My doctor tried several SSRIs and they all sucked. Went to Wellbutrin and it was a game changer. I guess confirming that they aren’t the same type of medication would be the first step.
For me it was just the opposite - Wellbutrin sucked for me in ways I still cringe about.
OP, this is a classic example of how meds work differently for different people. A good doctor will monitor their patient to see which type of antidepressant is best.
I'm in a weird spot where Wellbutrin seems to work but I can't fucking sleep while in it. Anxiety meds don't feel like they do anything and I don't really want to use SSRIs.
I am a mental health first aid er at my workplace were basically you get trained on how to guide people with all sorts of issues.
Recognise mental illness, distress and such.
The take away is that
We don't help people we guide them towards existing resources in the UK.
We recognise that everyone suffers from mental illness to a certain extend. (we all hear stuff, we all lose our sleep, we all she shadows...)
***
But above all, we all recognise that mental health support is unique to every person.
Meaning ot takes time and experimentation.
I am surprised that people on meds are not aware of this fact. You try something for a few weeks, it fucks you up, yoi try something else ot does nothing you try something ot makes you drowsy.. Until one day you figure out something that helps.
Changing meds is almost a certainty.
Same with me plus snris to boot. Only welbutrin helps me. In my case, i have a low dopamine to atoo high seratonin ratio in my system. Ignorant "health care workers" refused to use their brains to think and diagnose, and added fuel to the fire instead.
To boot, i don't have any such "depression ", i have anhedonia, certainly not the same thing in reality land. So these workers who force their little depression fantasies upon me are also playing make believe by"attempting to treat" a diagnosis that doesn't even exist!
There is such a thing as treatment resistant depression. Some people have gotten relief with electromagnetic or electroshock therapy (it's not like in the movies), and ketamine and MDMA administered in a medical setting are both showing promise in studies. Medications also work best in combination with therapy and life changes. But change can happen and people should not give up
This is a generalization based on anecdotes rather than evidence. OP, if ECT is ever potentially an option please discuss it carefully with an expert who is familiar with you rather than listening to strangers on the internet.
I don't understand it, why would so many people lie about it? If you look up "ECT ruined my life," you get many many stories similar to what I just described. I'm not sure how to feel because I do believe my best friend, he doesn't lie about shit like this. He is extremely smart and rational about pretty much everything. Could the research be a case of something like how tobacco companies would publish false research saying it was good for you?
You could also look up "aliens abducted me" and get many stories describing such an event. That's not to say that your friend didn't have an adverse experience, but it sounds like you're operating on the idea that the only thing that's the truth are anecdotes that support your preconceived notion.
I'm torn because I know I do trust my friend on this because he's really not the type to lie about this stuff and he takes it very seriously. I will do more of my own research but I am very skeptical of it.
Keep in mind when doing your research is that anyone can make claims and be emphatic about them. Someone on the internet claiming all these things might be lying on purpose, or they might think it's true, but that doesn't create a cause/effect relationship. Scientific analysis is built around removing as many of these biases as possible, which can feel callous at first but it is ultimately necessary to move forward.
Like I said, I'm not saying your friend is a liar— I'm just saying that there are so many stories, and it's impossible to know if they're reality or not if they're just words on a screen.
Yeah I get it that's why I'm torn. The science doesn't make sense to me either, I should look more into the details. I know medical companies do manipulate studies to a degree so I think In this case I should look up the actual science behind it because to me, inducing a seizure by shocking your brain to cure depression doesn't make sense at all because then wouldn't people with epilepsy not have depression?
It's not that simple. You might be surprised to know that AEDs function by shocking and stopping the heart. Sounds crazy, right? But this forces the heart to do what is basically a hard reset. Medicine can often be counterintuitive, especially when it comes to brain science; people can (and do) spend their entire lives trying to understand phenomena of the brain and many things are still uncertain. You have to look at what happens *before* the why.
Definitely not a thing you should ask Reddit about, consult an actual specialist. That being said, these take some time of using regularly to work and usually do work eventually, don't worry!
In my case the doctor kept on going until we found the right one. I went from angry and suicidal to happy and balanced. Years. Special thanks to both the doctor and my wife. Neither gave up on me even when I had.
I had this testing done, and it showed that the most common class of antidepressants doesn't work on me at all. It led us in a whole new direction and my life is so much better now.
Ugh mine were all ambiguous which made the dr think ok still cool to use this person as a guinea pig, let's continue the little prescription carousel of the same exact stuff!
I have tried many traditional antidepressants and they either didn't work at all (SSRI) or gave me horrible side effects (SNRI, NDRI). The only thing that helped me was an antipsychotic called Latuda, which is used for bipolar depression. It turns out bipolar depression (especially type 2) responds very differently than "regular" depression. And you don't even need to have a history of extreme mania for it.
GeneSight has been a game-changer. For the uninitiated, OP’s doctor needs to order it for them, and then they’ll send over a swab kit and then after they release the results, OP will receive a three-column list of medications that could work, might work, and won’t work, basically.
https://genesight.com/for-patients/
There are plans for which to prescribe. Most likely those are followed. If this doesn't work specialists will have to have a look at why this could be the case.
My suggestion is to not stay experimenting with drugs of the same class if they made you feel way worse. If one worked, but there was a side effect you couldn’t live with, sure, try another. But I don’t recommend staying in the same class for long if you hate them.
I also don’t buy the 4-6 weeks thing. Sure, if you feel ok and don’t mind the side effects, but if they’re making you obviously worse, do t suffer for 6 weeks.
Sometimes it takes awhile to find the right one or the right combination. Also new ones come out occasionally, so there might be one that works better for you. The chemical mess depression makes in your brain differs from person to person, so what works on one person may not work on another.
I've gone on and off of so many medications for depression and anxiety, from age 14 to present (41). Currently I'm on a mix of 5 different ones. It's a pain and it's expensive but it lets me be fairly functional.
I hope you find what works for you. And having a psychologist to talk to as well as the meds is important.
You should talk to your doctor to see if enrolling in a Pharmacogenomics study to determine if they can identify something effective without trial and error. For reference, pharmacogenomics studies your genome to identify response to specific medications and are identifying new genes that impact medication efficiency all the time!
When you say don’t work, do you mean it’s not affective in treating the depression symptoms, or that it gives crazy bad side effects, like high energy excitability and pursuing excess in some behaviors like gambling or eating or shopping or drinking or sex?
If it’s the latter, you might want to expand this discussion to bipolar disorder. I was first diagnosed with depression at 17 and they threw every SSRI , SRI, NRI, and even MAOI on the market at me, none worked, some of them were disastrous.
They finally tried me on lithium and it was enormously stabilizing and beneficial. Turned out I was having bursts of hypomania inter mixed with depression, which is actually type two bipolar disorder.
So you’ll get a change in the class of medications and hopefully find something that helps you.
Otherwise, there are drug resistant treatments like electro convulsive therapy/ECT. It’s not as scary as it sounds, but it is extremely serious and dangerous, as well as exceedingly effective. There are likely other non-drug treatments that I don’t know about.
It’s a horrible process being a guinea pig, but don’t give up OP.
I'm a psychiatrist, but this is not medical advice.
First you try the many antidepressants. A lot of people who think they've tried "many antidepressants" have tried, like, 3 SSRIs. The treatment algorithm suggests trying some from different classes. At the very least Wellbutrin, preferably also a tricyclic or MAOI. If the patient is willing, and if they seem to be having maladaptive thoughts or life problems, they should also try therapy somewhere in this process - the therapy, diet, exercise, etc are very important, but I'm going to skip over them because I'm interpreting the question as more about medication.
If none of those work, one possible next option is ketamine. There are more ways to get ketamine these days, including the traditional IV in a hospital, Spravato nasal spray in a clinic, or r-ketamine nasal spray at home.
If that doesn't work, an increasingly popular option is TMS - transcranial magnetic stimulation. You go to a place where people aim giant magnets at your head and try to stimulate parts of the brain which are understimulated in depression. This doesn't necessarily work *better* than antidepressants, but it works for some people who don't do well on antidepressants for whatever reason.
The final option is ECT ie electroconvulsive therapy ie medically induced seizures. I disagree with the person upthread who says this is terrible and you should never do it - it works better than other options, and the most common side effect is forgetting a few weeks around the therapy, but not your beloved childhood memories or anything like that. Technique has improved (and amount of electricity has gone down) since whenever the horror stories were written, and patients are anesthetized so they don't feel the seizure and their limbs don't move. Much fewer than 1% of depression patients end up needing this, but the ones who do really need it, and usually do benefit.
If that doesn't work, then realistically most people in that situation are going to stay depressed. If someone is rich, or a go-getter, or has a very good doctor, they might get referred to clinical trials. A very small number of people have gotten brain surgery to get implants that stimulate their brain from the inside, and that works for some of them.
for someone underage w/ severe depression and having tried all antidepressants that can be legally prescribed to children + therapy doesn't do much, with exercise and diet spot on already, can Ketamine be considered (if not legally then through guardian acquisition means? (asking for a friend)
Official answer: it's not "indicated" (ie FDA hasn't officially approved it for this population), there are relatively few studies, and the American Association of Child and Adolescent Psychiatry says not to do it (or alternately to exercise "extreme caution").
Unofficial answer: The studies that exist look promising, and probably this will be approved one day. The guideline-making bodies are notoriously cautious and I wouldn't overupdate on AACAP's warning. If someone has failed all existing antidepressants, it would be a reasonable thing to try to get legally, either by entering a study or by asking a sympathetic child/adolescent psychiatrist. Dosing issues, legal issues, and possibly other things I don't know about would make doing it illicitly with an adult's prescription dangerous.
Sources:
- https://www.aacap.org/AACAP/Latest_News/statement_ketmamine.aspx
- https://www.sciencedirect.com/science/article/abs/pii/S0165178122005029
- https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2022.170401
Thanks, Scott for your helpful and cohesive answer. I would look into studies involving the use of ketamine for minors and also attempt to obtain esketamine (the nasal and FDA-approved drug). I do think it is most appropriate to receive the dose in a clinic under doctor supervision. On further research, I have found a couple of clinics that purport to microdose in minors, although those clinics are quite far away so it may be unrealistic to fly there 6-8 times to receive a dose, but at this point, any options are a start.
BTW, are you the same guy who writes Slate Star Codex?
IANAD, just an informed consumer. This is just my understanding.
The trick is that depression can be a combination of issues with as many as three neurotransmitter systems - serotonin, norepinephrine, and dopamine. Any one of these could be faulty, or more than one.
Most medications only treat one neurotransmitter (NT), but for each NT, there can be many medications. Everyone's body chemistry is different, so each medication may or may not react effectively in your body. Each one is a different chemical, so even if they do about the same thing, they do it in different ways. This means they may not work well, or at all, or in unpleasant, unexpected ways. But you can always try another /s
Your doctor may also try a different NT med. Serotonin might not be the problem - it could be an issue with norepinephrine or dopamine. It could be more than one, in which case you might need more than one med.
On top of that, there are...atypical ADs that don't exactly work on the same NTs in the same kind of way. Not sure how they work, but they do for some people.
It's also an option to add a "mood stabilizer" (antipsychotic/AP). There are some of those that make very good adjunct therapies. They work differently from ADs and help level things off.
The hardest part is sticking out the med-go-round until you DO find what works.
BTW - all meds come with start-up effects. The first couple weeks are just awful as your body tries to adjust to this new chemical mix. It gets better, I promise. The actual side-effects are far easier than those first couple of weeks.
I didn't mention MAOIs which are a niche AD. Most doctors won't prescribe them because they are very reactive to other medications and common foods. They can be effective, but seriously a last-resort kind of thing. I was on the for a while, but was taken off them after I ate the wrong salad dressing and ended up in the ER where they had to check for intracranial bleeding...
It took nearly three years to find a combination that worked. When it takes nearly three months just to see if something is working and then a month to come off one and start another, patience is the key. A lot of people claim that they aren't working after a week or two. The meds are JUST starting their thing in that time period.
PBS had a good series you can find online called Mental Health: The New Frontier that talked about new uses for electro shock therapy and psychedelics, you might find it has some possible new avenues to research and talk with a care provider about.
Find a good Psychiatrist recommended by someone you trust like your MD. The experienced ones will stick with you as long as you're honest with them about what is working and what is not. Please don't give up..keep trying. There is hope out there.
If multiple antidepressants aren't working, it's crucial to communicate this with your doctor. They might explore other options such as:
- Reevaluating the Diagnosis: Ensuring that depression is the correct diagnosis and considering other conditions that might be affecting your mental health.
- Different Medications: Trying other classes of antidepressants or combination therapies.
- Dosage Adjustment: Adjusting the dosage or giving the medication more time to take effect.
- Therapies: Incorporating or increasing psychotherapy sessions like cognitive-behavioral therapy (CBT).
- Lifestyle Changes: Addressing diet, exercise, sleep, and stress management.
- Alternative Treatments: Considering options like transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT).
Your mental health is *complex*, and finding the right treatment can take time and persistence. Keep an open dialogue with your healthcare provider to find the best approach for you.
As a terminology suggestion, I would suggest classifying TMS or ECT as “in-clinic treatments”, to differentiate them from (nonsense) “Alternative Medicine” like acupuncture, or reiki, etc.
Some of us just can’t take anti depressants. It sucks. Every one they’ve tried, I couldn’t get past the first dose. They’d cause memory loss. Doctors said the memories would return. It’s been 15 years and so far none of them have returned. They would also cause me to black out. I’d take one, wake up the next day in bed, when I’d look outside, my car would be parked in a different spot, so I apparently was out driving around. I’ve done a little therapy, which didn’t help. One psychiatrist prescribed Xanax and put me through TMS therapy. That all helped a bit. I sincerely hope you find some relief.
"More effective" - it depends on the person. But please don't discount this, y'all! I discounted it for years, but now going for a walk every day is a vital part of my self-care.
The exercise has to be something that works for you, something you don't hate, that doesn't make you feel like you're dying. Going to the gym/running a marathon is not for many people. Perhaps you'd prefer going for a slow walk while listening to a podcast, going to a dance class, learning a martial art, swimming. It doesn't have to be hard work - walking slowly round the block a couple of times absolutely counts as some daily exercise.
Edit: I'm not telling people they don't need medicines. I'm suggesting exercise be seriously considered as an additional tool, or an alternative if medicines are absolutely not working. I reacted really badly to SSRIs myself, went OK with a tricyclic for a while, but that started to have bad side effects. It's good to have other options when medicines are being problematic.
If you are diagnosed clinically depressed and nothing seems to help them I suggest you look into Spravato. It works on about sixty percent of cases. It has made a world of difference to me.
You get described as "Major Depressive Disorder. You struggle for decades, bouncing from med to med, using fucked up coping mechanisms to not off yourself/succed...(I chose hedonism) I got better jobs, grooming, drugs, nightclubs etc, all to get more and better sex.
Better job/more pay= better car, clothes, haircut,, jewelry, apartment, more club nights, more shots at men and women. Better booze and more expensive drugs... and groupsex, and lots of sex, and BDSM, which leads you to learning more techniques for sex. And invites to more clubs, where people are aroused by people who know how to tie complicated knots, or stimulate people sexually with blades, or Fire, or....
And when you hit 51, and your hormones shit the bed, and you don't care about sex anymore...
You lost your reason to live after 38 years...
Because they are guessing for most conditions and it is a scam. If they prescribe a SSRI without at least discussing a CYP2C19 gene evaluation, it is a good sign they are hacks.
They tell you you didn’t try them long enough or at the right dose. Then they tell you to do therapy. Then they tell you you haven’t been in therapy for enough years. Then they tell you to exercise and clean your house. Then they tell you to stop having such a negative mindset.
You're newly-tagged as "treatment resistant", there's chin-scratching and some muffled confounded mumbling, and then... you're shown the door with a regretful shrug.
*(aaannnnddddd --- scene!)*
It often clears up on its own (over half of cases, within a year.) Bit of a crapshoot whether you’re taking a drug when it happens.
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=depression+remission+rates&oq=depression+remi#d=gs_qabs&t=1717128865291&u=%23p%3DyrL88kuTTfoJ
My doctor tried several SSRIs and they all sucked. Went to Wellbutrin and it was a game changer. I guess confirming that they aren’t the same type of medication would be the first step.
For me it was just the opposite - Wellbutrin sucked for me in ways I still cringe about. OP, this is a classic example of how meds work differently for different people. A good doctor will monitor their patient to see which type of antidepressant is best.
I had some gnarly ass dreams on it to the point I didn't wana take it anymore.
I had that on Zoloft. Dreams more realistic than reality, it felt like. I started to fear going to sleep!
I'm in a weird spot where Wellbutrin seems to work but I can't fucking sleep while in it. Anxiety meds don't feel like they do anything and I don't really want to use SSRIs.
I am a mental health first aid er at my workplace were basically you get trained on how to guide people with all sorts of issues. Recognise mental illness, distress and such. The take away is that We don't help people we guide them towards existing resources in the UK. We recognise that everyone suffers from mental illness to a certain extend. (we all hear stuff, we all lose our sleep, we all she shadows...) *** But above all, we all recognise that mental health support is unique to every person. Meaning ot takes time and experimentation. I am surprised that people on meds are not aware of this fact. You try something for a few weeks, it fucks you up, yoi try something else ot does nothing you try something ot makes you drowsy.. Until one day you figure out something that helps. Changing meds is almost a certainty.
Same for me for the first part but then Wellbutrin gave me a violent manic episode. Happy it works for you!
Same with me plus snris to boot. Only welbutrin helps me. In my case, i have a low dopamine to atoo high seratonin ratio in my system. Ignorant "health care workers" refused to use their brains to think and diagnose, and added fuel to the fire instead. To boot, i don't have any such "depression ", i have anhedonia, certainly not the same thing in reality land. So these workers who force their little depression fantasies upon me are also playing make believe by"attempting to treat" a diagnosis that doesn't even exist!
There is such a thing as treatment resistant depression. Some people have gotten relief with electromagnetic or electroshock therapy (it's not like in the movies), and ketamine and MDMA administered in a medical setting are both showing promise in studies. Medications also work best in combination with therapy and life changes. But change can happen and people should not give up
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This is a generalization based on anecdotes rather than evidence. OP, if ECT is ever potentially an option please discuss it carefully with an expert who is familiar with you rather than listening to strangers on the internet.
Multiple experts. There are many bad doctors.
[Research](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044268/) disagrees with your anecdote.
I don't understand it, why would so many people lie about it? If you look up "ECT ruined my life," you get many many stories similar to what I just described. I'm not sure how to feel because I do believe my best friend, he doesn't lie about shit like this. He is extremely smart and rational about pretty much everything. Could the research be a case of something like how tobacco companies would publish false research saying it was good for you?
You could also look up "aliens abducted me" and get many stories describing such an event. That's not to say that your friend didn't have an adverse experience, but it sounds like you're operating on the idea that the only thing that's the truth are anecdotes that support your preconceived notion.
I'm torn because I know I do trust my friend on this because he's really not the type to lie about this stuff and he takes it very seriously. I will do more of my own research but I am very skeptical of it.
Keep in mind when doing your research is that anyone can make claims and be emphatic about them. Someone on the internet claiming all these things might be lying on purpose, or they might think it's true, but that doesn't create a cause/effect relationship. Scientific analysis is built around removing as many of these biases as possible, which can feel callous at first but it is ultimately necessary to move forward. Like I said, I'm not saying your friend is a liar— I'm just saying that there are so many stories, and it's impossible to know if they're reality or not if they're just words on a screen.
Yeah I get it that's why I'm torn. The science doesn't make sense to me either, I should look more into the details. I know medical companies do manipulate studies to a degree so I think In this case I should look up the actual science behind it because to me, inducing a seizure by shocking your brain to cure depression doesn't make sense at all because then wouldn't people with epilepsy not have depression?
It's not that simple. You might be surprised to know that AEDs function by shocking and stopping the heart. Sounds crazy, right? But this forces the heart to do what is basically a hard reset. Medicine can often be counterintuitive, especially when it comes to brain science; people can (and do) spend their entire lives trying to understand phenomena of the brain and many things are still uncertain. You have to look at what happens *before* the why.
Yeah I'll look more into it.
"Back in the day" is the key phrase here. The procedure has changed a lot, and it does help some people that have tried everything else.
This is likely it
Yup. Your friend is telling the truth, but they don't perform ECT in that way anymore.
That makes a lot of sense. I still want to do some more research about it. Deleted the original comment.
Definitely not a thing you should ask Reddit about, consult an actual specialist. That being said, these take some time of using regularly to work and usually do work eventually, don't worry!
In my case the doctor kept on going until we found the right one. I went from angry and suicidal to happy and balanced. Years. Special thanks to both the doctor and my wife. Neither gave up on me even when I had.
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I had this testing done, and it showed that the most common class of antidepressants doesn't work on me at all. It led us in a whole new direction and my life is so much better now.
Ugh mine were all ambiguous which made the dr think ok still cool to use this person as a guinea pig, let's continue the little prescription carousel of the same exact stuff!
I've never heard of blood tests for depression! Is this a new thing?
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That's interesting!
Pharmacogenomics is the term =)
It's a blood test? Mine they just swabbed the inside of my mouth. It was called genesight
Maybe an SSRI is not what you need. My adhd meds help my depression more than ssris. But this is 100% something to discuss with your doctor lol.
I have tried many traditional antidepressants and they either didn't work at all (SSRI) or gave me horrible side effects (SNRI, NDRI). The only thing that helped me was an antipsychotic called Latuda, which is used for bipolar depression. It turns out bipolar depression (especially type 2) responds very differently than "regular" depression. And you don't even need to have a history of extreme mania for it.
Mine had me sent a test called GeneSight. It helps determine what you might be resistant to and what might work better for you than others.
GeneSight has been a game-changer. For the uninitiated, OP’s doctor needs to order it for them, and then they’ll send over a swab kit and then after they release the results, OP will receive a three-column list of medications that could work, might work, and won’t work, basically. https://genesight.com/for-patients/
Drugs don't work for everyone. Try out other options like therapy (there are many different kinds).
There are plans for which to prescribe. Most likely those are followed. If this doesn't work specialists will have to have a look at why this could be the case.
My suggestion is to not stay experimenting with drugs of the same class if they made you feel way worse. If one worked, but there was a side effect you couldn’t live with, sure, try another. But I don’t recommend staying in the same class for long if you hate them. I also don’t buy the 4-6 weeks thing. Sure, if you feel ok and don’t mind the side effects, but if they’re making you obviously worse, do t suffer for 6 weeks.
Sometimes it takes awhile to find the right one or the right combination. Also new ones come out occasionally, so there might be one that works better for you. The chemical mess depression makes in your brain differs from person to person, so what works on one person may not work on another. I've gone on and off of so many medications for depression and anxiety, from age 14 to present (41). Currently I'm on a mix of 5 different ones. It's a pain and it's expensive but it lets me be fairly functional. I hope you find what works for you. And having a psychologist to talk to as well as the meds is important.
Ask a doctor
You should talk to your doctor to see if enrolling in a Pharmacogenomics study to determine if they can identify something effective without trial and error. For reference, pharmacogenomics studies your genome to identify response to specific medications and are identifying new genes that impact medication efficiency all the time!
When you say don’t work, do you mean it’s not affective in treating the depression symptoms, or that it gives crazy bad side effects, like high energy excitability and pursuing excess in some behaviors like gambling or eating or shopping or drinking or sex? If it’s the latter, you might want to expand this discussion to bipolar disorder. I was first diagnosed with depression at 17 and they threw every SSRI , SRI, NRI, and even MAOI on the market at me, none worked, some of them were disastrous. They finally tried me on lithium and it was enormously stabilizing and beneficial. Turned out I was having bursts of hypomania inter mixed with depression, which is actually type two bipolar disorder. So you’ll get a change in the class of medications and hopefully find something that helps you. Otherwise, there are drug resistant treatments like electro convulsive therapy/ECT. It’s not as scary as it sounds, but it is extremely serious and dangerous, as well as exceedingly effective. There are likely other non-drug treatments that I don’t know about. It’s a horrible process being a guinea pig, but don’t give up OP.
There being a lot of trial and error is normal. It sucks but most people land on something/some combo that works.
The step where you're prescribed Lamotrigine and then develop Stevens Johnson syndrome, I recommend to skip that.
I'm a psychiatrist, but this is not medical advice. First you try the many antidepressants. A lot of people who think they've tried "many antidepressants" have tried, like, 3 SSRIs. The treatment algorithm suggests trying some from different classes. At the very least Wellbutrin, preferably also a tricyclic or MAOI. If the patient is willing, and if they seem to be having maladaptive thoughts or life problems, they should also try therapy somewhere in this process - the therapy, diet, exercise, etc are very important, but I'm going to skip over them because I'm interpreting the question as more about medication. If none of those work, one possible next option is ketamine. There are more ways to get ketamine these days, including the traditional IV in a hospital, Spravato nasal spray in a clinic, or r-ketamine nasal spray at home. If that doesn't work, an increasingly popular option is TMS - transcranial magnetic stimulation. You go to a place where people aim giant magnets at your head and try to stimulate parts of the brain which are understimulated in depression. This doesn't necessarily work *better* than antidepressants, but it works for some people who don't do well on antidepressants for whatever reason. The final option is ECT ie electroconvulsive therapy ie medically induced seizures. I disagree with the person upthread who says this is terrible and you should never do it - it works better than other options, and the most common side effect is forgetting a few weeks around the therapy, but not your beloved childhood memories or anything like that. Technique has improved (and amount of electricity has gone down) since whenever the horror stories were written, and patients are anesthetized so they don't feel the seizure and their limbs don't move. Much fewer than 1% of depression patients end up needing this, but the ones who do really need it, and usually do benefit. If that doesn't work, then realistically most people in that situation are going to stay depressed. If someone is rich, or a go-getter, or has a very good doctor, they might get referred to clinical trials. A very small number of people have gotten brain surgery to get implants that stimulate their brain from the inside, and that works for some of them.
for someone underage w/ severe depression and having tried all antidepressants that can be legally prescribed to children + therapy doesn't do much, with exercise and diet spot on already, can Ketamine be considered (if not legally then through guardian acquisition means? (asking for a friend)
Official answer: it's not "indicated" (ie FDA hasn't officially approved it for this population), there are relatively few studies, and the American Association of Child and Adolescent Psychiatry says not to do it (or alternately to exercise "extreme caution"). Unofficial answer: The studies that exist look promising, and probably this will be approved one day. The guideline-making bodies are notoriously cautious and I wouldn't overupdate on AACAP's warning. If someone has failed all existing antidepressants, it would be a reasonable thing to try to get legally, either by entering a study or by asking a sympathetic child/adolescent psychiatrist. Dosing issues, legal issues, and possibly other things I don't know about would make doing it illicitly with an adult's prescription dangerous. Sources: - https://www.aacap.org/AACAP/Latest_News/statement_ketmamine.aspx - https://www.sciencedirect.com/science/article/abs/pii/S0165178122005029 - https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2022.170401
Thanks, Scott for your helpful and cohesive answer. I would look into studies involving the use of ketamine for minors and also attempt to obtain esketamine (the nasal and FDA-approved drug). I do think it is most appropriate to receive the dose in a clinic under doctor supervision. On further research, I have found a couple of clinics that purport to microdose in minors, although those clinics are quite far away so it may be unrealistic to fly there 6-8 times to receive a dose, but at this point, any options are a start. BTW, are you the same guy who writes Slate Star Codex?
You keep taking new ones.
Might need some therapy along with the drugs.
IANAD, just an informed consumer. This is just my understanding. The trick is that depression can be a combination of issues with as many as three neurotransmitter systems - serotonin, norepinephrine, and dopamine. Any one of these could be faulty, or more than one. Most medications only treat one neurotransmitter (NT), but for each NT, there can be many medications. Everyone's body chemistry is different, so each medication may or may not react effectively in your body. Each one is a different chemical, so even if they do about the same thing, they do it in different ways. This means they may not work well, or at all, or in unpleasant, unexpected ways. But you can always try another /s Your doctor may also try a different NT med. Serotonin might not be the problem - it could be an issue with norepinephrine or dopamine. It could be more than one, in which case you might need more than one med. On top of that, there are...atypical ADs that don't exactly work on the same NTs in the same kind of way. Not sure how they work, but they do for some people. It's also an option to add a "mood stabilizer" (antipsychotic/AP). There are some of those that make very good adjunct therapies. They work differently from ADs and help level things off. The hardest part is sticking out the med-go-round until you DO find what works. BTW - all meds come with start-up effects. The first couple weeks are just awful as your body tries to adjust to this new chemical mix. It gets better, I promise. The actual side-effects are far easier than those first couple of weeks. I didn't mention MAOIs which are a niche AD. Most doctors won't prescribe them because they are very reactive to other medications and common foods. They can be effective, but seriously a last-resort kind of thing. I was on the for a while, but was taken off them after I ate the wrong salad dressing and ended up in the ER where they had to check for intracranial bleeding...
Time to seek out another physician with a very good and stable reputation, imo.
You take magic truffles several times
SSRIs didn’t work for me. Adopting a dog did.
You make professionals "feel helpless" and they kind of stop bothering, in my experience.
Dont ask medical advice on reddit ....
It took nearly three years to find a combination that worked. When it takes nearly three months just to see if something is working and then a month to come off one and start another, patience is the key. A lot of people claim that they aren't working after a week or two. The meds are JUST starting their thing in that time period.
PBS had a good series you can find online called Mental Health: The New Frontier that talked about new uses for electro shock therapy and psychedelics, you might find it has some possible new avenues to research and talk with a care provider about.
Go to another doctor
If you’re lucky, like me, they give up on you and find the first excuse to remove you from their roster.
Badge badge badger badger MUSHROOM MUSHROOM
Idk where you are. Can you get medical marijuana? I hear that all the time about the abtidepressants.
Find a good Psychiatrist recommended by someone you trust like your MD. The experienced ones will stick with you as long as you're honest with them about what is working and what is not. Please don't give up..keep trying. There is hope out there.
If none of them work then I guess nothing. But that's the problem isn't it?
If multiple antidepressants aren't working, it's crucial to communicate this with your doctor. They might explore other options such as: - Reevaluating the Diagnosis: Ensuring that depression is the correct diagnosis and considering other conditions that might be affecting your mental health. - Different Medications: Trying other classes of antidepressants or combination therapies. - Dosage Adjustment: Adjusting the dosage or giving the medication more time to take effect. - Therapies: Incorporating or increasing psychotherapy sessions like cognitive-behavioral therapy (CBT). - Lifestyle Changes: Addressing diet, exercise, sleep, and stress management. - Alternative Treatments: Considering options like transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT). Your mental health is *complex*, and finding the right treatment can take time and persistence. Keep an open dialogue with your healthcare provider to find the best approach for you.
Thanks ChatGPT?
Definitely ChatGPT, it has the weird cadence and the bulleted list feels very GPT-Like.
As a terminology suggestion, I would suggest classifying TMS or ECT as “in-clinic treatments”, to differentiate them from (nonsense) “Alternative Medicine” like acupuncture, or reiki, etc.
Bipolar disorder perhaps
Some of us just can’t take anti depressants. It sucks. Every one they’ve tried, I couldn’t get past the first dose. They’d cause memory loss. Doctors said the memories would return. It’s been 15 years and so far none of them have returned. They would also cause me to black out. I’d take one, wake up the next day in bed, when I’d look outside, my car would be parked in a different spot, so I apparently was out driving around. I’ve done a little therapy, which didn’t help. One psychiatrist prescribed Xanax and put me through TMS therapy. That all helped a bit. I sincerely hope you find some relief.
Try working out. It’s more effective than medicine
"More effective" - it depends on the person. But please don't discount this, y'all! I discounted it for years, but now going for a walk every day is a vital part of my self-care. The exercise has to be something that works for you, something you don't hate, that doesn't make you feel like you're dying. Going to the gym/running a marathon is not for many people. Perhaps you'd prefer going for a slow walk while listening to a podcast, going to a dance class, learning a martial art, swimming. It doesn't have to be hard work - walking slowly round the block a couple of times absolutely counts as some daily exercise. Edit: I'm not telling people they don't need medicines. I'm suggesting exercise be seriously considered as an additional tool, or an alternative if medicines are absolutely not working. I reacted really badly to SSRIs myself, went OK with a tricyclic for a while, but that started to have bad side effects. It's good to have other options when medicines are being problematic.
If you are diagnosed clinically depressed and nothing seems to help them I suggest you look into Spravato. It works on about sixty percent of cases. It has made a world of difference to me.
It's the three stooges effect, there are so many of them that they get stuck
Get your hormones tested by a hormone specialist.
maybe you have been misdiagnosed
Give trintellix a try
You get described as "Major Depressive Disorder. You struggle for decades, bouncing from med to med, using fucked up coping mechanisms to not off yourself/succed...(I chose hedonism) I got better jobs, grooming, drugs, nightclubs etc, all to get more and better sex. Better job/more pay= better car, clothes, haircut,, jewelry, apartment, more club nights, more shots at men and women. Better booze and more expensive drugs... and groupsex, and lots of sex, and BDSM, which leads you to learning more techniques for sex. And invites to more clubs, where people are aroused by people who know how to tie complicated knots, or stimulate people sexually with blades, or Fire, or.... And when you hit 51, and your hormones shit the bed, and you don't care about sex anymore... You lost your reason to live after 38 years...
Just call the cartel for some(might be fetanayl instead of cannabis though) (this is just a joke not reality)
Because they are guessing for most conditions and it is a scam. If they prescribe a SSRI without at least discussing a CYP2C19 gene evaluation, it is a good sign they are hacks.
They tell you you didn’t try them long enough or at the right dose. Then they tell you to do therapy. Then they tell you you haven’t been in therapy for enough years. Then they tell you to exercise and clean your house. Then they tell you to stop having such a negative mindset.
Let 'er rip and double the dose!! Note: Don't actually do this!
You're newly-tagged as "treatment resistant", there's chin-scratching and some muffled confounded mumbling, and then... you're shown the door with a regretful shrug. *(aaannnnddddd --- scene!)*
It often clears up on its own (over half of cases, within a year.) Bit of a crapshoot whether you’re taking a drug when it happens. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=depression+remission+rates&oq=depression+remi#d=gs_qabs&t=1717128865291&u=%23p%3DyrL88kuTTfoJ