Q. Can Dopamine agonist help with depression when other treatment fail?
Hello doctor,
I have ongoing horrible depression, I have tried TMS, every SSRI, Ketamin, and electroshock. I take Ritilin, Colonpin, Levothyroxine, and Ambien. Would a dopamine agonist possibly help with depression when all others have failed? Please suggest.
Hello,
Welcome to icliniq.com.
It is a refractory depression. There are a few pieces of evidence to show that dopamine agonists like Pramipexole may help in such cases.
1. Adding Bupropion (Ethyl cellulose aqueous dispersion (NF), glyceryl behenate, methacrylic acid copolymer) to SSRI (selective serotonin reuptake inhibitors).
2. Mirtazepine (Colloidal silicon dioxide, Corn starch, Hypromellose, Lactose monohydrate, Magnesium stearate) plus Venlafexine (Sodium starch glycolate, Povidone, Magnesium stearate, Ferric oxide yellow).
3. MAO (Monoamine oxidase) inhibitors like Tranylcypromine (Calcium sulfate dihydrate, Erythrosine).
4. Dopamine agonists like Pramipexole (Pramipexole dihydrochloride monohydrate) are added to antidepressants.
5. Concurrent CBT (Cognitive behavioral therapy) sessions.
6. Augmentation with Aripiprazole.
7. Augmentation with lithium.
8. Adding Olanzapine Fluoxetine combination.
I hope this helps.
Thank you.
Investigations to be done:
Erythrocyte folate levels test.
Vitamin D levels.
Hello doctor,
Thank you for replying. No SSRI has ever worked, I have tried them all. I just read up on MAO inhibitors, I know it has more side effects, but is it worth trying? I do not have bipolar, no mania. It is more than no memory, my brain no longer connects with my body. I watched my mom slowly die from this with no proper diagnosis. Kindly help.
Hello,
Welcome back to icliniq.com.
Yes, MAO inhibitors do have side effects but not as common as usually projected. You need to avoid certain food items while on them like pickles, and canned processed foods. But they are worth giving a try under the supervision of a psychiatrist, especially in a refractory case like yours. Besides SSRI other treatment options as told by me in a previous post are also there. Vortioxetine has been shown to be especially useful with cognitive issues. More importantly, do not lose hope, remember every problem has a solution and sooner or later you will find it, and help is just a step away.
Thank you.
Hello doctor,
I lost hope a long time ago, it is just my body is still here. I cry every single day and now to the point of panic that I do not leave the house. I have suicidal ideas beyond belief, I feel no joy, and I even lost my empathy over the last few years. I do not mind avoiding food or eating. I weigh 100 pounds. I talk to my psychiatrist. I truthfully have taken the tablet of Prozac in a week, but it does not help. Would MAO have interaction with Klonopin or Ambien? Thank you so much for responding. I feel hopeless.
Hello,
Welcome back to icliniq.com.
Usually, MAO inhibitors are started after four to five weeks of stopping SSRI. MAO-I does not have many interactions with Klonopin (Clonazepam) except for a slight chance of increased blood pressure, and with Ambien, it can just increase the sedative effects of Ambien. But these interactions are more theoretical than practical.
I Hope this solves your query.
Thank you.
Hello doctor,
Are you in the states? I am looking for a neuropsychiatric voluntary inpatient unit that will accept me.
Hello,
Welcome back to icliniq.com.
Sorry, I am not from the US. You have to find that with the help of a local psychiatrist.
Thank you.
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