long-term, mega doses etc.

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After a hellish treatment-resistant year+ of severe depression, trying paroxetine followed by venlafaxine, dothiepin (as it was then), mirtazapine and reboxetine (the worst - horrible anxiety) my psychiatrist tried lithium augmentation. I refused to stay on reboxetine and asked to go back on dothiepin as, ironically, I found the side-effects much more tolerable than those associated with the newer drugs.

Dosulepin (200mg) and lithium carbonate (400mg) worked really well for me. They quite possibly saved my life and almost certainly saved me from ECT. I took them for 6 years - yes, 6 years at 200mg, not exactly a 'maintenance dose'. During that time I had few side effects, felt great, took up running, went trekking in the Himalayas and passed my advanced driving test. Came off everything in 2005 and don't remember having any problems. Insomnia was once again a problem but always has been for me. Apart from that life was going really well for me and by the end of 2008 I was feeling really happy and optimistic about the future.

Don't know why the depression came back in February 2008, but it did. Could well have been associated with the subclinical hypothyroidism (6 years of lithium?? another story). So back to see a new psychiatrist, who persuaded my GP to put me on thyroid replacement at last, which has made me less weak and exhausted but not much effect on the mood.

Now I'm on 300mg a day (!) of dosulepin and 600mg lithium. It is all taking a long time to have much effect but despite the industrial-strength dose there seem to be few side effects. Also, the thyroxine dose needs to be titrated, so it's early days there. Just wondered if anyone else had had a good response with dosulepin, come off it and found it to be less effective second time around? Also scared about the prospect of being on it for a long time to come and its long-term effects.

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    Hello my story is similar to yours except I don't have a thyroid condition yet. I have been taking prothiaden/dothiepin for sixteen years mainly at 150mg which is what I'm taking at the moment. I am also on lithium/priadel 1,000mg. Last year I had a relapse so mirtazapine was added into the mix. This helped a great deal but I put on a stone and a half. My diagnosis is severe recurrent depressive disorder. Most of the time I keep well. When I'm ill I'm very very ill suicidally depressed. I have often wondered what would happen if I came off the dothiepin. Recently I have withdrawn from mirtazapine. It was a hellish experience and I had the full run of hallucinations, sleep disturbance sleep walking, severe panic and anxiety. I had a small gap after I had my son but went back onto dothiepin fairly quickly and it seems to work well. Now I'm not so sure. I have been warned that I might be hospitalised if I want to come off any other meds as I have such a bad reaction to them. If the meds work for you then you should stay on them unless your pdoc says otherwise. They are 'heavy duty' meds but they work well for us?
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    Thanks for your reply. I've accepted the fact that I'll be taking these drugs long-term. To be honest, I'd much prefer to be on a drug that has been around since 1969 than one of the newer ones. At least its side-effect profile and long-term use are well established and it is is known to be very effective. Given the number of people who take this drug, I think if there were any serious problems associated with its long-term use, or coming off after many years they would be well known by now. That's what I tell myself anyway!

    Interesting to hear your experience of mirtazapine. That is one of the possibilities for adding in if no improvement by mid November. Good to hear it worked for you but sorry you had such a nightmare time coming off. Sounds very unpleasant. Did take mirtazapine for a couple of months on its own before and don't remember any side effects, although am fortunate to be relatively tolerant to most drugs I've taken.

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    If I have another relapse my psych has said he will add in an anti psychotic such as risperidone. Think I will need to be persuaded that there is no alternative. I'm quite intolerant to a lot of drugs including most pain killers. It is quite difficult sometimes. The mirtazapine did give me the boost that I needed last year.
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    Have now been on atypical antpsychotic olanzapine (Zyprexa) for nearly a week (in hospital). Low dose 2.5mg. Side effects include very dry mouth - but then all 3 of my AD meds cause that, also slight tremor for first few days which has now subsided. Apparently weight gain is very common and have met several people here who have experienced this. Mind you, the food here is very good and very plentiful. Felt a bit more motivated today. It can be very boring in this place.
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