By eighteen I had been on at least a half a dozen anti-depressants with little to no relief. Around the age of seventeen I had changed psychiatrists; at the end of every session, she brought my parents in and explained what diagnoses she was toying with and which new pills we would try. It seemed like no matter what we did as far as playing with dosage, I never seemed to find any relief. I will admit that I may have been leaving out a huge piece of my history, so they often misinterpreted certain symptoms as bipolar as opposed to chemical dependency and post-traumatic stress disorder. Regardless, until I went to treatment and had the good fortune to meet the most brilliant psychiatrist, I never progressed in any direction when it came to the psychiatric meds that were dispatched. It is not to say that finding the right cocktail of meds improved my overall state of mind, but it does work to decrease the biologically based depression and anxiety to a degree, allowing me the ability to function and progress in the management of my psychological issues. In order to best handle my treatment resistant depression, anti-depressants and anti-depressant augmentations have proven themselves reliable.
Treatment resistant depression is often better treated with a traditional anti-depressant in conjunction with a mood stabilizer, stimulant, or anticonvulsant. Using these medications in conjunction with one another means that they are often given in lower dosages; for example, I am on Cymbalta with a low dosage of lithium carbonate. The lithium is at a fraction of the dosage it would be if it was being used to treat bipolar symptoms.
In addition to the lithium, I am also on Deplin. Deplin is not a psychotropic drug, but it provides a huge amount of folic acid, increasing the effectiveness of psychotropic medications. According to Deplin’s website, “as many as 70% of people with depression have a genetic error called the MTHFR polymorphism that limits their body’s ability to reduce dietary folate or folic acid into L-methylfolate” (Deplin, 2011). Deplin is ideal, because it has little to no side effects.
The other major benefit of the anti-depressant augmentation is that it allows me to be on a lower dose of Cymbalta, while still reaping the benefits and avoiding the negative side effects. In my experience, I do not suffer from negative side effects from a medication until I reach a high dose. For example, I used to be on a very high dose of Cymbalta and found that I couldn’t concentrate. My doctor lowered the level of Cymbalta and started introducing anti-depressant augmentations. I now experience the positive effects of my anti-depressant while experiencing none of the negative side effects.
For the first several years of anti-depressant use, I failed to get consistent, high-quality therapy and refused to be honest in the therapy sessions I did have. I did not divulge my full history or current drug and alcohol abuse. It was a conscious decision to not talk about or lie about my chemical dependency. I genuinely thought that I knew better. I believe that my drug use played a huge role in my anti-depressant regimen never being successful. I was not near processing the real issues and I likely had chemical reactions going on between my medicines and illicit drugs that not only rendered the medicine less effective but also reinforced my depression. Without dealing with the underlying issues, I do not know how much the appropriate medicine could have really helped. The right medications are a miracle, but it is only through the right medications and good therapy that transformation and permanent change can occur.
Deplin. (2011). What is L-methylfolate. Retrieved 2012, from Deplin: http://www.deplin.com/folate-for-depression/