Quote Originally Posted by Jo79 View Post
Treatment resistant depression and anxiety and OCD has also been suggested. This is my fifth and longest episode in 10 years (iíve been unwell since January)

I was on 200mg sertraline and 15mg mirtazapine since 2017. I increased the mirtazapine to 30mg in January and changed sertraline to escitalopram in April. Was feeling great for two months but crashed again so stopped the escitalopram and have been taking venlafaxine since July, increased to 225mg in August but didnít get much response (The odd day of euphoria) so added the quetiapine in October. Iíve had some reasonable periods of stability, maybe a week to 10 days at a time but then going downhill again for 2-3 weeks.
I wonder why a TCA isn't being considered instead of antipsychotics and anticonvulsants. For example, clomipramine (Anafranil) has the best track record for OCD, is the most powerful SNRI on the market and is, imho, a better bet than what you're on, or is proposed. Plus, I think it's way too early to apply the 'treatment-resistant' label when just 2 ADs from the same class and another which is arguably not much different have failed.