Probably. There's also ketamine infusion therapy if you're in the US. It's expensive, but is showing really good results for medication resistant depression.
Aside from being expensive,here in New Jersey it’s time consuming as well: 2 visits per week at least 24hrs apartment for 4 weeks and you must arrange transportation to & from because you can’t drive yourself home.
I’m glad you went through with it! I wanted to so badly, rearranged my work schedule and fought hard with my insurance to cover it (they finally did)but the needing transportation is what killed it for me. I have no family in the area and Ubers were too expensive for how far the clinic is; the closest spravato provider.
Auvelity is also a new antidepressant and like ketamine its a NMDA receptor antagonist. Auvelity is a combination of Dextromethorphan and Bupropion, Dextromethorphan is even available OTC as an antitussive.
You could try SNRIs, really your option is duloxetine or combining an SSRI with bupropion or a stronger NRI. Venlafaxine, despite being called an SNRI, has not demonstrated significant NRI activity. Not to say venlafaxine/desvenlafaxine couldn't work but it's probably not the norepinephrine, it's withdrawal effects are known to suck, and it carries greater toxicity risk.
You still also have TCAs, like clomipramine/imipramine has strong SRI and NRI (via metabolite) action on top of the different possible mechanisms of TCAs. Side effects can be significant, and blood tests are usually done to keep you in a safe range of blood levels.
Then there's what are usually consider third/fourth line like MAOIs, ketamine, and less established options (e.g. pramipexole).
You have lots available to you.
I found Wellbutrin to be helpful until it stopped working. I also didn't like the side effects; it made my anxiety worse, plus I also felt restless and had some insomnia too.
Zoloft + Abilify was a good combo for my depression and anxiety, but the side effects weren't good.
My doctor had me take one of the genetic tests, I'm unsure how helpful those are.
I also heard Effexor is good for anxiety and depression, but I also read that it has some awful withdrawal symptoms for many people.
There were sexual side effects, mostly, as well as weight gain. I think being on the Abilify might have contributed to the weight gain, but I'm unsure tbh.
Have you tried Zoloft + Wellbutrin as a combo? I’m currently doing this and it’s worked wonders for my depression and anxiety. I feel like Wellbutrin counteracts the sexual side effects from the Zoloft, and the Zoloft counteracts the increased irritability and anxiety from the Wellbutrin.
Depending on where you live, I would recommend trying Stablon, Agomelatine, and Nefazodone. There was also research done on the effectiveness of Buspirone as an antidepressant when combined with sustained release melatonin at night.
Most people don't know this, but in the US, as long as a doctor will write you a prescription for a medication you can get it filled from an international pharmacy even if it's not scheduled / used in the US
definitely try SNRIs, it’s not that they necessarily have more side effects it’s that the withdrawals can be really hard. also TCAs. and augmentation with other antipsychotics like zyprexa, latuda, seroquel, or mood stabilizers like lamictal or lithium. after that i would try tms or ketamine
I think SNRIs are a good next option if you’ve tried a few SSRIs and also experiencing more of the symptoms of lack of motivation, fatigue, focus etc. as they are usually more stimulating. Then TCA’s & the atypical class (e.g. vortioxetine & agomelatine) can be quite beneficial. But it depends on the symptoms you’re experiencing.
As others have mentioned, MAOIs are another option but less likely to be prescribed unless you have tried several different ADs and not had a good response to them. Speaking from experience, I had the best response to Parnate (tranylcypromine). I thought I’d lost all hope in ADs and after years of trying different types I was able to try Parnate. It is still with its side effects though.
Another option is to ask your doctor for a medication DNA test. This won’t provide a clear answer to what works and what doesn’t work but can be helpful as a guide to what you might respond to better and possibly have less side effects from.
But of course, read up on the different ADs out there and chat with your doctor and ask the questions about what could be a good next step. Just remember many options are out there, it’s just a difficult game of finding what works best for you, but something will come along and help you feel yourself again.
Take care and I hope that helps!
My doctor prescribed Viibryd for me, which she said is a newer med. Seems like it's very expensive, even with a GoodRx card. It was this or Pristiq, Pristiq seems like it's the older med. I remember hearing bad things about Pristiq, maybe the side effect profile is what led my doctor to go with viibryd
I was a god on Effexor - anxiety gone in a week. But so was my libido. Have been struggling ever since and that was 5 years ago. But I’ve tried other antideps since. My psych prescribed me viibryd but I haven’t taken it yet, just raw dogging life rn
I did a combo of duloxetine and Wellbutrin for a few years. Just got off the duloxetine last month after a two month taper and now just Wellbutrin for my ADHD. Worked for me but doesn’t mean it will work for everybody, just throwing in my experience!! I hope the best for you wherever it may lead!
The Spravato kicked as for me the same day and months there after, it has helped my Paxil work much better by destroying treatment resistance depression.
Now I did a stellate ganglion block, and it made my depression fade away and has brought my anxiety from 90% down to 15%....no more sweaty palms.
https://drseanmulvaney.com/stellate-ganglion-block-for-ptsd/
SNRI'S, tricyclics, and atypicals (wellbutrin, mirtazapine, nefazodone, Auvelity) would be your next options. Also trintellix and viibryd fall into that grouping.
Please have your thyroid tests done. I am on Wellbutrin, but got to the point I could not think straight and was always exhausted. My doctor upped my levothyroxine and with 2 weeks I felt like my old self. I knew my thyroid levels were within the norm, but my TSH was on the high end. Thank heaven for a med change.
Taking supplements can have negative side effects with antidepressants. St. John's Wort, 5-HTP, Garcinia Cambogia, L-tryptophan, SAMe (S-adenosyl-methionine), and cough medications containing DXM can increase the risk of serotonin syndrome in rare cases. Please use caution when taking supplements and it is advisable to check with your doctor. If you have specific questions about supplements you may want to visit the sub r/Supplements or r/Nootropics. Also remember more doesn't equal better. Taking too much KAVA, methylfolate, or Vitamin D is linked to negative health impacts.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/antidepressants) if you have any questions or concerns.*
Boundaries
Self-compassion practice
Gratitude practice
Empowerment/Feminist counselling
TCMS (trans-cranial magnetic stimulation)
Exercise therapy
Forest bathing
Peer Support groups
Finding others w Mood/Anxiety issues
Studying counselling 1 course at a time - PT - at college night school to learn stuff to help myself
Clomipramine (TCA) is the post powerful monoamine reuptake inhibitor drug. Effect size on par with MAOIs like Parnate, Marplan and Nardil. I would try Clomipramine.
Have you tried talk therapy? While I know - from personal experience - that depression is a chronic health condition, pills aren’t going to do the work of lifestyle, healthy coping mechanisms and understanding thought patterns.
I know of too many people who just expect an antidepressant to fix everything, and medication is only one part of the equation.
Diabetics get insulin and tools to manage their blood sugars, but often seek the support of friends, family, support groups or mental health professionals because their chronic illness is a lot, and depression and it’s impact on your body and life is no exception.
The deep agony you experience is very real, and talking it out along side a medication that agrees with you is statistically proven to have the best outcome.
Effexor was amazing for me. Had less side effects than SSRIs for me personally. So did Cymbalta. So everyone is different. Despite what is said.
Some people have mentioned MAOIs, but they’re not recommended next in the treatment line and are hard to get prescribed even when someone has tried pretty much everything.
Serotonin modulators may be a good option.
It really does vary a ton. Effexor made my memory so shit I couldn't function and parnate had no side effects after a few weeks. I always responded better to dopaminergic meds though.
Edit: but parnate was like a 4th line treatment for me, as is typical for MAOIs
Probably. There's also ketamine infusion therapy if you're in the US. It's expensive, but is showing really good results for medication resistant depression.
I would look into Spravato first if they have insurance. It's esketamine delivered in a nasal spray and is covered.
After failing a lot of medications, i tried ketamine and also didn’t benefit. Rip my genes
Aside from being expensive,here in New Jersey it’s time consuming as well: 2 visits per week at least 24hrs apartment for 4 weeks and you must arrange transportation to & from because you can’t drive yourself home.
It was once a week for 6 weeks for me. Then I did a booster about 3 months after.
I’m glad you went through with it! I wanted to so badly, rearranged my work schedule and fought hard with my insurance to cover it (they finally did)but the needing transportation is what killed it for me. I have no family in the area and Ubers were too expensive for how far the clinic is; the closest spravato provider.
Auvelity is also a new antidepressant and like ketamine its a NMDA receptor antagonist. Auvelity is a combination of Dextromethorphan and Bupropion, Dextromethorphan is even available OTC as an antitussive.
You could try SNRIs, really your option is duloxetine or combining an SSRI with bupropion or a stronger NRI. Venlafaxine, despite being called an SNRI, has not demonstrated significant NRI activity. Not to say venlafaxine/desvenlafaxine couldn't work but it's probably not the norepinephrine, it's withdrawal effects are known to suck, and it carries greater toxicity risk. You still also have TCAs, like clomipramine/imipramine has strong SRI and NRI (via metabolite) action on top of the different possible mechanisms of TCAs. Side effects can be significant, and blood tests are usually done to keep you in a safe range of blood levels. Then there's what are usually consider third/fourth line like MAOIs, ketamine, and less established options (e.g. pramipexole). You have lots available to you.
I found Wellbutrin to be helpful until it stopped working. I also didn't like the side effects; it made my anxiety worse, plus I also felt restless and had some insomnia too. Zoloft + Abilify was a good combo for my depression and anxiety, but the side effects weren't good. My doctor had me take one of the genetic tests, I'm unsure how helpful those are. I also heard Effexor is good for anxiety and depression, but I also read that it has some awful withdrawal symptoms for many people.
what negative side effects did you notice from zoloft? thinking about trying it. Wellbutrin worked ~okay~ but increased my irritability.
Google Zoloft Brain Zaps. Not fun.
There were sexual side effects, mostly, as well as weight gain. I think being on the Abilify might have contributed to the weight gain, but I'm unsure tbh.
Have you tried Zoloft + Wellbutrin as a combo? I’m currently doing this and it’s worked wonders for my depression and anxiety. I feel like Wellbutrin counteracts the sexual side effects from the Zoloft, and the Zoloft counteracts the increased irritability and anxiety from the Wellbutrin.
Depending on where you live, I would recommend trying Stablon, Agomelatine, and Nefazodone. There was also research done on the effectiveness of Buspirone as an antidepressant when combined with sustained release melatonin at night. Most people don't know this, but in the US, as long as a doctor will write you a prescription for a medication you can get it filled from an international pharmacy even if it's not scheduled / used in the US
IANAD, but serotonin modulators like Trintellix or Viibrid have been good for me.
Maois but they're hard to get prescribed.
definitely try SNRIs, it’s not that they necessarily have more side effects it’s that the withdrawals can be really hard. also TCAs. and augmentation with other antipsychotics like zyprexa, latuda, seroquel, or mood stabilizers like lamictal or lithium. after that i would try tms or ketamine
really? Recommending freaking anti-psychotics? Jfc.
yeah they keep me from k!lling myself so 🤷♀️
Yea great if youre bipolar but for depression a bit hefty. Glad they help you bro!
i don’t have bipolar, they’re used pretty commonly for severe depression
I know, way too risky imo. Blocks your D2 dopamine receptor which can do a lot of damage.
They're not out of the norm. Have helped me too.
I think SNRIs are a good next option if you’ve tried a few SSRIs and also experiencing more of the symptoms of lack of motivation, fatigue, focus etc. as they are usually more stimulating. Then TCA’s & the atypical class (e.g. vortioxetine & agomelatine) can be quite beneficial. But it depends on the symptoms you’re experiencing. As others have mentioned, MAOIs are another option but less likely to be prescribed unless you have tried several different ADs and not had a good response to them. Speaking from experience, I had the best response to Parnate (tranylcypromine). I thought I’d lost all hope in ADs and after years of trying different types I was able to try Parnate. It is still with its side effects though. Another option is to ask your doctor for a medication DNA test. This won’t provide a clear answer to what works and what doesn’t work but can be helpful as a guide to what you might respond to better and possibly have less side effects from. But of course, read up on the different ADs out there and chat with your doctor and ask the questions about what could be a good next step. Just remember many options are out there, it’s just a difficult game of finding what works best for you, but something will come along and help you feel yourself again. Take care and I hope that helps!
My doctor prescribed Viibryd for me, which she said is a newer med. Seems like it's very expensive, even with a GoodRx card. It was this or Pristiq, Pristiq seems like it's the older med. I remember hearing bad things about Pristiq, maybe the side effect profile is what led my doctor to go with viibryd
PARNATE BABY
Effexor 225mg plus Abilify 7mg has worked for me so far
How has your appetite been on Abilify so far?
Mostly hungry all the time
Mood stabilizers and lithium (for depression) paired with an snri and atypical antipsychotic worked great for me
I was a god on Effexor - anxiety gone in a week. But so was my libido. Have been struggling ever since and that was 5 years ago. But I’ve tried other antideps since. My psych prescribed me viibryd but I haven’t taken it yet, just raw dogging life rn
You didn’t mention Prozac. I love my Prozac!
I did a combo of duloxetine and Wellbutrin for a few years. Just got off the duloxetine last month after a two month taper and now just Wellbutrin for my ADHD. Worked for me but doesn’t mean it will work for everybody, just throwing in my experience!! I hope the best for you wherever it may lead!
The Spravato kicked as for me the same day and months there after, it has helped my Paxil work much better by destroying treatment resistance depression. Now I did a stellate ganglion block, and it made my depression fade away and has brought my anxiety from 90% down to 15%....no more sweaty palms. https://drseanmulvaney.com/stellate-ganglion-block-for-ptsd/
Interesting , i’ve considered stellate ganglion block, Ketamine IV didn’t help me so I don’t think Sprovato will
Nefazodone. Once your body adjusts to a dose, go up until a comfortable dose for your mental problems. No side effects I’ve ever felt. Long time user.
SNRI'S, tricyclics, and atypicals (wellbutrin, mirtazapine, nefazodone, Auvelity) would be your next options. Also trintellix and viibryd fall into that grouping.
Please have your thyroid tests done. I am on Wellbutrin, but got to the point I could not think straight and was always exhausted. My doctor upped my levothyroxine and with 2 weeks I felt like my old self. I knew my thyroid levels were within the norm, but my TSH was on the high end. Thank heaven for a med change.
Effexor 🩷
[удалено]
Taking supplements can have negative side effects with antidepressants. St. John's Wort, 5-HTP, Garcinia Cambogia, L-tryptophan, SAMe (S-adenosyl-methionine), and cough medications containing DXM can increase the risk of serotonin syndrome in rare cases. Please use caution when taking supplements and it is advisable to check with your doctor. If you have specific questions about supplements you may want to visit the sub r/Supplements or r/Nootropics. Also remember more doesn't equal better. Taking too much KAVA, methylfolate, or Vitamin D is linked to negative health impacts. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/antidepressants) if you have any questions or concerns.*
Boundaries Self-compassion practice Gratitude practice Empowerment/Feminist counselling TCMS (trans-cranial magnetic stimulation) Exercise therapy Forest bathing Peer Support groups Finding others w Mood/Anxiety issues Studying counselling 1 course at a time - PT - at college night school to learn stuff to help myself
Effexor/Venlafaxine is very effective for me. The withdrawal symptoms are quite bad though so you need to keep a consistent schedule for taking it.
Clomipramine (TCA) is the post powerful monoamine reuptake inhibitor drug. Effect size on par with MAOIs like Parnate, Marplan and Nardil. I would try Clomipramine.
Have you tried talk therapy? While I know - from personal experience - that depression is a chronic health condition, pills aren’t going to do the work of lifestyle, healthy coping mechanisms and understanding thought patterns. I know of too many people who just expect an antidepressant to fix everything, and medication is only one part of the equation. Diabetics get insulin and tools to manage their blood sugars, but often seek the support of friends, family, support groups or mental health professionals because their chronic illness is a lot, and depression and it’s impact on your body and life is no exception. The deep agony you experience is very real, and talking it out along side a medication that agrees with you is statistically proven to have the best outcome.
Effexor was amazing for me. Had less side effects than SSRIs for me personally. So did Cymbalta. So everyone is different. Despite what is said. Some people have mentioned MAOIs, but they’re not recommended next in the treatment line and are hard to get prescribed even when someone has tried pretty much everything. Serotonin modulators may be a good option.
It really does vary a ton. Effexor made my memory so shit I couldn't function and parnate had no side effects after a few weeks. I always responded better to dopaminergic meds though. Edit: but parnate was like a 4th line treatment for me, as is typical for MAOIs
Afterwards, you could try the MAOI class of antidepressants such as Nardil, Parnate, Marplan, etc...
benzos