Desperate for hope with treatment resistant depression

[symphony]

Idek why I'm making this post. Beyond that I'm desperate (obviously). I seriously doubt anyone here can give me any advice that a mental health profession can't, but here I am asking anyways. Why? Well, for starters, I can't CTB for several months but at this point I feel like I can't survive that long either. And ideally, I'd rather live than die so long as I could have an actually livable life.

My primary issue is Major Depressive Disorder, recurrent, severe. And I'm treatment resistant. I've had symptoms on and off (including suicidal ideation) for most of my life, but this episode, which started around 3.5 years ago, has been by far the longest and most severe. It's taken everything from me. I'm highly dysfunctional and straight up just can't bear the suffering anymore. I'm in fucking agony and one way or another, I need it to end.

I've tried so many meds, more than I can even remember. SNRIs, SNRIs, anxiety meds, meds for suicidal ideation in particular, meds that aren't antidepressants but get used as such. I've tried every major therapeutic modality in individual sessions, group sessions, and residential settings. I've spent months in hospitals. I've done ketamine, ECT, and TMS. Nothing has helped. And not for lack of trying.

I have no hope left anymore, and honestly? It seems that even mental health professionals have started giving up on me more and more too.

I'm just desperate to escape the pain, and with CTB so far out, I'm wondering how in the world I'm supposed to make it even just til then, ya know?

Anything that could possibly help, please. I'm desperate.

 

[UpandDownPrincess]

My first thought was TMS, but I see you've tried that already.

If it was a while ago, they have refined the procedure and it is supposed to be more effective now, if that helps at all.

I know it's not much, but know that you are heard and believed.

 

[symphony]

My first thought was TMS, but I see you've tried that already.

If it was a while ago, they have refined the procedure and it is supposed to be more effective now, if that helps at all.

I know it's not much, but know that you are heard and believed.

It was late 2021. Thanks for your reply though. I appreciate the support - even that does help, even if just for tonight.

 

[Meretlein]

It does seem you like you have run through the standard acceptable treatments for treatment resistant depression and even some newer treatments such as ketamine.

I don't normally suggest this to people but have you ever thought about giving psychedelics such as LSD or mushrooms a try? I know you have done ketamine but if that was a prescribed treatment they likely did not give a large enough dose to produce the strong mental effect those drugs can have. On a personal level, I have found psychedelics to be far more helpful for my mental health than dissociatives like ketamine. I am here today because of LSD. Though my story will ultimately end in ctb, LSD gave me the energy to go on for a few more years.

Feel free to message me any question you have about psychedelics.


Deep brain stimulation is also an option though the high risk and relatively low response rate (50%-60%) would give me pause.

Deep brain stimulation in the treatment of depression

Major depressive disorder is a worldwide disease with debilitating effects on a patient's life. Common treatments include pharmacotherapy, psychotherapy, and electroconvulsive therapy. Many patients do not respond to these treatments; this has led to ...

www.ncbi.nlm.nih.gov

Treating Severe Depression with On-Demand Brain Stimulation

UCSF Health physicians have successfully treated a patient with severe depression by tapping into the specific brain circuit involved in depressive brain patterns and resetting them using the equivalent of a pacemaker for the brain.

www.ucsf.edu

There is also vagus nerve stimulation

Frontiers | Transcutaneous Vagus Nerve Stimulation (tVNS) Enhances Response Selection During Sequential Action

Transcutaneous vagus nerve stimulation (tVNS) is a non-invasive and safe technique that transiently enhances brain GABA and noradrenaline levels. Although tV...

www.frontiersin.org

I am just putting out options that have helped people and you have not tried yet. I hope you can find some relief.

 

[symphony]

It does seem you like you have run through the standard acceptable treatments for treatment resistant depression and even some newer treatments such as ketamine.

I don't normally suggest this to people but have you ever thought about giving psychedelics such as LSD or mushrooms a try? I know you have done ketamine but if that was a prescribed treatment they likely did not give a large enough dose to produce the strong mental effect those drugs can have. On a personal level, I have found psychedelics to be far more helpful for my mental health than dissociatives like ketamine. I am here today because of LSD. Though my story will ultimately end in ctb, LSD gave me the energy to go on for a few more years.

Feel free to message me any question you have about psychedelics.


Deep brain stimulation is also an option though the high risk and relatively low response rate (50%-60%) would give me pause.

Deep brain stimulation in the treatment of depression

Major depressive disorder is a worldwide disease with debilitating effects on a patient's life. Common treatments include pharmacotherapy, psychotherapy, and electroconvulsive therapy. Many patients do not respond to these treatments; this has led to ...

www.ncbi.nlm.nih.gov

Treating Severe Depression with On-Demand Brain Stimulation

UCSF Health physicians have successfully treated a patient with severe depression by tapping into the specific brain circuit involved in depressive brain patterns and resetting them using the equivalent of a pacemaker for the brain.

www.ucsf.edu

There is also vagus nerve stimulation

Frontiers | Transcutaneous Vagus Nerve Stimulation (tVNS) Enhances Response Selection During Sequential Action

Transcutaneous vagus nerve stimulation (tVNS) is a non-invasive and safe technique that transiently enhances brain GABA and noradrenaline levels. Although tV...

www.frontiersin.org

I am just putting out options that have helped people and you have not tried yet. I hope you can find some relief.

Wow, thanks for the reply and the citations. I'll look into that.

 

[Cathy Ames]

Two additional suggestions.

Some people think that the bright light therapy works for regular depression, not just SAD.

Chronotherapy... sort of a controlled sleep deprivation type thing, which I did via sleep phase shifting. This used to work for me but has quit working. I probably abused it. Also it is very difficult to live a normal life during the shifting.

Also it is very difficult to live a normal life during the shifting.

Actually, it's impossible.

 

[symphony]

Two additional suggestions.

Some people think that the bright light therapy works for regular depression, not just SAD.

Chronotherapy... sort of a controlled sleep deprivation type thing, which I did via sleep phase shifting. This used to work for me but has quit working. I probably abused it. Also it is very difficult to live a normal life during the shifting.

Actually, it's impossible.

Huh! I didn't know that. Thanks for the input.

 

[self destructing]

Hi @symphony. I really resonate with your desperation, and I'm sorry we're in this place. The rough contours of your story mirror mine - depression most of my life, an absolutely crippling episode going on three years, every treatment option you mentioned (bar ketamine). Hope feels like a cruel joke, and yet still I can't bring myself seriously to CTB (I have absolutely no energy, and I still cling irrationally to life).

My doctor has not given up hope, though. He's prescribed me a couple of MAOIs (moclobemide and Parnate, neither of which worked). Next up is Nardil. I'm not sure if you've tried an MAOI, but FWIW there's a reason it was the last level of treatment in the STAR*D trial for patients who had failed all other treatment options (the STAR*D treatment levels are described more fully in this paper).

Maybe a year back, he also brought up neurosurgery: it's still in the early stages, but MRI-guided focused ultrasound (MRgFUS) is a new, scalpel-free surgery that uses ultrasound energy to target a specific part of your brain. It's another, possibly safer, and also cheaper way to conduct an anterior capsulotomy (which, to my lay understanding, is an established neurosurgical procedure historically for intractable anxiety and OCD. Basically, they produce a lesion in the anterior limb of the internal capsule. And as I have zero science background, I can't elaborate further ). Here's some research: https://sci-hub.hkvisa.net/10.1038/s41380-020-0737-1

 

[symphony]

Hi @symphony. I really resonate with your desperation, and I'm sorry we're in this place. The rough contours of your story mirror mine - depression most of my life, an absolutely crippling episode going on three years, every treatment option you mentioned (bar ketamine). Hope feels like a cruel joke, and yet still I can't bring myself seriously to CTB (I have absolutely no energy, and I still cling irrationally to life).

My doctor has not given up hope, though. He's prescribed me a couple of MAOIs (moclobemide and Parnate, neither of which worked). Next up is Nardil. I'm not sure if you've tried an MAOI, but FWIW there's a reason it was the last level of treatment in the STAR*D trial for patients who had failed all other treatment options (the STAR*D treatment levels are described more fully in this paper).

Maybe a year back, he also brought up neurosurgery: it's still in the early stages, but MRI-guided focused ultrasound (MRgFUS) is a new, scalpel-free surgery that uses ultrasound energy to target a specific part of your brain. It's another, possibly safer, and also cheaper way to conduct an anterior capsulotomy (which, to my lay understanding, is an established neurosurgical procedure historically for intractable anxiety and OCD. Basically, they produce a lesion in the anterior limb of the internal capsule. And as I have zero science background, I can't elaborate further ). Here's some research: https://sci-hub.hkvisa.net/10.1038/s41380-020-0737-1

Wow, thanks for the info. I briefly tried one MAOI but was taken off of it quickly due to side effects... which also could have been caused by a too-high dose of lithium instead of the MAOI. I'm so sorry you find yourself stuck in a similar situation and I'm wishing you all the best.

 

[self destructing]

Wow, thanks for the info. I briefly tried one MAOI but was taken off of it quickly due to side effects... which also could have been caused by a too-high dose of lithium instead of the MAOI. I'm so sorry you find yourself stuck in a similar situation and I'm wishing you all the best.

You're welcome. And thank you for your kind words.

My doctor also tried lithium as an adjunct to an MAOI (moclobemide). He hoped the lithium would help lessen my ruminating. Alas, it just blunted aspects of my mood and deepened my suicidality. We stuck with the MAOI for a bit longer, though. As I mentioned, my doctor is switching me to yet another MAOI: he hopes for a better side effect profile in addition to improving my depression.

At times (many, many times) I regret so responsibly disposing of my unused TCAs and lithium :(

 

[symphony]

You're welcome. And thank you for your kind words.

My doctor also tried lithium as an adjunct to an MAOI (moclobemide). He hoped the lithium would help lessen my ruminating. Alas, it just blunted aspects of my mood and deepened my suicidality. We stuck with the MAOI for a bit longer, though. As I mentioned, my doctor is switching me to yet another MAOI: he hopes for a better side effect profile in addition to improving my depression.

At times (many, many times) I regret so responsibly disposing of my unused TCAs and lithium :(

I hear that last bit.. although I can confirm lithium toxicity is not fun.