Treatment resistant depression

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Things that I have tried before:

Seroxat (Paroxetine) – Didn’t work
Celexa (Citalopram) – Didn’t work
Prozac (Fluoxetine) – pooped out
Zyban (Bupropion, low dose) – Didn’t work
Wellbutrin (Bupropion) – Didn’t work, only made me angry
Effexor (Venlafaxin) – Mild effect in mood improvement, zero improvement of fatigue
Modafinil (Provigil) – Did wonders for my excruciating fatigue, until…it pooped out shortly after
Caffein – Gives me 30 minutes of totally artificial energy, enough to crawl out of bed. But also increases anxiety…
Yoga, osteopathy, therapy- no noticeable effect

I guess this (above) is why they call it “treatment resistant”, right?!

I am currently stuck with:

225mg/day Venlafaxin/Effexor, 100-200mg/day Modafinil, 200mg+/day Caffeine

9 hours of sleep per night

and this is the minimum to be able to start working in the morning and yet the brain fog never lifts. Although my mood is slightly better I still feel an immense weight over my shoulders and all I think about is running home and hiding in bed.
Some days I think that this can’t be “it”, there must be something else out there to help me. Yet the only perspectives that are still left are:

Electro-convulsive therapy (ECT)
Transcranial magnetic stimulation

which are, as far as I know, not compatible with an active professional life.
So I am still hanging in here, waiting for better days to come…I hope I have the strength it takes to carry on, in case they never do.

Any suggestions?

Sleep, Dreaming and Depression: the fine balance bewteen too much and too little

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Depression comes in a variety of colors and shapes.

When in comes to sleep, it can be associated both with excessive sleepiness (hypersomnia) or with difficulties in falling asleep or in sleeping continuously for a reasonable number of hours (insomnia). 

Altered sleep patterns are one of the key symptoms of depression, a box that most of us tick without asking further questions. In my case, the constant sleepiness and fatigue justified a 2 day sleep test which taught me what I already knew:

- I am naturally a “long sleeper”, i.e., I need 10 hours per night to feel rested

- have a short REM latency, meaning that I start dreaming shortly after falling asleep

- and I have more REM sleep than a normal person.

While I was probably born to be a long sleeper, the two latter come hand in hand with depression and result in very vivid dreaming. My sleep is not restful or refreshing, I remember my dreams almost every morning and often they are long and complex enough to write a small book. This could be fun and inspiring…and it is a source of some surreal conversations. However, in practical terms, it is basically like living two lives: it means having to deal with a lot of stressful situations that did not really happened, on top of every day (real) life. It is tiring, often overwhelming and disturbing. My most “epic dreams” are usually followed by a worsening in my mood and fatigue.

Although I know that I am not alone here, there little information published about this correlation and I had to work hard to convince my Dr that excessive dreaming (REM) and depression are closely linked in my case. If in one hand this helps me to understand my disease, on the other it has no practical implications: you need to treat depression to decrease REM % and increase latency, which in turn should contribute to improve depression. Confused? Here is the most recent explanation, in very simple terms:

 

“In some people who are depressed, it’s a good thing to suppress their REM [sleep] because REM is associated with specifically strengthening emotional memories, and in many cases negative memories. So there’s an idea that it might be that in people who have too much REM, as many depressed people do, these negative memories are getting over-strengthened, and that can actually be quite damaging and quite pathological.”

Dr. Penelope Lewis – Director of the Sleep and Memory Lab, University of Manchester, UK and author of “The Secret World of Sleep: The Surprising Science of the Mind at Rest”

How about you? Do you sleep and dream too much or too little?

 

Smiling Depression

People with depression are great pretenders! We can leave home with a big smile in our faces, perfect make up, looking healthy and refreshed and can easily be mistaken by the happiest people on Earth. Sometimes, we feel some miserable inside and are so concerned in concealing it…that we over do it! We smile too much, we speak too much and finally when we get home and close the door behind us…we are exhausted of being that “other happy person, just wanting to crawl in bed and “die” until the next morning.
Many will tell you that it is a way of hiding the disease from their employers, friends and family, others are in denial and are trying to convince themselves, other…are just in survival mode. Whatever the reasons are to wear this mask the truth is that many of us do it, and very successfully, turning the “smiling depression” into one of the most dangerous ones.
We go so far in trying to hide it that I remember seeing my current therapist for the first time and telling her about my feelings with tears pouring down my face…while my slips were still smiling! Sad isn’t it?
Well sufferers of this strange form of depression never miss a day of work, never admit being too tired, too sick, find excuses to avoid social contact and put an enormous amount of pressure on themselves. The fatigue that results from this lifestyle can only be solved with endless hours of sleep during evenings and weekends, when we allegedly went “traveling” or to the “cinema”. My phone is often…”broken” or in silence. I have done my 10 hours of “pretending to be my happy me” in the office so now I just want to be my sleepy and unhappy me.
Sleeping has since very early (and for various reasons, which I will tell you about later) became my favorite coping mechanism….what is yours?and by the way do you know anyone who could suffer from “Smiling depression”? Tell me about him/her.
Sweet dreams everyone….

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Entering the forest…is anybody there?

Hello
This is my first trip into the blogosphere forest. I know I am not alone.
I come with a “secret” (or many): I suffer from treatment-resistant depression, it started in my early adolescence and apart from my soul-mate and my psycotherapist, no one else around me is supposed to know about it. I have the maximum academic degree one can achieve, a demanding job and never stopped working. All my close family have suffered from depression, both my parents tried to end it all and me… well my secret weapon is my sense of humor (since medications don’t work perfectly anyway)! And I am still here.

I will tell you all about it if you help me to make sense of all of this…will you?