The title is a kind of weak ripoff from the Seinfeld-ian Pimple Popper MD, but still, it’s fairly apt. I have major depressive disorder, and I take a boatload of pills. Because my memory isn’t that great and I don’t want to forget to take them, I have them all laid out on a shelf in my bookcase. If anyone comes into my living room chances are they’ll notice the mini pharmacy I’ve got going on, but I am so beyond caring about what people think about that.
In this post I’m going to break down the various things I’m putting into my body to try and stay afloat with my depression. Medications will never be all of the picture, but for me they are an important part of my treatment plan.
Mirtazapine 30mg and venlafaxine 300mg: These are my two antidepressants. I have always responded better to antidepressants with more activity related to norepinephrine than serotonin, so these two fit the bill. The combo is sometimes referred to as “California rocket fuel” because of its potency. Mirtazapine is actually most sedating at lower doses, so I’ve settled on the middle of the road 30mg dose because I didn’t sleep as well on higher doses.
Lithium 1200mg: I don’t have bipolar disorder, but lithium has actually been recognized for a long time as an effective augmentation strategy in major depressive disorder. If I start feeling worse one of the first things my doctor and I consider is increasing my lithium, since I tend to respond fairly quickly to dose increases. When my serum levels get higher, though, I tend to have increased problems with tremor and coordination, turning me into a complete klutz, complete with wipeouts on the sidewalk and falling down stairs.
Quetiapine 600mg: Atypical antipsychotics are also effective for treatment augmentation in depression. Of the ones I have tried, quetiapine has been most effective for me. It helps with my mood and is very reliable for getting to sleep.
Dextroamphetamine 15mg: I first tried dextroamphetamine a year and a half ago when I was really slowed down in both movement and thinking. It helped, but I wasn’t keen on taking “speed” any longer than needed, so I only took it for about a month. I restarted it earlier this year when I got really slowed down again. It helped, but when I tried to decrease the dose my mood dropped. Research has shown that it tends to be effective as an antidepressant augmentation strategy for only a couple of months or so, and then the effect tends to wear off; however, I’ve tried several times to decrease the dose and it makes me feel worse. My doctor has a good attitude about it, and has no problem with me taking it on an ongoing basis when it’s clearly working.
Propranolol 10mg prn (as needed): Lithium gives me an intention tremor, which occurs with intentional movement as opposed to a resting tremor. It’s worse if my lithium level is higher or if I’m worn out, and probably the dextroamphetamine doesn’t help either. Propranolol helps keep it in check, and I tend to use it mostly for days that I’m working, since patients generally aren’t reassured about getting an injection if the nurse drawing it up has shaky hands.
Lorazepam 0.5-1mg prn: Anxiety is generally not a prominent feature of my illness, so I’ve never needed to use lorazepam (Ativan) on a regular basis. I find for me it’s most effective to get a bit of a numbing effect when I’m going into particularly stressful situations. Since I use it so seldom, I’m able to get away with a small dose.
Min-Ovral: I have spent much of my adult life on birth control, but decided a couple of years ago to take a break. When I got depressed last year, my hormones went crazy. I was getting my period every 3 weeks and PMS was having a big impact on my mood. Now I’m back on birth control and my hormones are steady and happy. The estrogen in the Min-Ovral may also give my neurotransmitters a bit of a boost.
Omega-3 fatty acid plus vitamin D supplement: There have been research studies that have shown that omega-3’s have some beneficial effect on depression. Vitamin D may also play a role in depression, and since I live on the Wet Coast of Canada where it rains for a good chunk of the year supplementation seems like a good way to go.
Multivitamin/mineral/antioxidant supplement: Besides helping my overall health, the goal with this is to have some effect on decreasing oxidative stress, which may play a role in depression.
L-methyfolate and vitamin B12 supplementation: I get these in an intramuscular injection every 2 weeks from my naturopath. Both play a role in the methylation cycle that’s involved in neurotransmitter synthesis, and L-methylfolate in particular has been shown to be useful in depression.
So that’s me, Pill Popper RN. What’s in your medicine cabinet?