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Thread: When no ADs work

  1. #1
    Join Date
    Jan 2019
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    When no ADs work

    Hello I'm in a bad way. I don't respond to SSRI and have tried tricyclic. I had success with SNRI first time round but not any more. Is there any AD known to work when nothing else does? I am more GAD than depression. Surviving on quetiapine anti-psychotics but get leg cramps side effects.

  2. #2

    Re: When no ADs work

    Hi, in the UK the official guidance from NICE is that people with GAD resistant to ADs should be considered for Pregabalin (Lyrica). Have you discussed this with your doctor?

  3. #3
    Join Date
    Mar 2011
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    450

    Re: When no ADs work

    Sorry to hear of your struggles with ADs. I know it's another AD, but have you ever been offered Mirtazapine?

  4. #4
    Join Date
    Jan 2019
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    12

    Re: When no ADs work

    Hello MB and BB

    Thanks for your kind advice.

    I'm not in UK and have to pay for medications myself. I tried up to 150mg pregabalin but not enough and couldn't afford more. As for Mirtazapine, I got the most painful leg cramps and frequency of urination as side effects and had to stop after 3 days.

    I motion this forum an AD called Trazodole. I wonder if that's worth a go

    Aho

  5. #5
    Join Date
    Jan 2017
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    1,220

    Re: When no ADs work

    Quote Originally Posted by Aho View Post
    I don't respond to SSRI and have tried tricyclic.
    Which tricyclic? Unlike SSRIs and SNRIs, TCAs vary significantly in their action ranging for the potent serotonin reuptake inhibitor clomipramine (Anafranil) to the norepinephrine, aka noradrenaline, reuptake inhibitors (NRIs) such as nortriptyline (Aventyl, Pamelor) and desipramine (Norpramin) so just because one didn't work doesn't mean none will. The fact that a SNRI worked for a while while SSRIs didn't indicates a NRI might be a good initial choice. The SNRIs are only weak norepinephrine inhibitors.

    Is there any AD known to work when nothing else does?
    Either a TCA, I suggest initially one of the NRIs as per above, or the MAOI tranylcypromine (Parnate). MAOIs were the most effective antidepressants I've taken for anxiety and I'm not alone in that judgment, but they fell out of favour because of dietary restrictions. Modern food processing techniques have significantly reduced the problem and adding a small dose of one of the NRI TCAs pretty much eliminates it. However, price and availability could be an issue due to the low demand for MAOIs these days.

    I motion this forum an AD called Trazodole. I wonder if that's worth a go
    It could be. Some have had very good results with it. It does have one drawback, especially while titrating up the dose, in that it is very sedating at lower doses. This becomes less of an issue at the doses - 225-300mg - typically prescribed for anxiety and depression, especially with the Oleptro extended (slow) release formulation which is better at keeping blood levels above the sedation threshold.

  6. #6
    Join Date
    Nov 2016
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    1,041

    Re: When no ADs work

    hi everyone! I'm having the same issue. I have anxiety, panic disorder, depression from anxiety, and some OCD related thoughts (but not diagnosed). I take 225MG of Effexor ER, along with Klonopin 2 mg a day (one in the morning and one late afternoon). The doctor added 30MG of buspar. I also take 25MG of seroquel (or sometimes half of that for sleep). I'm better than i was two years ago, but lately my anxiety is back and my mind is coming up with all kinds of obsessive anxiety thoughts. I need something calming. The doctor prescribed Deplin, but I don't have a deficiency and my genetics test came back that i process folate or whatever it's called properly. I have more energy since taking the Deplin, but had to stop since i was feeling panicky. I feel like my doctor doesn't know what to do. Should i switch doctors? Thoughts on Deplin? Thank you.

  7. #7
    Join Date
    Jan 2017
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    1,220

    Re: When no ADs work

    Quote Originally Posted by Ethansmom View Post
    I feel like my doctor doesn't know what to do. Should i switch doctors?
    I would be seeking a second opinion. I'm not a fan of just adding more and more meds to an antidepressant in the hope one might somehow get it to work, plus the Klonopin may be reducing Effexor efficiency. It can be a worthwhile adding an extra med, singular, when a AD is just falling a little short, but this doesn't seem to be your situation I think it would be better to reevaluate the whole med regime.

    Thoughts on Deplin?
    There is good evidence that folate deficiency can trigger depression and Deplin can increase AD effectiveness in those with the deficiency, but it seems to be a long shot with normal folate levels.

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