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Pharmaceuticals for depression not effective

Aug 25, 2004

Dear Dr. Horwath:

I was diagnosed with major depressive disorder (recurrent) as well as panic disorder back in 1990. I have been taking 1 mg TID of Klonopin for the panic disorder since 1990 and it has been totally effective. However, I have been through about 12 different antidepressants with anywhere from no relief to at best 40-50% relief. Currently I am taking 40mg of Celexa QD. It helps, but it really is not completely effective in relieving my symptoms (about at the 50% level, the best I have found in 14 years). When I found out I was HIV+ in 1997 I can only assume that this contributed additionally to my already established depression. I am on Sustiva and Combivir and can't help but wonder if the Sustiva ISN'T helping my depression (although it keeps me undetectable and with a strong t-cell count in the low 40% range). I am afraid to change the Sustiva since it is a "one shot" drug as far as my HIV goes, but, if it is adding to my depression I would change it in a heartbeat. Also, the last two professionals I saw (a psychologist and a psychopharmacologist) both stated they believe I have "drug resistant" depression to a fairly high degree. The latter even suggested that I undergo ECT. I'm tired of being unhappy and desperate all of the time. Knowing a bit of my history (and that my depression began BEFORE I was HIV+), what is your opinion on possible options to lead a better quality of life? I don't want to live like this any longer. (P.S. I've done plenty of "talk therapy" and it really doesn't help very much, so I believe the doctors when they say my depression is organic in origin).

Desperate to be happy,

Sad Sack

Response from Dr. Horwath

It is true that Sustiva causes depression in some people who take it. However, your depression started before your HIV and use of Sustiva, as you pointed out.

There are a variety of effective treatments for depression. Without knowing which drugs you've taken, for how long, and at what doses, it is difficult for me to suggest other options. Some psychiatrists are reluctant to prescribe tricyclic antidepressants or use lithium for augmentation of antidepressants, but these are among a variety of medication strategies that are often effective. I would advise getting a consultation from an expert psychopharmacologist who is experienced with depression (and HIV, if you can find one in your area).

Response to send in the clowns
Keeping A Good Attitude

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