Hi XXXXXXX

Thanks for writing in to us.

From the short description that you have given us, there is a history of chronic to severe depression and you have been battling it out for the last 20 years. Fighting depressions is not an easy job and I am sure you are putting great effort to keep yourself fine.

You do mention about having taken recommended medical regimes, could you please share details about your earlier medications and the duration for which you have been taking them, that would be wonderful. I would also like to hear from you about any life events that have affected you and may have come as obstacles in your fight with depression.

You could also share any experiences with therapists, number and frequency of such sessions and what you have felt about it. This will help me in assessing your condition better.

Marinol THC (tetrahydrocannabinoids) contains dronabinol as active ingredient and is an artificial cannabinoid. It does work in certain group of patients and mostly used as a short duration treatment. However, I would like to review all your medications taken in the past before suggesting you a more comprehensive approach towards a healthy life.

I am sure you will soon be independent and able to take care of your family.

Eagerly waiting to hear an update from you.

Regards
Dr A. Rao KAvoor

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Hi,

Thanks for writing back,

Let me shed some light on the options you have.
The usual reasons for not responding well to antidepressants are presence of additional problems in a patient with depression like an anxiety disorder, medical disorder, poor social support, long standing depression, substance abuse etc. There have been alternate options thought of for patients who show no response. Firstly there are many antidepressants that are available to us currently and inspite of belonging to the same class of drugs they have been found to show different responses in different patients and also in the same patient. These drugs take time to show improvement and a drug cannot be assumed to be not helping till the optimal dose is given for 10 to 12 weeks. That’s how long it may take to show full response in a patient.

The different antidepressants available to us apart from sertraline (Zoloft), bupropion (wellbutrin), fluoxetine(Prozac) and currently paroxetine (paxil) that you have tried are many like escitalopram, citalopram, venlafaxine, desvenlafaxine, fluvoxamine, mirtazapine, trazodone, duloxetine, tricyclic antidepressant class of drugs - which in turn has many molecules under it.

In case of no response another option is to augment these drugs with agents like lithium, buspirone, anticonvulsants etc. Another option is to combine antidepressants. There are various combinations that are known to show improvement in patients.

There are newer somatic treatments as well like rTMS or repetitive transcranial magnetic stimulation, Vagus nerve stimulation etc that are completely painless and simple procedures that have shown good response in many patients.

Marinol is not an approved drug for depression. It is still being studied in clinical trials and its effectiveness not established fully. You may have read that it has been studied in several patients and found useful but these studies have been found to have many limitations that render the results ambiguous. Apart from this, it has also been seen that cannabis can cause or worsen depression in many patients. Hence it would be worth trying other options first.

Please go back to your psychiatrist and discuss your problem in detail so that a solution can be found.

Wishing you lots of XXXXXXX in your life,

I hope this answers your question,
Write back in case of any doubts,
Dr. A. Rao. Kavoor.

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