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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Depression And Suicidal Toughts

I have been on many SSRI s over the past 26 yrs. I seem to develop a resistance to them after varying lengths of time. When this has happened, my psychiatrist switches me to another drug or adds a drug. While on medication last year I had a depressive episode, possibly triggered by my son & his family moving overseas. I was given Fetzima in addition to buproprion, which I have been on constantly for many years. I have never felt completely better since this episode. This weekend it reach crisis stage, inability to get out of bed, constant crying and for the first time, suicide ideation. Then I began reading about tardive dysphoria which made me feel even more hopeless. It seems with medication I will continue to get worse but without medication, I will surely get worse. Is it hopeless?
Mon, 3 Nov 2014
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Psychiatrist,  's  Response
Hi, thanks for the query. Its very sad to know that you are still not able to recover despite treatment for depression. In a sizable number of patients (almost 33%) trials with many drugs or simply drugs alone dont seem to work. In your case you seem to have received trials of SSRI & 1 trial of SNRI (Fetzima/levomilnacipran) (I am assuming that you received adequate doses of each drug for minimum 6-8 weeks & still inadequate symptom relief). Hence, depending on your clinical profile drugs like amytryptyline, nortryptyline, prothiaden, agomelatine (novel drug with unique mechanism of action) can be tried or agumentation of your current drug regimen with low dose atypical antipsychotic agents like quetiapine, aripirazole, amisulpride, olanzapine, risperidone or a trial of drugs like pregabalin, modafinil (to help you with fatigue related symptoms) thyroid hormone (T3/T4), lithium etc. in addition to your current antidepressant regimen can also be a good alternative. Lastly doing daily physical exercise, yoga-pranayama, regular sleeping patterns, avoiding excessive alcohol, caffeine, other substance of abuse (cannabis, heroin etc.) and taking help of psychotherapy/counselling techniques from a psychologist like cognitive behavior therapy (CBT), mindfulness based relaxation/therapies can also help you out. Dont loose hope. Be patient, this cloud of depression shall definitely subside
Hope this helps Good Luck
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Suggest Treatment For Depression And Suicidal Toughts

Hi, thanks for the query. Its very sad to know that you are still not able to recover despite treatment for depression. In a sizable number of patients (almost 33%) trials with many drugs or simply drugs alone dont seem to work. In your case you seem to have received trials of SSRI & 1 trial of SNRI (Fetzima/levomilnacipran) (I am assuming that you received adequate doses of each drug for minimum 6-8 weeks & still inadequate symptom relief). Hence, depending on your clinical profile drugs like amytryptyline, nortryptyline, prothiaden, agomelatine (novel drug with unique mechanism of action) can be tried or agumentation of your current drug regimen with low dose atypical antipsychotic agents like quetiapine, aripirazole, amisulpride, olanzapine, risperidone or a trial of drugs like pregabalin, modafinil (to help you with fatigue related symptoms) thyroid hormone (T3/T4), lithium etc. in addition to your current antidepressant regimen can also be a good alternative. Lastly doing daily physical exercise, yoga-pranayama, regular sleeping patterns, avoiding excessive alcohol, caffeine, other substance of abuse (cannabis, heroin etc.) and taking help of psychotherapy/counselling techniques from a psychologist like cognitive behavior therapy (CBT), mindfulness based relaxation/therapies can also help you out. Dont loose hope. Be patient, this cloud of depression shall definitely subside Hope this helps Good Luck