DEAR DR. ROACH: My wife was diagnosed with depression, and she has tried many medications such as risperidone, lamotrigine, amitriptyline, Depakote and others. The longest time a combination worked before her relapsing was less than three months. Some of the medicines that were given were even making the matter worse, and all efforts to convince the doctor weren’t successful. Presently, we are at home, just changing her diet and having her take plenty of water. — J.O.K. ANSWER: Depression is a medical illness that can lead to serious consequences if it is not successfully treated. Medication is one of the two mainstays of treatment (along with therapy), and there are many classes of antidepression medicines. For my patients with moderate to severe depression, I recommend psychotherapy in addition to medication, but this also depends on a person’s preference.
However, you didn’t specifically mention two of the most common classes of antidepressants: the SSRI class (such as citalopram or sertraline) and bupropion. She may already have tried these, but two of the medicines you mentioned are anti-seizure drugs (lamotrigine and Depakote). One is an antipsychotic medicine. These are often tried when the first-line medicines haven’t worked, so if she hasn’t tried one of the SSRIs or bupropion, these would be reasonable choices.
When a person doesn’t respond to the firstline treatment, then it is appropriate to begin seeing an expert in depression, such as a psychiatrist. Augmentation with a different class of medicines is a reasonable consideration at this point. Respiridone is a common choice, but there are many others.
Alternatives include transcranial magnetic stimulation and electroconvulsive therapy (ECT). Prior to medical school, I remember being horrified by ECT (based on some of the books I had read), but having seen the effect that ECT can have on severe depression, I have come to accept it as a very reasonable treatment for resistant, severe depression.
I don’t know how serious your wife’s depression is. Not everybody needs to consider all of these options. But it sounds like she is still having significant symptoms that aren’t being treated, so if at all possible, I would find a doctor who specializes in depression treatment.
