Posted by Robert_Burton_1621 on February 23, 2015, at 20:12:12
In reply to Discouraged after reading book on resistant cases, posted by fido on February 23, 2015, at 15:39:36
> This is really discouraging. I dont know how often this happens but when I think about that even IF you find a drug which actually works (which is already very difficult) and then it might only work for a short time then this is totally discouraging. :(
>Hello Fido,
I can sympathise with your sense of discouragement. However, because there doesn't appear to be any clinical consensus about the definition and sub-classification of treatment resistant depression, it is often a difficult and time consuming process to identify effective agents or combinations of agents to address it.
Another point may be that "treatment resistance" may simply be a description of a patient's non-response to a succession of agents which are themelves not optimal for his or her underlying type of depression.
The whole question as to why effective treatments "poop-out" is a really difficult but I think pressing one. Many people here have experienced this, and it can be by turns frustrating and profoundly dispiriting.
All in all, though, I think the extent of treatment resistance is very much underestimated. You will find a number of people here still persevering with alternative medications after a number of failures. But there are also success stories, some qualified others unequivocal. I would keep up hope as best you can.
You might like to do some research yourself on pubmed, for instance, for other studies or treatment strategies.
> What also really surprised me is that the author almost in all cases used mood stabilizers like lithium even in patients without bipolar depression!
Lithium as an augmenting agent may be described as a "mood stabiliser" but that description does not exhaust its pharmacological effects. It has been a first-choice augmentation agent to an anti-depressant for many, many years. It may act serotonergically, though there are people here with much more accurate knowledge about such things than me.
Atypical anti-psychotics are also used as augmenting agents to kick start anti-depressant response or (relatively) long-term. I never consented to long-term combination therapy because of the side-effects of AAP use (metabolic syndrome, especially).
> What was also interesting is that the author also frequently used ritalin in patients without adhd which had low energy as a side effect of antidepressants. This seems very uncommon.
Amphetamine adjunctive therapy is not that uncommon in cases of later-stage treatment depression, though obviously it needs to be managed with care.
May I ask what medications you have tried?
I do hope you obtain sufficient information and guidance from your psychiatrist. I agree that 8 weeks is a long time to be left on your own and self-assessing.
poster:Robert_Burton_1621
thread:1077033
URL: http://www.dr-bob.org/babble/20150223/msgs/1077049.html