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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How can severe depression be treated when antidepressants are not helping?

My boyfriend has been suffering from deep depression for one year now. I have taken him to the hospital emergency room 6 times. Each time they have given him a prescription for a different antidepressent to try. However, none have helped. The latest, Lexapro 10 mg, he has been taking for 4 weeks now and he has been suffering side effects of one leg and arm on his right side shaking, head sweating....and he is not feeling any better. We are trying to get information on electroconvulsive therapy to see if that is an answer, but it is not offered in our community. Do you have any suggestions?
Thu, 4 Oct 2018
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Psychiatrist 's  Response
Hello! Welcome to HealthcareMagic!

According to your history, he's suffering from depression, mostly treatment resistant depression. For that :

1) First of all, we should re-check the diagnosis. So, patient history and complaints should be thoroughly interviewed again.
2) If the diagnosis is correct, then, check the dosing of medications and trail given for each anti-depressant. Normally, we give a trial of 2-3 months to look for medication working or not with enough dose. For example, you said you are presently using tab Lexapro 10mg. Here, the dose trial ought to be at least 20-30 mg for a minimum duration of 3 months. If it fails, we shall switch to another antidepressant mostly SSRI.
3) If switching of drug fails-- we can go for combination of two antidepressants OR combination with adjuvents like Lithium or Thyroxine OR Electro-convulsive therapy as you said.
4) But, there are other choices like cognitive behavior therapy and relaxation techniques.
5) I also recommend that you investigate for thyroid profile and other organic causes that should ought to be ruled out.

Hope that clarifies your concerns. Thank you for the query.

Take care

Regards,
Dr. Bhagawan Rajana, Psychiatrist
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