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Question
Posted by: abc | 2003/12/08

treatment resistant depression

Diagnosed in 1999 with depression - since then on Cipramil 60 mg. Changed in 2002 to Nuzak 40 mg. Had relapse in August 2003 - changed Nuzak to 60 mg again without improvement after 1 month. Then my psychiatrist added Zyprexa 2,5 mg - still no improvement after another month (September). Then Zyprexa was upped to 5 mg (Oktober, November) - still no luck. Now (8 December) I started on Effexor XR 75 mg and Zyprexa 5 mg.
I'm aware I should first wait for Effexor to see if it works.
Have you any other ideas?


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Our expert says:
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Dear abc,
As I've mentioned before in answer to another question, I am deeply suspicious of how Zyprexa seems to have been marketed to doctors, as it seems to be added in on all sorts of occasions, in treating Depression, far in excess of the evidence that this is the best option. So put me down as a Zyprexa sceptic, so far.
Most antidepressants seem to be effective in around 70 % of the people who take them for depression ; and switching to another AD, even a similar one, and perhaps more logically to one from a different family and chemical type, may be more effective.
Your story is a little complex. You were first on Cipramil, and presumably responded to it (?), though 60 mg is rather a high dose of that drug ; then you were switched to Nuzak (Fluoxetine, like Prozac) ( ? because you weren't responding so well to the Cipramil ? ) Effexor works a little differently to the Cipramil/Nuzak family, and was a logical alternative to try --- so let's see if it works for you, as well it might.
If not, there are other types of ADs to be tried ( such as Aurorix ) ; and there are other methods for improving the response rate of ADs, other than the over-promoted Zyprexa, which can also be tried.

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