Expert: Ivan Goldberg, M.D. - 5/29/2005

Question
 I am 54,I have taken over 35 different anti-depressants and combinations of other drugs that are used in bipolar depression.  I was diagnosed in 1970 and "finally" in 1995 I found a Dr. who put me on Nardil.  For the first time in my life I had a taste of what others feel as "normal".
 In 1996 I had a stroke, so Nardil was "out"-way too complicated for all the other drugs.
 I've tried so many more but nothing works.  I do a lot of research on the net looking for something that might work.  I remember hearing that there was to be a "Nardil Patch", but have heard no more.
 Any suggestions?  SSRI's, tricyclics, SSNRI's and the other non categoric ones seem to do nothing much.
 Thanks for your help.
Sijka

Answer
Hi . . .

I have not heard of a Nardil patch, but there has been talk of a selegeline patch. Selegeline is a MAOI that does not require food restrictions.

While many people have tried Lamictal, few have had their blood level of Lamictal checked to make sure that they are taking an adequate dose.

Another possibility is the Dalhousie Cocktail. See the following abstract:

J Psychopharmacol. 2001 Jun;15(2):136-8.
 
The 'dalhousie serotonin cocktail' for treatment-resistant major depressive disorder.

Dursun SM, Devarajan S, Kutcher S.

Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. sdursun@is.dal.ca

We describe the successful treatment of five patients with treatment-resistant major depressive disorder (TR-MDD) with a combination pharmacotherapy of pindolol, tryptophan and nefazodone. Five TR-MDD outpatients who had previously not responded to at least four different antidepressant medication trials were initiated on 300 mg/day of nefazodone, 7.5 mg/day of pindolol and 1 g/day of tryptophan. Pindolol doses remained the same throughout the 20 weeks, while tryptophan and nefazodone dosages were gradually increased to 8 g/day and 450 mg/day, respectively. The Hamilton Depression Rating Scale (HAM-D) was used to evaluate outcome. By week 4, all cases demonstrated at least 50% decrease in HAM-D scores. At the end of the trial, the group mean HAM-D score had significantly decreased from 26.8 (+/- 1.9) to 1.8 (+/- 0.8) (p < 0.001). No significant adverse effects were reported. These results suggest that if serotonin availability and release is further enhanced by tryptophan in the presence of nefazodone and pindolol, an antidepressant effect may be produced in patients who are otherwise treatment-resistant. Due to limited sample size, an open design and an 'unusually' high successful efficacy rate of this preliminary study, controlled studies are required to confirm the efficacy of this treatment strategy.

Best regards . . .

Ivan
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