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Treatment resistant depression, where to go next and the few things that worked.

treatment resistant depression depression nmda receptor glutamate amygdala

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#1 GingerSnapped

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Posted 23 October 2017 - 06:41 PM


Hi there, I've been really enjoying the forum. I came here after exploring the topic of NMDA receptors, glutamate and depression.

I have treatment resistant depression. I'm bipolar but that has been controlled, hasn't been my problem as much as depression. I have tried everything and only have a handful of tricyclics, MAOI in pill form and a blood pressure medicine left untried. I burn out on SSRIs and have bad responses to antipychs. I have a therapist and psychiatrist. Unfortunately, I have also had ECT. I know it helps a lot of people but I am not a fan and had a very negative experience and was left changed.

I'm at crossroads where my depression is getting worse. I'm trying to figure out what is worth trying based on the few things that did help, my insurance only offers more ECT. Other than the depression I live a healthy life, you could call me a Girl Scout with a dirty mouth, but the depression is debilitating.

Lithium, lithobid does help. A small dose it's supposed to help for treatment-resistant depression and I'm diagnosed bipolar and it absolutely helps. I tried going off of it with a doctor's supervision and I ended up in a mixed state. I'm on a lower dose. I am tired of the side effects but oh well. As well as Selegiline in the form of the Emsam patch except its effectiveness has decreased over time. Not as much as an SSRI burnout but none-the-less.

I was wondering if there's any direction to be pointed in given that these where the few things that were effective. I've been fascinated with the theories about glutamate and the NMDA receptors. While being studied in various disorders just seem to correspond well to a more anxious depression which tends to be my problem. Although I'm overwhelmed in sifting through the information and Agonist vs. Antagonist. I've also been interested and the amygdala discussion. Also I'm limited on emsam although if I have to give that up I will.

I'm considering a ketamine trial but it would involve a considerable loan and I would also want to go into that as prepared as possible. Otherwise I'd like to know what sort of supplementation or experimentation that can help. I'm lucky enough to have a supportive doctor but he kind of has to be with the problems with coverage.

Thanks again, I appreciate any advice.
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#2 APBT

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Posted 23 October 2017 - 07:21 PM

See if this is of any value to you:  http://www.longecity...ms/#entry830390



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#3 GingerSnapped

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Posted 23 October 2017 - 10:09 PM

See if this is of any value to you: http://www.longecity...ms/#entry830390



I appreciate that, thank you. What I have read is promising but I am not interested in hallucinogens currently, I'm not in a good headspace and they did not give me positive experiences.

#4 Adam Karlovsky

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Posted 24 October 2017 - 05:46 AM

It astounds me that you tried ECT before trying the MAOIs.  Lithium + Tranylcypromine is a great combo.

 

If you want a cheaper alternative to ketamine you can try sarcosine, which is a glycine reuptake inhibitor with similar downstream effects. While ketamine can act quickly, sarcosine takes 2-4 weeks to work. Don't buy sarcosine from smartpowders, get it from a compounding pharmacy if you can.


Edited by Adam Karlovsky, 24 October 2017 - 05:47 AM.

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#5 GingerSnapped

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Posted 24 October 2017 - 08:41 AM

It astounds me that you tried ECT before trying the MAOIs. Lithium + Tranylcypromine is a great combo.

If you want a cheaper alternative to ketamine you can try sarcosine, which is a glycine reuptake inhibitor with similar downstream effects. While ketamine can act quickly, sarcosine takes 2-4 weeks to work. Don't buy sarcosine from smartpowders, get it from a compounding pharmacy if you can.


You won't find any argument from me with regard to MAOIs, my doctor af the time didn't think it mattered or was a good idea. Old attitudes. At the time I was in a depressive crisis, unfortunately some people with my insurance also had ECT prematurely or not as a last resort because you couldn't even see a therapist for literally months. The ECT doctor administered ECT while I was on lithium and Topamax, an apparent no no. My memory was deeply affected. It doesn't matter, arbitration clause and all. Pardon my rant. Also why even though Emsam has lost effectiveness I haven't tried another MAOI, I haven't had to worry about forgetting about the dietary restrictions. It's pretty good.

I really appreciate the advice, I wasn't aware of those before. Yes, I'd like to save ketamine or make sure I get the most use out of it when it comes to that. Pardon my crappy Google FU but is it safe to take such an amino acid on an MAOI?

Thanks again.

#6 hydrus

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Posted 24 October 2017 - 09:06 AM

Have you had your thyroid and other hormones checked?



#7 GingerSnapped

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Posted 24 October 2017 - 09:12 AM

Have you had your thyroid and other hormones checked?


Great question thank you. I am hypothyroid (I don't think Hashimotos, it was never discussed) and have been since I was a kid but without major fluctuations, I'm stable currently. I also saw an endocrinologst, everything is within acceptable margins.

I do have that weird, asthma/psoriasis/hypothyroid/depression association a lot of people seem to have. Friends joke it's just a pale ginger thing. I've looked into inflammatory theories but I'm not sure what I can safely supplement with an MAOI.

#8 Adam Karlovsky

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Posted 31 October 2017 - 11:20 AM

Depending on your blood lithium levels, could it be the lithium effecting your thyroid levels? Could be worth talking to your doctor about that.

 

Assume you can safely supplement anything that doesn't have clinically meaningful serotonin reuptake, or serotonin releasing effects. Norepinephrine reuptake is fine but needs to be tapered.

Dopamine reuptake is fine. Serotonin/Norepinephrine/Dopamine agonism and antagonism is fine. Avoid fermented foods unless you are also taking a norepinephrine reuptake inhibitor like Nortriptyline.

 

Supplements worth trying... Look into nigella sativa extract, and sulfaphorane for your asthma and psoriasis. Ashwagandha extract for your hypothyroid. Boron can help with inflammation, and micronized palmitoylethanolamide is pretty good too. Agmatine is a weak but worthwhile adjunct for depression, and nelumbo nucifera extract is a decent for mood stability (though it might put a roof on your maximum happiness). Nicotine patches (or vaping) and cytisine work well for mood too. None of these interact with Tranylcypromine.

 

Lifestyle stuff worth trying... I'll mention light therapy. Where ever you spend most of your day, buy a mix of half cool halogen bulbs (for green-blue) and half incandescent bulbs (for orange-infrared) and really brighten up your environment. Might as well get a few pot plants, too. Ice baths and/or saunas can make a big difference. While many people swear by ice baths, I prefer sauna myself.

 

Have you tried Bupropion? If nicotine works for you then Bupropion might too. Have you tried Nortriptyline? I mentioned that earlier. Both can be combined with Tranylcypromine, I consider the Tranyl the primary antidepressant because it provides neurogenesis and is more less likely to "poop out" , while Bup/Nort augment the antidepressant effect and either energize or help you sleep (depending which one you pick).

 

Modafinil works, but I find it builds tolerance fairly quickly. Otherwise have a look at TDCS and TMS treatments for depression. Worst case scenario you can try one of the newer antipsychotics like Brexpiprazole or Cariprazine, but while I say worse case I don't mean it's worse than having depression.

Anyway, don't give up! There are plenty of options, and you have good reason to hold onto hope :)


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#9 Eryximachus

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Posted 02 November 2017 - 01:48 AM

I would give seroquel another try.  Many doctors start at low doses, but the sweet spot for bipolar depression/mania seems to be 200mg to 300mg per day.  

 

Is it possible you are not giving yourself time to adjust to side effects?  I say this as lithium actually has far fewer side effects than pretty much any other psychiatric medicine.  If I had to rank psych meds, I'd say lithium is the most easily tolerated, followed by benzos.  Everything else is going to take time adjusting.   

 

My recommendation:

200mg of seroquel per day, instant release at night.

150mg of nuvigil in the morning

2000mg of metformin per day to prevent weight gain/sugar cravings.  

 

Remember, one of the reasons antipsychotics work is they have the opposite effect of adrenaline, which regulates blood sugar.  Just as amphetamine kills your appetite and makes you lose weight in the short term as well as makes you alert, seroquel increases your appetite, makes you tired, and makes you hungry.   Metformin mitigates that quite a bit, and nuvigil will a bit too. 

 

Most of the sedative effect of seroquel is caused by antihistamine action.  Nuvigil works because it is a histamine agonist.  This is why older versions caused itching/skin irritation or at worst, serious allergic reactions.   



#10 Kinesis

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Posted 02 November 2017 - 04:18 AM

You mention a “handful of ... tricyclics .. left untried”. If amitriptyline hasn’t been tried, anyway, it would be premature to conclude your depression is “treatment resistant”. It comes with sides and takes some time to get acclimated, but is a gold standard med worth a try in a difficult case. I was once prescribed it in combination with bupropion, which another poster has mentioned, and the combo was impressive.

It’s not a first resort, but should be on your list of candidates if you’re considering things like ECT and expensive ketamine treatments. Regardless of what you choose, I wish you a full and speedy recovery.
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#11 GingerSnapped

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Posted 03 November 2017 - 07:40 PM

Depending on your blood lithium levels, could it be the lithium effecting your thyroid levels? Could be worth talking to your doctor about that.

 

Assume you can safely supplement anything that doesn't have clinically meaningful serotonin reuptake, or serotonin releasing effects. Norepinephrine reuptake is fine but needs to be tapered.

Dopamine reuptake is fine. Serotonin/Norepinephrine/Dopamine agonism and antagonism is fine. Avoid fermented foods unless you are also taking a norepinephrine reuptake inhibitor like Nortriptyline.

 

Have you tried Bupropion? If nicotine works for you then Bupropion might too. Have you tried Nortriptyline? I mentioned that earlier. Both can be combined with Tranylcypromine, I consider the Tranyl the primary antidepressant because it provides neurogenesis and is more less likely to "poop out" , while Bup/Nort augment the antidepressant effect and either energize or help you sleep (depending which one you pick).

 

Thank you for the advice! I have tried Wellbutrin, I don't remember what my response was only that I tried it more than once and it didn't work out. Granted, I didn't use is as part of the combinations suggested here. In answer to your other question, I have had hypothyroidism since puberty but the lithium as is known doesn't help, but according to tests I am in acceptable range. My doctor thought about experimenting with T4.

 

Great to know that about Emsam, I had avoided anything amino acid related out of MAOI fear. (To be fair I haven't had any problems except years ago taking a nasal decongestant on bad advice from a doctor, no food problems.) My memory isn't fantastic for reasons noted above which was why I had hesitated to try any other MAOIs for fear of causing an incident.

 

Thanks again so much, I'm going to look into all of this.


You mention a “handful of ... tricyclics .. left untried”. If amitriptyline hasn’t been tried, anyway, it would be premature to conclude your depression is “treatment resistant”. It comes with sides and takes some time to get acclimated, but is a gold standard med worth a try in a difficult case. I was once prescribed it in combination with bupropion, which another poster has mentioned, and the combo was impressive.

It’s not a first resort, but should be on your list of candidates if you’re considering things like ECT and expensive ketamine treatments. Regardless of what you choose, I wish you a full and speedy recovery.

 

Thank you, unfortunately ECT was already done as said my insurance wouldn't even cover individual therapy or programs that weren't just AA at the time for people in crisis and they got in trouble for it. Well... they paid a fine to the state at least.

 

I need to look into what I had tried, I mainly remember having EKGs before taking them, thank you for the advice.


Edited by GingerSnapped, 03 November 2017 - 07:49 PM.


#12 GingerSnapped

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Posted 03 November 2017 - 07:47 PM

I would give seroquel another try.  Many doctors start at low doses, but the sweet spot for bipolar depression/mania seems to be 200mg to 300mg per day. 

 

I say this as lithium actually has far fewer side effects than pretty much any other psychiatric medicine.

 

I appreciate the advice. I actually use 1 25 seroquel for sleep, I can't tolerate more than that without falling asleep. I've been on that for two years or so.

 

I've been seeing a doctor since 2008, unless I have a terrible reaction I can't try another medication without having been on it for the appropriate amount of time first. I am aware that it does take time. I tend to be a bit paradoxical in my responses. I don't know if it's related but I have the mutation of the MC1R gene (redhead, although you don't have to be so to have it) where anesthesiologists wince because it is hard to put me under.

 

Also you're right, for the most part lithium is okay I just found it difficult to lose weight on it, supposedly not good for my thyroid, not good for psoriasis, I'm constantly thirsty, I can't take more than 600 mg generic Lithobid without getting very sick to my stomach. In context though these are livable things, I was spoiled in that Emsam (when it worked) had zero side effects. I'll definitely look into the other suggestions.


Edited by GingerSnapped, 03 November 2017 - 07:56 PM.


#13 foreseason

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Posted 24 November 2017 - 08:29 PM

Psychedelic assisted therapy would be my suggestion. It shows more promise than any current treatment options. It also has the potential for long term efficacy and to get to the core underlying issues as opposed to band aid fixess

I would check out http://www.maps.org and http://www.reset.me as a good start. Rolling stone also had an excellent article a few months back

http://www.rollingst...c-drugs-w470673

Obviously the legality issues make it more complicated, but there’s a large underground network of psychedelic therapists.

Good luck

Edited by foreseason, 24 November 2017 - 08:32 PM.


#14 Eryximachus

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Posted 25 November 2017 - 04:49 AM

How do you determine "shows more promise"?  Because Rolling Stone writes an article about it?  The same editorial staff that continues to promote the fiction that "rape culture" exists and ruined the lives of dozens of men with one of hundreds of false rape accusations?  

 

Rolling Stone, quite frankly, is run by utter lunatics.  Nothing printed in that magazine is of any value whatsoever. 

 

The use of psychedelic drugs shows *some* promise.   We are a long way away from reasonable treatment guidelines.  

 

And honestly, a lot of it is total BS.  I've got a good hookup who put together some 12mcg tabs of LSD.   I tried the whole microdosing thing, and it was nonsense.  I just felt weird. It never felt better.  It was good stuff. I took 10 at a time, and the dosage was spot on.   

 

 


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#15 GingerSnapped

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Posted 25 November 2017 - 05:01 AM

The use of psychedelic drugs shows *some* promise.   We are a long way away from reasonable treatment guidelines

 

I have to agree with this point. I don't want to condemn anyone for trying to grapple with this beast of a problem. I don't judge anyone for their activities whether medical or for entertainment but the enthusiasm over recommending psychedelics can be misguided and biased with personal enthusiasm for hallucinogenic experiences. It often assumes the origin of the depression being a traumatic event and the long term results just aren't in. Most people feel pretty high and incredible when they feel like they've tackled a big issue or had a breakthrough, the long term is something very different. In the thread I noted by disinterest and personal reasons but every now and again I have a friend who well... wishes they could live at Burning Man send me another article about it. It's also very callous towards those who have life-altering bad trips and bad experiences, regardless of dose. Not because people shouldn't make suggestions based on one bad or negligible experience, but people are so enthusiastic about it they tend to aggressively invalidate the experiences of those it didn't work for.


Edited by GingerSnapped, 25 November 2017 - 05:05 AM.

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#16 jack black

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Posted 25 November 2017 - 06:22 AM

 

 I have had hypothyroidism since puberty but the lithium as is known doesn't help, but according to tests I am in acceptable range. My doctor thought about experimenting with T4.


 

 

what is your TSH? any other thyroid test results?



#17 VitD_1

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Posted 21 January 2018 - 06:41 PM

Gingersnap- for what it is worth, I have treatment resistant MMD and ketamine is the only thing that has worked to date for me (night-and-day difference).  I was able to enroll in a study so it was free.  You should see if there is a study going on in your area.  The downside is now that i have found something that works i don't have the $$$ to do the infusions. It is very frustrating. I am very hopeful for GLYX-13 and NRX-1074. I do wish someone could correctly reverse engineer those two as I don' think we will see them (especially NRX) released for a while. 



#18 GingerSnapped

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Posted 22 January 2018 - 07:06 AM


I have had hypothyroidism since puberty but the lithium as is known doesn't help, but according to tests I am in acceptable range. My doctor thought about experimenting with T4.


what is your TSH? any other thyroid test results?

I don't recall only that it was perfectly normal and controlled.

#19 GingerSnapped

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Posted 22 January 2018 - 07:13 AM

Gingersnap- for what it is worth, I have treatment resistant MMD and ketamine is the only thing that has worked to date for me (night-and-day difference). I was able to enroll in a study so it was free. You should see if there is a study going on in your area. The downside is now that i have found something that works i don't have the $$$ to do the infusions. It is very frustrating. I am very hopeful for GLYX-13 and NRX-1074. I do wish someone could correctly reverse engineer those two as I don' think we will see them (especially NRX) released for a while.


I appreciate that. Wish I could. I applied for a university study. I haven't heard from them in weeks when they said we'd get started very soon. They don't answer, I left a message, no returns. I have no idea why, I meet all criteria and have no exclusionary factors such as history of drug abuse or unclean tests. I could have had a low QT in an EKG which happened once from Seroquel but that was supposed to be resolved.

If it helps I learned there that they have a lot of enthusiasm for intranasal ketamine although that's not what they were studying. They believed attidues would change about the gold standard of infusions with upcoming studies. It's also cheaper and more accessible. Well, not for me though.

I don't know what to do.
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#20 VitD_1

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Posted 23 January 2018 - 01:31 AM

 

Gingersnap- for what it is worth, I have treatment resistant MMD and ketamine is the only thing that has worked to date for me (night-and-day difference). I was able to enroll in a study so it was free. You should see if there is a study going on in your area. The downside is now that i have found something that works i don't have the $$$ to do the infusions. It is very frustrating. I am very hopeful for GLYX-13 and NRX-1074. I do wish someone could correctly reverse engineer those two as I don' think we will see them (especially NRX) released for a while.


I appreciate that. Wish I could. I applied for a university study. I haven't heard from them in weeks when they said we'd get started very soon. They don't answer, I left a message, no returns. I have no idea why, I meet all criteria and have no exclusionary factors such as history of drug abuse or unclean tests. I could have had a low QT in an EKG which happened once from Seroquel but that was supposed to be resolved.

If it helps I learned there that they have a lot of enthusiasm for intranasal ketamine although that's not what they were studying. They believed attidues would change about the gold standard of infusions with upcoming studies. It's also cheaper and more accessible. Well, not for me though.

I don't know what to do.

 

 

That is really weird they have not followed up. Is there only one medical facility doing the trial in your area?  I remember i applied to a few different ones. 

 

I have heard about the internasal, I actually found a compounding pharmacy in the US that compounds it.  I was going to ask them for a list of docs they have seen Rx's from and try to reach out. I figured it was worth a try.  I am going to try msi-189, if i can get a hold of some. 

 


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#21 GingerSnapped

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Posted 23 January 2018 - 07:51 AM

 

There

That is really weird they have not followed up. Is there only one medical facility doing the trial in your area?  I remember i applied to a few different ones. 

 

I have heard about the internasal, I actually found a compounding pharmacy in the US that compounds it.  I was going to ask them for a list of docs they have seen Rx's from and try to reach out. I figured it was worth a try.  I am going to try msi-189, if i can get a hold of some. 

 

 

Yeah I don't know why myself. Perhaps my own MD knows, but I haven't talked to him in person in 7 months or so (gotta love my health insurance). There aren't any other studies in my area unfortunately. There are plenty of unaffordable $3,000+ options. I don't have enough credit. There is a doc who gives out Rxs for intranasal and they (@#$@%$^#$%) charge the same as infusions.

 

I did find it interesting to hear prestigious people endorse intranasal ketamine and they didn't agree that intravenous was necessary for the blood-brain barrier like many claim. That said, I am at a loss trying to find it independently. I'd look like a Girl Scout at a Satanic Ritual trying to pretend to be a part of the party scene.



#22 GingerSnapped

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Posted 29 January 2018 - 11:43 PM

 

 

Gingersnap- for what it is worth, I have treatment resistant MMD and ketamine is the only thing that has worked to date for me (night-and-day difference). I was able to enroll in a study so it was free. You should see if there is a study going on in your area. The downside is now that i have found something that works i don't have the $$$ to do the infusions. It is very frustrating. I am very hopeful for GLYX-13 and NRX-1074. I do wish someone could correctly reverse engineer those two as I don' think we will see them (especially NRX) released for a while.


I appreciate that. Wish I could. I applied for a university study. I haven't heard from them in weeks when they said we'd get started very soon. They don't answer, I left a message, no returns. I have no idea why, I meet all criteria and have no exclusionary factors such as history of drug abuse or unclean tests. I could have had a low QT in an EKG which happened once from Seroquel but that was supposed to be resolved.

If it helps I learned there that they have a lot of enthusiasm for intranasal ketamine although that's not what they were studying. They believed attidues would change about the gold standard of infusions with upcoming studies. It's also cheaper and more accessible. Well, not for me though.

I don't know what to do.

 

 

That is really weird they have not followed up. Is there only one medical facility doing the trial in your area?  I remember i applied to a few different ones. 

 

I have heard about the internasal, I actually found a compounding pharmacy in the US that compounds it.  I was going to ask them for a list of docs they have seen Rx's from and try to reach out. I figured it was worth a try.  I am going to try msi-189, if i can get a hold of some. 

 

 

Update: Even though they met with me on the understanding that I adjusted my medication to not have any more EKG problems that precluded me from the test, they refused to call me back but weeks later told my MD that they don't want patients who alter their medication to be in the study. I wasn't using Seroquel for psych issues, I was using it for sleep and it gave me lowQT syndrome.

 

This is just awful.



#23 Tom_

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Posted 30 January 2018 - 01:15 AM

Atypical Antipsychotics aside from lithium are the gold standard in Bi-Polar Depression. Poor response to one or more does not dictate a poor response to another. Aripiprazole and Amisulpride are both effective for Bi-Polar depression and come with less sedation and weight gain that Quetiapine or Olanzapine. Lamotragine has been shown to prevent cycling to depression but the evidence that it actually elaviates depression is not as strong. It also requires a much longer trial - upto 14 weeks. It comes highly recommended by Stalh. A major cause of treatment failure is insufficient length of drug trial - often due to side effects or impatience. Remember side effects tend to subside after a few weeks. For an atypical antipsychotic the minimum trial length should be six weeks.

Antidepressants should be avoided if possible to prevent switches to manic/mixed states. Bupropion is often the place to start. TCA's are an option but tend to have unplesant side effects. MAOI's - Moclobremide or Selegiline (in patch form) are safer MAOI's. Otherwise the old staples Phenalzine or Tranyclypromine are well studied.

Stimulants (NOT WITH MAOI'S) can be trialed cautiously alongside an antidepressant and anti-manic/antipsychotic.

A common cause of treatment resistant depression in Bi-polar is comorbidity. Personality Disorders, particularly Borderline, ADHD, anxiety and PTSD are most common - in which case improving those tend to help.

Stopping Benzo's is always a good idea. Stop abusing drugs/drinking if a problem. Getting a good amount of sleep. Bright Light therapy.



#24 world33

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Posted 30 January 2018 - 03:50 AM

If you are interested in learning about any genetic cause(s) of your depression you might consider to take the following steps as follows:

 

1) Take a whole exome genetic test at https://genos.co/ (the cheapest whole exome genetic test option) for 499$

 

2) Plug the raw data results into Genetic Services such as livewello.com, selfhacked.com, promethease.com, nutrahacker.com (only works with 23andme limited genetic test) and search for genetic mutations that are associated with MDD

 

3) Go to Malacards.org to find which genes are associated with MDD and also which genetic tests, drugs, publications are available for each associated gene.

 

In particular two genes have the highest score in the MDD Malacards page:

HTR2A (5-Hydroxytryptamine Receptor 2A), TPH2 (Tryptophan Hydroxylase 2)

For Bipolar disorder check this Malapage.org page.

 

There could be so many other genes involved (e.g. MTHFR methylenetetrahydrofolate reductase gene mutations that do not allow you to convert folic acid into the active form l-methylfolate).

Unless you are happy to try the genetic route it is hard to pin point which supplement/drug might work for you. It is expensive I know but it might be worth it and point you into the right direction based on your specific genetic profile.


Edited by world33, 30 January 2018 - 04:03 AM.

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#25 GingerSnapped

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Posted 31 January 2018 - 08:08 AM

Atypical Antipsychotics aside from lithium are the gold standard in Bi-Polar Depression. Poor response to one or more does not dictate a poor response to another. Aripiprazole and Amisulpride are both effective for Bi-Polar depression and come with less sedation and weight gain that Quetiapine or Olanzapine. Lamotragine has been shown to prevent cycling to depression but the evidence that it actually elaviates depression is not as strong. It also requires a much longer trial - upto 14 weeks. It comes highly recommended by Stalh. A major cause of treatment failure is insufficient length of drug trial - often due to side effects or impatience. Remember side effects tend to subside after a few weeks. For an atypical antipsychotic the minimum trial length should be six weeks.

Antidepressants should be avoided if possible to prevent switches to manic/mixed states. Bupropion is often the place to start. TCA's are an option but tend to have unplesant side effects. MAOI's - Moclobremide or Selegiline (in patch form) are safer MAOI's. Otherwise the old staples Phenalzine or Tranyclypromine are well studied.

Stimulants (NOT WITH MAOI'S) can be trialed cautiously alongside an antidepressant and anti-manic/antipsychotic.

A common cause of treatment resistant depression in Bi-polar is comorbidity. Personality Disorders, particularly Borderline, ADHD, anxiety and PTSD are most common - in which case improving those tend to help.

Stopping Benzo's is always a good idea. Stop abusing drugs/drinking if a problem. Getting a good amount of sleep. Bright Light therapy.


I appreciate that but is this a form letter? As I said above, I don't do benzos, any drugs, I don't even drink, I'm already on Emsam which stopped working and was never great. I'm not comorbid. I've taken all of those except Amisulpride, I do not respond to antipsychs well.

If you are interested in learning about any genetic cause(s) of your depression you might consider to take the following steps as follows:

1) Take a whole exome genetic test at https://genos.co/ (the cheapest whole exome genetic test option) for 499$

2) Plug the raw data results into Genetic Services such as livewello.com, selfhacked.com, promethease.com, nutrahacker.com (only works with 23andme limited genetic test) and search for genetic mutations that are associated with MDD

3) Go to Malacards.org to find which genes are associated with MDD and also which genetic tests, drugs, publications are available for each associated gene.

In particular two genes have the highest score in the MDD Malacards page:
HTR2A (5-Hydroxytryptamine Receptor 2A), TPH2 (Tryptophan Hydroxylase 2)
For Bipolar disorder check this Malapage.org page.

There could be so many other genes involved (e.g. MTHFR methylenetetrahydrofolate reductase gene mutations that do not allow you to convert folic acid into the active form l-methylfolate).
Unless you are happy to try the genetic route it is hard to pin point which supplement/drug might work for you. It is expensive I know but it might be worth it and point you into the right direction based on your specific genetic profile.


Thank you. I'm disabled so it's not an option but should I have the money I'll definitely do that and I was not aware of that before.

#26 ceridwen

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Posted 31 January 2018 - 09:14 AM

Seeing as depression can cause low levels of Klotho. I would recommend vitamin D3 and vitamin k to go with it and/or Astragalus

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#27 GingerSnapped

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Posted 19 February 2018 - 11:30 PM

Thank you looking into that. I'm ineligible for TMS because ECT failed me, but they won't give you TMS unless you try ECT first. I am ineligible for the local Ketamine study because of my low QTc interval. If I could afford infusions, they don't care about that at all.

 

L-Methylfolate has made no difference. I forwarded the recommendations here to my doctor who said they were all "far too dangerous." As if being forced to find alternatives on your own isn't dangerous.

 

I get far worse around my period but birth control only made me nauseous and isopregnanolone is far down the line. I'm at a loss right now.


Edited by GingerSnapped, 19 February 2018 - 11:32 PM.






Also tagged with one or more of these keywords: treatment resistant depression, depression, nmda receptor, glutamate, amygdala

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