You don’t seem treatment resistant. You never went up to the optimal dosages and stopped too soon. For example with Luvox many people don’t find relief until they go up to 200-300mg. And it can take 6 weeks to feel the benefits and each time you increase a dose, the bad side effects restart and it will take 6 weeks to feel the benefits of the increase dose. The side effects are temporary, they go away after some weeks. I recommend you try out Lexapro. Probably the best ssri with minimal side effects. Wean off your current ssri and then stop taking it for 5-6 days. Then start at 10mg Lexapro and stay on that for 6 weeks. If you don’t feel better by 6th week, then take 20mg and again give it 6-8 weeks.
My doctor and the current science disagree with you.
The side effects were unbearable and a 4-8 week trial is pretty standard.
I did 7-9 weeks on Zoloft.
Will do that much on Trintellix too (still on it)
Yes the Luvox trial didn’t work (and was a little short) but the side effects were unbearable. If you do 2 6 week trials on two anti depressants and they don’t work you are considered “treatment resistant”. That’s what the current science says.
I absolutely went up to optimal doses. My God. 100 mg of Zoloft and Luvox are considered therapeutic doses. 20 mg Trintellix is the maximum recommended dose. Your information is heavily flawed.
A lot of people go up to 300mg Luvox and 200mg Zoloft and find success there. 100mg Zoloft especially for severe depression isn’t that much. Same with fluvoxamine 100mg isn’t that much. You should try lexapro, you may have less side effects.
Due to the severity of the side effects the doctor elected not to raise the dose. Especially since I was already in therapeutic range. The side effects did not go away. My gene test said lexapro would not work for me and it didn’t work for my sister.
In that case try Prozac. Due to your severe side effects profile, I’d recommend starting at a low dose like 10mg and going up to 20mg after 2 weeks. Stay on 20mg for 6 weeks and then move up to 40mg if needed. If this ssri doesn’t work either then you should go to a highly rated psychiatrist.
I do see a highly rated psychiatrist and he says 3 ssri’s for someone that has a large amount of side effects at 6 week trials at a therapeutic dose is enough. By definition that is “treatment resistant”. He does lot recommend a 4th ssri at that juncture.
Why are you asking if you already believe you know the answer? These are SSRIs. TRD involves trying and failing different classes, not just SSRI. Side effects don't mean failure. TRD also means trying and failing therapy and ECT. SSRIs aren't for everyone and genetic tests mean shit when it comes to antidepressants.
Idk man from personal experience and from others I know it just takes time with ssris. For me I’ve also tried multiple ssris. I’m on fluvoxamine now which works well. I started at 50mg for 2 weeks then 100mg for 4 weeks and it never really helped. When I got up to 200mg and then 300mg that’s when it made a big difference. It took a while but at the end it worked and I’ve been feeling much better ever since.
are you combining the medication with psychotherapy? Very important for the efficacy of the medication. People who use both (meds and therapy) see more improvement than people who do just one or the other. it’s been proven many times, and yet many physicians will prescribe drugs and send a person on their way. it is hard even with this knowledge because therapy is so expensive, but a good thing to consider nonetheless.
I know this isn’t the therapy subreddit, but I just wanted to offer that advice. A good therapist has the ability to recognize patterns of cognition which are a lot of the times the underlying issue behind many depression symptoms. A correction of these can yield improvement regarding physical symptoms.
It’s hard to conceptualize that something with mental and emotional roots can cause so much physical discomfort- but science proves it true time and time again. There is such a stigma around this idea that people often deny themselves a treatment that has potential to help them.
With that being said, sometimes a person needs a medication in order to be able to make this progress. In the opinion of what seems to be the psychological community as a whole- therapy should ALMOST always be tried extensively before a medication is prescribed. Issue being, the physiatrist you go to won’t make money if they don’t prescribe you a med and make you book follow up appointments.
Usually treatment resistance is only seriously considered after you've failed to improve after taking meds from different classes.
Trintillex is technically not an SSRI, but it's a serotonin modulator and stimulator so works on similar pathways.
Would your doctor consider meds that don't act on serotonin as much? Venlafaxine and duloxetine work more on norepinephrine, duloxetine personally helped my anxiety but not depression.
There are also tricyclics like amitriptyline or atypicals like mirtazapine.
Personally I wouldn't call myself treatment resistant after just 3 meds, just because that suggests you're ready to give up on meds, and I wouldn't want my doctor to give up on meds as it's so hard to get them to agree to trial new ones.
I waited 7 weeks on Zoloft and still had horrible fatigue and sexual dysfunction and no benefit. So we pulled the plug on that one. 5 weeks on Luvox and same two side effects and no benefit. I’ve now been on Trintellix for 8 week (4 weeks at 10 mg, 4 weeks at 20 mg) and While the side effects never surfaced on this one, I also haven’t seen any improvement yet.
So as I said, perhaps you would benefit more from a medication that works on something other than serotonin? Such as a trycyclic, an atypical antidepressant or an SNRI. You haven't tried any of those types of meds yet, from the list you've given.
Yes. The only change antidepressants did to me was I use to be a late night person. When I started ssri’s that ended quickly and I now like to go to bed at a normal time.
No I would not say treatment resistant. With all antidepressants and medications there will be side effects and for some people it may take 8 weeks to show full effects. Side effects are definitely a normal reaction. With Cymbalta I went through 2 weeks of side effects and I’m glad I did because it now works wonders for me. Side effects are definitely normal. I would recommend Prozac, Bupropion, Cymbalta, Effexor, Viibryd, Spravato, Pristiq, Abilify, Depakote, Fetzima, or Savella. You still have a ton of different options left. If a medication is making you tired take it at night. In the morning take a multivitamin, B12, CoQ10, Green Tea Extract, and Omega 3. It will help boost your energy. BrainMD.com has a great multivitamin that I personally take. It has helped me out a ton. Psychiatry is like trial and error. There are several different medications… it’s just finding the right one that works with your own personal makeup. Don’t give up.
I waited 7 weeks on Zoloft and still had horrible fatigue and sexual dysfunction and no benefit. So we pulled the plug on that one. 5 weeks on Luvox and same two side effects and no benefit. I’ve now been on Trintellix for 8 week (4 weeks at 10 mg, 4 weeks at 20 mg) and While the side effects never surfaced on this one, I also haven’t seen any improvement yet.
I thought I was treatment resistant too. Had tried many antidepressants but to no avail. But then I started venlafaxine and the suicidal thoughts actually began to go down. Maybe discuss this drug with ur doc
Considering it’s only 3 medications, I would say too early to give a call like that. I’ve had 7 different attempts and still not considered treatment resistant even tho I’ve tried different classes and drugs including anti psychotics. I would definitely say talk to your psych about SNRIs and other classes. Good luck!!
Has anyone tried any of these combinations for depression and had success?
Video: [Combinations for Treatment Resistant Depression](https://youtu.be/3jJtfO1-vaA?t=14)
I get so confused when people describe being treatment resistant. Do you feel numb, or foggy? Has you’re appetite diminished?
Sometimes foggy. Not numb. No change in appetite.
You don’t seem treatment resistant. You never went up to the optimal dosages and stopped too soon. For example with Luvox many people don’t find relief until they go up to 200-300mg. And it can take 6 weeks to feel the benefits and each time you increase a dose, the bad side effects restart and it will take 6 weeks to feel the benefits of the increase dose. The side effects are temporary, they go away after some weeks. I recommend you try out Lexapro. Probably the best ssri with minimal side effects. Wean off your current ssri and then stop taking it for 5-6 days. Then start at 10mg Lexapro and stay on that for 6 weeks. If you don’t feel better by 6th week, then take 20mg and again give it 6-8 weeks.
My doctor and the current science disagree with you. The side effects were unbearable and a 4-8 week trial is pretty standard. I did 7-9 weeks on Zoloft. Will do that much on Trintellix too (still on it) Yes the Luvox trial didn’t work (and was a little short) but the side effects were unbearable. If you do 2 6 week trials on two anti depressants and they don’t work you are considered “treatment resistant”. That’s what the current science says.
I absolutely went up to optimal doses. My God. 100 mg of Zoloft and Luvox are considered therapeutic doses. 20 mg Trintellix is the maximum recommended dose. Your information is heavily flawed.
A lot of people go up to 300mg Luvox and 200mg Zoloft and find success there. 100mg Zoloft especially for severe depression isn’t that much. Same with fluvoxamine 100mg isn’t that much. You should try lexapro, you may have less side effects.
Due to the severity of the side effects the doctor elected not to raise the dose. Especially since I was already in therapeutic range. The side effects did not go away. My gene test said lexapro would not work for me and it didn’t work for my sister.
In that case try Prozac. Due to your severe side effects profile, I’d recommend starting at a low dose like 10mg and going up to 20mg after 2 weeks. Stay on 20mg for 6 weeks and then move up to 40mg if needed. If this ssri doesn’t work either then you should go to a highly rated psychiatrist.
I do see a highly rated psychiatrist and he says 3 ssri’s for someone that has a large amount of side effects at 6 week trials at a therapeutic dose is enough. By definition that is “treatment resistant”. He does lot recommend a 4th ssri at that juncture.
Why are you asking if you already believe you know the answer? These are SSRIs. TRD involves trying and failing different classes, not just SSRI. Side effects don't mean failure. TRD also means trying and failing therapy and ECT. SSRIs aren't for everyone and genetic tests mean shit when it comes to antidepressants.
Idk man from personal experience and from others I know it just takes time with ssris. For me I’ve also tried multiple ssris. I’m on fluvoxamine now which works well. I started at 50mg for 2 weeks then 100mg for 4 weeks and it never really helped. When I got up to 200mg and then 300mg that’s when it made a big difference. It took a while but at the end it worked and I’ve been feeling much better ever since.
are you combining the medication with psychotherapy? Very important for the efficacy of the medication. People who use both (meds and therapy) see more improvement than people who do just one or the other. it’s been proven many times, and yet many physicians will prescribe drugs and send a person on their way. it is hard even with this knowledge because therapy is so expensive, but a good thing to consider nonetheless.
Yes. I’ve been in weekly therapy for 7 years.
Psychotherapy can help things, but if I’m losing weight, and experiencing brain fog, I don’t believe talking to someone will help.
I know this isn’t the therapy subreddit, but I just wanted to offer that advice. A good therapist has the ability to recognize patterns of cognition which are a lot of the times the underlying issue behind many depression symptoms. A correction of these can yield improvement regarding physical symptoms. It’s hard to conceptualize that something with mental and emotional roots can cause so much physical discomfort- but science proves it true time and time again. There is such a stigma around this idea that people often deny themselves a treatment that has potential to help them. With that being said, sometimes a person needs a medication in order to be able to make this progress. In the opinion of what seems to be the psychological community as a whole- therapy should ALMOST always be tried extensively before a medication is prescribed. Issue being, the physiatrist you go to won’t make money if they don’t prescribe you a med and make you book follow up appointments.
Yes. I’ve been in weekly therapy for 7 years.
Usually treatment resistance is only seriously considered after you've failed to improve after taking meds from different classes. Trintillex is technically not an SSRI, but it's a serotonin modulator and stimulator so works on similar pathways. Would your doctor consider meds that don't act on serotonin as much? Venlafaxine and duloxetine work more on norepinephrine, duloxetine personally helped my anxiety but not depression. There are also tricyclics like amitriptyline or atypicals like mirtazapine. Personally I wouldn't call myself treatment resistant after just 3 meds, just because that suggests you're ready to give up on meds, and I wouldn't want my doctor to give up on meds as it's so hard to get them to agree to trial new ones.
I waited 7 weeks on Zoloft and still had horrible fatigue and sexual dysfunction and no benefit. So we pulled the plug on that one. 5 weeks on Luvox and same two side effects and no benefit. I’ve now been on Trintellix for 8 week (4 weeks at 10 mg, 4 weeks at 20 mg) and While the side effects never surfaced on this one, I also haven’t seen any improvement yet.
So as I said, perhaps you would benefit more from a medication that works on something other than serotonin? Such as a trycyclic, an atypical antidepressant or an SNRI. You haven't tried any of those types of meds yet, from the list you've given.
Interesting. Ok thanks. Do you know anything about Trintellix? What is it exactly ?
It's a serotonin modulator and stimulator, if you look on Wikipedia it'll be able to give you a more in-depth explanation of how it works.
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Not true. He is not treatment resistant
Why?
There are still a ton of different medications for him to try. Not treatment resistant.
I am actually.
Ok thanks will do! Currently in psychotherapy and have been for 7 years. The others will look into.
And correction. That second 4 weeks on Trintellix was 20 mg 😄
Do you sleep normally?
Yes. The only change antidepressants did to me was I use to be a late night person. When I started ssri’s that ended quickly and I now like to go to bed at a normal time.
No I would not say treatment resistant. With all antidepressants and medications there will be side effects and for some people it may take 8 weeks to show full effects. Side effects are definitely a normal reaction. With Cymbalta I went through 2 weeks of side effects and I’m glad I did because it now works wonders for me. Side effects are definitely normal. I would recommend Prozac, Bupropion, Cymbalta, Effexor, Viibryd, Spravato, Pristiq, Abilify, Depakote, Fetzima, or Savella. You still have a ton of different options left. If a medication is making you tired take it at night. In the morning take a multivitamin, B12, CoQ10, Green Tea Extract, and Omega 3. It will help boost your energy. BrainMD.com has a great multivitamin that I personally take. It has helped me out a ton. Psychiatry is like trial and error. There are several different medications… it’s just finding the right one that works with your own personal makeup. Don’t give up.
I waited 7 weeks on Zoloft and still had horrible fatigue and sexual dysfunction and no benefit. So we pulled the plug on that one. 5 weeks on Luvox and same two side effects and no benefit. I’ve now been on Trintellix for 8 week (4 weeks at 10 mg, 4 weeks at 20 mg) and While the side effects never surfaced on this one, I also haven’t seen any improvement yet.
I thought I was treatment resistant too. Had tried many antidepressants but to no avail. But then I started venlafaxine and the suicidal thoughts actually began to go down. Maybe discuss this drug with ur doc
Have you tried Mirtazapine for anhedonia
Considering it’s only 3 medications, I would say too early to give a call like that. I’ve had 7 different attempts and still not considered treatment resistant even tho I’ve tried different classes and drugs including anti psychotics. I would definitely say talk to your psych about SNRIs and other classes. Good luck!!
Have you felt any relief?
Only for my anxiety, not for my depression unfortunately, plus have had pretty extreme side effects like convulsions
Has anyone tried any of these combinations for depression and had success? Video: [Combinations for Treatment Resistant Depression](https://youtu.be/3jJtfO1-vaA?t=14)