1.my daughter who is 30, has the problem of anxiety and depression for last 3 years. She takes paroxetine 62.5 mg for the same but still faces depressive symptoms. 2.her psychiatrist told that she seems to have treatment-resistant-depression. She was given ample ssri ,snri, ndri plus at last - mirtazapine & trazodone as well but we got disappointment. 3. Doctor told us that we will be trying tca's on her, along with paroxetine. And he tried opipramol and prothidian recently. 4.thus could you suggest some good tricyclic antidepressants to be used with paroxetine? 5. We will surely discuss it with our psychiatrist first and then will start. Please suggest some good tcas with paroxetine. Will be very thankful.
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As per the information provided, you seem to have tried most of the anti depressant medications. There are certain guidelines to confirm a diagnosis of treatment resistant depression. If there is no positive family history of psychotic illness and if she has never suffered from psychotic symptoms in the past during the depressive episode, there is a good evidence to suggest usage of pramipexole tablet for resistant depression that has shown promising results. But clinical evaluation and ecg has to be done prior to start of this medication. Using abnormally high dosage of ssris can result in serotonin syndrome which can be life threatening. Judicious usage of anti depressants is necessary.
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Dear lybrate-user you will surprise to know that upto 30% of patient don't responds to two or more medication. In such case it is important to know why she is not improving. Most of the time we missed other psychological problem that exist with depression such as personality issue, anxiety problem, family issue, personal issue, medical problem etc. Until unless these aspect is taken care of, medication effect remains limited. Since you asked for good tca, efficiency of all tca is almost same. Please request your doctor to ascertain there is no psychological or physical comorbidity. I am sure if patient doesn't have these than doctor has only option to follow treatment resistant protocol.
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Tcas & paroxetine is not a very rational combination due to their pharmacological properties. For treatment resistant depression there are other options to be tried. For example antipsychotic augmentation, repetitive tms, electro convulsive therapy and others. You can discuss those options with your psychiatrist.
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First of all a detail review needed to see any loose ends that might have been missed. Then some psychotherapeutic intervention needs to be planned to augment effect of medication. Lastly, I have reservation about tolerability issues with a combination of paroxetine and tca. We might need to explore other combinations.
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She need spiritual upliftment, talk to me.
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