re: treatment-resistant depression

**This post was actually written 5/6/13, but I dated it 5/6/03 so it would be at the very back of all my blog posts, rather than mixed in with the rest of my feed. I wanted to be able to link to it from another blog I wrote 5/6/13, without having it stand out as its own post.

I have tried eight different medicines for depression over the last 13 years, one of which had no response, and three which had a good response initially, but "pooped out" (yes, that is actually a term used in the clinical literature) after several years. I have also tried being off medicine and substituting exercise, meditation and other spiritual practices, and cognitive behavioral therapy in an attempt to live without medication and its inherent side effects. My last bout of wanting to go off medication ended in me finally concurring with my therapist and my meds lady that I will just have to be on psych meds for the foreseeable future. It's possible that someday when the kids are grown, there will be some period of time when I have little stress and lots of space in my life to compensate and manage my depressive/anxious tendencies without pharmaceuticals. But at present, me trying to cope with the symptoms of my depression/anxiety without meds required a higher price than I was willing to pay, in terms of my family's well-being and my own level of functioning.

One of the things they do in treatment-resistant depression is they combine and augment meds. Certain meds for depression have been shown to work better for treatment-resistant individuals if they are combined with another depression med or even some other psych med that is not otherwise used for depression, such as lithium. So, when Zoloft pooped out on me after several years, I switched to Effexor, which worked well for a while; and when it wasn't working well enough anymore, even after raising the dosage, we added Wellbutrin. When we had maxed out the Effexor dosage, and it seemed to stop working all together, I tried dropping it and taking Wellbutrin by itself for a while. It was somewhat effective, but not completely, so eventually we added Prozac. This worked splendidly for half a year or so, but after the mess that was Samuel's first semester of Kindergarten, the constant stress seemed to "break" the effectiveness of my meds, and I needed some kind of adjustment again. This lead to the latest adjustment, in which I have been taking methylphenidate, which seems to work really well, and leads me to ponder whether I have ADHD myself, or if it just works because of how it augments my existing depression meds.

This whole process is kind of scary, because there is a part of me that thinks, "What if we run out of meds to try? What if they all stop working eventually?" This fear was probably part of what drove me try to find a way to live meds-free and to resist trying new meds for so long after dropping Effexor. Apparently, you can cycle back to an old medicine after a long break and sometimes it will work again, and we can try this if I do run out of new medicines to try. However, scientists are always tweaking the medicines we have into new formulations and inventing new ones, so it's possible I will never run out of things to try, or that I will eventually hit on one that never poops out.

Some of you may think I'm sharing too much; that this should be more personal than I'm making it. I did that for a lot of years, and I think I'm done with that approach. I've come to understand and accept that there is obviously something legitimately different about my brain chemisty, and it's okay to acknowledge and want to treat that. In fact, it's a lot healthier for me and my family to accept it in a matter of fact way and to seek effective treatment. This was hard for me to accept for a long time, so I hope that by being open about my own experience, maybe I can help others escape from shame and seek the treatment they need.