Treatment Resistant Depression

[Doubledog]

I have had depression since my 20’s and likely in teens. I’m now 56 and my meds are no longer working like they once did. I’m going to be meeting with a clinic about other options ie: ECT etc. I’m very scared and anxious as this feels next level to me in my illness. Have you tried ECT and/or Esketamine and what has your experience been? I think I’m most worried about the risks and having something like ECT make me non functional. Any thoughts or experiences you’ve had would be great to hear about. Thank you!

[gajh]

I am sorry to see that no one has responded to your post. I am not the best to respond, but I hope it is better than nothing. I wish you had some success stories to read. I have not had ECT. I had Spravato the nasal inhaler of Ketamine. I did not have success with it, but I recommend you try it because it is noninvasive and is supposedly highly successful. Why not give it a try? It may work for you. I tried TMS Transcranial Magnetic Stimulation. Again noninvasive. I had limited success with that that was not long lasting. Again I still recommend you try it. I don't know if you are already a member on the Anxiety and Depression Support group on this site or not, but there are a couple of people there that talk about having great success with TMS. Maybe you could repost there and see if one of them respond with a success story. I did LENS Neurofeedback Low Electrical Neurofeedback System. That is not readily available so I do not know if it is available to you where you live. I have had some success with that. I had 12 treatments and I will try more treatments in 6 months when my practitioner returns to this area. He is the only one available and he leaves for 6 months out of the year. I have had success with LENS. Not as much as I had hoped for, but certainly enough to make it worth doing. LENS is not covered by insurance so that has been out of pocket. Spravato and TMS were covered by insurance. Even though I am not a great success story I really want to offer you hope. It is definitely worth trying new things. You never know what will work for you and you are worth the effort. I hope this has been of some help for you. I wish you the best of luck.

[Doubledog in reply to gajh]

Thank you so much for sharing this information. I really appreciate it.

[67anxiousgoat in reply to Doubledog]

I have had major depressive disorder for 20 years. I tried ECT about a year ago. (antidepressants clog the memory). Unfortunately it did nothing for me but lighten my pocket book. I have had one Spravato treatment and then had to stop due to my blood pressure being to high. I have never had high blood pressure so this is another ailment to deal with. When I get my blood pressure down I am going to continue the Spravato treatments. I have to have someone to take me to the treatments to drive me home. My first treatment was supposed to be on a Monday but my blood pressure was to high and they wouldn't give the treatment. The next day I went back and my blood pressure was low enough I got a treatment. You get pretty high on the ketamine but it wears off in a couple of hours. My next appt. was on that Friday and my blood pressure was too high. I got up and expressed anger to the point of telling them I hope I die so I don't have to come back. The significance of the outburst of anger is I have not felt anything but depression for years. For me to get angry and express it was definately a change. From the one treatment? I hope to regain happiness and hope in the next treatments. For years I have felt nothing but sadness. I didn't remember what getting angry was like. I was just surprised by my outburst as the staff was. So I am hoping the Spravato may work for me. I will get back on here and let ya'll know when I get to start my treatments again what the results are.

[Hidden]

I just joined this community and searched TRD with your post coming in at the top. The other two people who commented on your post shared some good information.

Like you probably did, I went through a number of unsuccessful therapies until I was faced with two options from my psychiatrist: ketamine and TMS. My doctor is an expert in the field of TMS, so he was pushing that, but I was initially nervous about blasting my dorsal prefrontal cortex with massive magnetic pulses, lol! I went with ketamine initially, and to my surprise my doctor prescribed me troches (a dissolvable polyethylene glycol or gelatin cube that holds the drug, if you didn't know) loaded with ketamine that I could take at home. We started off with a small dose of 50 mg to monitor any blood pressure spikes, and eventually moved up to a whopping 250 mg! Yeah, you get altered enough that you are couch-bound for a good hour. I felt it had some efficacy, but the results weren't that astounding for me, so we moved on to TMS. I do recommend the treatment, because it has shown efficacy in many people.

The TMS treatment was painful and time consuming ... had to go into my psychiatrist's clinic four days a week. For me, it clearly had the best efficacy out of all of the many previous treatments I tried. But it still wasn't good enough in my case.

In desperation I started investigating the latest research in TRD. As a medicinal chemist, I am fortunate to have the background to locate and understand peer-reviewed journal articles in the field of research on therapeutics to treat disease. The results from research into utilizing psilocybin to treat MDD were absolutely astounding: great efficacy, no toxicity, no serious adverse effects, no real addiction potential (Watford, T., & Masood, N., 2024) (Davis, A. K., et. al., 2021) ... checking all the boxes of what you would want to achieve if you were to go out as a medicinal chemist and try to invent a drug. I was also fortunate to be living near Oakland, CA where mushrooms were decriminalized, and there was a brick-and-mortar shop where you could purchase some. I should probably mention here that I can't officially recommend psilocybin, as it is a schedule I drug at the Federal level. The definition of a schedule I drug is "drugs with no currently accepted medical use and a high potential for abuse" (Drug Scheduling, n.d.). This does, in my opinion, not even come close to correlating with the conclusions of dozens upon dozens scientific studies into utilizing psilocybin to treat psychiatric diseases. Anyway, I'm not into getting the serotonin/dopamine spike in my CNS, so I set up a microdosing regimen. For my weight that was 200 - 400 mg of dried mushroom per day for 4 days per week. Outside of feeling a twinge of euphoria a couple times, I have never felt anything from the mushrooms. For me, the combination of psilocybin, talk therapy, and moving away from the location where I had so much of my history of profound suffering was nothing short of remarkable. I am not cured of my diseases yet, by my condition has been vastly improved. If you are interested in trying psilocybin as a therapeutic, do it legally, and help in scientific research endeavors to find novel ways to treat depression you can enroll in a clinical trial. There are a variety of ways to do this, but this link is one of the best:

clinicaltrials.gov/

I wish you the best of luck in finding successful solutions to your disease. Please feel free to share my text with anyone who has interest.

References

Watford, T., & Masood, N. (2024). Psilocybin, an Effective Treatment for Major Depressive Disorder in Adults - A Systematic Review. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 22(1), 2–12. doi.org/10.9758/cpn.23.1120

Davis, A. K., Barrett, F. S., May, D. G., Cosimano, M. P., Sepeda, N. D., Johnson, M. W., Finan, P. H., & Griffiths, R. R. (2021). Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA psychiatry, 78(5), 481–489. doi.org/10.1001/jamapsychia...

Drug scheduling. (n.d.). DEA. dea.gov/drug-information/dr...