Treatment resistant depression

[Sad57]

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. 

[Eagle Ray]

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

[Sad57]

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? 

[Eagle Ray]

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

[sbella02]

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,

SB

[Sad57]

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? 

[Sad57]

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. 

[Sad57]

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

[Sad57]

Is any discussion about various medications banned on this site? 

[Eagle Ray]

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.