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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How Should Chronic Depression Be Treated?

I need help with treating my Major Depression. I am unable to function and cannot hold a job. I have tried Antidepressants in the following order: Zoloft, Celexa, Lexapro, Prozac, Luvox, Pristiq, Viibryd, Effexor, and Paxil. I am currently taking 20mg Cymbalta daily. I would like to go up on this medication please.
Tue, 13 Jan 2015
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Psychiatrist,  's  Response
Hello thanks for asking from Health Care Magic

You are suffering from Major depression and have tried many antidepressants like sertraline (zoloft), celexa (citalopram), lexapro (escitalopram), prozac (fluoxetine), luvox (fluvoxamine), pristiq (desvenlafaxine), vibryd (vilazodone), effexor (venlafaxine) and paxil (paroxetine). You are currently on cymbalta (duloxetine) and still your depression is not under control.

You have been on almost all SSRIs and SNRI group of antidepressants and no drug resulted in relief. It could be due to resistant depression. Some times associated hypothyroidism or low vitamin B12 levels didn't allow medicines to show full effects. Get your thyroid status checked to rule out the condition.

Resistant depression responds to augmentation of other drugs along with conventional anti-depressants like lithium carbonate, lamotrigine, thyroid hormone etc. These drugs augment the effects of antidepressants.

In severe recurrent resistant depression ECT also prove useful. I would advise you to consult your psychiatrist for these treatment options.

Thanks, hope this helps you.
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Psychiatrist,  Dr. Seikhoo Bishnoi's  Response
Hello thanks for asking from HCM

You have major depression and this has resulted in loss of job and inability to function normally. You have already taken Sertraline, Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Venlafaxine, Paroxetine and a number of other drugs. These medicines probably didn't work and now you are on Duloxetine 20 mg. The drug is an SNRI drug and as per my opinion the doses should be increased more to get full effect. The drug usually start showing effects in 40-60 mg doses. If one antidepressant fails to act then supplementation with some other drug can be done. The drugs like Lithium, Lamotrigine etc can help to augment antidepressants in resistant depression. Visit a psychiatrist for proper prescription.

Thanks, hope this helps you.
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How Should Chronic Depression Be Treated?

Hello thanks for asking from Health Care Magic You are suffering from Major depression and have tried many antidepressants like sertraline (zoloft), celexa (citalopram), lexapro (escitalopram), prozac (fluoxetine), luvox (fluvoxamine), pristiq (desvenlafaxine), vibryd (vilazodone), effexor (venlafaxine) and paxil (paroxetine). You are currently on cymbalta (duloxetine) and still your depression is not under control. You have been on almost all SSRIs and SNRI group of antidepressants and no drug resulted in relief. It could be due to resistant depression. Some times associated hypothyroidism or low vitamin B12 levels didn t allow medicines to show full effects. Get your thyroid status checked to rule out the condition. Resistant depression responds to augmentation of other drugs along with conventional anti-depressants like lithium carbonate, lamotrigine, thyroid hormone etc. These drugs augment the effects of antidepressants. In severe recurrent resistant depression ECT also prove useful. I would advise you to consult your psychiatrist for these treatment options. Thanks, hope this helps you.