Posted by Tony P on September 28, 2008, at 1:46:37
In reply to Exotic Meds for Treatment Resistant Depression, posted by glenni on September 27, 2008, at 5:11:48
> I have treatment-resistant depression and am interested in hearing about experiences with the more exotic medications such as opiates, ghb, ketamine, alzheimers meds, etc.
===========
Well, I'm either treatment-resistant, atypical, or both, and probably fit somewhere on a Bipolar III effect spectrum. Or else I'm just a hard guy to please. I don't do well with SSRI's, at least by themselves -- I get more side effects than benefit, with the possible exception of Lexapro. Down the years, I've tried quite a few odd meds, and found a few that worked for me. Some of the following probably belong on the Alternative board, but since you asked, it's convenient to summarize my experience with both Rx and "alternative" remedies in one place.The Alzheimer's meds and supposed GABA enhancers that I've tried (mostly non-Rx or European so-called nootropics) have been a total washout as far as I'm concerned. Other people swear by them; YMMV. I've tried GABA, GABOB, Piracetam, Pramiracetam, Galantamine, DMAE and Picamolon. None of them had an effect that I could _feel_, but perhaps an objective measurement would have showed some improvement. I certainly would not consider them antidepresssants by themselves.
I've tried Tianeptine (atypical Serotonin booster), and found it a moderately effective antidepressant with very few side effects, but in the long run not powerful enough or broad-spectrum enough to do the job for me. Also, not available in North America.
I tried Trivastal and bromocryptine (both dopamine enhancers) and found them essentially harmless but not very effective, so if you're treatment-resistant, they may not do much for you, at least by themselves. On the other hand, you never know 'til you try; YMMV.
Yohimbine, or yohimbe bark (taken as tea) is an effective aphrodisiac and can help with the sexual side-effects of SSRI's. However, I haven't found it works as an antidepressant for me; on the contrary, it makes me very anxious in high doses, and I crash the next day and have a mini-depression.
Dextromethorphan (DM or DXM), which has some pharmacolgical similarities to ketamine, has occasionally been proposed as an antidepressant. In doses higher than you would normally take in cough mixture, it has some short-term stimulant properties, but I found it likewise had a long hangover period (12-48 hrs depending on dose) which was very depressive. There may be some risk of permanent brain damage (there definitely is with ketamine) with high doses on a regular basis.
The following HAVE worked for me. They're not really exotic, but they're not quite main-line either: Selegeline, Requip, Buspar, Modafinil, Adrafinil, Reboxetine.
Selegeline was very effective at a low dose (5-10 mg/day) _combined_ with other antidepressants (mainly Remeron in my case). There's a significant risk in combining an MAOI with almost anything else, but with selegeline IMHO it can be managed with cautious dosing and careful monitoring, especially BP. It made me anxious & physically shaky, though; Inderal helped with that & helped keep my blood pressure down.
I take Requip (ropinirole) as part of my regime, and have for about 2 years now. It was originally developed for treatment of Parkinson's, but was also approved a couple of years ago for Restless Leg Syndrome. A small pilot study in the Can. J. Psych. a year or two before that found that people on a wide variety of anti-depressants and mood stabilizers almost all improved when ropinirole was _added_ to their medication. I haven't seen a follow-up, but there ought to be one by now.
It's hard for me to judge, since I've never really experimented with going off & on it again, how much it contributes to my sense of well-being, but it's my impression that it has a small but significant mood-brightening effect. It enhances dopamine, which few antidepressants do directly, although the sites at which it acts tend to be sedating rather than stimulating ones, but I am sure there is some positive effect that spills over, as it were, to the mood-enhancing receptors.
The other reason I take it is that the first time I tried Remeron I got RLS so bad it involved my whole body and drove me close to suicidal. With Requip added, I can take Remeron and some other meds such as Seroquel that otherwise give me severe RLS or akathisia.
Remeron works for me but it's not enough by itself. I'm currently taking: Remeron, Cymbalta, Requip, Buspar, clonazepam, Seroquel if I need it at night, and modafinil (Provigil/Alertec) &/or adrafinil if I need them during the day. I suspect some of these may be fighting with each other to some extent, but I hate to mess with the mix if it's working, which for the most part it is.
Buspar works well for me, again in combination with major ADs, although about 4 out of 5 people say they don't get any benefit from it. For me, it enhances mood and activity level, and helps prevent anger and depression as a reaction to stress.
Modafinil (Provigil/Alertec) & adrafinil I find are primarily helpful in promoting daytime alertness if you suffer from hypersomnia (like sleeping 10-15 hrs. a day) as part of your depression, or if you have sleep apnea. They do also have a mild energizing and mood-brightening effect.
And let me not forget to mention coffee, which (I've read) also boosts dopamine. A triple latte with my other morning meds and I'm set for the day. But seriously, I think coffee (or tea if it's good strong English-style) is a much neglected antidepressant, or at least adjuvant. Techically caffeine's addicting, but I find it's self-limiting because of the unpleasant side effects of too much. I seldom want more than my morning 2-3 cups, and I even cut that back for a while when I started on Selegeline, and again when I switched to Cymbalta, and found I was getting anxiety attacks (surprise, surprise) half an hour after my morning coffee. I don't suppose a coffee regime by itself has ever cured anyone of major depression, but -- in moderation -- it sure helps!
I, too, am curious about GHB, ketamine and the like, but there are
a) some very high medical risks involved (like permanent brain damage & death, especially combined with other things, including alcohol)
b) legal issues
c) questionable purity if obtained from an illegal source,
so I'm staying away from them. And I'm pretty sure opiates are a blind alley, offering only very temporary relief, as well as being mostly illegal or highly controlled. Moreover, there is growing evidence that depression and a predisposition to addiction are closely linked (quite likely they have genes in common), so opiates are doubly risky to those of us with depression.
TP
poster:Tony P
thread:854329
URL: http://www.dr-bob.org/babble/20080926/msgs/854559.html