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Steven Olsen
Steven Olsen, Therapist
Category: Mental Health
Satisfied Customers: 1765
Experience:  More than twenty years of expertise in counseling, psychological diagnosis and education
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Treatment resistant MDD-will pay bonus for helpful answer

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My wife has suffered from MDD for some time and has been treated by more than one Physician for it, all with no total remission of symptoms. She has tried a variety of SSRIs and SNRIs as well as Lithium and Lamitcal added to SSRIs. Some SSRIs did work for a time, (Like Luvox it combined with Abilify were somewhat effective for 8 months) then they poop out and stop working. For the past year she has been on Zoloft with Abilify. This didn't help when she first started so the Psych added Wellbutrin, this never really worked just gave her muscle pain. She was advised to stop the Wellbutrin and the Psych added 15 mg of Adderall 2x daily to her 100mg of Zoloft and 1mg Abilify. She noticed an immediate improvement in symptoms. For about six months she was somewhat stable on those medications. The exception is the premenstrual period, she became fatigued and depressed again during this time and things seem to improve when her period started. For the past 6 weeks she has been struggliing with no motivation and lack of interest in normal activities along with extreme fatigue. We adjusted the Adderall to 20mg 2x daily and dealt with some extreme anxiety and nervousness. When she skipped a day taking the Adderall those symptoms went away. Her Psych advised her to try to increase the dose more slowly 17mg 2x a day and see if that helped. No anxiety, but also no help with the depression either. Now she is taking 20 mg Adderall 2x daily for depression and unless she also has caffiene (this wears off quickly) becomes depressed and lacks normal motivation. We are wondering what to do? The doctor recommended the XR version of Adderall but at this point we are sKeptical about it. Could it be some weird hormonal thing or is it that the Adderall has become ineffective because she has built up a tolerance for it. I have watched her take 20mg Adderall then take a nap shortly after. Is this a paradoxical response to the stimulant? What's next? She is scared that she will revert back to the deep depression that made her attempt suicide last year.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Steven Olsen replied 5 years ago.

This is not an uncommon reaction to anti-depressants for a woman of childbearing age. You are correct, monthly fluctuations in hormonal levels can account for a great variance in mood stabilization. And, it is not (unfortunately) an infrequent process to see medications change at 6-9 month intervals.

 

Why is this so? There is only so long a neural cell can be encouraged chemically to absorb more serotonin. In most people, 1-2 years is a common therapeutic interval, but in some people, especially women, this interval is much shorter. As a result, various medication combinations are used with greater frequency.

 

Adderal in adults has been used in the fashion you describe, although not all psychiatrists will use this combination for treating depression. Yes, the Adderal can act paradoxically, causing relaxation and sleep.

 

As your wife may have metabolic issues, a best practice is to see an endocrinologist, who can evaluate her hormonal, renal, hepatic and metabolic processes to see if her biochemistry is indeed a culprit in her response to medication. I will also say that some research on effective stabilization of mood also encourages the use of natural supplements in combination with medication.

 

Your wife many wish to gain permission to take 1000mg of Omega Three Fatty Acid per day along with 100 mg of Magnesium glycinate, 100 mg of Calcium and 10 mg of Zinc. Research in the US and UK shows promising stabilization of mood with this combination. Steven

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Expert:  Steven Olsen replied 5 years ago.

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