ya got me there, lol. Haven't had to do anything so drastic... yet.
>
> For the record, I also failed the following when prescribed them to treat my depression. Some, primarily the opioids and psychostimulants, worked wonderfully for a while... but for various reasons didn't work out:
>
> ~~OPIOIDS -- Ultram, Hycodan, Avinza, Duragesic
> ~~STIMS -- Concerta / Ritalin, Focalin, Adderall, Dexedrine / DextroStat, Desoxyn, Cylert, Provigil, Adipex-P, Bontril, Tenuate, Sanorex, others...
> ~~MOOD STABILIZERS -- Lamictal, Gabitril, Topamax, Neurontin, Keppra, Tegretol, Trileptal, Depakote (again I know I'm leaving some out...)
> ~~DA AGONISTS/RELEASERS -- Symmetrel, Mirapex, Requip, Parlodel
> ~~ANTIPSYCHOTICS -- Risperdal, Zyprexa, Geodon, Abilify, Seroquel, Mellaril, Stelazine, Thorazine
> ~~AUGMENTORS -- BuSpar, Visken, Cytomel, lithium carbonate, others
>
> But then there's Xanax, which I'm still taking and which does have a pronounced antidepressant -- even somewhat hedonic -- effect on me.
>
> That's basically the tip of the iceberg as far as what I've tried, but I'd say it places me far into the Stage 4 categorization.
>
> Cheers,
> MichaelJust the tip of the iceberg?
poster:Bob
thread:673609
URL: http://www.dr-bob.org/babble/20060802/msgs/675208.html