MH@H Depression

Treatment-Resistant Depression: What My Meds Do Help With

Treatment-resistant depression and what my meds do still help with - image of pill bottle and depressed person

Pretty much the same cocktail of meds I’m on now used to work well, and got me into full remission (i.e. no symptoms at all between episodes). I’m not sure what got me thinking about this recently, but while my depression has become increasingly treatment-resistant overall, my medications are still doing a pretty good job in certain areas. This post will explore where they’re still working and where they’ve flown the coop.

Depressed mood

For me, depressed mood was never about sadness. The best description I’ve come up with is experiencing the mental equivalent of physical pain. The meds definitely take the edge off of this. My mood is still low, and I haven’t experienced good mood for several years now, but it’s not usually front and centre shouting for attention.

Anhedonia

The meds used to control this fully, but since my illness has become treatment-resistant, this is a symptom they just can’t budge. Anhedonia means I don’t enjoy anything, and am not interested in any of the things I used to be interested in. Even when there are things I like, such as blogging, it’s on a cognitive level rather than having any positive emotional element that goes along with that.

Sleep

Before I got on my current cocktail of meds, I struggled a lot with insomnia during depressive episodes, both in terms of getting to sleep and waking up early. Now, other than the occasional hiccup, my meds take care of the sleep pretty well.

Appetite

In the past, I lost significant amounts of weight while depressed because I had no appetite. Now, my appetite will drop off if I’m feeling particularly low, but for the most part, that isn’t much of an issue any more.

Psychomotor slowing

This is where the wheels have really fallen off. Psychomotor retardation is a physical slowing of movement, accompanied by slowed thoughts. When I tried coming off my antipsychotic about six years ago, this was the symptom that came rushing back in a relapse. I went back on the antipsychotic, was in remission for another couple of years, and then relapsed again. Since then, the psychomotor slowing has progressively gotten worse. I’m taking a stimulant, dextroamphetamine (Dexedrine), and it helps somewhat, because when I run out of it, I get slower. But this is by far the most stubborn symptom that’s caused the most disruption.

Cognition

This is hard to judge. I have considerable cognitive symptoms (concentration, memory, etc.), and those have probably worsened over the last few years, but It’s hard to say where I am in relation to my old baseline when in full remission, because so much time has passed since then. But overall, I’d say this is an area where my meds aren’t doing a heck of a lot anymore.

Low energy

It’s hard to get a clear picture on this, because the psychomotor slowing drowns it out. I can say that lack of energy is never the rate-limiting step these days; my limitations physically are from the psychomotor symptoms, not from low energy.

Guilt, worthlessness

I don’t think feelings of worthlessness were ever an issue for me. Apparently I had delusional guilt during my first hospitalization, but I don’t have any memory of that. Since then, though, guilt hasn’t been a problem. I’m not sure how much of that is meds and how much is that it’s not really personality-congruent. I don’t tend to be self-critical, and never have. My guess is that the guilt during my first episode was influenced by having a hard time with the identity shift from nurse to patient.

Suicidal ideation

I think the fact that it’s been 8 years since my last attempt is a testament to the fact that the meds are working in this area. Treatment-resistance has brought a new baseline lack of desire to continue living, but that feels quite different from suicidal ideation. I do still get some flare-ups of suicidality, but I’ve never been impulsive in that sense and I know I can get through flare-ups, so they don’t concern me all that much when they do pop up.


I’m definitely grateful for what the meds have continued to give me, especially in terms of sleep. Sleep makes a huge difference. Maybe something new and wonderful will come along for the rest of it, maybe it won’t, but in the meantime, I’m just here.

If you take meds, are there certain things that they do and do not help with?

book cover: Managing the Depression Puzzle, Second Edition, by Ashley L. Peterson

Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.

It’s published by MH@H Books and available on Amazon and Google Play.

20 thoughts on “Treatment-Resistant Depression: What My Meds Do Help With”

  1. I wish you could get better help with everything the meds don’t help with!! ๐Ÿ™ I’m really glad you manage to survive the suicidal flashes!! It’s a continual source of sadness for me that there are so many gaps in your treatment’s efficacy!! ๐Ÿ™

    My meds help with a lot. My sleep schedule used to be messed up beyond repair, and now it’s normal. And I’m less irrational overall. The main problem is that I’m still paranoid, because it doesn’t seem to respond to medicines very well. I was less paranoid on Geodon, but Geodon took away my creativity, and I’d only want to go back on it out of desperation in a temporary sense, if needed, like for several months or so. So I still have to deal with daily paranoia and a bizarre sense of unpredictability with my personality, moods, irritability levels, weird stuff. I’m just not very consistent.

    Fortunately, it’s all liveable as long as I don’t have to go to work. That would be bad. It all falls apart there.

  2. I suspect that my lithium dose contributes to my excessive sleeping, although I did that before lithium, too. On the plus side, it does eliminate my suicidal thoughts pretty well. Otherwise, I think think my other meds do a just-ok job of helping my motivation and mood. IV ketamine makes a pretty dramatic difference in my anhedonia, but it’s not long-lasting for me.

  3. I’m sorry that the meds only help with certain things.

    I’ve been on a lot of meds. Most didn’t work at all, some worked for a while and then suddenly stopped. The current cocktail seems to be doing reasonably well at getting me through the days and back into the workplace in a limited way, but my sleep is still disrupted (too much rather than too little) and, perhaps related to that, my energy levels are often low. I don’t usually feel ecstatically “happy,” but I do at least not often feel noticeably depressed, and I can get some pleasure from things.

    1. Oh, I meant to say: would you consider experimenting with meds further to see if a different one is better, or would you rather stick with what you know works a bit?

      1. I’ve already tried a lot of different things. One thing I’ve been considering is an MAOI, but I’m not sure that I could make myself care enough to stick to a tyramine-reduced diet, which could be problematic.

        1. Part of the issue is that negative consequences are meaningless to me. Hypertensive crisis? Bring it. And if a family member lived with me, I’d say fuck it, get out of my house.

  4. Itโ€™s difficult to find the right combination. I donโ€™t know if itโ€™s even possible for some people. Myself included. But, I am now back to trying again. I suppose everyone gets there, regardless of how or when it happens.

  5. I was on Wellbutrin in the trial phase. Four years later, my GP (prescribing because I was taking it for “ADHD,” and had not yet been diagnosed by a psychiatric practitioner) had me on 750 mg per day. A dose that I continued to take for the next six years. (We later found out from a mental-healthcare provider that this was “unheard of, and irresponsible!”)

    As they weaned me off of Wellbutrin, I began having seizures — which were attributed to “toxic levels” of the medication over a long period of time. Unfortunately, the removal of Wellbutrin from my medication regimen did not end the symptomatic seizures (and I have since been diagnosed with “Generalized Seizure Disorder, Origin Unknown”).

    I have taken a slew of psychiatric medications over the years — all prescribed by psychiatrists since the ill-fated Wellbutrin incident — and many did nothing at all.

    It was only after I was properly diagnosed (which took years) with Borderline Personality Disorder, and Complex PTSD that we were able to start trying the right medications. I now take 200 mg of Sertraline (Generic Zoloft) for the depressive symptoms associated with my afflictions. It helps to keep me out of the deep, deep dark — but not completely apart from it.

    I have yet to find a drug that alleviates suicidal ideation altogether, but the Zoloft seems to help with the impulsive need to succumb to such ideas.

    As for insomnia:

    Zolpidem (Generic Ambien) had me walking, cooking, and driving while asleep. My husband started hiding the keys, and barring the doors. As a result, that trial was very short lived.

    Quetiapine (Generic Seroquel) helped with falling sleep; but I still suffered from night terrors… and gained a lot of weight.

    I am now on 15 mg of Mirtazapine (Generic Remeron), paired with 5 mg of Melatonin an hour before; and that seems to have done the trick. I sleep for at least six hours; and experience night terrors far less frequently. (It still causes a bit of weight gain; though not nearly as much as the Quetiapine.)

    I have also recently found that exercise helps a tremendous amount with enhancing the mood-regulating effects of Zoloft and the effects of the Mirtazapine. I have to will myself to get up and move everyday — and am blessed that Mitch helps with that. If he weren’t here to encourage me (and vice versa) to get off my duff, I never, ever would.

    Mental illness is a vicious b*tch, Girl… but you are not alone! ๐Ÿ’•

  6. This was a great entry. I love your research and reviews, but I also like when you share experiences.

    You always seemed to be in a good mood reviewing my books. ๐Ÿ˜‰

  7. I have been on the same meds for years. The ones that I have trouble with is pain killers. Doctors in Saskatchewan are very hesitant about certain types of pain killers. Several years ago the College of Physicians gave doctors a slap on the hands for over prescribing ones like Oxycodone and ones in that same family of meds.
    I take Amitriptyline along with pain killers to help me sleep. The side effect of these is I feel like I am constantly drowsy during the day.

  8. I find it hard reading posts like this, because I want to problem solve and think of something that could help! I’m glad that the meds are helping you with your sleep though and hopefully you will find other avenues that will help improve things.

  9. Quality sleep, in my opinion, is the best remedy to deal with depression. Although you are going to have to consider other measures too, but good quality sleep makes you want to work on all those measures!

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