They are saying my mum is resistant to medicines tried so far.. What next?

[JoeyLin]

My mum is 65. She has been on sertraline, then a combination of Mirtazapine and Venlafaxine.. Now they are going to try fluoxtine ..

However, they have increased doses and changed.. but still no change to her mood. Brain scan has come back clear. She has also taken olanzapine.

What would be next after these class of medicines?

My DH has treatment resistant depression as part of a wider bipolar diagnosis, (although his mania tends to present as anxiety / inability to focus). He is on a combination of lamotrigine, sertraline and quetiapine. It's not perfect but it's done a better job of keeping him stable and preventing suicide attempts than any of the many, many drugs his various psychiatrists have previously tried over the years. He's in his 70s now btw, so not too dissimilar to your mum OP. Good luck, it's tough going but I hope her medical team find something that helps her.

I'm not a professional so my comments are just from my experience. And I wouldn't give advice personally as I don't know enough. I just know with me I was undiagnosed autistic and ADHD, I suffered autistic burnout but we didn't know that's what it was -at first I was diagnosed with depression and anxiety and out on meds, some of which you have mentioned. And they made me worse, they made me really bad mentally. So dosed are upped new meds are tried etc etc it was the start of years of my life lost to being mentally unwell. Had a couple other mental health misdiagnosis in there. Eventually I refused meds as they didn't help. I got better. Had an autistic child realised I was autistic and I got happy/ok with who I am.

I often think of meds are not helping have you tried none? Just rest and compassion for the person to recharge and move on. I had suicide attempts because of those meds. Many nurodiverse people have similar experiences with SSRI. Our brains lack dopamine not serotonin.

But this is just my experience not advice

Ketogenic metabolic therapy is extremely effective for mental health problems. Look up the work of Dr. Christopher Palmer. He’s a psychiatrist who treats his patients with metabolic therapy.

I take Amitriptyline. The first line ones just don't work on me. Mirtazepine did nothing, literally tried it all. They wouldn't prescribe me the Amitriptyline until I had tried everything else available and wouldn't prescribe it higher than 50mg unless I had a psychiatrist request them too.

After a bit of digging I found that this is because it has a lot of side effects (I experienced hardly any, just a dry mouth) and is absolutely lethal in overdose. GP was quite resistant to me trying it, called it a sledgehammer solution but it does undeniably work. It made a huge difference to my mood and also makes you sleep so that helped too.

The psychiatrist said it was fine, didn't understand what the GP was worried about and prescribed it happily. Said he would rather I was on that than Duloxetine which was GPs suggestion.

Worth trying HRT as this can also resolve depression/anxiety symptoms in peri/ante/post menopausal women. There are loads of different antidepressants out there which can be tried- different things work for different people. Also worth looking at what’s happening in her life that may have triggered the depression. Can anything be done to change things?

I'm so sorry to hear you and your mum are going through this - I had a very similar situation with my mum. She'd had a period of extremely severe depression about 30 years ago, and then it seemed to come back almost overnight with no obvious cause, and she went from being incredibly warm, funny, social, to a husk who had to essentially be forced to do anything other than sit on the sofa with the TV on (but not really watching).

Like your mum, she wouldn't engage with a therapist (I'm not sure how telling a woman who tried to throw herself out of the car on the way to the session that she should 'focus on enjoying smelling the flowers' was supposed to help), or me, or her other family members, or her friends. She went through what seemed like endless medication changes with no effect whatsoever. There was a period of about six weeks where she suddenly developed crippling anxiety, which eventually went away - but the depression didn't. She ended up being sectioned at one point and spent about six weeks in a psychiatric unit where she apparently managed to convince the doctors she was recovering - only for her to revert right back to the exact same almost catatonic state the day after she came home.

In the end, the only thing that worked was ECT. She had a few weeks of sessions and nothing changed - I was honestly convinced that nothing would bring her out of it and I'd never have my 'normal' mum back again. Then after maybe the fifth week of treatment, she suddenly started having better days. Nothing too shocking - but letting me wash her hair, being persuaded to come out in the car for a drive, watching a TV show together. And then one day, it was honestly like the sun came out - I asked her how she was feeling and she said 'not too bad', and now (she was unwell for about a year and a half in total) she's back to normal. I know ECT is a 'once everything else has been exhausted' treatment but honestly, I really think she'd be dead if it wasn't for that. If you can discuss it with a doctor, please do.

There is a flipside to ECT though and some people are never the same again, in a bad way. My husband went into ECT a professional holding down a full-time, challenging job, but plagued with persistent depression and near-constant suicidal ideation. He came out of six weeks of it broken, with his memory and concentration permanently shot to pieces (and still with the depression etc) and ended up having to leave that profession completely a few months later because he could no longer cognitively function.

Doctors don't know how it works and there isn't much information out there about long-term effects - you might be told it can have a 'short-term' effect on memory and concentration but for some people it's not short-term at all. A light went out inside my husband on that treatment table and never came back on.