You didn't say how severe your symptoms are when you are depressed
My dystymia is characterized mostly by mild/moderate anhedonia, difficulty making decisions and lack of motivation. It is some sort auf agitated dystymia with much restlessness. I have to say that the psychomotor agitation is the worst part about it... I would like to calm down and not be psychotic hamster ^^
I had two acute depressions, but those were mostly reactive to difficult life circumstances.
I am not suicidal and I never was.
Dysthymia is actually very hard to treat. Acute depressions are when your brain is out of whack, so you just need a little boost in order to return to a "normal" state. The problem is that dysthymia is "normal" for your brain. It is very difficult to change this homeostasis.
I have found out for myself that an organized and strict lifestyle (sleep hygiene, exercise, regular relaxation, eating habbits) has very positive effects on my Dystymia, but it doesn't lead to full remission. That's why I am trying also ADs and psychotherapy etc.
The real dilemma here isn't your medication options. There are plenty of potent drugs out there. The issue is that psychiatrists don't want to prescribe them.
IMO, based on research I have done, you need to be aggressive and pursue a full remission.
So your doctor is probably unwilling to prescribe the meds powerful enough to give you full remission. They are completely accustomed to working with SSRIs, antipsychotics and a few other drugs.
I agree. Especially in Germany they are very strict and overcautious when it comes to anti depressants and psychopharmacology. They mostly prescribe SSRIs.
Here are some stats on German prescriptions: http://www.mind-and-brain-blog.de/en...tidepressants/
Mirtazepine is a good compromise, probably as good as you are going to get from your doctor now, and it won't give you those unwanted side effects. Neither will Wellbutrin. It should be easy enough to get a prescription for either or both of these drugs.
I was also thinking about some synergetic combos
, for example Venlafaxine + Mirtazapine or a SSRI + Mirtazapine. But I definitely need something that stimulates my appetite & and helps with my sleep & agitation... Mirtazapine seems to be a promising candidate
Mirtazapine in combination with an SSRI, SNRI, or TCA as an augmentation strategy is considered to be relatively safe and is often employed therapeutically, with a combination of venlafaxine and mirtazapine sometimes referred to as “California rocket fuel”.
Antagonism of the 5-HT3 receptor, an action mirtazapine shares with the approved antiemetic ondansetron, significantly improves pre-existing symptoms of nausea, vomiting, diarrhea, and irritable bowel syndrome in afflicted individuals. Mirtazapine may be used as an inexpensive antiemetic alternative to ondansetron. Blockade of the 5-HT3 receptors has also shown to improve anxiety and to be effective in the treatment of drug addiction in several studies. In conjunction with substance abuse counseling, mirtazapine has been investigated for the purpose of reducing methamphetamine use in dependent individuals with success. In contrast to mirtazapine, the SSRIs, SNRIs, MAOIs, and some TCAs increase the general activity of the 5-HT2A, 5-HT2C, and 5-HT3 receptors leading to a host of negative changes and side effects, the most prominent of which including anorexia, insomnia, sexual dysfunction (loss of libido and anorgasmia), nausea, and diarrhoea, among others. As a result, it is often combined with these drugs to reduce their side-effect profile and to produce a stronger antidepressant effect.
Like many other antidepressants, mirtazapine has been found to have antinociceptive properties in mice. However, unlike most other antidepressants, though similarly to venlafaxine, these effects are mostly mediated through downstream modulation of the endogenous opioid system, of which in the case of mirtazapine the μ opioid and κ3 opioid receptors are mainly involved. Interestingly, while virtually all antidepressants differ little in their maximal effectiveness in the treatment of major depression, mirtazapine and venlafaxine have demonstrated superior efficacy in treating severe types of depression such as psychotic depression and treatment-resistant depression. This may be due to their unique influence on the opioid system, which is a property that may give them an advantage over other antidepressants in cases of severe depressive symptomatology.
A comparative meta-analysis of 12 major antidepressants found that venlafaxine, mirtazapine, escitalopram, and sertraline were significantly more efficacious than duloxetine, fluoxetine, fluvoxamine, paroxetine, and reboxetine. A combination of venlafaxine and mirtazapine achieved remission rates (defined as a HAM-D score of 7 or less) of 58% in one controlled trial. In combination with an antipsychotic medicine aripiprazole, better results in treatment resistant depression in older adults have been demonstrated.
Doctors love to switch from one SSRI to another, but it is very likely if you experience nasty side effects on one SSRI you will experience the same problems on another SSRI.
Yes, that's what I am afraid of. Doctors here like to cycle SSRIs and waste the life-time of their patients...
I am on an MAOI which is popular on these forums, I don't want to go into much more detail but read around here for testimonials. MAOIs are powerful drugs, and Parnate especially produces remarkably few side effects. I have insomnia, that is it. .
To get a MAOI prescribed in Germany, I would have to lay down onto the track bed and wait for the train to cut my head off
They'd rather prescribe me electro-convulsive therapy than MAOI
Oh and if Cara Delevigne jumps you but you don't feel into her, send her my way
Unlikely, but I will keep that in mind