topic Re: Treatment resistant depression in Depression

Treatment resistant depression

Sad57 — Sun, 11 Aug 2024 06:47:41 GMT

This is my first post so I'll write only the basics. Over the last 10 years I've tried 15-20 different antidepressants from all categories for my: Chronic Depression, Anxiety and PTSD. As none of them worked, last year I was diagnosed with TRD. I'm seeing my Psychiatrist and GP on the regular basis. Thanks to one "of the label" medication I am able to get uo in the morning and do some basic chores. I'm talking about 3-4 hours window. The rest of the day I spend in bed. Is there anything new in the medical field? I read about some nasal sprays which is apparently helpful but it's extremely expensive and not affordable for people like me. Any info would be much appreciated.

Re: Treatment resistant depression

Eagle Ray — Sun, 11 Aug 2024 10:20:18 GMT

Hi Sad57,

I’m really sorry to hear of the tough time you’ve had. It would be disheartening to struggle finding the right treatment but I’m glad at least one has given you some capacity for activity for 3-4 hours in the day.

One thing that has helped me has been a somatic approach, specifically one called Somatic Experiencing. It is not based on any medication but works through the body’s natural healing mechanisms in the presence of a therapist who knows how to do this work. In my case I’m diagnosed with C-PTSD, anxiety and depression. The depression for me has involved a chronic freeze state where it is really hard to move for long periods of time. Working with this method I’ve learned you pass through the fight-or-flight state (anxiety) when coming out of freeze. But what often happens is the anxiety can feel too much and the body retreats back into freeze (depression). I think this is the chronic anxiety/depression loop many people find themselves in. The Somatic Experiencing method is very gently titrated to help a person gently come out of freeze in a supported way. The body may pendulate back and forth for a while but gradually, in the presence of safety, comes back to some kind of equilibrium. I’ve done some of this work with a clinical psychologist. I did have to try a few practitioners first before I settled on the right person.

I just mention this method as it has sometimes been known to work with treatment resistant depression and chronic PTSD. It may or may not be the right thing for you though. If you wanted to read about it there’s a few books by Peter Levine such as In an Unspoken Voice and Waking the Tiger. There is also a YouTube video online of him working with a war veteran with PTSD called “Somatic Experiencing - Ray’s Story” that helps show the approach a bit. It does have some references to Ray’s war experiences, just in case that is similar to your own in terms of any trauma triggers.

This is a bit out of the box in that it’s different from medication as well as standard talk therapy. It really comes down to whether it resonates with you and whether you can find an experienced practitioner to help facilitate it, if you did want to try it. You could chat with your psychiatrist for their perspective and whether they have any knowledge in this area.

In any case, I hope you can find something that begins to shift things for you. I have gone through periods where I can only be active for 3-4 hours so I know it is hard. For me it is a mix of health conditions plus chronic trauma that was stuck in my nervous system. That trauma has been progressively releasing over the last two years so I can feel a definite improvement. I had hormonal issues throw a spanner in the works too but I’m on hormone medication now that’s helping that. The best encouragement I can give is to not give up as there are ways through but it’s just a real challenge at times questing to find what works for you.

Take good care and all the best,

Eagle Ray

Re: Treatment resistant depression

Sad57 — Sun, 11 Aug 2024 21:35:23 GMT

Thanks for the tip mate. Sounds like a very good idea but I don't think I can do it. My concentration is almost non existent and my memory is fading as well. Have you ever tried TMS(Transcranial Magnetic Simulation)? Apparently it works for some people?

Re: Treatment resistant depression

Eagle Ray — Mon, 12 Aug 2024 01:40:53 GMT

Hi Sad57,

I haven't tried TMS, but there are some threads on TMS on this forum in the "Treatment, health professionals and therapies" section:

Treatments, health professionals and therapies

On the second page of that section there is someone with a thread describing some benefit from in-hospital TMS treatments:

TMS inpatient in Hospital

If you wanted to, you could have a chat with him as he has recently been doing this treatment. It may depend whether he is still engaged on the forum or not. You can also search the forum using the search icon at the top of the page. I imagine there may be a few threads on TMS going back over time.

I really hope you can find something soon that breaks the pattern of the depression. I'm glad you have that ongoing support from your psychiatrist and GP.

Take care and all the best,

Eagle Ray

Re: Treatment resistant depression

sbella02 — Mon, 12 Aug 2024 14:28:44 GMT

Hey, thank you for reaching out. I'm so sorry to hear that you've been struggling, and for such a long time - it can take a huge toll on us.

I'd just like to start off with the fact that a 3-4 hour window of productivity can make a big difference. It may not feel like very much, but if you're able to at least get some basic chores and tasks out of the way during this time, it can feel like an achievement for those moments where you're not feeling able to do very much.

As somebody who also struggles with concentration and memory, I find that techniques like meditation can be very hit or miss for me. Aside from the benefit of journalling, I'm also a big advocate for the importance of social support, whether it's face-to-face or online. Do you have friends, loved ones, or acquaintances who you frequently (or infrequently) see at all? You don't necessarily have to discuss what you're going through with them, but just having people there to connect with can be quite good for your mental health. You can even have a chat to your GP about support groups that may be available in your area, if you'd feel comfortable doing so.

Have you tried any therapies as well, or has it just been medication? As much as medication can be helpful for some symptoms and for depression that has a biological/physiological basis, concurrent therapy can also be quite useful. If you haven't tried any, or haven't tried any for a while, it may be useful to approach either your GP or psychiatrist once more and inquire about this.

Feel free to keep chatting with us, we're here to support you and listen.

All the best,

Re: Treatment resistant depression

Sad57 — Mon, 12 Aug 2024 21:00:30 GMT

It's always been only medication and the only person I speak to is my Psychiatrist. Due to my condition I don’t have any contact with my friends or anybody else. I don’t feel well when amount people so I spend almost all my day in bed. I had my chronic headache, anxiety and chronic insomnia under control but this supstitute GP cut my sleeping pills to a bare minimum. I have one per night but as I often wake up in the middle of the night I have nothing to put me back to sleep. After a night like that my TRD, PTSD, Anxiety, pain and insomnia are much worse. So basically everything good that I achieved in the last 2 years is ruined. Ruined by the doctor with God complex. I really have no clue what to do next?

Re: Treatment resistant depression

Sad57 — Mon, 12 Aug 2024 21:27:19 GMT

To be more precise l get exactly 28 sleeping pills for 28 days. But on my prescription it says "take one or two before sleep. So he protected himself with this false instructions. That's just one example who I am dealing with.

Re: Treatment resistant depression

Sad57 — Wed, 14 Aug 2024 21:25:27 GMT

Any new hope in the medical field? I can't believe that none of the various, new antidepressants work for the TRD.

Re: Treatment resistant depression

Sad57 — Fri, 16 Aug 2024 21:19:09 GMT

Is any discussion about various medications banned on this site?

Re: Treatment resistant depression

Eagle Ray — Fri, 16 Aug 2024 22:28:15 GMT

Hi Sad57,

We are not allowed to mention the specific names of prescription medications but it’s ok to mention the word antidepressants, for example. I did mention a very broad class of meds once but not a specific med (similar to using the term antidepressants), and that was changed by the moderators to make it more general. So it is a bit tricky to talk about meds except in the most general terms.

If you do want to discuss specific meds there are some online forums where that is allowed for specific medical conditions. I’m on one for a medical condition I have and meds are discussed openly there. The HealthUnlocked website covers many medical conditions and there may be a forum within that overarching site that is relevant to you.

I was going to respond to you in relation to new areas of treatment in relation to TRD but it will involve going into meds which is too difficult to do. I’ve found, in relation to my own conditions, doing a lot of online research has helped. I’ve read peer-reviewed journal articles (the ones freely available) and I constantly learn and cross-reference everything. It’s how I’ve gotten the right treatments in the end by gaining as much knowledge as possible and then approaching certain practitioners. I’ve found I’ve had to be consistently pro-active. I know that is so hard when you’re already struggling with low energy and mental health issues. I’ve treated it a bit like a quest and try to maintain interest and curiosity about what may work and that has helped me persevere to find answers.

I really hope you can find some good treatment and support soon. I relate to the isolation you describe in an earlier post. I have found getting second, third and even fourth opinions has been necessary in some cases in relation to mental and physical health issues. I’ve started to really be able to feel the difference between practitioners who really connect with you and work as a team with you to solve issues and those who remain distant and disengaged. It has really made a difference when I’ve found the right people to work with, from psychologists to GPs to specialists.

Take good care and sending you much hope and kindness.

Re: Treatment resistant depression

Sad57 — Sat, 17 Aug 2024 05:05:29 GMT

Thanks a lot for the advice and detailed info. All the best!

Re: Treatment resistant depression

sbella02 — Sun, 18 Aug 2024 12:31:23 GMT

I'm sorry to hear that you've had this experience, and I can see how it would leave a sour taste when wanting to seek professional help in the future.

I agree with what Eagle Ray has said, particularly about treating it like a quest. I would also suggest potentially looking into different kinds of therapy that may help to alleviate some of the more prominent symptoms. There are some therapy programs that can be really good for helping with sleep, for instance.

To echo Eagle Ray, second, third, and even fourth opinions can also be really useful. Every professional has slightly different experiences with regards to treating different conditions and symptoms, and sometimes you come across somebody who'll be able to help in a way that you haven't tried before. It's worth looking around, if you're able to. 🙂

Re: Treatment resistant depression

Sad57 — Mon, 19 Aug 2024 21:23:06 GMT

It's hard to communicate on this forum when we're not allowed to mention any medication. I also did some research and certain meds that helps me get out of bed in the morning was my idea. Fortunately the Government approved it for the last 2 years. Regarding exercise and spiritual healing, that's the Cach 22. You need them to feel better but you can't do it because of lack of motivation and energy.

Re: Treatment resistant depression

Sad57 — Mon, 19 Aug 2024 21:47:09 GMT

There's a certain Nasal Spray on the market which apparently works wanders for TRD. The only problem is that it's not subsidised by Medicare and the monthly cost of treatment is around $3000. I can't afford that.

Re: Treatment resistant depression

Eagle Ray — Wed, 21 Aug 2024 13:16:58 GMT

Hi Sad57 and wave to sbella 👋

I think I know the spray you are referring to and, yes, that line of therapy is very expensive and out of reach for many. As far as spiritual healing goes, I’ve managed to do some of this working with altered consciousness states without the aid of any substances, plant medicines etc. I seem to go into altered states quite easily, perhaps because I’ve always been dissociative. I've done some sound healing over a few years that definitely took me on some journeys. I've also had someone sing to me from the Shipibo shamanic tradition that lead to some profound shifts at a mind/body/spirit level. It can be a little challenging to maintain these kinds of shifts after they happen, but it all adds incrementally to the mind/body/spirit complex learning and knowing that healing is possible.

When I first arrived where I live now my mental and physical health really collapsed, but some days I managed to drive 10 minutes out to a seaside location. I've found a rocky hill there where I feel really spiritually connected. Often I've only just had the energy to sit there, but it is like the place has held me when I felt completely alone. I feel like at times I've gone into altered states there and a lot of spontaneous healing kind of just happened. It's not that it solved everything, but it has been a place where I have felt safe enough to let difficult emotions arise, be felt and let go of. For me, anyway, depression is emotion trapped and locked down in the body. It has to feel safe for that emotion to come out. While it is still trapped in me I stay in a freeze state. It can hurt when it's coming out and I've cried a lot of tears on that rocky hill, but it always feels better afterwards. Early on, when no one else was around, I've also screamed into the wind there. It has helped and it has been a constant source of safety and stability when so many other things were not stable for me.

I'm wondering if there are any nature places you feel connected with, or just any space that feels safe for you? Also, I can recommend calling helplines if you are ever feeling isolated or just would like someone to talk to. I have found it can sometimes help to at least partially shift how I'm feeling. I've found if the first person I speak to isn't the right fit, it is worth giving it another go and the next person is often just the right person to speak with. If you are looking for one with a good understanding of PTSD, The Blue Knot Foundation specialise in Complex PTSD, but I think would chat to you even if your PTSD is not of the Complex type. Their number is 1300 657 380 (7 days a week, 9-5 eastern states time). Beyond Blue, Lifeline etc are all there to support you too. I have called them all at various times.

I guess what has helped me turn a corner has been many individual things which added up together have made a difference. I also found that I was increasingly hormonally dysregulated too in the later stages of perimenopause, and being medicated for that with hormone medication has made a profound difference in relation to debilitating anxiety and depression. I don't know your age or gender, but it may be another thing to think about if you think that may be a factor.

Anyway, just some more thoughts. Take good care and we are here if you need a chat anytime or just need to express how you are feeling.

Re: Treatment resistant depression

Eagle Ray — Wed, 22 Jan 2025 06:57:16 GMT

Hi Sad57,

In the last few days I've learned about the role histamine intolerance can play in treatment resistant depression. I have been experiencing severe histamine intolerance for many months now though it's beginning to improve. I'm also dealing with depression. I've only just found out that the mainline antidepressants (cannot name specifically unfortunately) can fail to work in people with histamine intolerance. As histamine intolerance is not well understood in the medical profession, a lot of doctors are probably unaware of that, but there are clinical studies and medical journal articles on the topic. Currently I'm working with a naturopath to calm mast cell activation in my body and reduce histamine.

None of that may be relevant to you, but just in case it is related to your resistance to antidepressants working, I thought I would mention it as another possible avenue to look into. It's related to the interplay between histamine and serotonin. If you have significant histamine intolerance you would probably know in that you would have things like an ongoing post nasal drip, reactions to certain foods or possibly hives, dizziness, gastro disturbances etc. Sometimes there are logical biological reasons why something isn't working but it's just not something well understood medically yet.

I hope things may have improved for you in the last few months.

Best wishes,