Brief Answer: Severe Depression Detailed Answer: Hello. Welcome to Healthcare Magic. Well it seems like your depression is not responding to use of anti depressants alone and therefore as you rightly pointed out you need to augment the anti depressant. I reckon that you try a combination where there will be one chief anti depressant and the other drug will augment the former. I am listing below some very effective drug combinations which i have found of good use in my patients who had similar treatment resistant depression. 1) Lexapro ( escitalopram) at dose of 10-20 mg / day OR celexa at dose of 10-40 mg / day + Buspar ( buspirone) at dose of 10 mg bid or tid. 2) Lexapro at dose of 10-20 mg or celexa at dose of 10-40 mg / day + lamictal ( lamotrigine) at dose of 50-150 mg / day. 3) Lexapro or celexa at above doses + modafinil / provigil ( stimulant drug ) at dose of 100-200 mg / day. 4) Remeron ( mirtazapine ) at dose of 15-45 mg / day + effexor xr at dose of 37.5-75 mg / day. This combination is called as California Rocket fuel and has bee very effective against drug resistant depression. So you may discuss these drug combinations with your treating doctor and try to get one of them prescribed and you shall be able to appreciate the affects of the chosen drug regime within 2-4 weeks, although for full remission you may have to take the drug regime for at least 4-6 months. I hope this answers your query. If there is any follow up query that you need to ask then you may do so, i will be happy to answer it. If there is no further query/ follow up question that you need to ask then kindly rate the answer and close this conversation. Warm Regards

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Brief Answer: Follow up Detailed Answer: Thanks for the inputs. Well you see the problem is that stimulant drugs have high potential for abuse and dependence which makes almost all doctors wary of prescribing them in a very first meeting. So it is quite understandable that your doctor had become suspicious of your intentions when you asked for a stimulant as an augmenting agent. So my humble advice to you is that you shall allow the doctor to develop trust in you as a patient first so that you can later request for the prescription of a stimulant so in my opinion as of now you shall refrain yourself from asking her for prescription of stimulant drug as this will worsen the rapport between you and her and raise further doubts in her mind about you being a drug abuser. Kindly please introspect about this point with a tranquil mind and you shall see reason in this. So as of now you need not demand any sort of drug addition as this may not be well received by the doctor and make her more stubborn but instead place your request to her by saying that 'doctor, despite taking the anti depressant the depressive feelings are becoming worse, so while i trust your judgment completely and will do what you tell me to do but what is your opinion about adding an augmenting agent such as lamictal or buspar as i have read that these can act as good augmenting agents to the chief anti depressant in cases of severe depression where the single anti depressant is not effective in controlling the symptoms'. Say this in as many words and pattern and seek her response on this. This sort of subtle approach shall not only evoke a response from her on this topic of adding an augmenting agent but it shall also make her realize that your condition is not going to get better with the use of 1 anti depressant. You should not try to approach with an intention to influence her prescription but just let her have the freedom to prescribe with her own mind although by mentioning to her some options as above and giving her the right to make the last call, all of this shall improve your therapeutic alliance/ rapport with her thereby making her trust you more. In the next meeting you shall only mention the above drug and no stimulants since this will reflect negatively on you. Even if she is amenable in prescribing any one of the above drugs you shall feel happy about your chances of improvement since they are all good augmenting agents. You can talk about the stimulants at a later time that too if the need arises because at the moment you are walking on egg shells with this doctor and it will be prudent to stay in her good books and win her trust and not challenge her decision. I hope this makes sense. Hope this answers your query. If there is no further query then kindly rate the answer and close this conversation. Take care. God bless. Regards

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Brief Answer: Follow up Detailed Answer: Please do not panic, it is not as bad as you are thinking it has turned out to be. Your discussion with her in reference to another psychiatrist suggesting the benefit a stimulant can have on you is unlikely to get misconstrued by her and to be considered as if you were trying to seek a prescription. To me being a psychiatrist myself it does not look that way and is unlikely that she will have that impression on her, so relax. But as i said earlier try not to suggest anything to her directly and for a few meetings just try to show faith in her and win her trust as only then she will lower her guard and let you speak your mind out about the drug choices that can help you. However i myself believe that any doctor including her should be open minded and flexible and should consider hearing the patient's suggestions patiently and try to incorporate a drug within the regime if there is valid reason attached to it. I hope this makes it clear to you how you shall approach your doctor. Wish you all the best. I hope this answers your question. If there is no further clarification needed then kindly close the discussion and rate the answer. Regards

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