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Question
Posted by: Donnie | 2011/03/15

Second opinion?

Hi CS
To make a long story short: I have suffered from depression for most of my adult life and have had a few significant Major depressive episodes with extreme panic attacks and anxiety as well. I was relatively symptom free for a few years and with my previous episode I took a Citalopram/Luvox combo and I made a full recovery within 2 months. I felt so good that I actually quit taking AD''s all together. 4 Years later I had another Major depressive episode and the psychiatrist put me on Remeron/Luvox. It is now 7 months later, I am barely coping and my anxiety and depression is still rules my life. Could it be that the Remeron is not working for me (apart from fixing my sleeping problems) or is this particular episode just very persistent? CBT has helped a bit but I still feel that there is some piece of the puzzle missing.

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Our expert says:
Expert ImageCyberShrink

Hello D,
I haven't come across much use of the specific AD combinations you describe, and I'm not sure what precise chemical rationale lies behind them, but they seem to have worked well for you in the first combo, and not so well in the second example. If this combo is not working well ( and from what you say, it isn't ) I don't understand remaining on it for 7 months - generally 2 to 4 weeks is enouygh to see whether an AD treatment approach is working or not. If it hasn't worked in a month or 2, it isn't going to start working at 7 months.
Maybe the use of the Remeron was to help the sleeping in a sedative way, with the Luvox being relied on to be the main AD. The fact is at this time, this combo is NOT working acceptably, and oher methods should have been chosen a while back. As entirely untreated depressive episodes tend to lift after 9 months o so, 7 months is way too long to persist with an ineffective treatment plan.
I would expect your doc to discuss with you the reasoning behind any such combination of meds, and what exactly each component was expected to achieve.
Discuss the lack of results this time, and discuss other alternatives to try.

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Our users say:
Posted by: cybershrink | 2011/03/15

Hello D,
I haven't come across much use of the specific AD combinations you describe, and I'm not sure what precise chemical rationale lies behind them, but they seem to have worked well for you in the first combo, and not so well in the second example. If this combo is not working well ( and from what you say, it isn't ) I don't understand remaining on it for 7 months - generally 2 to 4 weeks is enouygh to see whether an AD treatment approach is working or not. If it hasn't worked in a month or 2, it isn't going to start working at 7 months.
Maybe the use of the Remeron was to help the sleeping in a sedative way, with the Luvox being relied on to be the main AD. The fact is at this time, this combo is NOT working acceptably, and oher methods should have been chosen a while back. As entirely untreated depressive episodes tend to lift after 9 months o so, 7 months is way too long to persist with an ineffective treatment plan.
I would expect your doc to discuss with you the reasoning behind any such combination of meds, and what exactly each component was expected to achieve.
Discuss the lack of results this time, and discuss other alternatives to try.

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