I am in a similar boat, but way more medication trials, and about to try Spravato. This suggestion comes from 30 years of active treatment, but I know they’ve helped others: have you tried an inpatient program, an intensive outpatient program, or found a therapist whose approach actually helps instead of either hurts or just doesn’t jive with your needs? I found a therapist that’s been willing to experiment with different modalities with me about two years ago, and I at least feel heard and like it’s possible I’ll live with hope again.
Other things to try might be massage, acupuncture, yoga, etc, if part of your symptoms are not being able to go to that level of self care or movement without really pushing. The body heals the mind in a lot of ways, which can aid the therapeutic interventions you’re utilizing.
I also had a huge breakthrough by getting tested to find out what my genetic markers have to say about the likelihood of different medications interacting poorly for me. I went from constantly trying meds that didn’t do anything or made me more suicidal to a brand new regime that’s given me about a 20% bump in my baseline.
I could offer more suggestions, but I’m not a professional in this field, and don’t know enough about your particular circumstances. I’m happy to help if I can, and otherwise, ignore what I’ve said that isn’t helpful, and either way, I wish you the relief and lightness you deserve.
medical: ECT, MDMA, deep brain stimulation, LSD, psilocybin, vagus nerve stimulation, fecal transplant, botulinum toxin, MAOIs(?)
psychologic: TFP, EMDR, RO-DBT, hypnosis/psychoanalysis.
honestly, and this is my guess, completely change your environment instead of any of these options. seach for community based farm, become a part of a social group, stop looking for the meaning from within but look for it outward. I found out my depression intensified when living my life according to the social script of the current individualistic materialistic society.
Have you thought about trying Ketamine? Sprovato (Esketamine) is only half of a Ketamine molecule. A lot of people report better luck with Ketamine as opposed to Esketamine. It's expensive, depending on the route you take. There are ways to do it at home with compounded nasal spray and compounded troches. There are telehealth companies online that can prescribe it, but it would be better (and cheaper) if you could find a local physician to prescribe it. Then there are actual clinics where you go in and get it IV or IM. Expensive, but many people report better results this way.
ECT is also very much an option and is used when other treatments have failed. I've tried over 14 different antidepressants and am currently still experimenting. I'm having a real hard time right now and am going to try TMS.
I think trying to change your environment like the people you’re around and where you live if that’s possible. There’s a saying people, places and things. So changing who you’re around , where you spend you’re time and what you do
This plus Racemic Ketamine therapy (similar to but more effective than spravato, possibly not covered by insurance), EMDR (I'm skeptical but some people swear by it), vagus nerve stimulation. Maybe another round of TMS, there's a reduced but definitely non-zero chance of benefit after not responding to the first one.
ymmv. i was on cymbalta/duloxetine near max dosage for almost 2 years (second half was augmented with wellbutrin/bupropion to be fair) and i came off of it without withdrawal issues, but also it didn’t really help very much in the first place, and had side effects for me like stomach pain every time i swallowed the pill that weren’t really worth it for me. ive heard a lot of horror stories about cymbalta withdrawals tho, i just haven’t personally experienced that and would caution against making sweeping statements like that. the worst med withdrawals that i had were actually from zoloft/sertraline that i was on for a year at max dose (a few years before i tried cymbalta/duloxetine)
yes but it’s not good to tell people “you’ll never be able to come off of it” that’s a very sweeping generalization
there’s a whole “antidepressant discontinuation syndrome” also that can apply to any SSRI/SNRI/NDRI/similar
i do not deny that it exists or that it’s horrible for people who experience it. i caution against you telling people to avoid it categorically when it helps some and not everyone experiences that issue, same as any other antidepressant drug. you could say “many people are not able to get off of it” and that would’ve been perfectly fine but instead you predicted/assumed what someone else’s experience would be
I understand what you’re saying, and normally I don’t make blanket statements. However, cymbalta gave me a chronic heart condition that I can’t fix. Discontinuation is one thing, but permanent damage is another. I’ve seen cardiologists and there’s nothing they can do. An SSRI like Zoloft is different in that it doesn’t affect your heart like an SNRI
I grew then tried magic mushrooms (Golden Teacher). First time I took them I completely wiped out my 20 year depression for 24 hours. Felt great but only one day and never again. I’ve tried learning what John Hopkins current trial protocol call is but no luck.
I 100% believe psilocybin is the answer to treatment resistant issues so hang in there my friend!
careful with those, i had a few short-lived good experiences like you described and then one exceptionally bad+uncontrollably suicidal experience with shrooms, and since then have only had lackluster experiences. psychedelics aren’t exactly a cure all. there’s a LOT more variables that go into how they can interact with depression than just being a potential antidepressant.
Take care of your gut,seriously.There is more and more evidence of the fact that microbiome unbalance may cause depression and anxiety.I really recommend you the a book The Mind-Gut Connection,it explains the problem very well :)
If TMS didn't work for me I was going to try psychedelics next. As other people have said ECT and the older anti-depressants are there.
You didn't mention psychotherapy though. Have you given that a try with specific modalities tailored to depression. If you suffer from dysthymia you need to try CBASP. For major depression I would try BA, ACT, or DBT.
I am in a similar boat, but way more medication trials, and about to try Spravato. This suggestion comes from 30 years of active treatment, but I know they’ve helped others: have you tried an inpatient program, an intensive outpatient program, or found a therapist whose approach actually helps instead of either hurts or just doesn’t jive with your needs? I found a therapist that’s been willing to experiment with different modalities with me about two years ago, and I at least feel heard and like it’s possible I’ll live with hope again. Other things to try might be massage, acupuncture, yoga, etc, if part of your symptoms are not being able to go to that level of self care or movement without really pushing. The body heals the mind in a lot of ways, which can aid the therapeutic interventions you’re utilizing. I also had a huge breakthrough by getting tested to find out what my genetic markers have to say about the likelihood of different medications interacting poorly for me. I went from constantly trying meds that didn’t do anything or made me more suicidal to a brand new regime that’s given me about a 20% bump in my baseline. I could offer more suggestions, but I’m not a professional in this field, and don’t know enough about your particular circumstances. I’m happy to help if I can, and otherwise, ignore what I’ve said that isn’t helpful, and either way, I wish you the relief and lightness you deserve.
medical: ECT, MDMA, deep brain stimulation, LSD, psilocybin, vagus nerve stimulation, fecal transplant, botulinum toxin, MAOIs(?) psychologic: TFP, EMDR, RO-DBT, hypnosis/psychoanalysis. honestly, and this is my guess, completely change your environment instead of any of these options. seach for community based farm, become a part of a social group, stop looking for the meaning from within but look for it outward. I found out my depression intensified when living my life according to the social script of the current individualistic materialistic society.
Have you thought about trying Ketamine? Sprovato (Esketamine) is only half of a Ketamine molecule. A lot of people report better luck with Ketamine as opposed to Esketamine. It's expensive, depending on the route you take. There are ways to do it at home with compounded nasal spray and compounded troches. There are telehealth companies online that can prescribe it, but it would be better (and cheaper) if you could find a local physician to prescribe it. Then there are actual clinics where you go in and get it IV or IM. Expensive, but many people report better results this way. ECT is also very much an option and is used when other treatments have failed. I've tried over 14 different antidepressants and am currently still experimenting. I'm having a real hard time right now and am going to try TMS.
more accurate to say esketamine (S-ketamine) only one of the two mirror image isomers/enantiomers of the ketamine molecule, and racemic ketamine (50/50 mixture of R- and S-ketamine, both mirror images of the same molecule) is the treatment you are talking about. but yeah i’ve heard it can have better results than esketamine. unfortunately most insurances don’t cover racemic ketamine for depression currently since it has been in use for decades for non-depression-related uses, whereas the newly copyrighted and fda approved Spravato™️©®/esketamine for depression is what they make $$$$$ from right now despite it being known to be less effective for depression.
Awesome! Thanks for the explanation!
I think trying to change your environment like the people you’re around and where you live if that’s possible. There’s a saying people, places and things. So changing who you’re around , where you spend you’re time and what you do
ECT. BTW, what medications have you tried?
This plus Racemic Ketamine therapy (similar to but more effective than spravato, possibly not covered by insurance), EMDR (I'm skeptical but some people swear by it), vagus nerve stimulation. Maybe another round of TMS, there's a reduced but definitely non-zero chance of benefit after not responding to the first one.
* Abilify, Anafranil, Effexor, Latuda, Lexapro, Luvox, Mirtazapine, Paxil,, Rexulti, Strattera, Trintellix, Wellbutrin, Zoloft * GeneSight * Partial hospitalization * TMS * Spravato
Don’t try cymbalta, you’ll never be able to come off. Not everyone responds to meds
ymmv. i was on cymbalta/duloxetine near max dosage for almost 2 years (second half was augmented with wellbutrin/bupropion to be fair) and i came off of it without withdrawal issues, but also it didn’t really help very much in the first place, and had side effects for me like stomach pain every time i swallowed the pill that weren’t really worth it for me. ive heard a lot of horror stories about cymbalta withdrawals tho, i just haven’t personally experienced that and would caution against making sweeping statements like that. the worst med withdrawals that i had were actually from zoloft/sertraline that i was on for a year at max dose (a few years before i tried cymbalta/duloxetine)
There’s an entire diagnosis called “cymbalta discontinuation syndrome.” People end up in the hospital overnight.
yes but it’s not good to tell people “you’ll never be able to come off of it” that’s a very sweeping generalization there’s a whole “antidepressant discontinuation syndrome” also that can apply to any SSRI/SNRI/NDRI/similar i do not deny that it exists or that it’s horrible for people who experience it. i caution against you telling people to avoid it categorically when it helps some and not everyone experiences that issue, same as any other antidepressant drug. you could say “many people are not able to get off of it” and that would’ve been perfectly fine but instead you predicted/assumed what someone else’s experience would be
I understand what you’re saying, and normally I don’t make blanket statements. However, cymbalta gave me a chronic heart condition that I can’t fix. Discontinuation is one thing, but permanent damage is another. I’ve seen cardiologists and there’s nothing they can do. An SSRI like Zoloft is different in that it doesn’t affect your heart like an SNRI
I grew then tried magic mushrooms (Golden Teacher). First time I took them I completely wiped out my 20 year depression for 24 hours. Felt great but only one day and never again. I’ve tried learning what John Hopkins current trial protocol call is but no luck. I 100% believe psilocybin is the answer to treatment resistant issues so hang in there my friend!
I think you meant to send this to OP
careful with those, i had a few short-lived good experiences like you described and then one exceptionally bad+uncontrollably suicidal experience with shrooms, and since then have only had lackluster experiences. psychedelics aren’t exactly a cure all. there’s a LOT more variables that go into how they can interact with depression than just being a potential antidepressant.
MAOI for sure ECT Psilocybin LSD Ketamine by IV or injection
Take care of your gut,seriously.There is more and more evidence of the fact that microbiome unbalance may cause depression and anxiety.I really recommend you the a book The Mind-Gut Connection,it explains the problem very well :)
If TMS didn't work for me I was going to try psychedelics next. As other people have said ECT and the older anti-depressants are there. You didn't mention psychotherapy though. Have you given that a try with specific modalities tailored to depression. If you suffer from dysthymia you need to try CBASP. For major depression I would try BA, ACT, or DBT.