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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4615
Experience:  MD Psychiatry
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My partner has been suffering from depression for 5 or 6 years.

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My partner has been suffering from depression for 5 or 6 years. He has continued to work where he struggles to 'portray' himself as well. Outwith work, he can only be with people, including me, when he feels able and distances himself when necessary. He is currently taking Ramipril, Citalopram and Trazodone Hydrochloride. He suffers severe insomnia and occasionally takes a triple doze of citalopram as he does not want to be prescribed sleeping pills. The medication appears to be having no positive effect and occasionally he is tearful and talks of there being "no point". He has been told that the only options left open to him are Lithium or ECT. I feel so helpless. I appreciate that without a full medical history you may not be able to advise however, if possible, could you please advise a) if there could be any contra-indications with current medication, b) are Lithium and ECT the only other options and c) any suggestions you would make if the patient was your partner.

Hi there,

 

Welcome to JUST ANSWER !

 

Well, it seems that both you and your partner have been struggling because of your partner's depression , and understandably so, however i need to tell you two things in reply to your question.

 

First of all , the current drugs he is taking , out of them trazadone and citalopram are the anti depressants , while ramipril is an ace inhibitor used for controlling high BP, or controlling palpitation or for other heart conditions.As for citalopram and trazadone are concerned they are fairly good anti depressants , but it is quite possible that your partner has developed tolerance to them meaning that the effectivity of these drugs has been reduced , and hence the symptoms of depression haven't got alleviated. and no there are no major side effects or contraindications of these drugs.

 

So, i propose you ask his doctor to put him on anti depressant called Venlafaxine extended release tab (EFFEXOR XR) instead of citalopram, and, along with it continue Trazadone , but make sure it is given at night. Also start him on clonazepam(klonopin) which is an anti anxiety drug , 1 tab to be given after lunch and 1 tab after dinner , this will keep him less anxious and stabilize his mood swings and also assist in sleeping. Also you may ask your partner to seek Psychotherapy ( counselling in lay term) ,which is offered by a clinical psychologist/ psychotherapist and this therapy is very effective in treating depression. The best type of psychotherapy for depression is Cognitive Behavioural therapy (CBT).

 

Besides , this lithium which is a mood stabilizer and since many years have been used in depression, can be given in low doses to assist the anti depressants in treating his depression, and once your partner has been stabilized , this drug and other drugs can be slowly tapered ,and eventually will be taken off.

 

As for your concern regarding ECT ( electro convulsive therapy), please take notice , that till date there has not been a better and safer treatment option for treating major depression than ECT, which may surprise you , as you must have thought of ect as a dreadful and painful treatment modality. I believe, almost all psychiatrist would swear by the unmatched effectiveness of ECT in treating depression, plus contrary to the perception , ECT is very safe and is given under General anaesthesia under supervision of a psychiatrist and anaesthetist and support staff, and is a short procedure taking 15-20 minutes and then the patient regains consciousness. I know, like others , you and your partner also have apprehension about using ECT, because of the negative publicity it has got , courtesy people who are ignorant towards depression as a condition as well towards the use of ECT . I am telling you this in detail because , if at all the need arises for you partner to take ECT, you should not worry and just go ahead with it , and this information might just help you and your partner to bring things into perspective and remain calm.

 

But, as of now, I suggest you discuss the modifications in the drug treatment i have mentioned above , with your partner's doctor . I believe , this change will have a positive outcome on his condition.

 

I wish your partner and you all the best .

 

I hope my answer serves your query according to your satisfaction.

 

Regards..

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